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PHARMA: Time to get Shakespearean at big Pharma? by The Industry Veteran

The Industry Veteran has been busy this summer, but luckily for those missing his unique view of the pharma world, he’s ba-ack. And in his purview this time is the whole issue of why Big Pharma is filling its top jobs with lawyers.

DICK: The first thing we do, let’s kill all the lawyers.

CADE: Is not this a lamentable thing, that the skin of an innocent lamb should be made parchment, that parchment, being scribbled o’er, should undo a man? Some say the bee stings: but I say, ’tis the bee’s wax; for I did but seal once to a thing, and I was never mine own man since.

Shakespeare, King Henry VI, part II: IV, ii

Late last week (July 26) Merck announced the promotion of corporate counsel Kenneth Frazier to succeed Peter Loescher as president, global human health, effectively making him the company’s chief operating officer.  Given Pfizer’s earlier decision to make their corporate counsel, Jeffrey Kindler, the CEO there, Frazier’s promotion means two Big Pharma companies within the past year have elevated lawyers to key, strategic positions.  The moves in both cases indicate the unwillingness of the respective companies to cleanly break from the unsavory and dysfunctional practices of their recent past.

By naming Kindler to the top spot, Pfizer’s board clearly desired a relatively inexperienced manager without settled attitudes toward the pharmaceutical industry.  As CEO it seemed apparent that he would move slowly and rely upon practiced hands within the company for guidance.  Kindler immediately acknowledged this when he promoted his rival for the CEO spot, CFO David Shedlarz, and publicly referred to him as his "right hand."  Such thinking among board members appears mystifying because if any pharmaceutical company requires fundamental changes to the economic model by which it conducts business, it is Pfizer.  Since the 1990s Pfizer led the industry in implementing the blockbuster, mega-company approach.  Under William Steere, an agile and precise thinker, the company grew and prospered with the strategy.  In the hands of his successor, the arrogant head of finance, Hank McKinnell, Pfizer’s capitalization declined by more than 30% while the rest of the industry ignorantly followed his long walk down a short pier.

Kindler’s claim to fame as corporate counsel consisted of his use of outside contractors to pursue foreign Viagra counterfeiters and harass them into ceasing their operations.  While serving as Pfizer’s legal counsel Kindler hired the former number-three man at the FBI to direct corporate security and together they retained companies such as the Blackwater Group, one of the largest US contractor in Iraq.  Blackwater, which maintains close ties with right wing religious groups in the US, performs the usual range of corporate security and sleuthing services.  It is also a mercenary army for hire that makes abundant use of stealth surveillance technology.

One example of Kindler’s failure to break with the blockbuster/mega-company approach appears in his dealings with third-party payers. 

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PODCAST/QUALITY/TECH/HEALTH PLANS: Disease management, technolgy and the future of health care–Gordon Norman tells all

Gordon Norman is Exec VP and Chief Science Officer at Alere Medical, formerly head of DM at Pacificare and a font of knowledge and opinion about disease management, technology, the role of health plans, and the chances for overall change in the  system. We agree much more than we disagree, but if you have any interest at all in the restructuring of health care, I’m sure that you will enjoy our conversation.

You’ll also enjoy Gordon’s recent talk at Healthcare Unbound–his slides are here

TECH/HEALTH2.0: Harris Shows Number of Cyberchondriacs increases to an Estimated 160 Million Nationwide

Harris Shows Number of Cyberchondriacs increases to an Estimated 160 Million Nationwide

As you know I’ve been following this number for 10 years (not to mention working with and at Harris during part of that time), and  the increase in the last few years has been remarkable. After all the fast pace growth in the internet was in the 1990s not in the 2000s, yet its use for health care continues to increase.

And talking about cyberchondria, I had severe chest pain about a month ago that felt pretty bad while I was out of state. I searched on the web for chest pain, confirmed that I had 3 of 4 symptoms of a heart attack and got myself to a doctor rapidly. The EKG was negative, but of course had there been no Internet I might not have bothered and I might have ignored a heart attack or arrhythmia.  Presumably that’s not the preferred use of health online, but it really helped me.

BLOGS: Why Blogs?

Independence Blue Cross medical director Alan Adler has written a fairly comprehensive piece on medical and health care blogging in Managed Care Magazine. It’s called Why Blogs?

UPDATE: Medicare, SCHIP and Kids

Last night the Senate voted 68 to 31 to renew and expand the State Children’s Health Insurance Program SCHIP). A day earlier the House voted 225-204, largely along party lines, to approve a larger expansion of the SCHIP program. As Matthew notes below, the Senate, unlike the House, would not try to help fund SCHIP by eliminating Medicare’s overpayments to Medicare Advantage for-profit insurers. (See my post below)

Meanwhile, President Bush has said that he would veto either version of the legislation. But the Senate bill garnered enough votes for its version of the bill to overcome a veto. (18 Republicans joined 48 Democrats and 2 Independents in the vote.)

According to PBS, the House and Senate plan to meet after their August recess to reconcile the differences between the two bills before sending a final measure to President Bush.

Below, Matthew offers his best guess as to what will happen next. He suggests if the Senate/House compromise avoids taking a whack at the Medicare Advantage private sector insurers, the President might well sign it. Nevertheless, Matthew believes that Democrats won’t be able to resist the temptation to include the provision cutting over payments to insurers in order to provoke the veto and then campaign on the fact that Republicans hate children.

I’m cynical but frankly, Matthew is so cynical. I take this as an ethnic (i.e. British) trait. On the other hand, I’m Irish, so I probably shouldn’t open a discussion about ethnic Achilles heels . . .

But I am idealistic enough to think that there are enough Democrats and Republicans who care about healthcare for uninsured children that they will eliminate the cuts to insurers in hopes of avoiding a veto.

It’s worth noting that on Tuesday, Sen. Orrin Hatch (R. Utah) and Sen. Edward Kennedy, (D-Mass), told the Washington Post that House-Senate negotiations will aim to keep the final bill within the scope of the Senate’s measure in order to try to avoid that Presidential Nix.In the end, if Congress doesn’t touch insurers’ profits, would President Bush say “no” to expanding SCHIP for kids? I don’t know.

What do you think?

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of  “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

POLICY/HEALTH PLANS: SCHIP passes the Senate, but I think for now Medicare Advantage is safe…for now

A version of SCHIP that doesn’t touch Medicare passed the Senate last night. It has a veto proof majority. Of course it now has to be reconciled with the house bill that raises more taxes and cuts Medicare Advantage. So this will now go one of two ways. Either the bills will get reconciled along the lines of the Senate bill and probably get signed by Bush, or the emerging bill will have a hack at Medicare Advantage and get vetoed.

My guess is that it’ll be the latter. It’s just too tempting for the Democrats to provoke the veto and then campaign on the fact that Republicans hate children. (Some temporary extension for the current SCHIP will be worked out as it expires in the background).

Meanwhile despite all the rhetoric remember this:

The Congressional Budget Office says the Senate bill would cover 3.2 million uninsured children, including 2.7 million who are currently eligible but not enrolled. The House bill, it said, would cover 4.2 million children, including 3.8 million already eligible for benefits. In addition, both bills would provide money to prevent 800,000 children now on the program from losing coverage.

According to KFF there are 8 million uninsured children today. So we’re only talking about covering up to half of currently uninsured kids. Which makes all the rhetoric about socialized medicine a little overblown. Even though unlike some of the more timid moderate Democrats I’m happy to say that socializing the insurance side of health care —as in putting everyone in one pool — would be a very good idea.

Meanwhile, perhaps the recent pressure on managed care stocks is a little over done? (Far be it from THCB to recommend a buy on UNH, but it’s at $48 which is way below where it’s been for a while!)

UPDATE: AHIP isn’t taking any chances, Its headline in its propaganda this morning is (I shit you not) "House Votes to Push Millions of Seniors out of Medicare Advantage"  Click thru and you can see a video of my favorite lobbyist telling only a small number of lies in 44 seconds. Did you know that Medicare Advantage is a "safety net" for seniors? Neither did I….

QUALITY/POLICY: Medpundit right on on cancer treatment

I didn’t get around to talking about the cancer treatment article in the NY Times last weekend, but Syd at Medpundit did. And I agree with her—we should be figuring out when to say no, heartbreaking though it is. Although buying a few extra months for a 35 year old mother in my mind is different from doing it for a 93 year old (even if he was President once). Look in the comments for a note from the subject of the NY Times article.

HEALTH PLANS: SCHIP and Medicare Advantage

You’ll be seeing more and more of Maggie Mahar here as she works blogging into her new role at The Century Foundation. But of course, she’s not the only one who’s made this connection. If you want to see more of your host’s caustic comments on Medicare Advantange, and lots of good comments around it, try here, here here, here or here. Here’s Maggie on this week’s dust up.

A debate rages in Congress: Who needs the money more  – UnitedHealth or the kids?

This week, a storm hit the House of Representatives when law-makers began  to debate a proposal that would, in the words of a Wall Street Journal editorial, “steal nearly $50 billion from Medicare Advantage, the innovative attempt to bring private competition to senior health care” in order to beef up the State Children’s Health Insurance Program (SCHIP), a program that delivers health care to poor children.

Last night, the House voted 225-204 to pass the legislation.

SCHIP is scheduled to expire September 30; the House bill would renew the program while expanding it to include another 5.1 million children at a cost of an extra $50 billion over five years. The bill’s backers propose to fund the legislation by increasing the federal cigarette tax by 45 cents while   simultaneously paring the premium that Medicare pays private insurers who provide Medicare to seniors. The goal of the bill, reformers say, is to ensure that all children in the United States have health insurance. The Wall Street Journal’s editors see things otherwise: “Democrats apparently want to starve any private option for Medicare,” the editorial concluded.

Rupert Murdoch hasn’t yet weighed in, so I decided to take a look at the proposal. Would the House bill really make it impossible for private sector insurers to continue to offer needed benefits to seniors?

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