Over at iHealthbeat the ever wonderful Jane Sarasohn Kahn writes about Paging Dr. Google.
Above the Fold
PHARMA/POLICY/POLITICS/PHYSICIANS: Tierney with some optimism on the DEA’s war on doctors
Writing (unfortunately behind the fire-wall) in the NYT, John Tierney attacks the Republicans as being the Party of Pain. With their attempts to stop the Oregon assisted suicide law, and the relentless attack of the DEA on pain doctors, the Republican conservative Christian establishment that captured the DOJ in 2001 continues to defy rationality. Tierney is hopeful, however, following the Supreme Court’s ruling in Oregon’s favor.
Of course we never needed to engage in this ridiculous vendetta against pain doctors anyway. In his harrowing long and excellent issue brief on the subject Ron Libby at Cato points out that Oxy wasn’t that big a deal anyway
A final problem with the DEA’s claims of an OxyContin epidemic is the agency’s inflated estimate of risk of death. In 2000 physicians wrote 7.1 million prescriptions for oxycodone products without aspirin or Tylenol, 5.8 million of them for OxyContin.55 According to the DEA’s own autopsy data, there were 146 "OxyContin-verified deaths" that year, and 318 "OxyContin-likely deaths," for a total of 464 "OxyContin-related deaths."56 That amounts to a risk of just 0.00008 percent, or eight deaths per 100,000 OxyContin prescriptions 2.5 "verified," and 5.5 "likely-related." Even those figures are calculated only after taking the DEA’s troubling conclusions about causation at face value.
So this is just a classic case of the DEA acting like the drunk looking for his keys under the lamp-post because that’s where the light is. And who suffers? Obviously the doctors in jail or ruined. And it’s not a issue for just a few pain doctors. Libby points out that between one in five and one in three pain doctors has been investigated by the DEA or local authorities. Would you keep doing your job if there was a one in three chance that you’d be investigated, maybe have your assets seized, and possibly be sent to jail for very long time just for doing it?
And why is it being done? Well the DOJ and local police departments get to keep all the money from asset forfeiture. In other words this is essentially theft with patients, doctors and the taxpayer picking up the tab
Tierney hopes that there’ll be a resolution to this:
The Supreme Court’s decision is a victory for patients and their doctors – including, I hope, some of the ones in prison for violating the federal legal theory that has now been rejected by the court. The doctors should go free, and Republicans in the White House and Congress should restrain the drug warriors who locked them up. When this year’s budget is drawn up, it’s the D.E.A.’s turn to feel pain.
These loonatics need to be stopped and whatever my political differences with Tierney and the Cato crowd I applaud them for getting this in the public eye. Unfortunately I think he’s being far too hopeful that any good will come of this given the number of theocratic fascists social conservatives still in the Administration and heading to the Supreme Court, and the current DOJ attempt to promote laws already overthrown by a (slightly) more liberal Superme Court.
BLOGS/TECH: Bloggers meeting, sadly without me
A group of tech bloggers are meeting at HIMSS at 8.30 pm on Sunday Feb 12th in San Diego at Hennessy’s Gaslamp pub. Sadly I wont be there as I don’t show up till the next a.m — being too cheap to pay for an extra night in a hotel and having non-refundable tickets and all — but Tim Gee, Neil Versel, Shahid Shah and maybe even MrHISTalk himself should be there.
POLICY: The future of retirement
In this book review of a couple of finance books in the New York Times, Neil Genzlinger is close enough to being right to remind us why we need to figure out the underlying problems in the health care system.
But as far as radical new ideas, the visionary approach would have been the blunt one: forget retirement planning. Hakuna matata. In the future, whether you have $15 million socked away or $1,500, nothing will matter – not food, not shelter, not golf, not active-senior communities – except health care benefits. Medical science, which already offers rebuilt knees and transplanted livers and faces, will soon offer new everything, but at a staggering cost. The Health Care Cabal will issue a one-page retirement plan: “In exchange for all your assets, including your children (and all their future earnings in perpetuity), the H.C.C. agrees to replace your parts as needed, while supplies last.” And everyone will sign it, because here in the have-it-all era, death is simply unacceptable.
THCB: Last call for submissions
Last call for submissions for the THCB health care reform
competition. Your mandate: solve the health care crisis in 250 words or less.
Be sure to, ahem … read the contest rules, before submitting your master plan, as it’s clear several of our contestants didn’t.
The grand prize:
potential international superstardom and a guest spot on the Eric Novack show.
POLICY: Joe Paduda explains what’s wrong with Part D’s economics
While we’ve been focused on what’s wrong with Part D’s implementation, Joe Paduda reminds us all about one of the other problems with Part D. It’s that by it’s nature a voluntary benefit is going to attract adverse selection. In other words, the only people signing up for it so far — and barring the dual eligibles who were involuntarily alloted into it there haven’t been too many, and DSS reports that there won’t be that many more — are the ones with big drug costs. So by definition eventually the plans will start losing money.
For now the PDPs are being covered against that risk, and the very generous taxpayer will make up the difference. But later on the taxpayer may not be so generous (as with Medicare Risk in the late 1990s) at which point the PDPs will start to exit.
This, by the way, is exactly the inverse of the problem with HSAs, where all the healthy people will leave the insurance pool, leaving those behind in a death spiral.
QUALITY/POLICY: Need an Organ? It Helps to Be Rich
ABC News reporter Joy Victory found a really juicy angle on the problems of being uninsured. Her article is called Need an Organ? It Helps to Be Rich. As you might suspect getting on the waiting list for an organ if you’re uninsured is pretty tricky. Entry to the list is controlled by the big medical centers that do transplants. Although everyone is supposed to be viewed independently of means, its totally obvious that if the patient is uninsured the hospital concerned will lose a packet on the procedure. So like every other aspect of care access for the uninsured, their chances of getting access to that list are much lower than those with insurance. And of course it goes without saying that unless they are lucky enough to be in a job offering great insurance — a number which is getting lower every day — they are not going to be able to buy insurance at any affordable price.
But the fun contrast that the article brings up concerns the other end of the transplant pipeline. Nearly 23% of those who’s organs are donated for transplantation were uninsured, who in other circumstances wouldn’t be eligible to accept their own organs! So this is a case where the haves are literally living off the have-nots.
You’d think that the advocates of universal insurance could run with this one a little?
POLITICS/POLICY/PHARMA: Compare and contrast GWB and LBJ on Medicare
Jonathan Cohn takes a good look at the Medicare implementation now and then, in What Bush could learn from LBJ on Medicare. Not too surprisingly the current screw-up wasn’t evident in 1965, even though the Johnson Administration had only 11 months to implement an entire new program, as opposed to the Bush Administration’s 25 months to add a new one on.
It does have to be said that McClellan’s golden boy image is starting to look a little like his brother’s — he of the “I know nothing” attitude (If you don’t know what I’m talking about look under N here)
PHARMA: The gift that keeps giving, or PhRMA being dumb and dumber
Somehow I’ve ended up on Peter Rost’s mailing list. Now he’s a guy who knows a thing or two about the wacky behavior of big pharma. Peter sent me a press release about that novel that PhRMA funded until the grown-ups figured out in horror what they’d done. Unfortunately, their ham-fisted attempt to cover up the fact that they’d funded a novel about terrorists poisoning the drug supply from Canadian pharmacies apparently won’t die. Much more on the background at Health Care Renewal.
But you’d think that PhRMA would shut up about this and hope everyone forgets. After all it was fun while it lasted but there are other pharma-related issues on the front page now! Think again.
The latest round is that the consultant that PhRMA used as an intermediary is now apparently trying to stop the sale of the book — that’s already been published — and make the authors take done the email trail that is pasted on their website. Given that it’s pretty clear that PhRMA paid for the initial payment to the authors (although the consultant has been accused of taking a cut on the way), it sounds a little unlikely that PhRMA isn’t also behind trying to get this email trail taken down, and the book off the shelves. Of course the author Spivak, while claiming to be in high dudgeon, is loving the publicity, and is hawking the film rights claiming Nicole Kidman wants to star in it!
PhRMA apparently only offered them $100K to shut up early in the process. Presumably with the publicity they were already getting the authors thought they’d make more by keeping going. Perhaps a bigger number might have given them pause. I guess like many of big Pharma’s other products they’re discovering that doing the recall costs more and more, the longer you’ve been covering up the bad results.
Remember guys, there is a high road, and in the long run you’re better off taking it!
POLICY: Busboys On The Street
I’m up at Spot-On talking about pay or play, and the San Francisco Busboys On The Street. Next week we’re taking the politico-nerds remedial education in another direction, but for now this finishes pay or play….
