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Op-Ed: Major Reforms in the Financing and Oversight of Clinical Research Neededt

Nov 27, 2009

By KATHLEEN BOOZANG

Seton Hall University School of Law’s Center for Health & Pharmaceutical Law & Policy has called for major substantive reforms in the financing and oversight of clinical research. In a White Paper entitled “ Conflicts of Interest in Clinical Trial Recruitment & Enrollment: A Call for Increased Oversight,” the Center proposes legal and policy changes to address conflicts of interest in the relationships between industry and doctors that can create unwarranted risks to trial participants and to the scientific integrity of research.

Over 60% of testing of experimental drugs and medical devices now occurs in physicians’ private offices; unlike years past, industry funds a much higher percent of clinical trials than government, frequently paying researchers significantly more than government does. For some physician practices, conducting clinical trials represents a significant portion of their income.Continue reading…

Some conversations are easier than others

Nov 26, 2009• 3

We’re continuing a tradition at THCB started last year. Asking you to take a moment this weekend to discuss your desires for how to live the end of your life as meaningfully as possible–If you want to reproduce this post on your blog (or anywhere) you can download a ready-made html version here Matthew Holt

Last Thanksgiving weekend, many of us bloggers participated in the first documented “blog rally” to promote Engage With Grace – a movement aimed at having all of us understand and communicate our end-of-life wishes.
It was a great success, with over 100 bloggers in the healthcare space and beyond participating and spreading the word. Plus, it was timed to coincide with a weekend when most of us are with the very people with whom we should be having these tough conversations – our closest friends and family.
Our original mission – to get more and more people talking about their end of life wishes – hasn’t changed. But it’s been quite a year – so we thought this holiday, we’d try something different.

A bit of levity.

At the heart of Engage With Grace are five questions designed to get the conversation started. We’ve included them at the end of this post. They’re not easy questions, but they are important.
To help ease us into these tough questions, and in the spirit of the season, we thought we’d start with five parallel questions that ARE pretty easy to answer:

Silly? Maybe. But it underscores how having a template like this – just five questions in plain, simple language – can deflate some of the complexity, formality and even misnomers that have sometimes surrounded the end-of-life discussion.
So with that, we’ve included the five questions from Engage With Grace below. Think about them, document them, share them.

Over the past year there’s been a lot of discussion around end of life. And we’ve been fortunate to hear a lot of the more uplifting stories, as folks have used these five questions to initiate the conversation.

One man shared how surprised he was to learn that his wife’s preferences were not what he expected. Befitting this holiday, The One Slide now stands sentry on their fridge.

Wishing you and yours a holiday that’s fulfilling in all the right ways.

(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team. )

Prevention is Not Only Good Health Policy, It’s Good Economic Policy

Nov 24, 2009• 26

By KENNETH THORPE, PhD

The current debate around how to best control burgeoning health costs has pushed the issue of prevention to the forefront. That’s right where it should be. By shifting our health care to be more pro-active and prevention-oriented, we can make a major impact on common and costly chronic diseases such as diabetes. In turn, this will help to secure the financial stability of our health care system and continued economic growth and prosperity.

Over the past century, the burden of disease among Americans has shifted from acute and infectious illness to chronic disease. With more than 75 cents of every dollar in this nation spent on patients with chronic disease, prevention offers the opportunity not to spend more money — but spend smarter. By embracing prevention, we can help more Americans lead healthier, active lives free from disease, so that they can avoid costly complications and hospitalizations, and remain productive in their communities and workplaces.

Prevention today involves a lot more than flu shots, cancer screening, and annual checkups. It is a pro-active strategy of disease avoidance and mitigation that should be embraced throughout and beyond the health system. In the context of chronic illnesses such as asthma, cancer, depression, heart disease and diabetes, prevention runs the gamut from lifestyle changes to screening for risk factors and symptoms, to early intervention to slow or reverse disease, to active management of already present cases.

Spotlight on Health 2.0: David Kibbe’s Motorcycle Tour

Nov 24, 2009• 1

Every week we bring you a video from Health 2.0! This week we’re featuring a golden oldie, David Kibbe’s motorcycle tour across America.

To see more videos from past Health 2.0 conferences, or to purchase the entire conference DVD sets from ’07 & ’08 click here. 2009 DVD sets will be available shortly, please check back for updates.

Public Anxiety Meets The Democratic Effort to Get Health Care Done at All Costs

Nov 23, 2009• 25

By ROBERT LASZEWSKI

The latest polls are an unmitigated disaster for Democratic efforts to get their health care bills passed.

This from Rasmussen this morning:

“Just 38% of voters now favor the health care plan proposed by President Obama and congressional Democrats. That’s the lowest level of support measured for the plan in nearly two dozen tracking polls conducted since June.

“The latest Rasmussen Reports national telephone survey finds that 56% now oppose the plan.

Interview with James Currier, Medpedia

Nov 23, 2009

By Matthew Holt

James Currier founded Tickle, a self assessment testing company later sold to career site Monster.com. But he's set the bar much higher in his next venture, Medpedia, Medpedia, as the name suggests, aims to be a comprehensive encyclopedia of medicine. It uses the wiki platform but it has more editorial control and restriction than Wikipedia–particularly limiting final editing rights to credentialed physicians. But Medpedia is also trying to do a whole lot more than that.

This effort has raised controversy from patients who feel (perhaps wrongly) that they're excluded from the process, from Clay Shirky (who suggested that Wikipedia is good enough), and from me (wondering why Medpedia is trying to do so much). James talked with me to discuss what Medpedia's goals are and to answer some of the criticisms.

James Currier, Medpedia

So Much For Comparative Effectiveness

Nov 20, 2009• 82

By MERRILL GOOZNER

The Obama administration’s commitment to cost control in health care can now be summed up in four words: Not on our watch.

Health and Human Services Secretary Kathleen Sebelius told American women this week that they have nothing to learn from the science that led to the U.S. Preventive Services Task Force guidelines on mammography.Insurance companies won’t change their payment policies, and the independent doctors and scientists who made up the USPSTF task force “do not set federal policy” or determine what services are covered by the federal government.”

What a golden opportunity has been missed to educate Americans about the implications of their health care choices. Otis W. Brawley, the chief medical officer of the American Cancer Society, in an op-ed in today’s Washington Post condemning the USPSTF guidelines, confirms that mass screening would only save at a maximum 600 out of the 4,000 women under 50 who die of breast cancer annually. What he failed to point out is that 1.14 million American women would have to be screened annually for ten years to achieve that goal. To cover the entire cohort (all women between 40 and 49) to replicate that benefit every year would require screening 11.4 million women annually. The cost, at $200 per mammogram (my initial estimate was accurate, according to this New York Times business section article), would come to $2.24 billion annually for the health care system.

So will the public option hurt hospitals? Not in the Ozarks

Nov 20, 2009• 13

By Matthew Holt

I've had this sitting in my inbox a while, but I thought that with the Senate bill out it was time to have a bit of weekend fun with it. The topic is the fear that a public option/government-run health plan/Hitler-ization of America (delete where applicable) will of necessity put all those worthy private health plans out of business. And worse because it will impose government's lower pay rates on providers, it'll also put them out of business, or at least into a position equivalent to that of Ukrainian peasants working on a collectivized farm.

Everywhere you go in the hospital world you hear complaints that Medicare pays less than private payers, and that the private insurance business is the only thing keeping providers alive.

Everywhere but Orark mountains of southwest Missouri and Northeast Arkansas.

Paul Taylor is the CEO of a tiny hospital system there called Ozarks Community Hospital. It's basically a safety net hospital and it only gets about 5% of its business from the leading commercial insurer, Blues of Missouri–part of Wellpoint. And does Wellpoint pay more for its patients than Medicare?

Err…no

In fact this chart shows that it pays less than half in many cases. I thoroughly recommend you read Pauls blog piece on the topic from which I lifted that chart. It's an entertaining, detailed and sensible read.

But what he's saying is that a public option will be better for hospitals serving lower-income populations than a simple expansion of private insurance.

This Just In

Nov 20, 2009• 4

By ARON BOROS

Yesterday, but the U.S. Treatment Services Task Force announced that leeches aren’t a particularly good treatment for most ailments. While noting that leeches might still be useful for certain specific circulation disorders, the USTSTF recommended against their use in other situations, like treating fever and abdominal pains.

Although the Task Force has no power to make anyone do anything, Rep. Dave Camp (R-Mich) was heard on NPR’s Morning Edition saying, “Some people discounted the idea that the government would actually put people to death … this actually is really showing how the insidious encroachment of government between the patient and their doctor plays out.” Camp neglected to address the facts: (1) overuse of leeches is expensive, and science-based recommendations about appropriate use would save the government money without harming patients, and (2) bloodletting can lead to negative side effects, such as upsetting the body’s natural humoral balance.

Harvard Study Gets it Wrong on EHRs and Quality

Nov 20, 2009• 8

By GLENN LAFFEL MD, PhD

America’s hospitals are a triumph of modernity, stocked as they are with PET scanners, ECMO machines, and ICUs bedecked in eye-popping gadgetry.

They are also the most complex organizations ever created by man. The seemingly simple process of delivering a drug from the pharmacy to the bedside for example, typically involves a 30-step process executed by a half-dozen people on 3 floors. There are hundreds of ways it can fail.

It often does, and that’s just half the story. Each hospitalized patient requires a unique combination of services including lab tests, physical therapy, a discharge plan and so forth. Since a complex process must be executed to produce each service, the hospital becomes a job shop.

By contrast, the processes used to produce cars and silicon chips are relatively unfettered. That is why piston rods can be produced in batches with every item meeting specs to the micron, while hospital processes often feature error rates of 10-20%.

This explains why hospitals have struggled for decades to improve quality. It also explains why a study by Ashish Jha and colleagues at Harvard has shown that hospitals using electronic health records (EHRs) don’t have better quality.