The Health Care Blog – Page 663 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Wrong Rx for the FDA

Mar 6, 2012• 3

By Henry Miller

The congressional legislators who oversee the Food and Drug Administration and control the nation’s coffers have shown again that they neither understand drug development nor the regulatory problems that plague it.

In February, Sen. Barbara A. Mikulski(D-Md.) unveiled a bipartisan bill intended to spur innovation in research and drug development for chronic, costly health conditions such as Alzheimer’s disease, cancer, diabetes and heart disease.

According to the press release, the bill will invest “in public-private partnerships to ensure scientists and researchers are able to develop new safe and effective drugs,” shrink product development timelines, increase the number of drugs in the development pipeline and expedite the FDA review process.

However, there is currently plenty in the development pipeline. The federal government is boosting funding for research and development on Alzheimer’s disease; the Department of Health and Human Services alone will allot more than $500 million to it in fiscal year 2013. Moreover, drug companies spend more than $65 billion annually on R&D.

For example, there are now nearly 100 drugs in development for Alzheimer’s disease, dementias and other cognitive disorders, and almost 900 medicines being tested for cancer.

Autofill Gone Wild

Mar 5, 2012

By Dinosaur, MD

I appreciate getting notes from specialists. Really. It’s great to be kept in the loop with patients’ care, especially when other doctors are using EMRs that directly fax me notes the same day as the visit. Sometimes, though, things can get a little out of control.

I’ve ranted before about offices that use templated EMRs to generate documentation of things they never actually did. Today I received the following letter:

Reason for the appointment:
1. Abdominal pain
2. Post colonoscopy with biopsy

History of present illness:
1. Abdominal pain: he failed to show up for this appointment

Current medications:
[med]
[med]
[med]

Past medical history:
[problem]
[problem]
[problem]
EGD 2008 negative, EGD 2011 negative, colonoscopy 2005 normal
2010 Chest CT with 3 mm lung nodule, low risk

The Power Couple: Common in Medicine, Rare in Business??

Mar 5, 2012

By DAVID SHAYWITZ, MD

A tweet not long ago from Andrew Rosenthal of Harvard Business School (HBS) and MassiveHealth announced that at a recent conference presented by the HBS Women’s Student Association, it was reported that 80% of women at the top (in business, I presume) have husbands who don’t work.

Whoa.

As high as that number is, I believe it – and I’m sure the reverse is true as well.

What fascinates me is the apparent contrast with medicine, where so many of the women and men at the top seem to have spouses who not only continue to work, but often are physicians as well.

For example, Boston.com recently presented an interesting spread on power couples in the Boston medical scene. This feature – including such notables as HMS Dean Jeffrey Flier and his wife, endocrinologist Terry Maratos-Flier; oncologist and New Yorker writer Jerome Groopman and his wife (and occasional co-author), endocrinologist Pamela Hartzband; and Barbara Bierer, SVP of research at the Brigham, and her husband, neuroscientist and former Harvard Provost Steven Hyman — only scratched the surface, and could easily have included many more examples.

I follow this area with particular interest, as my parents are both physicians, my wife is a physician, and many of our colleagues from training have married other physicians as well; generally, both partners continue to work and climb their career ladders together.

Dual career couples were also a prominent feature of my training. I learned immunology from the late Charlie Janeway, whose wife, Kim Bottomly, is also a distinguished immunologist, and currently President of Wellesley; one of my favorite preceptors in medical school was the late Nina Braunwald, a cardiac surgeon whose husband is the legendary academic cardiologist Eugene Braunwald; I learned about fetal ultrasonography from one of the field’s leading lights, Beryl Benacerraf, whose husband, Peter Libby, is chief of cardiology at the Brigham.Continue reading…

The Bottom Line

Mar 5, 2012• 10

By Kelly Wright, MD

It’s cool. So cool, that President Obama used one. So cool, it’s been on the cover of Newsweek. It’s been in multiple television commercials, radio advertisements, highway billboards, and was even coined one of the top 14 medical breakthroughs of 2011 by Boston Magazine, a city teeming with medical innovation. Yet surgeons and health economists are unable to explain the fascinating rise of robotic-assisted surgery.

Currently, a single company manufactures and distributes the robot, a line of surgical equipment used to conduct robotic-assisted surgery. The robotic system consists of a surgeon’s console with 3-dimensional high definition vision and a patient-side cart featuring robotic arms with proprietary wristed instruments. The system translates the surgeon’s natural hand movements on instrument controls into corresponding movements of instruments inside the patient, giving the surgeon control, range of motion, and depth of vision similar to open surgery.

The sole manufacturer hopes to establish the robot as the standard for surgical procedures by encouraging surgeons and hospitals to adapt the technique while marketing aggressively to patients about the benefits of robotic surgery. As of June 2011, the manufacturer had installed 1,933 robotic systems. They estimate that 278,000 robotic-assisted surgical procedures were performed in 2010, up 35% from 2009, and aims to achieve one million annual procedures in the United States over the next few years (Invester Report 2011). To achieve this goal, the manufacturer strategically markets to smaller hospitals and surgeons who may not be skilled at conventional laparoscopy to give them an edge for attracting patients.

Is My Cancer in the Wrong Body Part?

Mar 4, 2012• 2

By Elaine Waples

Recently, our city hosted the fifth annual national marathon to fight breast cancer. This is not part of the Komen “race for the cure” but rather a grassroots effort that mushroomed from its inception five years ago into the impressive event it is today. Thousands of people participate as runners, volunteers, and cheerleaders clad in the signature color. I must admit, seeing some grown men run twenty six miles wearing pink tu-tus is both awe inspiring and a testament to dedication over self-image.

Its supporters include corporate sponsors, vendors, and exhibitors, and (no surprise) pharmaceutical companies. Its originators are a local TV celebrity breast cancer survivor and a cancer physician at Mayo clinic. It promises to donate 100% of the money to breast cancer research or care. To date, the event has raised millions of dollars and has met its contribution promise. It’s all very worthy, noble and heartwarming.

So why do I get an embarrassingly annoyed feeling when the pink parade makes its way through my neighborhood? After all, isn’t it a victory that so many people today recognize the need for education and awareness about a terrible disease that kills 40,000 women a year? Of course it is. And I have met many women breast cancer survivors who have become warm wonderful friends and I am thrilled for the overwhelming support they have.

The frustration seems even more puzzling in light of the fact that I am a cancer survivor myself. I was diagnosed in 2010 with advanced primary peritoneal ovarian cancer, the most lethal of all gynecological cancers with an alarmingly small overall survival rate. So for the past two years of chemotherapy and difficult treatment, I have struggled to suppress what feels like a petty sentiment about all the pink attention. If I just own up to it, I feel left out and I really want a parade with everyone wearing teal in support of ovarian research and care. My cancer! My body part! A cure for me!
Continue reading…

Profits Are Up at Massachusetts Health Plans – Should You Be Upset???

Mar 4, 2012• 4

By DAVID WILLIAMS

Major Massachusetts health insurers all reported higher net income for 2011 than for 2010. The Boston Globe makes the profit numbers sound big, calling them “sharply higher” and reporting that executives collected more pay. And indeed, the profits seem large on an absolute basis: $38.5M for Fallon, $87.6M for Tufts, $93.5M for Harvard Pilgrim and $136.1M for Blue Cross. But actually the dollars are quite small when considered in context.

The $136.1M Blue Cross figure equates to less than $50 per member per year (they have 2.8M members), which is equivalent to about 2 primary care co-pays or about 1 day of what my business pays for a family premium.

CEO compensation is quite restrained as well. The Blue Cross and Fallon CEOs are in the $800,000 range, or about what a moderately successful orthopedist makes. At $1.2M, Harvard Pilgrim’s CEO is getting close to the income of a typical fertility specialist, and at $1.7M the Tufts CEO is at the level of a law firm partner. They are far from the highest paid people in Massachusetts and frankly I don’t see how they could be expected to make less.

With that said, I’m definitely unhappy with the fact that premiums have risen relentlessly. We’ve experienced annual double digit health insurance premium increases since opening our consulting firm 10 years ago. None of our other major expenses have grown at that pace.

Health plans aren’t the biggest cause of cost increases. Pressures come from providers (hospitals and physicians), suppliers (pharma and device), employers (who fail to embrace better managed care) patients (through increased demand) and government (through reimbursement policies and regulations). But for too long health plans were overly complacent about overall costs. Plans are becoming more aggressive about cost control now as they react to demands from customers, regulators and the public. Massachusetts plans have been creative about rolling out new benefit designs and payment plans that preserve quality and control cost.

Buckle Up

Mar 3, 2012• 6

By ROB LAMBERTS, MD

Rob Lamberts, MD Lipitor can destroy your liver.

Back surgery can leave you paralyzed.

People who take Chantix might kill themselves.

You may never wake up from a simple surgery.

These statements are all true. They also are very confusing to many of my patients when I am prescribing drugs or recommending surgery. What should they do when they hear such bad things about drugs, surgeries, or procedures? How much do they risk when they follow my advice?

It’s a hard world out there, with the attorneys advertising on TV about drugs my patients have taken, with the websites devoted to the harms brought on by a drug or an immunization, with Dr. Oz and other seemingly smart people telling them things that are contrary to my advice, and with friends and neighbors who give dire warnings about the dangers of following my advice.

There are so many voices out there competing with mine, that I sometimes spend more time reassuring than I do anything else. A doctor in our practice believes that Dr. Oz ought to issue a statement to doctors whenever he voices another controversial opinion as gospel fact so that we can be ready with our counter-arguments.

What can doctors do? We can’t quiet the other voices that speak against us. In truth, those voices have an important role in preventing us from becoming comfortable and dogmatic in our beliefs. So how do I combat such a heavy current against our advice?

By talking about seat belts.

Seat belts can kill you, you know. You can be trapped inside your car by your seat belt and not be able to get out before your car explodes. It’s not a fable; it can really happen.

You may be sealing your fate to die terribly every time you buckle your seat belt.

If You Feel OK, Maybe You Are OK

Mar 2, 2012• 6

By H. Gilbert Welch

Early diagnosis has become one of the most fundamental precepts of modern medicine. It goes something like this: The best way to keep people healthy is to find out if they have (pick one) heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or, of course, cancer — early. And the way to find these conditions early is through screening.

It is a precept that resonates with the intuition of the general public: obviously it’s better to catch and deal with problems as soon as possible. A study published with much fanfare in The New England Journal of Medicine last week contained what researchers called the best evidence yet that colonoscopies reduce deaths from colon cancer.

Recently, however, there have been rumblings within the medical profession that suggest that the enthusiasm for early diagnosis may be waning. Most prominent are recommendations against prostate cancer screening for healthy men and for reducing the frequency of breast and cervical cancer screening. Some experts even cautioned against the recent colonoscopy results, pointing out that the study participants were probably much healthier than the general population, which would make them less likely to die of colon cancer. In addition there is a concern about too much detection and treatment of early diabetes, a growing appreciation that autism has been too broadly defined and skepticism toward new guidelines for universal cholesterol screening of children.

The basic strategy behind early diagnosis is to encourage the well to get examined — to determine if they are not, in fact, sick. But is looking hard for things to be wrong a good way to promote health? The truth is, the fastest way to get heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or cancer … is to be screened for it. In other words, the problem is overdiagnosis and overtreatment.

What I Learned At Haas Business School’s Health Care Conference

Mar 1, 2012• 1

By John Graham

There’s a lot of entrepreneurial energy in the Bay Area, but I’m always surprised at how much of it is directed towards health care. As Apothecary readers surely recognize, if we were to rank sectors where the government lies ready to crush the entrepreneurial spirit, health care and education must lead the list.

So, I was excited to have wrangled an invitation to the UC Berkeley’s Haas School of Business‘ annual Business of Health Care Conference, a day-long event held last week. This year’s conference, the sixth, titled Entrepreneurial Solutions to Health Care Challenges, assembled a high-profile group of entrepreneurs, scholars, and investors.

The most informative panel that I attended addressed “Venture Capital – Positioning Health Care Startups for Success,” moderated by Rebecca Lynn of Morgenthaler Ventures. The panel comprised Missy Krasner, also of Morgenthaler Ventures and the former Google executive who launched the now defunct Google Health; Lisa Suennen, a co-founder of the Psilos Group (perhaps the longest-standing pure-play healthcare VC); and Jeff Tangney, former president of Epocrates and founder of Doximity.

Key take-aways from the panel discussion were:

Digital health is where the opportunity lies, but both healthcare investors and IT investors bring unhelpful biases to this new sector.
Although the Bay Area crowd is loathe to hear it, some of the best new health IT businesses are in places we’d shun – like Michigan or Nashville.
Some digital-health entprenreneurs think they have a business, but they only really have a product. Nothing wrong with that, but you’ve got to sell it, not fund it.