Boston Scientific is having a good run. Its sales are up and its new drug-eluting stent Taxus, which has been doing well outside the US, is close to approval here. J&J’s Cypher stent is likely to be the main loser when Taxus is approved here, but the arms race between these two and Guidant will continue. Of course everyone’s ignoring what the Stanford study said about the value of these stents last year.
Boston Scientific’s stock is up nearly 30% in the last 3 months.
You may remember the story from the Industry Veteran a few weeks back about the massive price increase in Abbot’s HIV drug, Norvir. Well the Sacramento Bee notes that things are close to going thermonuclear now.
In a Jan. 20 letter to the company, more than 150 doctors who specialize in HIV care said they will resign from Abbott advisory panels, refuse to participate in Abbott drug trials or attend Abbott-sponsored lectures. They will ban Abbott representatives from their offices and consider alternatives to Abbott drugs when possible for their patients.
Also today there was an editorial in Eye for Pharma which suggested that the reason for pharma’s poor levels of public trust were to do with its opaque practices:
Perhaps the industry simply hasn’t revealed enough of its inner workings to adequately earn the public’s trust. What lurks behind the manicured lawns and lights in the windows of pharma campuses is largely a mystery to most of our customers.
There is no easy answer. But maybe it’s a matter of working hard to push the black curtain aside and help the public better understand complicated matters like R&D costs and effort and how that translates to retail drug prices. Perhaps "open houses" and public outreach events would give the communities we live and work in a glimpse of the "inside" of pharma.
Nice try, but it’s price gouging like the Norvir incident and the blocking of imports from Canada that is really riling the public. And this is in advance of the Democrats taking on the Medicare bill as a big give away to Pharma. MoveOn is already starting to run those ads, that clamor is sure to grow. If I was in pharma, I’d be quickly thinking about what good things I could do to improve my image. Enhanced DSM and drug programs for poor kids might be one place to start and publicize what was being done.
According to this piece of gossip masquerading as a news story British Surgeons have taken to closing wounds with paper clips. I grew up in Britain and to this day I use paper clips instead of cuff links when I wear a dress-shirt. I’m glad that my erstwhile compatriots have found other uses for that essential technology!
When I went to a conference on Genomics at Northwestern University in 1997 there was great excitement that the human genome project was going to be finishing quicker than anticipated. There was also widespread controversy that one company, Incyte Pharmaceuticals, had patented a vast number of genes, or at least the ability to do anything with them–the academics in Chicago were worried about the effect this would have on their research. Incyte’s business was based on selling its library of genes to pharma companies for their R&D. A couple of years after that Incyte’s stock got caught up in the 1999-2000 craziness and at one point the company was worth $25 billion, give or take a billion.
But soon a combination of Craig Ventner’s Celera Genomics joining the gene sequencing arms race and the increased public domain access to genetic information brought that business back to earth. Yesterday Incyte shuttered its Palo Alto offices and with it the proprietary genomic data product lines, LifeSeq and ZooSeq and will concentrate on its own drug development work instead. Its market cap is now back below $1 billion and actually looks generous at this level.
Apologies for the appalling pun, but HSC is out with a very thorough and readable analysis of the for-profit conversion of many Blues plans, and what the impact of these conversions has been. They note that virtually all the converted Blues are ending up in one big organization (the new Anthem) and their conclusion pretty much matches my opinion–it doesn’t really make any difference whether the Blues are for-profit or not, they always acted the same way (i.e. like a health insurer!). But on the other hand the amount of money gained by the states or Foundations that resulted from the conversions is more than enough to exhaustively study all of health care’s problems. It’s just not enough to actually solve any of them.
Modern Physician has an interview with Bob Wachter, who’s new book is called Internal Bleeding. There are something in the region of 20 odd medical errors written up in the book, with a view to showing the system problems behind them. This is something of an old story, and Michael Millenson’s Demanding Medical Excellence gave a great account of the overall safety/quality environment a few years back. But the more the story can be told the better the chance that the battleship will be turned in the direction of safer medical care. In fact several large health organizations are actively working on these programs, such as Ascension’s Healthcare that’s safe.
Congrats to Don Johnson who’s excellent blog The Business Word is one year old.
With a hat-tip to Lisa Williams, this month’s Atlantic Monthly Journal has the first article I’ve ever seen in a mainstream magazine on EBM. The author calls for a national clinical institute to supplant the NIH and AHCQ, and actually make pronouncements on what works, and try to get the medical profession and health care industry to follow it. I’m so knocked out by an article on this topic getting into a major non-health care journal, that it would churlish to point out that our British cousins have already got one.
Over at Medpundit, Sydney Smith quotes the WSJ on health care cost breakdowns and argues that HSAs will allow market intervention in the share of spending that goes to doctors and pharmaceuticals, and will bring both that spending under control and enforce market discipline on the providers to give us stuff we want. The WSJ thinks that what the consumer wants is flash computer-based customer service and they may well be right. There are though a couple of problems with this, and it takes a nerdy wonk like me to point them out. First, it’s unclear exactly what the HSA can be used to pay for (OTC drugs? I doubt it; off formulary drugs? Maybe not in Medicare) so there’ll be less of a market in which it can enforce its discipline than might be suspected. Second, about half of physician costs are connected to other costs that involve hospital stays and surgery–in other words they happen after the deductible has already been blown and the HSA spent, and we’re not talking about 33% of spending but more like 20-odd % of the "market" being "managed" by these new HSA bearing consumers–and that’s assuming that everyone gets one. The real issue as George Halvorson points out and Milton Friedman despite his many intelligent view points gets wrong is that almost 70% of the money goes on 10% of the people. That’s where the costs need to be controlled, and there’s nothing in the HSA that can possibly do anything about that.
Now from the other side of my mouth, here’s why I’m getting one. I pay my own insurance and I have medical expenses that don’t reach my deductible and I’d love to pay those in pre-tax versus post-tax dollars. So for people like me, they’ll grow as a niche insurance product. But I’m only 8% of the market. 64% are in employer-based insurance and they’re beginning to flirt with consumer-directed health plans. Some of these consumer-directed health plans give money to the employees to put in their HSA. Once employers figure out that giving real money to employees for their HSA’s means taking it away from their self-insurance pool, they’ll either find the next trendy product OR reduce markedly the amount they give so that it is way less than the deductible. At that point all but the healthiest employees will move back to a more comprehensive plan.
Meanwhile Sydney will have to figure out why she’s creating a understandable consumer price list–and that’s not simply printing out the CPT codes– just for the 10% of patients walking into her office who are now paying with pre-tax but real dollars. My advice is to her is to mark those prices up!
In the course of some other research I ran across this fascinating site the Virtual Realty Pain Control at University of Washington’s Human Interface Technology Lab. Extreme pain, such as that experienced by burn victims while having their wounds cleaned, is so painful that strong opiates cannot make it bearable. Apparently distracting patients by using virtual reality, can make significant improvements in how they perceive their pain. I don’t know what this says about the mind-body relationship but I found it fascinating.
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