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HEALTH 2.0 UPDATE

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We’re pleased to announce a number of new additions to the roster of speakers at Health 2.0. First, we welcome Dr. David Brailer, formerly the Bush administration’s National Coordinator for Healthcare Information Technology and now the head of Health Evolution Partners. David has been busy since leaving Washington. For background, see this piece in the New York Times. Take a look at the Health Evolution Partners site for a bit more about his investment focus. David will be adding his special perspective to the Consumer Aggregators panel. He’ll be joining Google’s Adam Bosworth, WebMD’s Ann Mond Johnson, Microsoft’s Peter Neupert and Yahoo’s Bonnie Becker, along with moderator and  friend of THCB Jane Sarasohn-Kahn. UPDATES: The votes are pouring in the contest to nominate the final speaker for our social media for patients panel. If you haven’t had a look yet, we have a very interesting collection of nominees. Note: To prevent potential fraud our system tracks the IP address of every submission. Unfortunately, for some corporate networks this can cause problems. If you’d like to vote and have been unable to please email in**@********on.com.

APPLAUSE FOR:  Health 2.0’s latest charter sponsors – Healthline and Destination Rx. Welcome guys! ADDITIONAL UPDATES: Interested in exhibiting at Health 2.0? A limited number of tables are still available for sponsors. Contact  jo**@********on.com for pricing and other details.

You can also go over and have a look at the latest version of the Health 2.0 agenda here.

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PHARMA: Why Stretch? by Maggie Mahar

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Why does the
pharmaceutical industry pour billions into direct-to-consumer (DTC)
ads? One explanation is that drugmakers need a way to market new
products that they are having a hard time selling to doctors—at
least this is what one medical ethicist suggests in the May 2007
issue of The Oncologist.

Noting that more and more
pharmaceutical companies are peddling their products directly to
cancer patients, he writes:

"I have a
hypothesis about which types of oncology drugs are most likely to be
advertised directly to the consumer. I think they are less likely to
be those drugs that have been proven to have benefits, have no
competitors, or are known to be cost-effective. There would be no
reason to promote them, as they are going to be used anyway. In
contrast, it’s those drugs in competitive markets, at the margins of
evidence-based medicine, where pressure from patients resulting from
direct-to-consumer advertising might lead to more prescribing. I
suspect that these marginal drugs will be the very ones that are
advertised most, which is worrisome."

A recent report in The
New England Journal of Medicine confirms that drugmakers tend
to promote their newest drugs DTC: “Notably, nearly all
(17 of 20) advertising campaigns for the most heavily advertised
drugs began within a year after FDA approval of the drug. . .
.which raises questions about the extent to which
advertising increases the use of drugs with unknown safety
profiles.”

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POLICY: Guesses at important dates…

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In the comments to Brian Klepper’s piece yesterday, troublemaker commenter JD asks the following

Matt, I don’t know if you can do polls on this site, but I’d be interested to see what the readers here would guess as the date universal healthcare legislation passes. My own guess is that SCHIP expansion happens in 2009 (if not sooner), and effectively universal coverage is passed in 2011, effective in 2012. And my guess is that it is more like the Massachusetts model, actually, than Medicare-for-all. Idle wonkery, to be sure, but enjoyable idle wonkery.

I can’t easily put up a poll without pulling John off some real work, but you can all give your best guesses below. How about these three questions.

1) When will SCHIP pass?

2) When will comprehensive health care reform pass the Congress and get signed by the President?

3) When will we get to what reasonable people would agree was 100% universal coverage?

Have fun!

POLICY: Health Care Reform Now? Don’t Hold Your Breath

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While Brian goes into the details of what’s need for reform, it just so happens that a few weeks back I wrote an op-ed for the LA Times suggesting that the current “crisis” wasn’t bad enough. As (after soliciting the darn thing) they didn’t print it, I thought it was time to give it an airing and I’ve put up a version of it as my Spot-on piece for this week. It’s called Health Care Now? Don’t Hold Your Breath.

Judging by the number of articles about corporations, unions and politicians decrying America’s healthcare system, you could be excused for believing that we will have health care reform very soon. You’d be wrong. More

Reform’s Tougher Problem by Brian Klepper

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Yesterday, Matthew gracefully pointed to my post over at Bob Laszewski’s Health Care Policy and Marketplace Review, which I called "The Tougher Health Care Problem." Bob’s readership leans heavily toward the DC-based health care policy types who may not follow the happenings over here. The policy crowd is a slightly different but very important audience that I hoped might be receptive to a different message than they are typically pitched.

Reform is a complicated topic, particularly because the discussion tends to be so narrowly defined around its objectives: access, quality and cost. But an equally important issue is that American health care is fundamentally about power and money. Achieving reform requires a real understanding of the power dynamics involved.

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POLICY: Nanotechnology and the Regulation of New Technologies by Bart Mongoven

Bart Mongoven is a senior analyst with Austin based strategic intelligence consultancy  Stratfor.com, where he tracks public policy. This piece first appeared in the Stratfor Public Policy Intelligence Report. If you find his analysis interesting, you may want to take a look at his earlier analysis of the issues facing California Gov. Arnold Schwarzenegger’s health reform plan. You also may want to consider signing up for their free email reports, which I find very useful and well-informed.  — John 

Researchers from the Woods Hole Oceanographic Institution and Massachusetts Institute of Technology on Aug. 16 released a study stating that the production of carbon nanotubes gives rise to the creation of a slew of dangerous chemicals known as polycyclic aromatic hydrocarbons, including some that are toxic.
Discussion of a new regulatory regime for nanotechnology has been ongoing among think tanks, advocacy groups and industry for years, and findings that suggest the sector could generate public health risks will add to the growing pressure on regulators or legislators to decide how to regulate it.

The debate over the regulation of nanotechnology has taken place on two levels. The first is over the public health risks nanotechnology poses and ways to determine and measure those risks. This is mainly the familiar risk-assessment process applied to the products of a technology that acts slightly differently than previous technologies do.
At the center of a second debate over public policies governing nanotechnology is an older, more contentious issue: the politicization of science and technology.

At issue is the point at which government is justified in stepping into the realm of science to stop or slow scientific research, regardless of whether harm has been done. This concern lay at the center of the early debate over biotechnology, and also played a role in the debate over federal funding of stem cells and bans on human cloning.

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HEALTH PLANS: Who said this? No, really

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But if you take five people who didn’t get coverage through their employer or were self-employed and you ask them, ‘What’s the No. 1 thing that keeps you awake at night?’ I think a large percentage would say health care. What we’re trying to do is create a better environment for the consumer, the provider and the payer. To all work together.

One very scummy company is launching a PR offensive. I’m sure there are plenty of people who’ve bought HealthMarket’s quasi-fraudulent products who aren’t sleeping too well at night.

POLICY: Klepper, moonlighting again!

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Just when we thought we had him pinned down, Brian is moonlighting over at Bob L’s blog. His piece is called Solving the Access Problem Isn’t Enough If We Don’t Deal With Costs. Not absolutely true in my view. I think you need to do access first then deal with costs. He thinks you need to do them both together. But we’re both sensible enough to think that they’re both problems, and plenty of people—whether at Cato or at Harvard—disagree.

Another Step Toward Transparency — Brian Klepper

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It was the great economist Adam Smith who said that, for markets to work, they need (among other things) "perfect information." Health care hasn’t worked, in large measure, because its markets have had almost no information.

So in what could be a huge step forward for the health care transparency movement, a federal court has ruled that the public interest outweighs concerns about physician privacy, and that, next month, CMS should release to a consumer advocacy group the Medicare data sets for 4 states and the District of Columbia. Here’s a snippet from Saturday’s Wall Street Journal article (subscription required):

The data at issue include medical-procedure and
billing details that physicians send to Medicare to get reimbursed by
the federal insurance program for the elderly and disabled. Although
collected largely for billing and administrative purposes, the data
could be analyzed to see how often a doctor performs a given procedure
and even to compare mortality rates among patients of different doctors.

The government has until Sept. 21 to release the data,
covering Maryland, Illinois, Washington state, Virginia and Washington
D.C., to the nonprofit Consumer’s CHECKBOOK/Center for the Study of
Services. The group said it will set up a free database on its Web site
for public use. It has filed similar public-information requests for
Medicare claims data for all 50 states.

It’s worth noting that this Administration, which has prided itself on its advocacy for EMRs, transparency, RHIOs and all the rest of it, when it counted, sided with keeping doctor performance secret. When the chips were down, this is how it actually worked.

You can bet that analytical groups all over the country will pounce on this information, profile and post the performance of physicians in these states, and campaign for access to the rest of the data.

Until recently, despite a lot of very worthwhile effort, data that could be used to develop performance information have been scarce. Health plans, who had the largest health care data sets, weren’t forthcoming with them. Now they’re publishing pricing data, which are somewhat useful, but not as useful as some of the other information embedded in their repositories.

The importance of this case can’t be overstated. The release of the Medicare data, if it happens, will go far toward making physician performance data more available and commonplace. This is a major victory for health care reformers, and many thanks go to Consumer’s CHECKBOOK, the advocacy group that sued for the data. It’s still too early to break open the champagne, of course, because the powers that oppose transparency still have a month to get the decision reversed.

Read the court’s opinion here, and CHECKBOOK’s press release here. This is just one more brick in the wall, of course. But there’s steady progress. It’s happening. And everything will eventually change in health care as a result.

PHARMA/QUALITY: Merrill Goozner has dug into “The Most Costly Earmark in S-CHIP”

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GoozNews: The Most Costly Earmark in S-CHIP

Increased risk of death. No benefit. Higher costs for taxpayers. The ongoing Epo saga, whose latest chapter is being written on Capitol Hill, is a perfect example of why our health care outcomes are second-rate, while our health care costs are second to none.

This is a great bit of digging from Merrill, and it shows why FFS or in this case, Fee for drugs is just a bad way of paying for medical care. Do read it.

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