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POLICY: Two awful stories

• 10

Just before you get too lost in the wonkiness of health policy, just remember the financial implications of being sick in the wrong circumstancesin this country. Here’s a woman with a sick kid who is going to have her husband take a pay cut so that she can qualify for S-CHIP.

And here’s a benefit tonight in Richmond Virginia, for Kellie Brown, a student who needed an emergency appendectomy and has dropped out of college to pay of the $10,000 she owes. I kicked in a few bucks; if you’re feeling nice you might too.

Think of the economic insanity of these two things–someone dropping out of college, and someone moving to a lower pay grade because of health care costs!And no, this shit does not happen anywhere else in the civilized world.

HEALTH PLANS: I beat Lisa Girion!

• 11

This might be my proudest moment in blogging. Anyone can be ahead of the WSJ by 5 years. But on THCB I connected the dots between LA Times coverage of the dumb public relations of Wellpoint in California, and New York AG Andrew Cuomo’s assault on UnitedHealth Group yesterday afternoon.

That’s at least 6 hours (maybe 7) before Lisa Girion did it in the LA Times. I emailed Lisa to crow about it this morning…..of course she’s probably too busy being the de facto head of health insurance reform in California — and now the US — to email back, admit defeat and come work on THCB instead!

Being serious for one second, Lisa’s work in exposing the behavior of health insurers may be the most important series of work in health care journalism in the last few years—even more so than the series which exposed the problems at King-Drew and Walter Reed. There’s no question in my mind that it will lead to significant legislation which will go some way to cleaning up the health insurance industry.

And it’s not as if Lisa was mailing this in. She found the recission (retroactive insurance cancellation) stories herself, she did the digging in the courts, and she got what at first blush sounds like a very unsexy type of story to be a major issue in California’s most important paper day after day.

To my mind she’s become a national treasure and I hope that the powers-that-be at the NY Times or perhaps Pro Publica are paying attention!

PHARMA: The statin backlash (or WSJ later than THCB by 5 years!)

• 2

Yesterday the THCB hit meter went off the charts. not sadly because of some new genius posting on THCB, but because the WSJ has this article about Lipitor causing memory loss and Google searches are bring up an article from 5 years ago on THCB that I wrote—after reading a piece in Smart Money about the same topic. Here was the key paragraph form that article

Unfortunately the Smart Money article doesn’t give any denominators, so there’s no real evidence other than these anecdotal stories about whether significant numbers of people have had these reactions to Lipitor.  So despite the heart-rending stories, you can’t draw any conclusions. Also don’t forget that in the grander scheme of things (if you believe the conventional wisdom that lower cholesterol reduces heart disease), Lipitor is saving thousands of lives for each one it hurts–if it does hurt.

The problem is that increasingly it’s become evident that the statin story is similar to other heart intervention stories—the endpoint which it helps (lower cholesterol in the case of statins, less heart blockage in the case of CABG and stents) doesn’t necessarily reduce overall mortality all that much on an absolute risk basis—and may have other damaging side-effects. Of course the most under-reported side effect from CABGs is also neurological deficiency. In fact there are serious clinicians who believe that use of statins or revascularization prior to a heart attack is clinically wrong.

So it appears that we know far too little about what’s going on before we really should be putting statins “in the water” as the cardiologists use to joke.

Then of course there’s the business interests involved. Pfizer has been roundly criticized for its Lipitor off-label marketing (even if going after Robert Jarvik for his lack of rowing skills is a little silly). But the pressures around a $12 billion franchise are likely to create this kind of behavior.

And worse. Peter Rost (not exactly Pfizer’s best buddy) has been pillorying Schering Plough for the stock trading behavior of its senior execs before recent belated release of data on the failed Zetia trial. And now Congress is joining in there too.

All of which gives me  pause to think about whether the whole statin era may be on its way out. It’s looked so obvious for so many years that more people should be on them, but maybe the pendulum of the perception of the evidence is starting to swing the other way.

And when you read a message board like this one at DailyStrength, it certainly gives this 44 year old with borderline high cholesterol pause before wanting to go down the statin path. Still I guess Feb 14 is an appropriate day to be confused about affairs of the heart!

You can take your $15 fee and … ! by Paul Levy

• 13

In the past, I have sometimes used this blog to refer to articles
from medical journals when I felt they had broad public interest.
Sometimes, those articles have not been available to the general public
because they were only available by subscription. From time to time,
commentors to this blog have complained about this. I have let those
comments go by without reply.

But, finally, I have had enough. I
want to state this clearly and directly: When a respected medical
journal issues a press release about a given article that has important
public policy ramifications but does not make available the full text
of the article, it is a bad thing. It inhibits full public
understanding of the issue and makes us beholden to other people’s
interpretation of the article. It is inconsistent with the general
principle of academic discourse and also is counterproductive in
facilitating an informed debate on issues.Here is today’s example, from the Journal of the American Medical Association ("JAMA").  Last week, I received the following email from the AAMC (Association of American Medical Colleges):

The
Feb. 13 issue of JAMA will include an article on a new study examining
the status of institutional conflicts of interest policies at U.S.
medical schools. The study was undertaken by the AAMC and Massachusetts
General Hospital, and provides the first national data on medical
school policies and practices for dealing with institutional financial
conflicts of interest. Susan Ehringhaus, associate general counsel for
regulatory affairs in AAMC’s division of biomedical and health sciences
research, is the lead author on the article.

This topic
is clearly of great public interest and import, and so I asked the
question of whether the full article would be available for reading
upon publication. The answer I received today was, "No." Checking the
JAMA website, I confirmed this.  I can read the titles, the authors, and a short abstract.
But I can’t read the article and reach my own conclusions about the
methodology employed, the assumptions made, and the results.

Continue reading…

HEALTH PLANS: Insurers getting lambasted

• 5

First, 24 hours after being shamed in the LA Times, Wellpoint has backed down on getting docs to check up on whether their patients should have their insurance recisionned (is that a word?). It’s good to know that someone’s setting insurance policy in this country even if perhaps Lisa Girion wasn’t actually elected to the job!

Then it gets announced that the AG of New York state (traditionally a post filled by a  kick-ass hungry Democrat, these days Andrew Cuomo) is going after UnitedHealth sub Ingenix and a whole raft of insurers it works with on price fixing/reimbursement rate manipulation. What particular part of a health plan’s business practices Cuomo is going after it’s hard to tell. There’s usually plenty of choice!

But it is clear that if anything gets done about health care in the next cycle, insurers are front and center in the politicians sights.

And if you think this is just me talking, check out libertarian Arnold Kling, who for some strange reason manages to get his stuff on the op-ed pages of the WSJ. He basically agrees with me.

Let’s All Ask Secretary Leavitt To Explain HHS’ Schizophrenia On Medicare Physician Data – Brian Klepper

• 3

Regular readers will know that, last Sunday, I posted a column that pointed to HHS’ schizophrenic behavior when it comes to the release of Medicare physician data. First they fight the consumer advocacy group Checkbook.org’s lawsuit demanding the release of data in 4 states and DC. (The AMA’s Board Chair has admitted that they lobbied HHS to appeal the court’s finding that they should make the data public.) Then, a week ago last Friday, HHS announced a new program that would identify Chartered Value Exchanges (CVEs) in 14 communities – these are coalitions of employers, payers, providers and consumers – and then hand over the same physician data they’ve been fighting the courts to keep secret so these groups can combine them with data available from the private sector and create physician quality/cost report cards.

Continue reading…

CDC Officials Blocked Public Health Report

• 8

By MAGGIE MAHAR

The Center for Public Integrity, a public interest investigative journalism organization, has obtained copies of a Centers for Disease Control and Prevention (CDC) study of environmental and health data in eight Great Lakes states that was scheduled for publication in July 2007. The report, which pointed to elevated rates of lung, colon, and breast cancer; low birth weight; and infant mortality in several of the geographical areas of concern has not yet been made public.

A few days before the report was slated to be released, it was pulled. Meanwhile, at precisely the same time, its lead author, Christopher De Rosa, has been removed from the position he held since 1992.  The Center for Public Integrity is asking why.

The study, “Public Health Implications of Hazardous Substances in Twenty-Six U.S. Great Lakes Areas of Concern” was developed by the CDC’s Agency for Toxic Substances and Disease Registry (ATSDR) at the request of the International Joint Commission, an independent U.S-Canadian organization that monitors and advises both governments on the use and quality of boundary waters.

The CDC report brings together two sets of data: environmental data on known “areas of concern” — including superfund sites and hazardous waste dumps — and separate health data collected by county or, in some cases, smaller geographical regions.Continue reading…

HEALTH PLANS: Wellpoint can’t leave bad enough alone

• 8

You’d think the folks at Blue Cross of California or in their parent corporation in Indianapolis would have heard of Lisa Girion of the LA Times by now. Do they really think that by compounding the PR disaster they had with the recission stories of last year their public image is going to be helped by sending their prospective members’ applications to doctors and asking them to check them?

Health plans already ask doctors for medical records of their patients. And that’s a big enough pain as it is. Now it’s apparent that they’re asking them to check the forms of new enrollees. Their explanation that it’s for the good of the medical groups taking capitation probably doesn’t wash, as it’s probably the patient’s previous medical group which has the relevant information. Here’s the through the looking glass story from Lisa Girion at the LA Times.

My only assumption is that Wellpoint has decided that it can get away with basically anything and is desperate to make hay while the sun shines. After all no corporation can get away which such silly behavior for ever.

Hating employer-based insurance, Chelsea Clinton-style by Michael Millenson

• 8

Chelsea Clinton is complaining about her health insurance. As a self-employed consultant, I almost felt sympathetic, until I saw she works for an asset management firm, Avenue Capital Group, that manages just over $20 billion worldwide. They are able to accomplish this with just 350 employees spread out over (take a breath): New York, London, Beijing, Bangkok, Hong Kong, Jakarta, Luxembourg, Manila, Munich, New Delhi, Singapore, and Shanghai.

The company’s Web site says the core team has been together for many years, so I strongly suspect the pay and benefits are actually quite, quite nice. Chelsea told CNBC she is “not happy” with her health insurance, but she didn’t offer enough detail to determine why her health benefits are so markedly inferior to the ones her Mom enjoys as a senator and that she’d like all Americans to be able to access.

Avenue Capital is more colloquially described as a hedge fund specializing in the debt and equity of “distressed companies.” I thought only Republicans did that kind of work, but it turns out her boss is a big Democratic donor. Poor Chelsea — first Stanford, then Oxford, then McKinsey & Co., and now this, stuck with “job lock” in a career that pays an ambitious 27-year-old just a few hundred thousand dollars or so annually on her way to a dreary low-seven-figure compensation. Who knows what hardship her health plan forces her to endure?

Call me cynical, but for that kind of money, you don’t need to buy into your senator’s health plan — you can buy the whole senator!

Editors Note: It’s worth mentioning that although Michael is a general purpose cynic he’s also a declared supporter of Obama for President.

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