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BLOGS/POLICY: And over at Spot-on, c’est moi

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I have found myself another gig amongst a great group of political writers led by the intrepid Chris Nolan. Chris is a leading Silicon Valley journo and a policy wonk, and she has surrounded herself with a group of op-ed type writers whose politics are absolutely across the map, but whose writing is entertaining and incisive. She calls it “standalone journalism” and I’m happy to be along for the ride. The intention is that I do a weekly piece over there which will be a bit longer and more political than the health care wonkery you tend to see here. I hope you’ll all go over and take a look, not just at my pieces but at all of them.

The site is called Spot-on, and my first piece is called Adventures in a Health Care Nation.

PHARMA: Looks like more good news for the Vioxx plaintiff bar!

So according to the NEJM there were serious errors in the original Vioxx study–that is errors of omission.

The New England Journal of Medicine publicly alleged Thursday at least two of the authors of a major Canadian-led study on the former blockbuster drug Vioxx withheld data on adverse events from the journal.

So as the NEJM now says the Merck team hid an additional three heart attacks from the data in the VIGOR study as the deaths occurred after a cut-off date. If they’d included them the risk of having an MI was 500% higher not 425% higher with Vioxx compared to an NSAID.

On the other hand why didn’t the researchers just move the cut-off dates for deaths in Vioxx patients in study back to before they started on the drug. That would have produced much better data!

OFF-TOPIC: In my dreams…

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So I’m reading a loony conservative psychologist’s blog and I see this link about a Florida teacher having sex with a 14 yr old. Being a standard British pervert I click over. If you’re not a pervert like me you can ignore it (but I know 90% will click over). And holy mackrel! I know she’s nuts, stupid and what she did was wrong, blah, blah, blah. But if I was 14 (or for that matter any age) and something that attractive ever offered me the option, well I wouldn’t want her to be sent to jail—that’s for sure!

OK, the rest of you can all go back to reality now.

INTERNATIONAL/QUALITY: U.S., Canada heart-failure mortality compared

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This one’s from last week, but well worth a quick look. A study in the Archives of Internal Medicine compared heart-failure mortality in the U.S. and Canada

Two findings emerged from a recent Archives of Internal Medicine report on heart-failure mortality rates. One affirms the notion that the U.S. is a leader in acute care, but the other finding offers evidence that there’s room for improvement in the management of chronic conditions.The report, which was released Nov. 28, compared 30-day and one-year mortality rates of American and Canadian heart-failure patients measured between 1998 and 2001. The findings: after risk standardization, the 28,521 U.S. Medicare beneficiaries studied had a lower 30-day mortality rate than the 8,180 similarly aged patients at hospitals in Ontario, Canada (8.9% vs. 10.7%), but one-year adjusted mortality rates were essentially the same (32.2% in the U.S. vs. 32.3% in Canada).

So in other words we spend a lot more here and there some short-term benefits, but soon enough the differences disappear (but of course the money is still gone!).  I was struck by this particularly because Vic Fuchs did a study back in the 1980s at Stanford hospital comparing the outcomes of patients admitted to the same hospital by the faculty versus community doctors. Compared to the community doctors the faculty doctors supplied more services and spend more money on patients with similar acuity (i.e. similarly sick patients). And in the short term their patients had better  results, but after several months outcomes were the same. When Fuchs talked to them with the results, both sets of physicians thought that their type of care (i.e. more intensive versus less intensive) was better for the patients.

The health economists, though, amongst us tend to believe that there’s precious little point paying a lot more money to keep very sick people alive slightly longer, when within a year they’re going to be as dead as the rest of them. And that appears to be the way it works in Canada too. Anyone really surprised?  Of course with the Dartmouth data we also know that the same variation is exactly the case between different parts of the US.

POLICY: It’s not just me saying that the individual market sucks

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You’ve heard me saying it often enough.  And later this week I will start to tell you my new personal horror show in navigating yet another twist in the individual insurance market.  But given the lack of a rational government regulated system that anyone can access, the NY Times is right to say that Employer-Backed Health Care Is Here to Stay, for Lack of a Better Choice.

What is also clear, though, is that there are no clear alternatives. Corporate executives and many others are leery of a government solution, but no one has come up with a private-sector option that has gained significant support. Because individuals who buy private insurance on their own pay much higher prices than the group rates employers get, many people could probably not afford health insurance if their employers were not buying it for them.

And I love what Helen Darling, the voice of big employers on health care, says in this juicy quote.

"There’s no functioning individual market" for insurance, Ms. Darling said.

Too bloody true, no matter how much free-market fantasists who haven’t read their Adam Smith might wish it weren’t so.

PHARMA: Cox-2s–Really putting the boot in

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So the latest study about the Cox-2s shows not only that they give heart trouble, they’re used for people who shouldn’t need them, etc, etc, etc. No this study shows that they don’t even do what they’re supposed to do—they are no better than NSAIDS in preventing stomach bleeding

British scientists said on Friday they had found no evidence that prescription painkillers designed to protect against stomach bleeding were safer than older drugs.Julia Hippisley-Cox, of the University of Nottingham in England, said she had found no proof the painkillers, known as COX-2 inhibitors, were less likely to cause gastrointestinal bleeding than aspirin or other treatments called non-steroidal anti-inflammatory drugs (NSAIDS).

A benighted class of drugs, forsooth, as the 7,000 soon to be laid-off Merck employees must be thinking.

PHARMA: Pfizer fires Rost

Pfizer fired its troublesome VP Peter Rost, the one who’s been criticizing them for opposing drug re-importation.  It looks like they suckered him — he tried to start a whistleblower suit for the way that Pharmacia had been marketing a drug. “Pharmacia offered doctors illegal inducements to use genotropin, its growth hormone, as an anti-aging drug for adults”. He obviously thought that Pfizer (which bought Pharmacia in the middle of all this) was covering it up, but they’ve convinced the DOJ that they had brought it to the FDA’s attention before Rost did. So now that the government has pulled out of supporting his suit, Pfizer can call him a wrecker. So they’ve booted him.

Which leaves one issue behind. Given that his position involved being paid $600,000 a year to basically do nothing, how do I apply for the job?


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BLOGS: Disappearing & Reappearing posts

If you’ve been on THCB and seen a post that looks weird or unfinished, and then later noticed that it’s gone away, let me tell you what’s happening. Because Typepad got pretty unreliable I started using a client-side blog editor called BlogJet (made in Russia so it happens). I’m still in the trial period but it’s pretty sweet and it’s the only WISYWIG editor out there (for the PC world at least).  But there is one bug and that’s the one that’s showing up. When I tell it to “post as draft” a piece I’ve just started (usually by using the “BlogJet this” capture tool which grabs the URL) it’s been posting it as a published piece visible to y’all instead.

I then have to go into Typepad to “un-publish” it/ It’s then back in my draft queue and I can then use Blogjet (or Typepad) to rewrite it, and usually I then have it publish it at a later time — that’s a very nice feature given that I try to publish in the middle of the night and don’t want to be up all night hitting the “publish” button.

As it turns out this is NOT BlogJet’s fault, but another teething trouble thing with Typepad.  I know that as they told me as much and are trying to fix it. Hopefully they will soon, as that “post as draft” feature from BlogJet feature even works with the blighted Blogger, and given that BlogJet does almost everything Typepad does other than host, it almost makes me want to return to Blogger. But I think Google’s doing well enough without more help from me!  And TypePad has been so nice to this point I hope that they a) fix the problem and b) give their clients a free client-side editor.  Perhaps they could just cut the BlogJet guy a big check?

PHARMA: Cheerleaders and sex-symbols

Talk about slightly unfortunate timing.  Just one day after the New York Times has an article about how pharma companies go about recruiting cheerleaders as detail babes reps, Bayer announces that it’s hiring the ex-Ms Mick Jagger, and very leggy supermodel, Jerry Hall as a "Global Ambassador for its Erectile Dysfunction Campaign".  In case you’re a little innocent about cheerleaders’ place in American culture, guess what a Google search for "Cheerleaders turns up. (Don’t hit the "I’m feeling lucky" button if you’re at work!).

Jerry is of course well known for recounting that "my mother told me that men want a cook in the kitchen, a maid in the house and a whore in the bedroom. I told her that I’d take care of the bedroom part and hire the other two".

Somehow one gets the impression that the grown-ups have left Beavis and Butthead in charge down in the marketing department, which wouldn’t matter if it wasn’t for that teeny bit of criticism that pharma companies have been facing over their DTC and physician-based marketing activities.

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