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PHARMA: Rost loses, or wins?

There’s an amazing place in the world called the Chinese War Memorial. It’s in Taiwan, and it recounts the tale of the Chinese Civil war from the nationalists side, ending with the glorious retreat to the Republic of China, while that little revolutionary difficulty is still going on in those other small Chinese provinces over there on the mainland. It may well be the only place where the losers wrote the history books!

I’m not sure whether Peter Rost’s suit against Pfizer/Pharmacia is in quite the same league, but thanks to the power of the blogosphere we have the official version “Suit dismissed, Pfizer wins” in Brandweek and then we have Rost’s version—we lost on a technicality that will be overturned by the same judge and so we won really. (This is from an email he sent out to his list)

We have a GREAT Qui Tam Court decision, which will help us move the Genotropin qui tam case forward. For me personally, it is a complete vindication of the false accusations Pfizer repeatedly made against me in the press. As you may remember, Pfizer had filed a motion to dismiss my complaint and had made four arguments, three of which the Court eloquently rebuked and the fourth is a technicality which will be relatively simple to handle based on additional information.

Apparently the key question is whether there is a patient database somewhere in the bowels of Pfizer that has patient identifiers that identify the specific program. Or not—as I assume Pfizer thinks. And I guess in the next round we’ll find out who’s telling porkies and who’s not.

Meanwhile Rost has a party coming up on his blog this Sunday. I won’t spoil his surprise, but you might get somewhere in guessing what it is if you look at the title this Spot-on column I wrote a while back.

 

POLITICS: McLellan–a man too soon?

The NY Times calls McLellan’s resignation the Departure of a Pragmatist. The basic problem was that his “reign” at FDA will be remembered for the pained look on his face when he was forced to defend the ban on reimportation on 60 Minutes, and the horlicks that was the introduction of Part D. He never looked too happy defending the stupid industry-based bills that the Congress sent him.

What he really wanted to do of course was turn Medicare into a real influential purchaser. There’s going to be a huge political fight about that, but it will happen eventually. And that’s a role for which he’ll be much better suited. Perhaps he’ll come back then?

POLICY/BLOGS: Comments, and debate right here on THCB

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It’s Friday, it’s still the late summer, and people are drifting back to work…few comments on any of the posts. But wait!

On one tiny post here on THCB, debate and comment fever has broken out with over 65 back and forth comments. If you’ve missed it, go look at the debate, largely inspired by Jack Lohman, who’s book on the corrupting influence of money on politics is the basis for quite some ranting—from a Republican who favors single payer no less!

POLICY/POLITICS/HEALTH PLANS: Communist alert! (Well not really…)

The Minnesota Blues plan is floating a proposal for universal care. It looks at first glance like a Mass type individual mandate. Not so long ago Ken Melani, now CEO of Highmark, the dominant Western Pennsylvania Blues plan, had a similar idea.

So it appears that little by little the non-profit Blues are coming around to the fact that they have to have some plan in place to survive the coming revolution. This assumes that their future is a choice between being state regulated utilities in a multi-payer universal care system, or being replaced by the government in a single payer system. And there’s little doubt which one they’d rather take.

Of course these Blues have been denied the option of going for-profit, as the various state legislatures are now wise to the scam that enabled an earlier generation of Blues executives to make themselves rich beyond recognition while providing damn little back to the states that had allowed them that tax-free status for decades (see the experience in Maryland, for instance).

Those that have gone over to the dark side are of course adopting all of the tactics you’d expect, while of course the non-profit guys claim that they have to do the same to remain competitive. If they could construct a universal care multi-payer model in which everyone has to play by the rules of the big local state regulated utility, they’d do fine.

And apparently there are enough senior people, in at least Minneapolis and Pittsburgh, who are beginning to think that that’s the choice they’ll end up with in a few years. So they’re starting to float the proposals now.

PHARMA: Probably another false start from the DEA

The black stone that resides in the chest of DEA administrator Karen Tandy in the place where the rest of us have a heart must have some gravel chipping off today. The DEA allegedly has revised its rules on prescribing pain-killers:

Yesterday, DEA Administrator Karen Tandy said the agency had been wrong in limiting the multiple prescriptions and had made the tough decision to reverse course. She said the DEA received more than 600 comments from doctors, patients and others about its policies on narcotic pain killers, many of them strongly opposed to the agency’s position on limiting refills.

But basically this is a tiny move—allowing multiple prescription refills for those in chronic pain, but only by doctors who the DEA considers not to be in violation of their unwritten laws. After all, 2 years ago—right in the middle of William Hurwitz’s trial when his defense was about to introduce them—they introduced some similar guidelines they’d worked on with pain specialists for two years. So what happened then?  Well given the choice of allowing rational behavior, even according to guidelines they developed and allegedly agreed with, and putting a doctor treating the chronically ill in jail. Guess which one they took?

The agency briefly posted the guidelines on its Web site in 2004 but then pulled them down and disavowed them.

Siobhan Reynolds from PRN is rightly, rightly suspicious

But Siobhan Reynolds, who created the Pain Relief Network several years ago to help defend pain doctors who she said were being unfairly arrested and prosecuted, disagreed and said the new DEA policy has changed little. "Ms. Tandy states here, as she has on many occasions, that doctors need not fear criminal prosecution as long as they practice medicine in conformity with what these drug cops think is ‘appropriate,’ " Reynolds said. "If that isn’t a threat, it will certainly pass for one within the thoroughly intimidated medical community.”

The story is that chronic pain is massively under-treated in this country, and opiates are the most effective way of dealing with that pain. Yet as I pointed out over at Spot-on the mad Calvinists who run our criminal justice system care not a whit. 

POLICY: Becker-Posner miss the point

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And in, I hope, the last comment on the Cutler piece, two venerable Univ of Chicago economists debate it on their blog, the Becker-Posner Blog

Posner ascribes the problem of the high cost of adding a year of life to an elderly person to the desire of people near the end of life to spend whatever it takes to stay alive. Other than that’s not how people at the end of their life usually feel, the problem with these rational analyses is that they don’t understand how health care works. Decisions about end of life care are not made by patients–they are made by doctors and health care organizations. Wennberg’s work clearly shows that. The enormous practice variation in end of life care is a factor of cultural variation amongst physicians not one of patient choice—the patient don’t know about it. And it applies whatever the insurance status of the individual because it’s ingrained in local medical cultures.Other countries have got their physicians somehow to accept that (for instance) heart surgery or kidney dialysis on a 95 year old with a life expectancy of 6 months is not good medical practice. Here we routinely do it (as in Posner’s father’s case).Stopping that absurdity is the solution to our health care crisis as that’s where the vast majority of the unnecessary spending is. But to do that we have to change medical culture, and rather more difficultly, health care system incomes!

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