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)
Above the Fold
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.
POLICY: Unrealistic, unfair mercatilism in health care.
I like Don Johnson’s blog Businessword but sadly when you really push him, as I’ve done in his comments over the last couple of years, he either won’t answer or his answers reveal a political philosophy that is downright mean. So in his criticism of Krugman’s analysis on his blog and in comments at THCB here, Don essentially says that if you’re poor or sick in America, well that’s just tough titties. And, as a by product, it’s OK for the insurance market to screw over those who really need individual insurance because, well, because it’s a "market". Same way it’s OK for Enron to defraud the California rate payer, or same way it’s OK for Healthsouth to defraud its shareholders. After all they’re operating in "markets" too. But Don misses the wider point. Because of the way the US system is set up — because we’re a richer country than any in Europe, and because the majority of people can afford to pay way too much for our health care — we systematically overpay for things that no rational market would value. That does not help our economy, it hurts it as most health care spending is non-productive to the overall economy.
The other point that pro-unrestrained booty capitalists in health care, or those Krugman was criticizing, go on about is the huge waiting lists in Canada and the UK. Well as I mentioned in the UK the wealthy can trade up with their own money while the less well-off get a decent standard of care. Meanwhile single payer advocate Don McCanne found this just excellent chart from Stats Canada which shows that median waiting times for non-emergency surgeries in Canada are just over 4 weeks! I’m more than prepared to wait 4 weeks for non-emergency surgery if it means that poor people wont be crushed by their medical bills and can get access to basic health care. (For far more details on this see my "Oh Canada" piece). And anyone who doesn’t think that’s a fair equation is just mean in my viewpoint. Not to mention that such a system would cost me as a tax payer and a premium payer less money! Money I could spend on other, more productive things, like Frappuchinos.
POLICY: Ezra Klein on Health Care in France
Ezra Klein is a nauseatingly over-achieving student at UCLA who, at an age when I was trying to pick sufficient 10p pieces out of the gutter to buy myself a half of ale at the college bar (and usually end up back in the gutter), has a successful blog and is on the way to becoming a writing star of the liberal ilk. Ezra’s blog goes all over the map in a fascinating way. This week he’s featuring a whole series on health care systems in other countries. Dangerous work, Ezra — that’s where I started. The first one is about Health Care in France and it’s really good.
Policy: A Break in the Florida HIV case By John Pluenneke
It sounded a lot like one of those stories from Florida we keep hearing about. A mystery like the chads. Or the anthrax case, which started not far away in Boca Raton.
Two months ago a worker at the Palm Beach Department of Health (DOH)
accidentally sent out an email containing a list with the names of
6,500 people with HIV/AIDS. Officials thought the problem had been
contained. It turned out it had not. About thirty days after the incident mysterious letters started
appearing at the homes of people named on the list. "Your name appears
on a list of people with HIV/AIDS", the letters began.
Somebody had apparently gotten their hands on the list. That somebody
was using it to target people with HIV/AIDS. The head of the Palm Beach
Health Department called the case "terrorism." Speculation immediately
focused on the e-mail leak.
Had a copy of the list somehow escaped and found its way into unfriendly hands? It seemed unlikely we’d ever know exactly what happened. After all, the
anthrax case showed how difficult it is to track down somebody who
wants to go around using the U.S. postal service to mail things to
people.
There has however been a break in the case. Late last week, the Palm Beach Health Department said it has fired an analyst
in its HIV/AIDS program. It also said it had discovered another
security breach. There is suspicion that Dr. Shireesh Patel was the
person responsible for the disappearance of 15 pages of the paper copy of the Palm/Beach HIV/AIDS list.
According to documents obtained by the Palm Beach Post, the internal
investigation into the matter found that Patel lied to investigators
about the incident. It also found that he asked fellow employees to
help him cover up the mistake.
There are also new details about the number of letters sent. According
to the report, which was filed by inspectors Jerome Worley and Paladin
Henderson (a solid name for law enforcement, if ever there was one), 36
letters were sent to people with HIV/AIDS in the Palm Beach area.
Case closed? Perhaps not. The Orlando Sentinel
has a piece which ran over the weekend, which strongly suggests that
things are far from settled. According to Department spokesman Tim O’Connor the
paper copy of the list could not be the source of the leak because the
missing pages do not include any of the names of patients who received
letters. Very mysterious. Very mysterious, indeed.
It would be interesting to know what Dr. Patel has to say for himself, wouldn’t it?
PHARMA: Why is Crawford’s FDA nomination stalled?
Good salacious stuff for a Friday. Apparently the scuttlebut inside the FDA is that reason that the FDA acting commissioner Crawford’s nomination is being held up is because he’s favoring an FDA staffer. What this means, according to a much more frank article in FDA Webview is that he’s hoofing his secretary and taking her on lots of "business" trips.
FDA Webview has learned that the investigation into FDA commissioner-nominee Lester M. Crawford requested by Senate HELP Committee chairman Mike Enzi (R-WY) involves an anonymous allegation that Crawford has been having an affair with his special assistant, Susan Bond. A close confidant has denied any affair exists, however. According to well-placed sources, the investigation Enzi asked FDA’s Office of Internal Affairs (OIA) to conduct involves allegations of waste of government resources in unnecessary travel expense and irregular promotion of Bond to her present position. OIA, which has a long history of ineptness, secrecy and bullying, reports directly to Crawford, raising questions as to why Enzi turned to it instead of the HHS Office of the Inspector General, which has a much better record. Personnel issues, however, especially those involving improper use of government resources, are within OIA’s charter.
I’m of the opinion that what you do with your private parts in your private life is private, and that so long as you’re doing your job well who cares? But I suspect several of the Republican Senators on the confirmation committee don’t agree with me, and I suppose a government official shouldn’t play favorites (although of course they all do). What with holding back on Plan B, it does appear that Mr Crawford’s "family values" planning is a little awry.
HOSPITALS: Hospitals on the verge of a nervous breakdown
Sorry, so the title is another bad attempt to be imitate an old Spanish movie but the problem is real enough. If the formula is, increase the number of jobs available without insurance, add more people moving into a county without regular access to physicians, reduce the number of community clinics, and limit the amount of services at county hospitals, then the result will be more and more people showing up in the ER at other local hospitals. And of course if this is in LA County, all those problems are going to be magnified. The study claims that at "40 private hospitals reporting jumps in
emergency room visits by the uninsured, the cost of caring for them
rose from $63 million in 2000 to $77.5 million in 2004." So amazingly enough, the health care system for the people at the bottom appears to be connected to the one for the rest of us? Who’d have thought it, in this day and age when there are no social problems, no issues with inequality, and we’re all happy in Arnie’s golden state?
POLICY: Krugman on the international health care context
Paul Krugman has a great column out about the international health care context, called The Medical Money Pit. There’s nothing new or original that THCB readers or Health Affairs readers won’t already know. We spend more and basically get less, but we lead the league in surgeons driving Porsches. But it’s very good that someone is raising this issue outside of pure policy wonk circles. Even Krugman seems stunned that our government spends so much more per head than other governments which cover all their people, and all we get for it is Medicare for seniors and crappy coverage for the very poor. And by the way those numbers don’t count the role of the Feds and states as employers paying for health care coverage for 10 million government workers–if you add that in, the government share of spending is higher (although that math doesn’t really matter as we don’t cover any more people because of which column you put the spending in).
What Krugman doesn’t say is that, in general, government spending in those other countries guarantees a basic level of care for everyone, and that the rich (even in the UK, but not in Canada) can trade up with their own money for a nicer class of waiting room or to jump the line. And they do, and there’s not only nothing wrong with that. It doesn’t destroy the basic fabric of the social system. And if we had universal health care here, it would be true here too, and there would be nothing for those in the upper social tiers here to be afraid about. But you won’t find that rumor getting out when this gets discussed politically.
