It’s some kind of a record. IBM has been a top story
three times this week, culminating in the news yesterday that it’s
going to
be reinventing healthcare IT with the University of Pittsburgh Medical
Center (UMPC). Some of the more cynical observers of the healthcare IT
scene note that UPMC seems to have been down this road with Cerner
before, and that many times academic centers’ alliances with IT vendors
(such as
Vanderbilt’s with McKesson) haven’t really produced that much new and
startling. Nonetheless, Big Blue is taking serious aim at the
healthcare world, while GE is working with Intermountain in Utah
(usually acknowledged to be the leader in "care processes delivery"),
and Kaiser is working hand in
glove with Epic, to name just a few. You can add to that the news that
Accenture is looking to get seriously into the provider implementation
market here (by buying CapGemini’s practice) as it already is in the
UK. Finally, persistent rumors have Oracle sniffing around a major HCIT
vendor purchase,
perhaps Cerner. There is clearly a shortage of good implementation
people on the clinical IT front, and the strategy folks at all these
big companies see healthcare as the next big industry (along with
government) to deliver their paychecks for a mix of high margin
software and consulting services.
I just hope all you providers out there can afford it!
Above the Fold
HEALTH PLANS: I agree wth the NY Times in general, but perhaps someone should tell Wellpoint that they are doing badly
So yesterday the NY Times has an article suggesting that the good times are over for health insurers. In the last five years they’ve seen huge growth and profits while they’ve retreated from active care management and trying to push provider prices down and instead have returned to their roots as underwriting, financial machines that simply pass on the costs of the system to their clients (i.e. us). Well that’s not exactly what the article says they’ve been doing, but it is what they have been doing. I tend to agree with the NY Times, as I don’t think that the profit growth of the Uniteds and Aetnas is sustainable over the next few years. However, no one bothered to mention this to Wellpoint which this morning announced earnings that blew the doors off expectations and sent the Wellpoint stock price up 6%.
And of course the way the health care business works — remember that 85% of the costs are with 15% of the people — even if your overall enrollment isn’t going up very fast, you just need to get better at avoiding a few expensive enrollees to be very profitable. If you can figure out some way to at least start to manage the care of the sick people you do enroll better — and to be fair Sam Nussbaum at Wellpoint does seem to be trying to do this with diabetics — then you may still make some decent profits so long as you get your pricing right. So there’s your reason why shorting Wellpoint may be a bad, even if very tempting, idea. It of course may not be enough to stop me from being stupid and doing it anyway.
PHARMA: DTC advertising works; not exactly a revelation!
So I spent far too much of my life trying to figure out the exact impact that DTC drug ads would have on the exact consumer sub-demographic so that marketing could be refined, and consumer segments sliced and diced. Turns out that was totally unnecessary. All you have to do is to get the patient to say the name of the drug in front of the doctor and think that they might have an associated symptom and the doc is only to happy to get them out of the office with said script.
And it’s good for a five-fold increase in prescriptions compared to patients who don’t ask for it by name. The hidden persuaders don’t need to be that hidden!
HEALTH PLANS: The Blues says that AHPs would Raise Costs, Won’t Reduce Uninsured
Here’s some totally self-serving propaganda from the Blues about how terrible AHPs are and how Federal AHPs would raise costs, create more uninsurance and (although they don’t mention it) be a likely venue of huge amounts of fraud — as were the AHP’s predecessors the MEWPs. The only issue I have with this propaganda is that it’s basically true!
Now the Blues have much to feel guilty about, in that they have beefed up their profits while being much more aggressive about their underwriting, and have managed to flail around politically when they could ensure themselves a decent future in a universal insurance system — although that would take some leadership which is yet to be apparent. Plus they are obviously not a united movement. How can Anthem identify with a tiny independent non-profit Blues of Lesser Bupkiss?
But in this instance, they are on the sides of the righteous policy wonks.
POLICY: Now they are saying that there are fewer uninsured?
As if this one couldn’t be seen coming a mile off.
When you have nothing to say about an issue, change the numbers. In the 1980s the Thatcher government in Britain reduced the number of unemployed at a stroke by changing the way they counted them. If you were not eligible to collect benefit because, say, your husband or wife earned too much, then — Hey Presto! — you weren’t unemployed any more, even if you’d been laid off and couldn’t find a new job. Now we hear that the Administration is saying that the CPS apparently overcounts the number of uninsured.
And this is from the clowns who brought us guarantees that WMDs were in Iraq and that the invasion of said nation would be paid for by the oil revenue, as our soldiers would be greeted with sweets and flowers. And we should trust them over decades of decent research by the census bureau why?
Oh, and Thatcher changed the counting to try to stop the unemployment number going over the political sensitive 3 million number. But for all her efforts it went over that number under the new counting system within a few months anyway. And anyone who doesn’t think we’ve got a crisis going on in uninsurance here either has never tried to buy health insurance in the individual market, or just doesn’t get out enough.
PHARMA/PHYSICIANS: Smoking Gun on the Chemotherapy Drug Concession? by Greg Pawelski
Neil Love, M.D. reports from a survey of breast cancer oncologists based in
academic medical centers and community based, private practice oncologists. The
academic center-based oncologists do not derive personal profit from the
administration of infusion chemotherapy, while the community-based oncologists do
derive personal profit from infusion chemotherapy, while deriving no profit from
prescribing oral-dosed chemotherapy.
The results of the survey show that for first line chemotherapy of metastatic
breast cancer, 84-88% of the academic center-based oncologists prescribed an
oral dose drug (capecitabine), while only 13% prescribed infusion drugs, and
none of them prescribed the expensive, highly remunerative drug docetaxel.
In contrast, among the community-based oncologists, only 18% prescribed the
oral dose drug (capecitabine), while 75% prescribed infusion drugs, and 29%
prescribed the expensive, highly remunerative drug docetaxel. The existence of
this profit motive in drug selection has been one of the major factors working
against the individualization of cancer chemotherapy based on testing the cancer
biology.
This is not to imply that the academic center-based oncologists are without
their fair share of collective guilt. They were misguided in not recognizing
that they were trying to mate notoriously heterogeneous diseases into
one-size-fits-all treatments. They devoted 100% of their clinical trials
resources into trying to identify the best treatment for the average patient, in
the face of evidence that this approach was non-productive. However, such
unsuccessful experiments will never be viewed as such by the thousands of people
whose careers are supported by these experiments.
Henderson, et al, entered 3,100 breast cancer patients in a prospective,
randomized study to compare cyclophosphamide/doxorubicin alone versus
cyclophosphamide/doxorubicin plus Taxol (in the adjuvant, pre-metastatic
setting). The results were microscopically positive, at best, and cannot begin
to justify the enormous financial and human resources expended (while making no
effort at all to test and improve methods to individualize treatment).
But these results changed the face of the adjuvant chemotherapy of breast
cancer.
Cyclophosphamide+Doxorubicin+Taxol became standard of care. Taxol recently
went off patent. Now the thrust is to identify on-patent therapy which is
microscopically better in clinical trials of one-size-fits-all treatment.
Already, the community-based oncologists are migrating to
Cyclophosphamide+Doxorubicin+Docetaxel (expensive/remunerative) so what was the
purpose of doing that 3,100 patient prospective, randomized Henderson study?
POLICY: Medicare to start real rationing
Just briefly today….
It looks like Medicare is just starting down a path that it inevitably will have to take. Deciding when and how to say no. The NY Times has an article about the very start of this trend.
(Fixed Link)
PHARMA: Overstepping the line. Who could have known?
It’s a tough life these days in the pharma business. Profits are down, sales force lay-offs are coming up, and the industry is restricted from using its favorite techniques to get doctors to write more scripts, while its reputation is in the gutter. Some people must be looking for a return to the halcyon days of the mid-late 1990s, when new blockbusters were rolling out of the pipeline (rather than off the patent), the public loved the industry, and anything went on the sales side.
But wait. Apparently not absolutely anything went, or at least not according to the pesky US Attorney’s office in Boston. They’ve apparently decided that offering a few important doctors an all expenses-paid trip to the south of France (where they’d supposedly have to show up at a conference, mind you) in return for writing a few scripts of a failing anti-AIDS drug, is apparently an indictable offence!
Hang on a minute. The "offence" was in 1996. The indictment took 10 years. Isn’t this the same US Attorney’s office in Boston that couldn’t get a conviction in the TAP pharmaceuticals case, when basically everyone knew and the company all but admitted paying direct bribes to doctors to get them to prescribe Lupron? Do they really think that at the same time when Enron, Worldcom, Healthsouth and scamsters in dotcoms and Wall Street were putting together their schemes to defraud the world that a few regional sales directors, desperate to keep their jobs, should face hard time for offering out a few trips for a doc and his long-suffering wife or mistress to hit the beach? And how different is that from taking the doctor out to a dine and dash every week? How’s a poor pharma rep to know where the line is?
Coda: One of the docs that apparently wouldn’t take the bait was a Dr RL of Florida. Over on DB’s MedRants one of the most fun commenters is a retired doc called RGL, otherwise known as Roaring Remy. Could Roaring Remy and the Dr. RL in the indictment be per chance related? And if so, didn’t Remy want to go to the south of France? Would he have preffered somewhere cooler?
PHARMA: Pay me more money or I’m moving my operations off-planet!
So poor impoverished Sir Tom McKillop, CEO of Astra-Zeneca, a man knighted for his services to British industry, is upset. Now just because his main achievement in life is to replace one purple pill with another that is more or less identical but continues to be patent protected, doesn’t mean you shouldn’t hear him out. Apparently those pesky Europeans are not paying enough for their drugs, and that has forced, forced, innocent European drug makers to move all their R&D operations out of Europe to the US. I’m frankly a little curious as to why this has happened,and why all research into pharmaceuticals in Europe has stopped — even if it’s true (which it probably isn’t). After all you can do the research for a product anywhere and sell it anywhere, and most research is done by teams in multiple countries anyway. Quite what the connection is between when a product is developed and where it’s sold is beyond me. McDonalds sells millions of cheeseburgers a year in Japan and China, but the hamburger was invented in the good old US of A (or Germany–take your pick).
But let’s give Sir Tom his due. He says that AZ sorta moved its research out of Europe to America because America pays the highest price for drugs. This allegedly encourages innovation, although one might point out that plenty of innovation has come from companies developing products outside of the US aimed at the American market. Tom may himself have heard of Sony, Toyota or even Glaxo–all of whom have had a bit of success here with stuff invented and built there.
But no matter, here’s the next logical leap. If those pesky American politicians want to import drugs from Canada, just the way those pesky Brits and Germans did parallel imports from Spain and Greece, then gawdammit, we’re moving all our research shops to India and China! Well hang on a sec. Ignoring the fact that imports from Canada are less than $2bn of a $240bn US drug market, isn’t the innovation that makes research here so vibrant due to the high prices for drugs here? And now the innovation is all going to move to China and India presumably because the price of drugs is going to be higher there, after ours here come crashing down to Canadian levels. Given average spending on drugs here is roughly $1,000 per head per year which is not a lot less than average GDP per capita there, someone better quickly tell the Chinese and Indian governments that they need to quickly increase the price of drugs in those countries to what is effectively the point that the entire national income is spent on pharmaceuticals! That would please Sir Tom.
On the other hand, perhaps it’s not the price of drugs that would encourage Sir Tom to move his research shop to India or chin. Perhaps it’s the price of PhD research slaves? On the other hand, after he’s moved his R&D to India and China, surely Jupiter or Mars will raise drug prices to tempt him there?
PHARMA/POLICY: Another Canadian import to cause trouble?
As you know I (along with a couple of other medical bloggers) have long been opposed to the War on drugs and the ridiculous ban on marijuana. Marijuana has obvious medical uses, particularly as an anti-nausea and anti-neuralgia agent. Many other wonders are claimed for it as an anti-cancer agent, etc. These may or may not be true but as clinical trials are not allowed we can’t tell for sure, and it doesn’t seem any less effective than many of the equally ineffective chemo regimens that are used in oncology–if a patient tells you that he’s alive because of marijuana, who are we to take it away from them? I of course think that marijuana should be legal, fully regulated (and taxed) like any other herbal supplement or alcohol.
However because of its obsession with promoting arrests, prisons and the black market, the US government has been blind to all the news on medical marijuana as it’s just too inconvenient to note that a supposedly evil drug with no medical value is actually therapeutically useful. Well now the Canadians have gone further than allowing patients to use their own marijuana, they’ve actually approved a medicine that is liquid marijuana. I’ll let the MPP take it from here, but suffice to say if the drug warriors cared a fig for reason, they’d be tying themselves in logical knots over this one.
The Canadian government has just delivered a body blow to the U.S. government’s irrational prohibition against the medical use of marijuana. Today, Canada approved the prescription sale of a natural marijuana extract — for all practical purposes, liquid marijuana — to treat pain and other symptoms caused by multiple sclerosis.
In short, the Canadian government has just certified that virtually everything our own government has been telling us about marijuana is wrong. Sativex, produced by GW Pharmaceuticals in Britain, is literally liquid marijuana. It is nothing like Marinol, the synthetic THC pill old in the U.S. and sometimes falsely touted as an adequate substitute for marijuana. Rather, Sativex is a whole-plant extract, containing the wide variety of naturally occurring compounds called cannabinoids that are unique to marijuana. It also contains trace elements of other compounds in the plant, which scientists believecontribute to its therapeutic value.
Sativex is to marijuana as a cup of coffee is to coffee beans. If Sativex is safe and effective, marijuana is safe and effective. And Sativex is safe and effective. Studies have shown significant effect against pain and other symptoms caused by multiple sclerosis and other debilitating conditions, and over 600 patient-years of research have established a remarkable record of safety.
Sativex should certainly be approved in the U.S., but the process may take years — if it is allowed to happen at all, given our federal government’s reflexive hostility to the medical use of marijuana. And more importantly, now that we know beyond doubt that marijuana is a safe, effective medicine, how long will our government continue to arrest patients who use it?
Visit http://www.mpp.org/sativex.html to learn more about the issues associated with Sativex. Please visit http://www.mpp.org/donate2088 to give MPP the money we need to continue lobbying to end our government’s war on medical marijuana users.
