Word on the Street November 14, 2010
Posted by Charles Bosdet in Humor.Tags: Humor, wordplay
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fam-i-nist \ˈfa-mə-ˌnist\
noun, adjective
1. A proponent of starving an overweight condition.
2. One who advocates a laissez-faire approach to resolving overpopulation.
Readings in Health Care: U.S. Doctor Presses Need to Catch Up to 19th Century Medicine October 17, 2009
Posted by Charles Bosdet in Comparisons, Health care, Health care results, United States.Tags: Checklists, cleanliness, Gawande, Health care, healthcare, Hospitals, ICU, Infections, intensive care, Intensive Care Units (ICUs), Johns Hopkins Hospital, New Yorker, Peter Pronovost, Sinai-Grace Hospital, United States
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“The Checklist; If something so simple can transform intensive care, what else can it do?,” by Atul Gawande. The New Yorker, December 10, 2007.
Would 21st-century American medical professionals risk patients’ lives by ignoring hospital procedures that were well established in the 19th century?
Yes.
In this article, a doctor crisscrosses the United States, lobbying physicians to adopt a checklist of basic cleanliness routines at hospitals. Amazingly, he meets resistance even though he can prove that hospitals using the list quickly reduced patient infections by two thirds.
You might think this isn’t an issue 140-odd years after Louis Pasteur’s and Joseph Lister’s pioneering work in bacteria and sterilization, and Florence Nightingale’s application of cleanliness standards in U.S. patient care.
If something so simple can transform intensive care, what else can it do?
Report: Medicare Enrollees More Satisfied Than Members of Private Employer Insurance Plans October 16, 2009
Posted by Charles Bosdet in Canada, Comparisons, Government health care, Health, Health care, Health care results, Health care statistics, Insurance, Medicine, Statistics, United States.Tags: Canada, Commonwealth Fund, employer insurance, Government health care, Health Affairs, Health care, Health care reform, Medicare, patient satisfaction, poll, private insurance, Socialized medicine, survey, United States
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American Medicare patients are happier with their care, get medical care with fewer hassles and suffer less financial hardship than people in employer-provided insurance plans, according to a recent study reported in Health Affairs on the Web.
Abstract
One key issue in health reform concerns the relative roles of coverage offered through private insurance and public programs. This paper compares the experiences of aged Medicare beneficiaries with those of people under age sixty-five who have private employer coverage. Compared with the employer-coverage group, people in the Medicare group report fewer problems obtaining medical care, less financial hardship due to medical bills, and higher overall satisfaction with their coverage. Although access and bill payment problems increased across the board from 2001 to 2007, the gap between Medicare and private employer coverage widened. [Health Affairs 28, no. 4 (2009): w521–w532 (published online 12 May 2009; 10.1377/hlthaff.28.4.w521)]
(Emphasis added.)
Implications
A Commonwealth Fund brief about the project concluded:
Offering the choice of a Medicare-sponsored public plan to those under age 65 would likely increase access to care, reduce administrative burden, and offer people security of coverage, and could possibly contribute to greater competition among both public and private insurers—thereby increasing responsiveness to consumers’ needs.
(Emphasis added.)
Key Research Findings
- Medicare beneficiaries are more satisfied with their insurance coverage. Only 8 percent of elderly Medicare beneficiaries rated their insurance “fair or poor,” in contrast with 18 percent of individuals with employer-based insurance. Thirty-two percent of Medicare beneficiaries had at least one negative insurance experience, compared with 44 percent of those covered by an employer plan.
Chart: Health Affairs, 2009
- Medicare beneficiaries report easier access to physicians. Ten percent of Medicare beneficiaries’ physicians did not accept their insurance, compared with 17 percent of respondents with employer-sponsored plans.
- Medicare beneficiaries are less likely to report not getting needed services. Twelve percent of elderly Medicare beneficiaries reported going without care, such as prescribed medications or recommended tests, because of cost restraints. Of individuals with employer-based plans, 26 percent reported experiencing these cost/access issues.
- Medicare beneficiaries are sicker and poorer but report fewer medical bill problems. Elderly Medicare beneficiaries were more likely to rate their health as fair or poor than the employer-coverage group (28% vs. 11%); more likely to have multiple chronic conditions (38% vs. 11%); and more likely to have incomes below 200 percent of the federal poverty level (51% vs. 27%). Yet, Medicare beneficiaries were less likely to report a medical bill problem than those covered by employer plans.
(Emphasis added.)
Patient Satisfaction Results in Canada
The U.S. study’s results appear similar to patient-satisfaction data for Canada’s single-payer medicare system, in which government pays private providers for goods and services but runs very few health care facilities.
Source: Statistics Canada
Sources
K. Davis, S. Guterman, M. M. Doty, and K. M. Stremikis, “Meeting Enrollees’ Needs: How Do Medicare and Employer Coverage Stack Up?” Health Affairs Web Exclusive, May 12, 2009, w521–w532. Web URL:
Statistics Canada. “Patient satisfaction with any health care services received in past 12 months, by sex, household population aged 15 and over, Canada, provinces and territories, occasional” (CANSIM Table 105-4080). Ottawa, Statistics Canada, 2006. See data charts on the Web: “Indicators of Well-being in Canada; Health — Patient Satisfaction.” Web URL: http://www4.hrsdc.gc.ca/.3ndic.1t.4r@-eng.jsp?iid=7).
Health Care: Is Netherlands a Model for U.S.? October 14, 2009
Posted by Charles Bosdet in Government health care, Health, Health care, Health care results, Medicine.Tags: Health care, Health care reform, healthcare, Lehrer, Netherlands, Newshour, PBS, United States
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From The Newshour with Jim Lehrer (October 6, 2009), an illuminating look at The Netherlands’ health care system.
Recommended Reading: Attack of the Killer Clots October 9, 2009
Posted by Charles Bosdet in Health care, Health care reform, Health care results, United States.Tags: blood clots, clots, Health care, healthcare, Medicare, pulmonary embolism, reform, Wall Street Journal
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Click on the article title below to open the article in a new tab or window.
“In the Hospital, Facing a Scourge of Killer Clots; Medicare Move Spurs Efforts to Improve Screening for Risk of Pulmonary Embolism,” by Laura Landro, The Wall Street Journal, April 1, 2009.
Nearly 4,000 U.S. patients die of blood clots in an average week; some 200,000 people annually. Many of those deaths are avoidable and the government is squeezing health care providers to clean up their act.
Now, a growing number of hospitals are moving to do a better job of averting life-threatening clots. [But for] the most part … hospitals and surgery centers often fail to screen patients for risks of DVT, and only about a third of patients receive the recommended prevention therapies, studies show. Helping to pressure hospitals to do a better job to prevent blood clots is a threat of reduced payments from Medicare, which last year began withholding payments for certain preventable occurrences.
Readings in Health Care: Needless Death in U.S., but in Austria a Drowned Girl Is Returned to Life October 9, 2009
Posted by Charles Bosdet in Health, Health care, Health care reform, Health care results, Insurance, United States.Tags: Atlantic, Austria, drowned, girl, Goldhill, Health care, Health care reform, healthcare, revived, United States
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Click on article titles below to open them in a new tab or window.
“How American Health Care Killed My Father,” by David Goldhill. The Atlantic, September 2009.
After the needless death of his father … a business executive began a personal exploration of a health-care industry that for years has delivered poor service and irregular quality at astonishingly high cost. It is a system, he argues, that is not worth preserving in anything like its current form. And the health-care reform now being contemplated will not fix it. [He proposes] a radical solution to an agonizing problem.
“Resuscitaton in near drowning with extracorporeal membrane oxygenation,” Annals of Thoracic Surgery 2001; 72:607-608.
A young girl lies at the bottom of an icy pond for about 3o minutes before anyone can retrieve her. Ninety minutes after the accident medical generalists at General Hospital Klagenfurt, Austria, bring her back to life.
Pretty dramatic stuff, and not even the lingua franca of medical journal writing can render the results lifeless on the page:
Other than a moderate weakness of the right leg and the left arm [after initial treatment], there were no further neurologic deficits. During the next 6 months, she had physiotherapeutic support and logopedic training. By the control examination 20 months after the accident, she was doing well and was developing without any neurologic abnormalities.
If something so simple can transform intensive care, what else can it do?
Great Moments in Legislative Sociopathy: For One Senator It’s a Very Small World, After All October 9, 2009
Posted by Charles Bosdet in Great Moments in Lawmaking, Health, Health care, Health care reform, Insurance, United States.Tags: benefits, bill, Coburn, gender gap, GOP, great moments, Health care, healthcare, Insurance, maternity, Republican, Senate, Senator, Stabenow
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As the U.S. Senate Finance Committee debated amendments to a health care bill late last month, Arizona Republican Senator John Kyl sought to strike language that defines the benefits insurers must offer.
Michigan Democratic Senator Debbie Stabenow argued basic maternity care should be covered.
“First of all, I don’t need maternity care,” Kyl argued, “and so requiring that to be in my insurance policy is something that I don’t need and will make the policy more expensive.”
“I think your mom probably did,” Stabenow suggested helpfully.
The amendment lost on a 9-14 vote.
Video: U.S. Senate Finance Committee, Friday, Sept. 25
Mary Travers (1936-2009) September 17, 2009
Posted by Charles Bosdet in In Memoriam.Tags: death, folk music, In Memoriam, Mary Travers, music, Peter Paul and Mary, peter yarrow
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Mary Travers <> Singer-songwriter, Peter, Paul and Mary. Photo: Undated, unsourced.
“If I Had a Hammer”
“Blowin’ in the Wind”
“Where Have All the Flowers Gone?”
“Leaving On A Jet Plane”
“500 Miles”
“Puff, The Magic Dragon”"
“People say to us, ‘Oh, I grew up with your music,’ and we often say, sotto voce, ‘So did we.’ “
– Mary Travers, Goldmine magazine
You remember when you felt each person mattered
That we all had to care or all was lost
But now you see believers turned to cynics
And you wonder was the struggle worth the cost
Then you see someone too young to know the difference
And the veil of isolation in their eyes
And inside you know you’ve got to leave them something
Or the hope for something better slowly dies
Carry on my sweet survivor
Carry on my lonely friend
Don’t give up on the dream
And don’t let it end
Carry on my sweet survivor
Tho’ you know that something’s gone
For everything that matters
Carry on
– Peter Yarrow
Free-Market Felons: So These Are The People We Can Trust to Provide Health Care Unsupervised? September 15, 2009
Posted by Charles Bosdet in Crime, Fraud, Government, Government health care, Health care, Health care reform, Pharmaceuticals, United States, Waste.Tags: Crime, criminal conduct, FDA, fine, fraud, Health care reform, HHS, Justice Department, penalty, pfizer, Pharmaceuticals, regulation
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I was thinking about corporate citizenship as I read the details behind the record $2.3 billion fine leveled against pharmaceutical giant Pfizer earlier this month. The details reminded me that it’s one thing to read about felonious corporate conduct in the shorthand of news stories but something else to read the criminal complaint.
Read the summary of Pfizer’s criminal plea and civil settlement below and ask yourself, as I did, “If this corporate sociopath were a person, would I let it babysit my kids? Trust it to safeguard my family’s health?” The summary is courtesy of the Stop Medicare Fraud Web site, put up by the U.S. Justice and Health and Human Services departments.
Criminal Plea
- Pfizer subsidiary Pharmacia & Upjohn, Inc. (Pharmacia), which was acquired by Pfizer in 2003, has entered a plea agreement.
- One count information charging felony misbranding under 21 U.S.C. §§ 331(a), 333(a)(2) and 352 of the drug Bextra.
- Criminal resolution includes $1.195 billion criminal fine and a criminal forfeiture of $105 million.
- This is the largest criminal fine ever imposed in a United States criminal prosecution.
- Bextra was approved in 2001 by the Food and Drug Administration (FDA) for the signs and symptoms associated with osteoarthritis, rheumatoid arthritis and primary dysmenorrhea (PD) (menstrual cramps).
- Pfizer marketed Bextra off label for acute pain and surgical pain and at dosages above the maximum levels approved by FDA.
- From 2002 through April 2005, Pfizer used false and misleading claims of safety and efficacy to promote Bextra for unapproved uses and for dosages above the approved level. Pfizer did this in the following ways:
- Headquarter Marketing Plans: Pfizer’s marketing team positioned Bextra for acute pain, surgical pain, and other unapproved uses, created sales materials and messages to promote Bextra for these uses, commissioned market research to test its sales materials, confirmed these unapproved messages, and allowed the promotion of Bextra for these purposes to continue. In such documents, Pfizer’s marketing team stated as the “intended” use and message for Bextra that Bextra was for “acute pain.”
- Field Force Implementation: Pfizer’s sales force promoted Bextra directly to physicians for these unapproved uses and dosages, including by drafting and distributing proposed physician standing orders and hospital-wide protocols and pain pathways that called for unapproved uses of Bextra.
- Payments and other Remuneration to Physicians and Purported Consultants: Pfizer and Pharmacia used so-called advisory boards, consultant meetings and other forums and remuneration, including travel to lavish resorts, to promote Bextra to medical prescribers for unapproved uses and dosages and with false and misleading claims as to its safety and efficacy.
- Sham Physician Requests for Off-Label Information: Pfizer’s sales force created sham physician requests from physicians for medical information in order to send unsolicited information to physicians about unapproved uses and dosages.
- Distributing Samples for Unapproved Uses and Dosages: Pfizer’s sales force provided promotional samples and otherwise promoted Bextra for unapproved uses and dosages to surgeons and other medical prescribers who had no FDA-approved use for the Bextra samples, or at that dosage.
- Control of Purportedly Independent Medical Education to Disseminate Off-Label Messages: Pfizer sponsored purportedly independent continuing medical education programs (“CME”) to disseminate specific messages about unapproved uses of Bextra, including promoting the use of Bextra for acute pain and surgical pain.
- Use of a Publication Strategy and Outside Vendors to Foster and Draft Publications to Disseminate Off-label Messages: Pfizer also promoted Bextra for unapproved uses and dosages by initiating, funding and sometimes drafting articles about Bextra for unapproved uses without appropriate disclosures of Pfizer’s role.
- Prior convictions and settlements of Pfizer entities:
- In 2007, Pfizer subsidiary Pharmacia & Upjohn, Inc. paid $34 million and pled guilty to paying kickbacks for formulary placement of its drugs and entered into a Deferred Prosecution Agreement for off-label distribution of the drug Genotropin.
- In 2004, Pfizer subsidiary Warner-Lambert pled guilty and paid more than $430 million to resolve criminal charges and civil liability in connection with its fraudulent marketing practices with respect to the drug Neurontin.
- In 2002, Pfizer, and its subsidiaries Warner-Lambert and Parke-Davis, paid $49 million to resolve civil claims that it had failed to report best prices for its drug Lipitor as is required under the Medicaid Drug Rebate Statute.
- Prior convictions and settlements of Pfizer entities:
Civil Settlement
- Combined federal and state civil settlement of $1 billion
- Federal government’s share of the settlement amount is $668,514,830
- States’ (which are entitled to a portion of the settlement attributable to the Medicaid program) share of the settlement amount is $331,485,170
- Resolves allegations that Pfizer violated the federal False Claims Act by knowingly causing false or fraudulent claims to be submitted to, or causing purchases by, Medicaid, Medicare and other federal health care programs by:
- Illegally promoting the drugs Bextra, Geodon, Zyvox, and Lyrica for uses not approved by the FDA and that were not medically-accepted indications for which the United States and state Medicaid programs provided coverage;
- Making and disseminating unsubstantiated and false representations about the safety and efficacy of Bextra, Geodon, Zyvox, and Lyrica;
- Paying kickbacks to health care providers to induce them to prescribe Bextra, Geodon, Zyvox, and Lyrica;
- Paying kickbacks to health care providers in connection with its marketing of nine other drugs: Aricept, Celebrex, Lipitor, Norvasc, Relpax, Viagra, Zithromax, Zoloft, and Zyrtec (Kickback Drugs)
- Allocation of combined civil settlement amount by drug:
- Bextra: $502,524,316
- Geodon: $301,462,065
- Zyvox: $97,945,019
- Lyrica: $48,223,886
- Kickback Drugs: $49,844,714
Settlement proceeds will be distributed among the following programs: Medicaid (federal and state share), Medicare, Department of Defense-TRICARE, Office of Personnel Management-Federal Employee Health Benefits Plan, Department of Veterans’ Affairs, Department of Labor, Bureau of Prisons
- Medicaid (federal and state portion) is the largest part of the recovery, constituting $705,287,596 of the combined civil settlement amount …
Meanwhile, Back at Pfizer Headquarters …
You might think getting hammered for jeopardizing people’s lives, bribing health providers and defrauding taxpayers might prompt some contrition and good corporate citizenship.
You would think wrong. BNET reports that Pfizer sought, among other things, to bury news of the $2.3 billion fine using a classic shuck ‘n’ jive PR Two-Step Plan:
Pfizer first disclosed the $2.3 billion fine on the same day it announced its merger with Wyeth and released its Q4 earnings. Most media missed the settlement because of they were focused on the merger. Pfizer also detailed the investigation in several of its quarterly SEC filings, but gave less detail in its quarterly earnings press releases, which come out before the SEC filings. Because people read the press releases first, and they tend to be similar to the SEC filings, no one noticed the settlement until BNET pointed it out on the morning of the Wyeth merger.
If you can stand any more corporate intrigue and skulduggery, read the way Pfizer disclosed the settlement.
