Those of you despairing of rich people being able to buy their way out of trouble may be encouraged by this headline—Scrushy, Siegelman found guilty on federal conspiracy, bribery charges . Well at least he’s going down for something. Perhaps this jury wasn’t quite a susceptible to the bought and paid for black Ministers that are Scrushy’s new best buddies, or maybe he didn’t bother hiring them this time around. At any event hopefully he gets what’s coming to him this time.
Above the Fold
PHARMA/PHYSICIANS: Yet more on Rx data sales
The NEJM has a perspective about the sale of Rx data of physicians prescribing patterns, which caused a lot of fuss on THCB a while back. In my view this is problem about number 728 on the docket of what’s wrong in American health care, and those physicians complaining about it should look to solve the first several hundred before they set their sites on changing the law, or just kick the drug reps out of their offices. There’s nothing particularly good about the current situation but it’s just not that big a problem and banning the sale of data won’t change it too much. the perspective from Robert Steinbrook largely agrees.
Prohibiting the release of prescribing data to sales representatives will not put an end to another practice to which some physicians object: the use of such data by managed care or pharmacy benefit managers. These entities have sources of information that are independent of the AMA Masterfile. It also will not stop visits from sales agents, which doctors have always had the right to refuse, nor will it curtail the marketing of drugs. According to the AMA, the potential effects of restricted release may include a reduction in the number of “offers physicians currently receive from the pharmaceutical industry, such as drug samples, CME programs and speaking engagements.”
HOSPITALS: Tenet saga over for now
This edition of the soap opera known as Tenet Healthcare Corporation is over, or at least has gone to commercial break. The DOJ settlement is for $725m in cash and another $175m in billing to Medicare it won’t collect. How much of that will come from the execs who sold stock before the news got out in 2002? Not much I guess.
If previous history is a guide, expect a name change and another scandal in 5–10 years.
BLOGS: Health Wonk Review is up
I knew I should have hired an unpaid summer intern. At IBM they have them by the dozen and one of them, Emily Goodson, has done a nice round up of health care blogging in Health Wonk Review over at HealthNex.
Any unpaid interns looking to boost their resumes know where to apply…
PHARMA: The Macular Degeneration Rip Off, By PAT AWASH
Occassionally I get actual patients writing into me at THCB and sometimes it’s worth letting their experience with the system tell a story about how the opaque world of drug and health services pricing comes home to ground level. This is a verbatim email from a 70 year old patient Pat Awash:
Friday, June 9, 2006 I was facing imminent blindness in one eye and poor vision in the other. Beginning Saturday a miracle began to unfold after an initial injection in my eye of Avastin. Avastin is used to treat mestasticized colon cancer and someone deduced that it might, just might be effective for Age-Related Macular Degeneration, the leading cause of blindness and vision impairment among the elderly.
Due to an undetermined cause, leaking fluid had formed a large blister behind my retina causing four changes in my eye-glass
prescription between February 24, 1906 and late May, 2006, the last of which
did not hold for four days. I was frightened to say the least. Only one day after the injection I experienced a 70% vision improvement. This improvement continues each day and I am using a three-year-old prescription.
I am writing in objection to the current policy of the FDA in regard to Avastin. It is an off-label use but the cost is minimal, only $60.00 when provided at cost as my physician does. The same drug company that
makes Avastin has developed Lucentis which has a slightly different molecular
structure than Avastin but is basically an analog. Only thing is, Lucentis will cost an expected $1,500.00 per dose. They claim a reported $400 million research cost but I’m wondering what is included in that amount.
I hope you get the picture. The manufacturer of Lucentis has changed the drug to the degree that it can be classified as a new drug. Whereas Avastin is expensive when used as a cancer drug it is very inexpensive for eye treatments because the dose is so small, and some would say Lucentis is not as effective. Once approved, Lucentis will be covered by
Medicare, a windfall for the manufacturer and huge cost to the public considering a rapidly aging population. Gentech could have done the trial on Avastin.
Everything would be ok except Genentech will no longer make Avastin available except to those who exclusively treat cancer patients.
No off-label applications and no choice for patients. Thankfully, my physician bought a substantial (several month’s) supply prior to the June 1, 2006 cut-off date.
I find this insane and I think you will too. I am sick and tired of experts saying how much trouble Medicare is in when this kind of shenanigan is going on.
Respectfully,
Pat Ahwash (a 70-year-old senior citizen)
TECH/CONSUMERS: Anytime, Anywhere Healthcare
This panel will focus on in-store clinics, and mobile devices in health care
On the panel is Michael Howe, CEO MinuteClinic, Delmer Dukjhart from Technology Center, Cisco & Don Jones, VP Healthcare, Qualcom
Intro from Richard Adler, IFTF—about 100 clinics around the country, small companies but big partners. Most NP run, no doc on site, but some experimenting with that problem. Lots of encouraging data presented about why these clinics are good in terms of cost and convenience. Of course one question is how much $$ per sq. ft can these clinics generate.
Next steps for these clinics? Video visit booth, with only pharmacy tech or EMT tech, remote contact to clinicians. CHCF has funded Mercer to create this.
Mobile health applications….several applications all built on growth in use of cell phones. Now 75% of adults have a cell phone (more than 60% of those in their cellphones) 8% of cell phones in US are smart phone. NOT just a US phenomenon 25% of worlds pop use them, and several other companies use them Italy’s cell phone penetration is 108%. China has 335m cell phones (25%). Lots of progress in medical devices, sensor arm bands, life shirt, etc, etc (Check out medgadget for more of all this). Two new ones are 3G doctor (apparently coming in the UK) and the VeriChip (My note—it is not far out….it already exists and John Hamalka has already got one).
Michael Howe, CEO MinuteClinic. Started because the founder was pissed off at having to wait 3 hours for an urgent care clinic visit for his kid’s ear infection, brought in retail experience (Michael). Have gone from 19 clinics to 84 clinics. Will have 250 clinics by end of years and going to 1000 clinics by end of 2008. It’s meant for binary decisions on confirmations of diagnosis and simple treatment. Cornerstone of the system is an EMR that functions like a pre-flight check list for a pilot. Can also change the algorithm/care for all clinics. Can provide summary of visit back to PCP if they can accept it.
Don Jones; “it’s very slow to drag that health care mule through the water”….but the fun part of his job is remote glucose monitoring, etc.
Del Dukjhart: So much synergy between wireless devices, clinics and the network. Lots of places where telepresence can get access to good quality health care. He thinks technology can solve many of the problems. Telepresence needs to get to be easier to use, that’s the big rock.
Michael—What’s the impact on PCPs? (my question)….there hasn’t been an impact on primary care docs. There’s resistance at first, but then they work as a complement, and then within a year or so they start giving referrals to their clinics. This is about making access and convenience for patients….it also means that patients will get access to maintenance care more easily. He thinks that the primary care doc is a coach who’ll uses resources like MinuteClinic
CONSUMERS/TECH: Technology in health in the next decade
Tech trends….
EMR is now banal, aparently its happening, and there’s congestion in hospitals on traffic over WiFi networks.
Personal products Nike has systems that track your health conditions as you run—your new buzz word is the “Body Area network”. Now we have the development of wearable and implantable biosensors. These sensors will be intergrated with sensors in the environment (Matthew’s Note—Intel has several prototype houses where there are sensors checking in on the occupants all the time). He showed us a list of a huge number of sensors announced in the consumer market place in both persona and ambient information over the last 6 months. Plus there’s also gathering more adn more data from “lifesensing”—capturing images and data from every moment of daily life.
Sensemaking is the process of putting all this data together and synthesizing it into results that can be used.
Abundant computing is going to provide the power to put this all together…so one of the most interesting applications is to take all of life data and synthesise it for new resutlts. Accenture labs has designed a persuasive mirror that is designed to change your behavior (eat too much food, get fat, etc—and show you a picture)
Medical telepresence—at “arms length future” we’ll have a critical care facilty at home—doctors can operate robotically on patients at home. He says this is a reach, (My note: actually I dont think so. We already have robotic surgey and we’re slowly seeing the separation of diagnoses and treatment, and the separation of the hands on/therapeutic process).
POLICY/TECH: Foodscapes ( cool word, huh!)
More from the IFTF meeting on Global Health….
Food production is a 200 year old paradigm dominated by producers. Food producers are going to have to deal with increasingly active bio-citizens. More than 70% of Americans identify themselves as environmentalists, while only 5% actually act on that in their shopping choice. And even being an environmentalist consumer is difficult, even if there is transparency about where the food came from, how it was grown and what resources were devoted to it. One site (experimental) is iBuyRight which will allow people to scan products with their cell phone and know all about what that food came from.
If health gets to the center of how we treat food, then this bio-citizenship trend may impact everyone That make make the boundaries of the corporation more porous. That will make things like socially responsible investment mainstream, we may see more impact on trust and branding of products, which may provoke more regulation. Food is no longer social, it’s more and more political, and changing behavior is going to be a major struggle. So can we improve the way individuals behave, but we also need a wider system change (or at least need to develop one). Lots about individual responsibility versus system change.
My comment: All these theories and information are getting lots of attention, but all the indicators (eating, obesity, fat/sugar consumption, etc, increased pollution, etc, etc) are all getting worse….and all the advertising/marketing is mostly going the wrong way.
QUALITY/TECH/POLICY: IFTF meeting on the Global Health Economy
I’m at an IFTF meeting on the Global Health Economy. IFTF has gone a little off into left field on the “health” issue since I left. They’re slowly coming back relating “health” back to the health care system (the stuff that we care about THCB), but the meeting is about personalized health, people opting out of the health care system, “body hacking” and how companies can sell to the health market (which primarily means food!). More later…
TECH: Is Newer Better? It’s a Coin-Toss, by Maggie Mahar
Last week The Annals of Internal Medicine roiled the medical world by publishing a study suggesting that the drug-coated stents produced by companies like Boston Scientific and J&J may not be quite as miraculous as first advertised.Following a two-year study, researchers at the Cedars-Sinai Medical Center in Los Angeles are now suggesting that the “putative superiority” of drug-coated stents "is founded on questionable premises. Or as The Wall Street Journal put it, the clinical trials of drug-coated stents (mostly funded by manufacturers), may “have exaggerated their real-life advantage.
Stents, you may remember, are those tiny metal scaffolds that cardiologists use to prop arteries open after they have been cleared of fatty deposits. Since they were approved in the early 1990s, manufacturers have made a fortune peddling the devices which, they say, can prevent a future heart attack while avoiding riskier and more invasive bypass surgery Today, stents are used in 85% of all coronary interventions in the United States.
Before turning to the new Cedars Sinai study, it should be said that THCB has long harbored doubts as to whether these cunning devices represented the best solution for quite so many patients. Back in 2003, THCB quoted a Stanford study which suggested that, over the long term, patients with multi-vessel disease would achieve better outcomes, at a lower cost, if they opted for the bypass.In 2005 THCB questioned the cost-effectiveness of the new, improved “drug-coated” stents that are designed to prevent the growth of scar tissue inside the artery. Granted, the drug coating has a real advantage: without it, scar tissue can cause the artery to narrow again. And while there is no proof that the coated stent improves survival (the scaring rarely leads to deaths from heart attack), scarring can affect a patient’s quality of life by causing chest pain. And ultimately, he or she may need to have the area opened up again.
Thus, drug-coated stents have become wildly popular, thanks in part to what The Annals of Internal Medicine describes as “aggressive marketing” and the unbridled expectations of patients Wall Street likes them too. At $2300 a pop (vs. a mere $700 for the uncoated, bare-metal variety), the newer stents are far more profitable. Despite the hoopla, nine months ago THCB was once again forced to ask “Are Stents A Waste of Money?” after reading about a study of 826 patients, published in Lancet, which suggested that the drug-coated stents made by J&J and Boston Scientific aren’t cost-effective for all patients and should be restricted to those at highest risk for heart attack.
A second 2005 study, published in The New England Journal of Medicine, added to the uncertainty about the widespread use of stents by reporting that patients suffering minor heart attacks do equally well with drug therapy. "In a study colliding with established practice, recovery from small heart attacks went just as well when doctors gave cardiac drugs time to work as when they favored quick, vessel-clearing procedures,” the NEJM reported. "The surprising Dutch finding raises questions over how to handle the estimated 1.5 million Americans annually who have small heart attacks – the most common kind. Most previous studies support the aggressive, surgical approach. ‘I think both strategies are more or less equivalent. I think it is more a matter of patient preference, doctor preference, logistics and, in the long run, it could be a matter of cost,’ said the Dutch study’s lead researcher, Dr. Robbert J. de Winter of the University Amsterdam."
Against that background, it should come as no surprise that the newest study published in the Annals last week is making hospitals think twice about using coated stents.
