Putting Pfizer’s $2.3b Drug Bust in Perspective September 15, 2009
Posted by Charles Bosdet in Pharmaceuticals.Tags: advertising, drugs, fine, illegal marketing, lawsuit, off label, pfizer, Pharmaceuticals, promotion, qui tam, whistleblower
add a comment
In this week’s edition, The New Scientist adds a bit of perspective to what Associate U.S. Attorney-General Thomas Perelli called ”the largest criminal fine in history,” leveled against pharmaceutical giant Pfizer. Pfizer was charged with illegally marketing drugs for “off-label” purposes, treatments for which the drugs had not been tested and granted FDA approval.
By any standard, the $2.3 billion sum that pharmaceutical giant Pfizer will pay to settle charges of improper drug promotion is big. But will it change anything?
Doctors can prescribe medications in situations other than those approved by drug regulators, but drug firms in the U.S. are not allowed to promote these “off-label” uses.
The payout settles claims by whistleblowers and the U.S. government that Pfizer broke these rules for a range of drugs including the painkiller Bextra, pulled from the market in 2005 because of evidence suggesting it might increase the risk of heart attack and stroke.
The sum represents less than three weeks of sales for Pfizer, based on 2008 figures …
Less than three weeks of sales.
Shame, Pfizer! Go to your room.
Survey Shows Physicians Support Public Health Insurance Option and Medicare Expansions September 14, 2009
Posted by Charles Bosdet in Government health care, Health, Health care, Health care reform, Insurance, United States.Tags: doctors, Government health care, Health care, Health care reform, healthcare, Medicare, NEJM, physicians, poll, public option, Robert Wood Johnson Foundation, survey
add a comment
Robert Wood Johnson Foundation survey shows physicians support reform plan that includes both public and private options.
Source: http://www.rwjf.org/healthreform/quality/product.jsp?id=48408
A RWJF survey summarized in the September 14, 2009 edition of the New England Journal of Medicine shows that 62.9 percent of physicians nationwide support proposals to expand health care coverage that include both public and private insurance options—where people under the age of 65 would have the choice of enrolling in a new public health insurance plan (like Medicare) or in private plans.
The survey shows that just 27.3 percent of physicians support a new program that does not include a public option and instead provides subsidies for low-income people to purchase private insurance. Only 9.6 percent of doctors nationwide support a system where a Medicare-like public program is created in lieu of any private insurance. A majority of physicians (58%) also support expanding Medicare eligibility to those between the ages of 55 and 64.
In every region of the country, a majority of physicians supported a combination of public and private options, as did physicians who identified themselves as primary care providers, surgeons, or other medical subspecialists. Among those who identified themselves as members of the American Medical Association, 62.2 percent favored both the public and private options.
The survey was conducted between June 25 and September 3, 2009 by Salomeh Keyhani, M.D., M.P.H., and Alex Federman, M.D., M.P.H., of the Mount Sinai School of Medicine in New York City. While the survey was conducted in several “waves” over a tumultuous summer for the health reform debate, no statistically significant differences were identified in physician responses throughout the summer.
Source: Robert Wood Johnson Foundation
Source: Robert Wood Johnson Foundation
U.S. Health Care Costs Lead the World (Surprise) September 14, 2009
Posted by Charles Bosdet in Government health care, Health care results, Health care statistics, OECD, Statistics, United States.Tags: comparison, Government health care, Health care, healthcare, OECD, Statistics, United States
add a comment
Newscientist.com explores some data supporting the need for U.S. health care reform. (To see the “video below” to which the narrator refers, click here to go to Newscientist.com.)
Note that U.S. health care costs were in the same range as OECD countries until 1980, after which they began to rise faster than in the other countries.
Perfect Toy for the Flying Burrito Brothers? September 14, 2009
Posted by Charles Bosdet in Automobiles, Humor.Tags: Automobiles, bizarre news, carrot, F3, Formula 3, organic fiber, race car, racing car, vegetable
add a comment
This has nothing to do with anything, but it’s so weird …
Pistonheads.com reports that this car, dubbed “The Flying Carrot,” is “made from carrots and powered by fuel made from chocolate….” And it will participate in an F3 race in mid October.
- Presumably, the ‘Flying Carrot’ car is lower in transfats.
According to Pistonheads.com:
The engine is a heavily modified BMW turbodiesel tweaked to run on biofuel, while the body uses vegetable fibres … and carbon fibre recycled from the aerospace industry. The cockpit, wheels and tyres conform to normal F3 specifications, although the steering wheel is made from carrots …
One wonders how many nanoseconds will elapse between a mishap involving this car and the first on-air reference to “tossed salad.”
Whether It’s “Oh CA” in Canada, or “CA Here I Come” in USA, It Doesn’t Really ‘Sing’ September 7, 2009
Posted by Charles Bosdet in Humor.Tags: Language
add a comment
You’d think they could have come up with a more sensible system of U.S. state postal codes. Designations like “Calif.” and “Minn.” were straightforward, unambiguous and therefore doomed.
As Bill Walsh notes at The Slot, a copy editing Web site:
… just as AK could be Alaska or Arkansas, AL could be Alabama or Alaska; MA could be Massachusetts or Maryland; MI could be Michigan, Minnesota, Mississippi or Missouri; MO could be Missouri or Montana; MS could be Mississippi or Missouri; and NE could be Nebraska or Nevada. I think that about covers it.
Not really. Probably because the two-digit extension was such a resounding success in postalspace, the system was extended to cyberspace “top-level domains.”
CA may be California for snail mail, but it is also Canada both for international postal code and .ca Internet domain.
DE is Delaware but also the .de Internet designation for Germany.
We MA RU the DE the CZstem was ADopted. But not before it puts us to ZZ …
In India, an American Experiences Highs and Lows of a Free-Market Health Care Patchwork September 7, 2009
Posted by Charles Bosdet in Comparisons, Health care, India.Tags: comparison, Health care, healthcare, India, United States
add a comment
Aruna Viswanatha moved from New York to New Delhi for a newspaper job. Within two weeks she embarked on a half-expected but involuntary introduction to India’s health care system. Some things she anticipated, but others …
What I hadn’t anticipated was that India’s treatment would turn out to be so good. And cheap. Unless you happen to be one of the hundreds of millions of Indians who are poor and don’t live in a major metropolitan area. The Indian healthcare system is an anarchic hodgepodge, with little insurance, little regulation and a range of services offered by hundreds of government-run, trust-run and corporate hospitals. The care it produced for me was fast, effective, courteous and cheaper than American medicine, even when adjusted for the lower cost of living. But that was the care it produced for me, a middle-class woman in the big city. As America considers healthcare reform, the Indian system is a testament to both the triumphs and the pitfalls of letting the free market heal people.
See her article, “How I got well in India for $50; My cheap, fast and effective treatment in New Delhi reminded me of everything wrong with American healthcare” at Salon.com.
Medical Bills Underlie 62% of U.S. Personal Bankruptcies; 78% of Filers Had Health Insurance September 7, 2009
Posted by Charles Bosdet in Health care, Insurance.Tags: American Journal of Medicine, bankruptcies, bankruptcy, Health, Health care, Insurance, medical bankruptcies, medical debtors
add a comment
Numbers of the day: Nicholas Kristoff wrote in in The New York Times (August 29, 2009):
A study reported in The American Journal of Medicine this month found that 62 percent of American bankruptcies are linked to medical bills. These medical bankruptcies had increased nearly 50 percent in just six years. Astonishingly, 78 percent of these people actually had health insurance, but the gaps and inadequacies left them unprotected when they were hit by devastating bills.
But the journal article is more direct in stating the cause of these bankruptcies, and it includes much more of interest:
Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills.
Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance. Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001.
See “Medical Bankruptcy in the United States, 2007: Results of a National Study,” The American Journal of Medicine (2009) 122, 741-746.
Click on the title of the journal article to see the report.
BW Readers Back Health Care ‘Public Option’ August 19, 2009
Posted by Charles Bosdet in Congress, Government, Great Moments in Lawmaking, Health, Health care, Health care reform, Insurance, Medicine.Tags: BusinessWeek, Finance Committee, Government health care, Health care, Health care reform, Health insurers, poll, Senate, UnitedHealth
add a comment
BusinessWeek posed the following question in a reader poll this week: “Should President Obama drop his proposal for a public health insurance plan to compete with private insurers as part of overall health care legislation?”
773 respondents as of August 19, 2009 21:46
Meanwhile, in Washington …
Anyone who carries health insurance should probably read an August 7 BusinessWeek article and note what’s going on in the Senate Finance Committee. Among other things, BusinessWeek reports in an informative 3,200-word article titled “The Health Insurers Have Already Won; How UnitedHealth and rival carriers, maneuvering behind the scenes in Washington, shaped health-care reform for their own benefit”:
A fundamental question about the health overhaul is what minimum standards will apply to the coverage all Americans will be required to have. … Senators stung by the projected $1 trillion price tag are winnowing down the required coverage levels to cut costs.
.
This is good news for UnitedHealth, which benefits when patients pick up more of the tab. In late spring, the Finance Committee was assuming a 76% reimbursement rate on average, meaning consumers would be responsible for paying the remaining 24% of their medical bills, in addition to their insurance premiums. Stevens and his UnitedHealth colleagues urged a more industry-friendly ratio. Subsequently the committee reduced the reimbursement figure to 65%, suggesting a 35% contribution by consumers—more in line with what the big insurer wants. The final figures are still being debated.
(Emphasis added. This nugget is on page 5 of the Web story.)
Of course, legislation would apply the proposed 35% consumer contribution margin industry-wide.
MSNBC commentator Keith Olbermann notes helpfully that Nevada limits casino winnings to 25% and “New Jersey casinos take home no more than 17% by law.”
Veterans Administration Outperformed Other Health Care Systems, 2005 Analysis Found August 18, 2009
Posted by Charles Bosdet in Government health care, Health care, Health care results, Health care statistics, VA, Veterans Administration.Tags: Government health care, Health care, Health care results, Health care statistics, RAND, Socialized medicine, VA, Veterans Administration, VHA
2 comments
Update: March 17, 2010 — Updated OECD data located here.
* * *
Updated September 29, 2009, to include Tables 1 (medical conditions examined) and 2 (quality indicators examined).
* * *
A popular mantra in the United States is that government-run health care would be a disaster because “it’s government.”
Setting aside the U.S. single-payer Medicare system, what if the U.S. government really did run a health care system top to bottom? Surely that would be the greatest test of government performance?
Rummaging the data mines I was startled by a research summary I found at RAND Corporation, the research and policy think tank founded in Santa Monica, California, in 1948.
Researchers examined 294 quality measurements at the Veterans Health Administration, comparing patient medical records with those in a national sample. The result, RAND reported in a research bulletin, was that “VA patients were more likely to receive recommended care than patients in the national sample,” and with a better outcome. In fact, the VA outperformed the national sample in all but one category of patient care delivery.
- VA patients received about two-thirds of the care recommended by national standards, compared with about half in the national sample.
- The greatest differences between the VA and the national sample were for indicators where the VA was actively measuring performance and for indicators related to those on which performance was measured.
- Quality of care for acute conditions—a performance area the VA did not measure—was similar for the two populations.
- VA patients received consistently better care across the board, including screening, diagnosis, treatment, and follow-up.
- For preventive care, the difference was greater: VA patients received about 65 percent of recommended care, while patients in the national sample received 20 percent less.
- Among chronic care patients, VA patients received about 70 percent of recommended care, compared with about 60 percent in the national sample.
(Bold emphasis added.)
I checked the researchers’ article in Annals of Internal Medicine against RAND’s summary of the results, and created the charts below from a table in RAND’s summary. The charts clearly show the VA scoring higher in all categories except acute care (Chart 4), where the VA scored two points below the national sample.
Medical Conditions and Quality Indicators Examined
Source: Annals of Internal Medicine
Policy Question and Comment
If the question in America’s current health care debate is whether the federal government can run an effective national health care system, this study suggests the answer could be “yes.”
Anecdotally, I live in Canada, which has a “blended” universal health care system in which government seems to achieve the same overall results — or better — than the U.S. model. In the Canadian system the government covers about 70% of health care costs at about 10% of GDP, compared to the U.S. system, which reportedly covers 46% of costs at more than 16% of GDP (2009). I’ve been reading and comparing data on the health care systems of the U.S., Canada and other OECD countries for a couple of months. That has been eye-opening for me, too. More on that later.
Sources
——. Improving Quality of Care; How the VA Outpaces Other Systems in Delivering Patient Care. RAND Health, Research Highlights, RB-9100, 2005. Available at www.rand.org/health
Asch, Steven M., Elizabeth A. McGlynn, Mary M. Hogan, Rodney A. Hayward, Paul Shekelle, Lisa Rubenstein, Joan Keesey, John Adams, and Eve A. Kerr, “Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample,” Annals of Internal Medicine, Vol. 141, No. 12, December 21, 2004.
