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PHARMA: Stunt doubles in pharma DTC?

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I’m sure (well I’m not sure but I’ll cheerfully and casually postulate) to keep you all amused on a Friday) that there are many possible overlooked problems with Lipitor and the statins. I’ve heard of severe muscle pain, even amnesia. But then again most cardiologists and the medical establishment recommend statins very widely and the general medical opinion is that they’re under-used.

I’m reading an interesting book The Last Well Person by Nortin Hadler whom I had the pleasure of meeting at the FIDMD meeting a few weeks back. Nortin is not exactly modest(!) but he’s very amusing and has firm firm opinions. In the book he systematically goes through the randomized clinical trial evidence of the value of much heart treatment including angioplasty, heart bypass, and statins. And his analysis from the West of Scotland trial (which admittedly was using Pravachol not Lipitor) is that statin use made only marginal absolute improvements in heart attacks and essentially no difference in overall mortality.

But is Congress investigating whether the medical establishment has been lead astray or is leading us astray? No.

Apparently the most important question is whether Robert Jarvik actually rowed his own boat in a Lipitor commercial….

INTERNATIONAL: Rational talk about Canadian Health Care

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I’m very happy to relate that one of the best pieces ever by me on THCB, Oh Canada, (written when THCB was just finding its feet in 2003) is still as relevant as ever. There are still inordinate amounts of crap talked about the Canadian system by defenders of the current US status quo (not that the far right loonies who dredge this stuff will say that’s what they’re doing). This is dspite the fact that no major US Presidential candidate, with the possible exception of Harry Truman, has ever proposed introducing such a system here.

But over on liberal blog Campaign For America’s Future (the guys who are backing  Jacob Hacker’s work and by the way taking credit for the Edwards, Clinton and some of Obama plan) Sara Robinson—a self described “health-care-card-carrying Canadian resident and an uninsured American citizen who regularly sees doctors on both sides of the border”—has written a very balanced piece called Mythbusting Canadian Health Care.

I can see the Canadian ex-pat trio of Pipes, Gratzer & Graham going into apoplectic fits even as I type!

HEALTH 2.0: Some simple 2.0 Definitions

The Pew Trusts’s e-patients blog (the one in honor of Tom Ferguson) has linked over to some very cool introductory videos to socal netowrking, blogs, wikis, & social bookmarking. About a minute each and great to explain these things to your grandma or CEO.

Here’s the post

BLOGS: Health Wonk Review up at the Health Business Blog

David Williams of the Health Business Blog fame has shaved his beard off. I had one of those terrible moments when I saw him a couple of weeks back of knowing I knew him but not being able to place the face–then I realized that was because he’s changed it! (He used to have much more hair on the bottom of his face than on the top!)

That’s all irrelevant. What’s not irrelevant is that today he’s hosting Health Wonk Review over at Health Business Blog.

The Ethics of CEO Blogging by Paul Levy

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Paul Levy is the President and CEO of Beth Israel Deconess Medical
Center in Boston. Paul recently became the focus of much media
attention when he decided to publish infection rates at his hospital,
despite the fact that under Massachusetts law he is not yet required to
do so.  For the past year and a half he has blogged about his
experiences in an online journal, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive.

Last week, the Harvard Medical School Division of Medical Ethics
held a session on the ethical issues surrounding blogging by a CEO,
particularly the CEO of a health care institution. Local examples were
this blog and the one published by Charlie Baker,
CEO of Harvard Pilgrim Health Care. Unfortunately, I could not attend,
but I received a note from one of the attendees who told me about some
issues that had been raised. I’ll report on that and add the comments I
would likely have made if I had been present.One of the
discussants identified four domains that he thought of as important in
thinking about the ethics of a CEO blog, and about which he posed some
questions: 1. Voice: Is the CEO blogger blogging as an
individual or as the voice of the organization? Charlie’s blog is
hosted in the HPHC website and linked to HPHC marketing materials.
Yours is on Blogger and not linked to the BIDMC site. But when the CEO
speaks, what he or she says can’t be separated from the organization. 

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HEALTH 2.0 San Diego Sold Out

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It’s official! Health 2.0 Connecting Consumers and Providers has sold out — exactly one month to the day before the conference. (March 3rd-4th/Westin San Diego.) If you absolutely, positively have to be there, we have opened a waiting list. A limited number of people may be offered passes in the event of cancellations or a change in availability. If your company wants a presence in the hall, a limited numbers of passes are still available for exhibitors and sponsors  email in**@********on.com for details.  What’s all the fuss about? Go take a look at the agenda. Stay tuned for updates. (TIP: If you’d like to receive notification of agenda changes, updates and other conference news sign up for our newsletter.)

Is Mandated Universal Coverage the Right Way to Achieve Health Reform? The Health Reform Debate We Haven’t Had Yet, by Jeff Goldsmith

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Goldsmith_2I don’t know how many of you linked over to Lawrence Brown’s perspective piece “The Amazing,
Non-Collapsing US Health Care System” in the January 24th issue of the New England Journal of  Medicine
(buried in Mathew’s “Whisper it quietly. . .” post), but it’s the most useful piece of political analysis of the  health reform conundrum I’ve seen in a long time.   

What Brown argues, convincingly, is that we really have three healthcare systems: public and private health FINANCING systems (which operate in the lucrative fantasy land of “reimbursement”) and a public CARE system (the safety net urban hospitals, community health centers, public health clinics, the VA, etc.) that serve the rural and urban poor and uninsured. 

Other than a few isolated outposts like Kaiser, the third health system that Brown discusses is the only place in the United States where population health is actually practiced. And, most important, it is also is the mysterious resource that prevents the 47 million uninsured, including a very large number of our 12 million undocumented people, from dying in our streets, and causing a huge political crisis. It is invisible to much of the voting public, but thank God we have a safety net healthcare system.

This latter system has been a political stepchild of state and federal governments, and lurches from financial crisis to financial crisis, living off the land. But it has successfully propped up the other two, and, I think, helped prevent a revolution.  Precisely because it has succeeded in reaching its target populations and helping them, albeit “too late” in the disease process, it has drained both political urgency (and funding) from making the first two “reimbursement” systems universal.

Continue reading…

On Mandates….

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I missed Friday’s debate but please can we all remember 3 things before we continue to get too excited about the Obama/Clinton faux dispute

a) Mandates alone don’t work to get to 100% coverage–every employer mandate has exemptions–every individual mandate needs exemptions or subsidies AND it needs a fundamental re-set on how ALL health insurers currently operateb) Most likely any mandate bill will get bargained down to less than it needs to be to workc) Unless the recession is really really bad and still that way in mid-2009, the current health insurance problem is not bad enough for there to be  a groundswell of support for an actual meaningful bill to pass over the sure to be violent opposition of AHIP, PhRMA, AHA, AMA et al.

Which means we’ll either get nothing or some watered down version of what AHIP/AMA proposes.

Which means we’ll all be back in 2012 asking how to fix health care…

Eric Novack’s SuperBowl lesson

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Eric writes:

It’s brief, but, being a Giants fan, there is little more to say…

Beware the Experts (reason #2,754)

Another reason why leaving control over our destiny- whether it be our leisure, work, or heath- completely in the hands of ‘experts’ should give us all pause… 9 out of 11 (89%) of Sports Illustrated Experts picked the New England Patriots to win Super Bowl XLII.  They lost. (I will leave it to Matthew to make a comment about how the Super Bowl is not really a ‘football’ game.)

An Analysis of Senator John McCain’s Health Care Reform Plan By Robert Laszewski

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RobertlaszewskiRobert Laszweski has been a fixture in Washington health policy circles for the better part of three decades. He currently serves as the president of Health Policy and Strategy Associates of Alexandria, Virginia. Before forming HPSA in 1992, Robert served as the COO, Group Markets, for the Liberty Mutual Insurance Company. You can read more of his thoughtful analysis of healthcare industry trends at The Health Policy and Marketplace Blog.

John McCain’s campaign reinvigorated, I am reposting my earlier analysis of his health reform plan.

McCain very rightly points to health care costs as the biggest issue, "We are approaching a ‘perfect storm’ of problems that if not addressed by the next president will cause our health care system to implode."

Therefore, his focus  is on the health care costs that make health insurance so expensive that individuals can’t afford it for themselves, employers can’t afford to provide it to their employees, and government can’t afford a wider safety net for the poor. He also reminds us that costs can’t be improved without dealing with quality in tandem. so expensive that many

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