THCB’s favorite vituperative contributor, The Industry Veteran, is back with some New Year thoughts. He got what I was up to on NY Eve a little wrong, but may have a closer idea about what the long term effects of the New Year will bring to Big Pharma. The Veteran writes:

A healthy and prosperous New Year to you!! For some reason I have a picture in my mind’s eye of you sitting in a pub, raising many pints to toast in the New Year. At 2:00 a.m. I see you wearing a thick turtleneck sweater beneath a Harris Tweed sport-coat as the proprietor gives his inevitable call, “glasses, gentlemen.”

The following article from Tuesday’s Financial Times says some interesting things about plausible effects of Medicare Part D. The author maintains it will push the US closer to the rest of the world in terms of a national payer system, greater transparency in drug pricing and cost constraints. To advance that last objective, he sees the feds pushing IT and more rational provider management patterns, a sort of revenge-of-the-nerds that should delight you and a segment of your readership. I suppose since neither a Republican or a Democratic administration is likely to enact the sort of changes I would prefer (e.g., tumbrels, guillotines and iron maidens for the Hank McKinnells of the world), the sort of temporized-neuterized change from the back office is better than nothing.

The thing that strikes me as amusingly ironic about Medicare Part D is that it shows the folly of leaving economic planning to the monopolistic corporations.  The US throughout its history has disdained strategic economic planning by government because of the secular faith in the market among the country’s business leaders. So here we have the Medicare Modernization Act as developed by Big Pharma’s Pfizers, Mercks and their PhRMA lobby. They fashioned the MMA, with its confusing, competing PDPs, specifically to prevent Medicare from acting as a single payer that could make volume discount purchases. After all, if they could elect George by manipulating an electoral system to create the illusion that 3,000 elderly Jews in Florida voted for Pat Buchanan, a Rube Goldberg MMA could certainly boost their earnings at taxpayers’ expense. Now here we have consultants, journalists and equity analysts forecasting that by decade’s end, the MMA will do precisely what the CEO malefactors wanted to avoid. I dread to think what would happen if Big Pharma’s CEOs were half as bright as their sycophants in Pharmaceutical Executive and the other vanity rags claim.

Although as the Veteran has pointed out before, the crew running big Pharma in 2003 will be long gone counting their millions by the time those chickens come home to their successors’ roosts.

The NEJM has an article and an interview about the Oregon assisted suicide ruling that is coming up before the Supreme Court. Because theocratic fascist John Ashcroft was unable to overturn the will of the Oregon voters legally he tried to get around it by using the controlled substance act. If the Supreme Court rules in the Administration’s favor, it has very serious consequences for palliative care. Basically doctors will be even more in fear than they are now of prescribing opiates, and patients will suffer.

The interview is pretty interesting. Despite both wanting the Supremes to rule against Ashcroft, one of the authors is in favor of the assisted suicide law, one against it. Diane Meier opposes it because she feels (rightly) that the average physician doesn’t have the training or the time to properly evaluate requests for assisted suicide.  Funnily enough America’s leading and crazed advocate of assisted suicide agreed with her, which is why Kevorkian advocated creating a medical specialty for helping patients who wanted it. The other author, Timothy Quill does approve of the Oregon law, citing that as an experiment it gives data showing that the law is working and that patients and their families are using it as the entrance to a discussion about what they actually need. And of course palliative care with opiates is one type of help those critically ill patients, who are often in tremendous pain, need. And of course the authors are terrified that the DEA will not understand that the line between proper palliative care and going slightly over that line to hasten a coming death is very fuzzy and one that often cannot be identified.

But in dealing with this issue, there are two massive problems faced by rational people in the US. First, the opponents of this type of care — including leading bloggers — are happy to start labeling any doctor thinking about this as a genocidal Nazi. Secondly, the DEA is already intervening with no regard to patient care in its insane prosecutions of doctors who are treating patients according to acceptable guidelines. Meier can claim that the DEA is good at intercepting illegal diversion of prescriptions, but it’s clear that the DEA couldn’t give a rats arse about diversions, they’re just out to impose themselves on anyone they don’t like. Consequently patients all over America are suffering already. The imposition of the DEA into end of life care won’t make much difference, other than the pain of those at the end of life will last less time than those living with chronic pain who can’t get the care they need because of the DEA’s appalling behavior. If you don’t believe me, read the comments on my last post on this subject.

I sincerely hope that the AMA looks past its nose and gets involved in this travesty of a public policy. Maybe this article is a start, but it may well be too late. The only hope is that this case will be decided by O’Connor, before the theocratic fascist that Alito appears to be gets on the court.