The NY Times has an article about how stents are likely to be found to be less useful than would be indicated by the amount of use they get from cardiologists. More bad news for JNJ and BSX, but something that THCB has been sniffing around for quite some time now.
Above the Fold
POLICY/POLITICS: Democrats debate health care
I can’t say that I’m very interested in what they’re saying now…I’ll check in more in a year and a bit. But the Democratic candidates Saturday had a debate about health care. More here at the Campaign for America’s Future.
HOSPITALS: Wow, a big new one in San Francisco
Looks like Sutter is opening its extensive coffers to create a big-ish new hospital mid-way between its flagship CPMC and their Fennian rivals at St Francis in the heart of San Francisco. Given that we’re not exactly underbedded here, I wonder if they’re eventually going to shutter one of their other campuses (presumably the Pacific campus which was the old Pacific-Presbyterian in the halcyon days of yore—e.g. 10 years ago)
HOSPITALS: HIStalk charity request for destroyed hospital
Read this, purloined direct from MrHISTalk’s site. If you’re feeling generous I think chucking a few bucks to the link at the end will at the least make you feel better this weekend, and to think that…at least it’s not us. And of course one day it might be.
I know I’m going to regret this because it’s work for me, but here goes. I felt really bad for Sumter Regional Hospital of Americus, Georgia, a tiny hospital in a small town that suffered amazing destruction in just a handful of minutes three weeks ago when a tornado ripped through its campus and pretty much destroyed it. I’ve worked in small hospitals and they are the lifeblood of a town – the main healthcare provider, the main employer, and a source of community pride. This isn’t one of your Taj Mahospitals that can just draw a few hundred million from investments and rebuild, not to mention how employees will get along with the potential of no paychecks. The hospital had good insurance (including business continuity) and will get some help from FEMA, but that’s not helping their employees or their town. As we speak, they’re running a 50-bed hospital out of tents borrowed from the Boy Scouts and FEMA.I mentioned here that they could use some help and figured hey, it’s less work for me if no one bites. Well, Jon Phillips of Healthcare Growth Partners threw down the gauntlet – he offered to match the first $1,000 in donations to the hospital. Of course, that put me on the hook to deliver, so I e-mailed the hospital and asked how they’re doing and see if we could help out. From Marcus Johnson, director of marketing and PR: "On behalf of Sumter Regional Hospital, I want to thank you and your readers for your kindness and generosity during our time of need. It’s been about 3 weeks since the storm, and we are trying to get back to a sense of normalcy. We opened a field hospital a few weeks ago that serves the basic healthcare needs of our community, and our plan is to move into something a little more sturdier in the coming weeks, possibly modular buildings. Our main building is currently uninhabitable, and we are still awaiting word from the engineers and insurance people regarding the rebuilding of the existing building or possibly even the construction of a new one. Our most pressing need is, of course, funds for rebuilding and donations to our employees, many of whom suffered damages to their cars and homes. Thanks again, Mr. HIStalk, for your assistance, and for more pictures, updates, etc. please go to our website at www.sumterregional.org."So here’s the deal. I’ll put out a "Donate" button below that will send your donation my way (since I don’t know of any other way to quickly collect donations as a group.) I can track and report those donations because I’ve set the "Donate" button to flag them for Sumter. I’ll list every contribution here and, once we’re finished, send the money to the hospital. I’ll contribute the first $250 (and maybe add to that if readers respond with me.) Now here’s the lofty goal I’m setting: I want to collect $10,000 for Sumter Regional Hospital from individuals and companies. That’s a lot, but I’d sure like to see us meet or exceed that number. It can happen if vendors help out. You’ll feel good for helping a little hospital and its employees, I’ll give you some recognition for pitching in, and I bet we can give them a much-needed boost. Look for a status page and news update from the hospital to follow.
You can donate by hitting this button
PHARMA/THE INDUSTRY: The Rx for the busy traveler
And now in the latest in niche marketing, pharmacies with NPs and pharamcists setting up shop beyond the security gates in airports.
PHARMA: Media bias against big Pharma? The Industry Veteran responds
Last week I got an email from a group I’d never heard of called The Business and Media Institute promoting their new study of how TV news media was biased against Big Pharma. Their main complaint is that while the news media are always harping on about high drug prices, but they never mentioned the cost of bring a new drug to market—which of course as anyone who believes in the industry-funded center at Tufts knows is $800m, $2 billion or $50 billion—all depending on what else the pharmaco would have done with the money it invested in year 1 of the 20 year development process. (The $50 billion number is my understanding that for a development started in 1986 the typical pharmaco was deciding between investing in researching a new molecule or buying Microsoft stock at the IPO).
And to be fair the news media didn’t even mention the amount Public Citizen admits it actually does cost to develop a new drug. (Clue: that number is a just a leetle beet lower than Tufts says it is). On the other hand the news media didn’t mention what happened to the Federal Office of Technology Assessment (OTA)when it put out a study also rebuking the Tufts numbers. (Hint: the OTA didn’t make political contributions and PhRMA does, so guess which one is still around!).
But none of this is surely anything new. News media understand that we the public are dumb and only have 6 seconds to understand any story. And there are a smattering of front groups on both ends complaining about bias in the media. I tend to be a scad more sympathetic to those on the left who think that the media is biased towards big corporations—after all the TV news media is owned by big corporations (Disney, GE, Viacom) whose CEOs meet those of big Pharma, or at least pass their corporate jets as they fly in and out of Jackson Hole. But I remain hopeful that some people watching the news are smart enough to see through the misinformation, at least eventually.
I did email back and forth with the PR flack from the “Business and Media Institute” which put out the study. I asked him the obvious question of who paid for the study and where the organization’s money came from. I didn’t exactly get the transparent response I was looking for. He said, ““Prescription for Bias” is the latest study in a series of special reports analyzing media coverage of specific issues and industries. No one paid for it. Our general funding comes from individual donors, none of whom represent the pharmaceutical industry.
Of course armed with a couple of minutes and Google you can find that the Business and Media Institute is part of a conservative group called the Media Research Center, and you don’t have to be Hillary Clinton to guess where their money comes from. I wasn’t going to get too excited about all this, but luckily for you all who think that THCB has gone soft in recent weeks, The Industry Veteran decided that he would instead. He also sees a bigger conspiracy theory at work. Here are the Veteran’s dulcet tones on the matter:
I see that the poor, bedraggled pharmaceutical industry feels itself unfairly vilified by the yellow-liberal media and other birds of the same flock whose true purpose lies in subverting our sanctified capitalist system. Pharma’s aggrieved cry from the heart began late last year when the industry’s big anoos’s, as Borat would call them, convened in Washington to develop a strategy for dealing with a Democratic-controlled Congress and a public, which at one time had been at Pharma’s feet, but is now at their throats. Did these knifemen of the Avantine Collegium decide to assuage Congress and the public by reducing prices on their me-too, palliative products? Did they deign to permit transparency into their clinical trials and their actual costs of drug development? Perhaps, one might plaintively hope, they developed innovative approaches for increasing public access to medication, reducing costs or improving the outcomes for people who use their products? If you believe that, it is probable you are also convinced that Saddam had weapons of mass destruction. Rather than altering the realities underlying their abysmal public image, Pharma’s capos relied upon the first refuge of scoundrels, that is, they decided to launch a PR campaign. Now on the heels of Pharma’s Washington parlay, we have a front group, Business and Media Institute in Arlington, Virginia, distributing a flack report that purports to show a “bias against drug companies” from ABC, CBS and NBC news during the first nine months of 2006. Their analysis does not justify close scrutiny any more than similar screeds such as Protocols of the Elders of Zion. A principal funding source for this Pharma champion is the Scaife Foundation, the right wing tank that brought us Whitewater, Kenneth Starr, the Contract on America and other quasi-fascist machinations during the Clinton years. The Business and Media Institute appears to possess all the requisite elements of a right wing, scorched earth campaign. They start with the self-pitying cry that liberal elitists in the media and academia discriminate against them. They then proceed to the Know-Nothing assertion that the “real people,” in their homespun wisdom, support Pharma’s predatory practices and, finally, there is the Dick Cheney implication that people who perceive greed at the core of Pharma are doing the anti-Christian work of terrorists or other subversives. This crude attempt to elevate Pharma’s lower-than-whaleshit image is only a first, sputtering attempt by a resolute group that maintains the largest lobbying army in Washington. Subsequent refinements are apt to be more insidious.
POLITICS/INDUSTRY: Oooh, vicious but beautiful.
From my favorite Cal health care economist
Pisano is an HBS professor, and for HBS professors books are consulting platforms. A strong consulting platform must demonstrate knowledge of the sector (check), stroke the egos of industry leaders (check), profess a cataclysmic view of the sector if things go on the way they have been going (check), and then offer a simple-to-grasp solution.
I’m not sure they tend to bother with Jamie’s reason #1, though even though Herzlinger, Porter, & Christensen are straight onto #4.
BLOGS: Health Wonk Review–here live and in person
Welcome to Health Wonk Review. Thanks to those of you who submitted in my own desired format. My sources tell me that (at least one of) the “commercial” carnival submission operations will have the perfect system shortly. But for now thanks for following those instructions (even if one or two of you claimed to find it easier this way!). This literally took me 2 hours less time than my previous hosting stint—for which my dog and fiancee thank you, even if my psychiatrist, 1-900 Psychic advisor, and various alcohol manufacturers are cursing at you.
On to the fray! We start with health care policy wonkiness.
Some folks seem to believe that transparency will solve all of humankind’s problems. Would that it were so, says David Harlow over at HealthBlawg. His post Of drug-resistant staph infections, public reporting of infection rates, and the consumer-directedness of it all applauds transparency, but cautions against viewing it as a panacea. Michael Cannon at Cato@Liberty also turns to transparency and quality information reporting. On THCB your host doesn’t agree that Michael got it anything like right the first time around, even though he was trying to be deliberately opaque subtle. But I think there’s agreement generally (Agreement? Between us two?!) when Michael argues that patients do not even need to know quality information in order for there to be pressure to improve quality.
For his second round, in an alliterative bit of rhetoric, David also at HealthBlawg asks if we are prepared "to see a P4P system that penalizes poor performers or eliminates payment for certain procedures or pharmaceuticals?" He was responding to some of Gail Wilensky’s recent thoughts (at a Congressional committee hearing and at the Health Affairs Blog) on fixing Medicare’s sustainable growth rate formula approach to physician reimbursement policy.
In the debut blog e-CareManagement, Vince Kuraitis writes on issues relating to chronic disease management (DM), technology and strategy. Discussing a recent study in NEJM, he describes how “dispersion of care” makes P4P for physicians in Medicare problematic, particularly for patients with multiple chronic conditions. To your hosts great dismay (not), he also touches on how dispersion of care disparages Porter’s framework for “Redesigning Health Care”. Hmm, some skepticism of the great Porter’s ideas, I fear that has occurred on THCB in recent days too.
Michael Cannon also reports at Cato@Liberty on the failings of managed competition in Medicare Part D, noting that Humana encouraged its participants to switch plans. In rather stark and predictable contrast, at THCB, yours truly was also fascinated by the problems Sierra Health Services was having with its new Part D plan but come to a rather different conclusion. He thinks that it shows exactly why health care insurance reform requires Enthoven-style managed competition regulation–including risk adjustment and common mandated benefits, or else the market is doomed to fraud and failure. (And no Michael, Part D is not Managed Competition!).
Talking of Managed Competition, in general, economist Jason Shafrin is a fan of a voucher-based health insurance system. In one of his recent posts in the Healthcare Economist blog, however, Jason discusses the difficulties in adequately risk-adjusting the value of these health insurance vouchers.
On Health Care Renewal, Roy Poses comments on an excellent, but long-overdue article in the Annals of Internal Medicine assesses how primary care and other "cognitive" physicians have been relatively under-reimbursed by the US Federal Medicare system compared to specialist "proceduralist" physicians. The problem with increasingly penurious reimbursement of primary care and cognitive services and increasingly lavish reimbursement of procedures, high-technology, and new drugs has been going on for at least 15 years, and clearly is an important cause of ever rising costs, declining access, and stagnant quality. This article still begs the question of why little has been said and nothing has been done to fix the problem to date.
Henry Stern presents Hoosier Health Care Provider? posted at InsureBlog, saying the State of Indiana and the Feds are working together to help empower folks when it comes to health care. He explains why basketball isn’t the only game at which Hoosiers excel.
And then there’s the only in health care legal stuff…
Eric Turkewitz at the New York Personal Injury Law Blog has a tale of an appellate court in New York providing a much more stringent discovery rule for HIV or substance abuse records than is "normal."
Reporting on the intersection of medical devices and information systems at Medical Connectivity, Tim Gee was struck by the regulatory challenges faced by medical devices that depend on networks. While private or isolated networks supporting medical devices will be around for some time, the market requirement to support enterprise networks is only going to get stronger. He discusses issues facing infrastructure vendors like Cisco as well as medical device vendors, as they struggle to adjust to pressures from both the FDA and the market.
Also at Cato@Liberty, Dan Mitchell documents a disparity between the funding of traditional and alternative medicine in Britain’s NHS
Let’s not leave out the sometimes murky world of pharmaceuticals.
David Williams of the Health Business Blog notes that generic Zocor prices are all over the map. He suggests scrapping insurance for routine items and turning on the shopping power of consumers to drive down prices.
Again at Cato@Liberty, Sigrid Fry-Revere comments on HPV vaccination mandates, arguing that Merck’s profits will benefit more than the public’s health. Maggie Mahar had a most excellent post about the whole Gardasil controversy at THCB a few weeks back, that’s well worth a look if you missed it.
At BioHealth Investor.H.S. Ayoub presents about a Cancer Drug, but not Drug Company, Praised by Networks. A familiar theme for the beleaguered bio-pharma industry. On the Health Affairs Blog, UC Berkeley economist Jamie Robinson writes about a new book on the biotech industry from yet another Harvard Business School professor (James Pisano). Robinson notes: “The biotech industry gets plenty of love but not much respect from our author in this survey of organizational strategies.”
And let’s not forget about new technology for patients
Dmitriy Kruglyak over at Trusted.MD finally reports on his trip to Boomer Business Summit and ASA Annual Conferences in Chicago, where he spoke about the impact of social media.
Scott Shreeve, at his eponymous blogspot, wants to tell us all a bit more about Health2.0. You’ll be hearing more about that, I can tell you.
And finally also connected to social media—in the beyond off-topic department, I got one submission from the carnival engine that wasn’t about health care at all—a total mistake submitted to the wrong place, as the author confirmed. But it was gripping reading (and a lot of it!) and will surely become part of a “novel” that will top the pulp fiction lists. This is about a cyber-feud in the MySpace generation that is way beyond the far side…
That’s it till next time, when HWR will be at Health Affairs Blog. Jane Hiebert White there would like to receive html coded entries by
email at jh************@***********rs.org. Deadline is April 4.
JOB POST: Senior VP – Ix Solutions
Healthwise.org Boise, Idaho. The Senior Vice President of Ix Solutions is responsible for mission fulfillment and the bottom line financial success of the Ix Solution product suite. Overall responsibilities include the product development, market development and partner development needed to prescribe and deliver the information and support tools people need to make better health and healthcare decisions. THCB JOB BOARD
POLICY/POLITICS: Looks Good, Doesn’t Fly
Over at Spot-on (where I’ve been remiss in keeping up my remedial education work for the non-specialists) I’m up talking about optimism over recent polling results about the nation’s appetite for universal coverage reform— Looks Good, Doesn’t Fly.
As ever come back here to comment.
Two weeks ago, what seemed to be a very interesting survey appeared in The New York Times.
It suggested that most Americans were supportive of universal health
care, and more importantly were interested in considering raising taxes
to pay for it. Several gleeful commentators on the left, and even a few
on the right, considered this was a new dawn for the health reform
movement.
Unfortunately this is nothing new. Americans have always been in favor
of universal health care. At least they have been when you ask them
about it in surveys. Unfortunately there are several other things they
say in surveys that they are also in favor of that undermine the
prospects for “universal” coverage. For example, in 2003 by small
plurality, Americans said they preferred the Canadian health care system to their own. But don’t worry they said the same thing in 1989!
None of these polls mean either that Americans do actually prefer the
Canadian system (especially given how little they know about how either
country’s system actually works) or that something similar will
actually hop the border and come to the lower 48 any time soon. Continue
