Light Up at Home, Lose Your Job

I previously <a href="http://hcrenewal.blogspot.com/2005/01/employers-vs-employees-control-of.html">posted</a> on some fundamental confusions caused by having employers pay directly for their employees health insurance. One was employers thinking that such payments entitle them to control their employees' health-related behavior, even off the job.<br />The <a href="http://www.detnews.com/2005/business/0501/27/A01-71823.htm">Detroit News just reported</a> that Weyco, ironically a medical benefits adminstration firm, fired four workers because they refused to be tested to see if they were smoking during off hours. The company already had stopped hiring smokers, and fined workers who continued to smoke. Weyco President Howard Weyers said his motivation included "saving money on the company's own insurance claims," <a href="http://olympics.reuters.com/newsArticle.jhtml?type=healthNews&storyID=7440773">according to Reuters</a>. An <a href="http://www.timesdispatch.com/servlet/Satellite?pagename=RTD%2FMGArticle%2FRTD_BasicArticle&c=MGArticle&cid=1031780483132&path=!news!columnists&s=1045855935174">editorialist also quoted </a>him as saying, "I don't want to pay for the results of smoking." Next on his agenda, again according to Reuters, is to "tell fat workers to lose weight or else."<br />The trend is spreading locally in Michigan, as Kalamazoo Community College is refusing to hire smokers to "reduce health care claims by 10 percent," per Sandy Bohnet, its Vice President for Human Resources.<br />The federal tax laws allow companies, but not individuals to deduct health insurance payments, so employers take money that could have added to employees' salaries to pay directly for their health insurance. Because they "pay" for employees' health insurance, some employers now seem to think they own their employees' bodies.<br />As a physician, I am no fan of smoking, but firing employees just because they smoke (off the job) just adds insult to injury. Of course, more rational tax laws could let individuals could make their own decisions about health insurance and health-related behavior, and be the ones responsible for their actions.

Light Up at Home, Lose Your Job

I previously posted on some fundamental confusions caused by having employers pay directly for their employees health insurance. One was em...

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The NIH Response to Whistle-Blowing: "Overwhelm with Force"

<a href="http://seattlepi.nwsource.com/national/apwashington_story.asp?category=1152&slug=AIDS%20Whistleblower">A follow-up from Associated Press </a>about the case of Dr. Jonathan Fishbein, who complained about questionable practices at a Ugandan site for a National Institute of Health (NIH) run study on nevaripine for the prevention of transmission of HIV. Fishbein had been praised by the Director of the AIDS Division of NIH, Dr. Edmund Tramont, and recommended for a $2500 bonus to recognize his performance in his first year on the job. But after AP reported his concerns about the Uganda site, (see my post on this <a href="http://hcrenewal.blogspot.com/2004/12/politics-and-nih-nevirapine-study-in.html">here</a>), his immediate supervisor emailed Tramont "how hard would it be to terminate him?" Tramont's response was to fire him, "In Clauswitzian style, we must overwhelm with force."<br />Science, and therefore science based medicine, of course, requires the free communication of research data and results, and the free analysis, interpretation, and discussion of them. The very last place in the world I would have expected to see someone who publicly discussed questionable research methods "overwhelmed with force" is the NIH, formerly one of the world's foremost biomedical research organizations.<br />This story, coupled with previous stories about major conflicts of interest affecting NIH leaders (see previous posts <a href="http://hcrenewal.blogspot.com/2004/12/more-outrageous-conflicts-of-interest.html">here</a> and <a href="http://hcrenewal.blogspot.com/2004/12/anechoic-effect-and-conflicts-of.html">here</a> and <a href="http://hcrenewal.blogspot.com/2004/12/few-echoes-from-allegations-of-nih.html">here</a>) suggests the NIH badly needs new leadership who will respect its mission.

The NIH Response to Whistle-Blowing: "Overwhelm with Force"

A follow-up from Associated Press about the case of Dr. Jonathan Fishbein, who complained about questionable practices at a Ugandan site for...

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Some Good Sense on Pharma

See some very sensible posts on <a href="http://www.medrants.com/index.php">Medical Rants </a>about the current controversies in the pharmaceutical world. <a href="http://medrants.com/archives/2005/01/25/the-new-yorker-comments-on-the-vioxx-lawsuits/">One</a> cites a New Yorker article about how Merck hoisted itself on its own petard by over-selling Vioxx as if it were a risk-free consumer product. To quote <a href="http://medrants.com/archives/2005/01/25/more-on-vioxx/">the other</a>: <blockquote>The pharmaceutical companies should provide moneys for drug testing, but have no influence on what studies are done or how they are performed. Only if we have the research at arm’s length from those in position to benefit from the study results can we have ethical evaluation of new drugs. Is this position anti-capitalistic? I argue that the public welfare requires that we have good data on drugs, diagnostic tests, etc. </blockquote>

Some Good Sense on Pharma

See some very sensible posts on Medical Rants about the current controversies in the pharmaceutical world. One cites a New Yorker article a...

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Doctors tell of Merck's Vioxx dismay

The firm faulted a study critical of the drug after making its researcher dissociate herself from it.<br /><br /><br /><br /><strong>By Lindsey Tanner</strong><br /><br /><strong>Associated Press</strong><br /><br /><br /><br />CHICAGO - Merck & Co. forced one of its researchers to remove her name from a study linking Vioxx to heart attacks, then criticized the findings before ultimately pulling the arthritis drug from the market last fall, two of the scientist's colleagues said.<br /><br /><br /><br />"Even after funding and agreeing with the design of the study, Merck publicly discredited our findings," Drs. Daniel Solomon and Jerry Avorn of Boston's Brigham and Women's Hospital wrote in this week's Archives of Internal Medicine.<br /><br /><br /><br />Merck spokeswoman Anita Larsen confirmed the company's action, saying Merck believed the study's conclusions "were not supported by the data." The incident came about six months before another study prompted the drugmaker to withdraw Vioxx.<br /><br /><br /><br />The journal contains several studies about Vioxx and Celebrex, the once popular and heavily promoted painkillers advertised as stomach-friendly alternatives to aspirin. They are under congressional and regulatory scrutiny.<br /><br /><br /><br />One new report echoes previous data suggesting that in some older patients the drugs might not offer as much protection as thought against gastrointestinal problems. A separate study suggests they have been overprescribed, frequently to patients at low risk for gastrointestinal problems. And other research supports evidence that Vioxx increases some patients' blood pressure.<br /><br /><br /><br />Vioxx was withdrawn Sept. 30 because of a study suggesting it doubled the risk of heart attack and stroke. Celebrex maker Pfizer Inc. halted its ads last month after a study linked high doses with increased heart and stroke risks.<br /><br /><br /><br />Both drugs are in a class called Cox-2 inhibitors. The Archives reports, published yesterday, come weeks before a Feb. 16-18 Food and Drug Administration meeting on the safety of all Cox-2 drugs. Also yesterday, the watchdog group Public Citizen petitioned the FDA to immediately remove from the market Celebrex and a related drug, Bextra, because of the potential heart risks.<br /><br /><br /><br />Critics contend Merck tried for years to suppress Vioxx risks found in numerous studies. The company maintains it has acted responsibly.<br /><br /><br /><br />The author-removal incident, mentioned in previous news reports, involved a Merck study of more than 50,000 patients age 65 and older taking Vioxx, Celebrex, traditional painkillers, or none of the drugs. The results, published last year in the journal Circulation, showed Vioxx patients faced a higher heart-attack risk than the other groups did.<br /><br /><br /><br />When the results came in, "Merck required a co-author who was an employee of the company to remove her name from the article immediately prior to publication," Solomon and Avorn said in an Archives editorial.<br /><br /><br /><br />Solomon identified the coauthor as Merck epidemiologist Carolyn Cannuscio. She did not respond to e-mail and telephone requests for comment.<br /><br />

Doctors tell of Merck's Vioxx dismay

The firm faulted a study critical of the drug after making its researcher dissociate herself from it. By Lindsey Tanner Associated Press CHI...

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Tommy Thompson on the US Department of Health and Human Services Bureaucracy

This isn't new, but I just found it, and couldn't resist posting it.<br />This quote <a href="http://www.jsonline.com/news/nat/dec04/280781.asp">appeared in the Milwaukee Journal Sentinel </a>last month, from a press conference Thompson gave after he announced his resignation.<br /><blockquote>"Out here, in this department, you get an idea and you have to vet it with all the division heads and the 67,000 employees. . . . then it goes over to the supergod in our society, and the supergod is O.M.B. [Office of Management and Budget.] And they turn you down nine times out of 10, just to show you who the boss is. Then it goes to the young intelligentsia of the White House, who don't believe that anything original or good can come from a cabinet secretary. And if you do get by them, it goes to the president. And if the president does agree with it, it goes on to the Congress, and if Congress ever does pass it, it's time to retire."</blockquote>

Tommy Thompson on the US Department of Health and Human Services Bureaucracy

This isn't new, but I just found it, and couldn't resist posting it. This quote appeared in the Milwaukee Journal Sentinel last mont...

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Poverty Amidst Plenty

In my local paper, the Providence Journal, was <a href="http://www.projo.com/news/content/projo_20050122_hosp22.2011fb.html">this story </a>about the now annual winter event, the hospital capacity crunch. With even a small and routine uptick in influenza and respiratory illnesses, local hospital emergency departments overflow, and patients wind up in every corner. Everyone seems bewildered by this, although the article notes that the new leaner hospitals run an 90% capacity, so any increase in demand overwhelms them. Furthermore, it seems impossible for hospitals to get enough nurses, although no one seems to care to think about why.<br />Similarly, in Houston, <a href="http://www.chron.com/cs/CDA/ssistory.mpl/topstory/3004871">a story from the Chronicle </a>about how the new Texas law designed to make mental health care more efficient has resulted in long waiting lists for anyone not overtly psychotic, and an apparent dearth of chronic care.<br />At the same time, <a href="http://www.chron.com/cs/CDA/ssistory.mpl/business/3004223">the Chronicle reported </a>how the latest trend in Houston general hospitals is patient amenities. It described, for example, the University of Texas M.D. Anderson's new Ambulatory Clinical Building, "with its commissioned artwork, hotel-like lobby, waiting rooms with wireless internet access and garden terraces."<br />So we have poverty amidst plenty. In the US, where health care costs increase annually much more than the inflation rate, where we spend more than $1.5 trillion on health care, we cannot provide enough emergency room and hospital capacity for the predictable acute respiratory illness surge in winter. In one city, the wait for an out-patient mental health care appointment for the poor is 3 1/2 months, but a state-supported hospital now displays commissioned artwork and provides wireless internet access? What does this say about the values of our health care leaders?

Poverty Amidst Plenty

In my local paper, the Providence Journal, was this story about the now annual winter event, the hospital capacity crunch. With even a small...

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Boston University Delayed Reporting Tularemia Outbreak

The Boston Globe reported (<a href="http://www.boston.com/news/education/higher/articles/2005/01/20/bu_delayed_reporting_possibly_lethal_exposure">here</a> and <a href="http://www.boston.com/news/local/articles/2005/01/21/infections_not_listed_in_bu_bid_for_biolab">here</a>) Boston University's (BUs) sluggish public response to an apparent tularemia outbreak at one of its research laboratories. In May, 2004, two laboratory staff became ill with flu-like illnesses. After a third worker got sick in October, researchers discovered that instead of working with harmless bacteria, their specimens were contaminated with a virulent tularemia strain. On November 4, the University's Biosafety Committee shut down the research project.<br />Why mention this here? Apparently, Massachusetts law requires immediate reporting of infectious diseases like tularemia, yet BU did not report the outbreak to the public health department until November 9. BU has been planning the construction of a Level 4 laboratory to study extremely virulent pathogens at a site in the densely populated South End of Boston. To gain approval for the new laboratory, BU filed an environmental impact report with the state Environmental Affairs department that claimed a perfect safety record for protecting workers against laboratory acquired infections. However, BU failed to update the report with information about the outbreak, despite state environmental regulations that require such corrections.<br />Finally, as <a href="http://www.boston.com/news/globe/editorial_opinion/editorials/articles/2005/01/20/lab_insecurity">a Globe editorial noted</a>, to sell the laboratory to a dubious public, BU promised maximum opennes and candor. However, BU never notified the public of the tularemia outbreak until the stories appeared in the Globe. At that point, the spin put on the events by BU spokesperson Ellen Berlin was, "It doesn't change our stellar safety record." Moreover, our "first obligation in this incident was to ensure there was no public health risk and to report the incident to ... local, state, and federal public health authorities," although, not apparently, to do so very quickly.<br />As <a href="http://www.boston.com/business/technology/biotechnology/articles/2005/01/19/bu_flunks_the_trust_test">a Globe columnist pointed out</a>, "Trust is a fragile thing - hard to build, harder still to rebuild." Many large health care organizations need some serious education about what openness and candor really mean.

Boston University Delayed Reporting Tularemia Outbreak

The Boston Globe reported ( here and here ) Boston University's (BUs) sluggish public response to an apparent tularemia outbreak at one...

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