healthy4u

Caught in the Cross-Fire: Merck Tried to "Neutralize" Vioxx Opponents

Here is a new kind of example of how physicians have been caught in cross-fires between competing interests. The <a href="http://www.nytimes.com/2005/02/11/business/11merck.html">NY Times reported </a>today about some newly obtained documents about how Merck marketed Vioxx. Particularly striking were references in them to the need to "neutralize" physicians who Merck marketers perceived were Vioxx opponents. To quote the Times, "In the 'neutralize' documents written by a Merck marketing executive, company officials identified dozens of influential but 'problem' physicians whom [sic] the company believed had either a negative view of Merck or Vioxx or were active boosters of Celebrex. To win them over, the documents show, Merck officials planned to offer them carrots like clinical trials, posts as consultants, or give them grants." A form that Merck used internally to request payments for doctors asked for "Expected Outcome/ Return on Investment." When I first read the headline, I feared "neutralization" meant something even more sinister. But the reality was bad enough. This is a vivid case of how when physicians are caught between powerful organizations, here, competing drug companies, the patients' interests seem to come last.

Caught in the Cross-Fire: Merck Tried to "Neutralize" Vioxx Opponents

Here is a new kind of example of how physicians have been caught in cross-fires between competing interests. The NY Times reported today abo...

Đọc thêm »

Lo Bat for Implantable Cardiac Defibrillators

<a href="http://today.reuters.co.uk/News/newsArticle.aspx?type=healthNews&storyID=2005-02-11T195110Z_01_N11525845_RTRIDST_0_HEALTH-HEALTH-MEDTRONIC-DC.XML">Medtronic warned physicians </a>today about the possibility of battery failures in one of its models of implantable cardiac defibrillators (ICDs), 87,000 of which were manufactured before 2003. The market for these devices has recently expanded, since Medicare approved their prophylactic use for patients with congestive heart failure. Medicare <a href="http://www.indystar.com/articles/5/218124-6655-010.html">planned to pay </a>from $28 to $36K for the device, and the procedure to implant it. I believe (but cannot find evidence at the moment to prove) that the price of the actual ICD is around $25K. If so, given that its circuitry cannot be that complex in this day and age, one would think that this would have been enough to buy an extremely reliable battery. This reinforces <a href="http://hcrenewal.blogspot.com/2005/02/interesting-report-from-boston.html">the questions I recently raised </a>about the pricing of medical devices versus their value to the patient.

Lo Bat for Implantable Cardiac Defibrillators

Medtronic warned physicians today about the possibility of battery failures in one of its models of implantable cardiac defibrillators (ICDs...

Đọc thêm »

"FTC Seeking to Break Apart Hospital Merger"

"FTC Seeking to Break Apart Hospital Merger"

Its about time that the government started paying attention to the concentration of power within hospital groups, and, of course in ever lar...

Đọc thêm »

An Interesting Report from Boston University on Controlling Health Care Costs

An interesting <a href="http://dcc2.bumc.bu.edu/hs/Health%20Costs%20Absorb%20One-Quarter%20of%20Economic%20Growth%20%202000-05%20%20Sager-Socolar%207%20February%202005.pdf">report</a> on entitled "Health Costs Absorb One-Quarter of Economic Growth, 2000 – 2005" from the Boston University School of Public Health has received a little <a href="http://www.latimes.com/news/nationworld/nation/la-na-health9feb09,0,2550528.story?coll=la-home-nation">notice</a> in the press. It's long, so I haven't been able to review it in detail, but it makes some pretty good points (although also seems to leave out some important issues that get discussed on Health Care Renewal.) <ul><li>It suggests that waste, bureaucracy, and fraud account for large proportions of health care costs. The data that justifies this assertion, however, is not immediately obvious.</li><li>It notes that prices are much too high, but seems to imply that this is a generalized pheonomenon. The example it uses, for example, is a general comparison of drug costs in the US and Canada. The report does not seem to grapple with discrepancies of price and value, for example that some drugs seem inordinately expensive compared with their benefit/harm ratio, while others may be quite cheap. Such discrepancies between price and value, of course, seem to occur for all kinds of health care products and services.</li><li>Its discussion of waste, fraud, and bureaucracy skirts the issue of ill-informed, incompetent, self-interested, and even corrupt leadership of health care organizations. For example, its discussion of fraud seems to focus mostly on that perpetrated by individual providers on insurance companies. How the Allegheny bankruptcy (<a href="http://www.acponline.org/chapters/ri/nl-fall04.pdf">here</a>, on p. 5) , or the <a href="http://hcrenewal.blogspot.com/2005/02/end-of-anechoic-effect-editorial.html">conflicts of interest at the NIH </a>would have fit into this framework aren't clear.</li><li>It recognizes that physicians actually make most of the important health care decisions for individual patients, and hopes that better informed, more evidence-based decision making will help. In fact, it puts most of the onus of controlling costs on physicians, while acknowledging that this is quite a burden, and that physicians will deserve considerable help with it. However, given its failure to deal with the issue of whether the pricing of particular items is excessive, it is not clear how it expects physicians to control costs, no matter how well they are educated in evidence-based medicine, if they do not understand and cannot influence pricing. Nevertheless, the report's approach to physicians is more sympathetic and understanding of the issues physicians face than much of what has been written about health care policy</li></ul>All in all, this is a thoughtful work that deserves careful reading and response.

An Interesting Report from Boston University on Controlling Health Care Costs

An interesting report on entitled "Health Costs Absorb One-Quarter of Economic Growth, 2000 – 2005" from the Boston University Sc...

Đọc thêm »

UC faulted for paying millions in bonuses

These are private-industry-level bonuses. One can argue that such bonuses are needed to retain top talent, but teaching hospitals do not have the income of, say, A Hewlett-Packard, IBM or Pfizer. Do teaching hospitals needs to rethink their executive compensation? I'll bet most line clinicians and patients would agree. -- SS Excerpts: The University of California gave nearly $2.4 million in bonuses to 65 top executives at its five teaching hospitals in 2004, with 11 administrators receiving more than $50,000 each. The bonuses averaged $36,000 and reached as high as $82,000, according to a report to the UC Board of Regents that was made public Wednesday by an employee union. ... the largest bonus went to UC Davis Medical Center chief executive officer Robert Chason. It totaled $82,000 -- 20 percent of his annual salary of $410, 000. At UC Davis Medical Center, 12 health care executives shared bonuses totaling $526,803. At UCSF, chief executive Mark Laret received a $79,495 bonus, 18.3 percent of his $434,400 salary. The bonuses for UCSF executives totaled $583, 740. "At every level of our organization, UCSF Medical Center strives to compensate its employees at the median of the market," Laret said in a statement released Wednesday. "UCSF Medical Center leaders receive their compensation in two parts -- a base salary plus an at-risk incentive based on performance. At this time, including both parts of their compensation, UCSF Medical Center leaders are paid well below the market for comparable academic medical centers." According to university documents, the bonuses were approved in October by UC President Robert Dynes and were outlined to the Board of Regents last month. The regents did not discuss the payouts publicly, and one reached Wednesday said he objects to the bonuses. "I am very disappointed with the bonuses that UC has given its health care executives," said Regent Ward Connerly, whose term on the board expires March 1. "There is a pattern of indifference among some of our more elite people at UC to the plight of our lower-paid employees and to the appearance that some of these bonuses are obscene. This indifference is not confined to health care executives." ... Medical center workers say the bonuses are a slap in the face. Many have gone without raises for several years and are anticipating salary increases of just 3 percent this year. "They keep telling us how little money they have ... but they always seem to have money for people they want to give raises to, and it always seems to be people at the top," said Jeff Cox, a lead building maintenance worker at UCSF. "It says that I don't matter. It is hurtful." ... "We think that the money could have been better spent on patient care and low-wage workers and maintaining the quality of services," said Faith Raider, a union spokeswoman. "We have seen a lot of cutbacks in staffing and services, and we think this money could have gone to that." Jennifer Lilla, president of the University of California Student Association and a biomedical sciences graduate student at UCSF, said the money also could have been used to offset cuts in student aid. "That is half of the money we are trying to get returned to the financial aid pool,'' Lilla said. "Yes, it made a difference in a handful of people's lives, but it could have made a difference in literally thousands of students' lives had it been diverted elsewhere.''

UC faulted for paying millions in bonuses

These are private-industry-level bonuses. One can argue that such bonuses are needed to retain top talent, but teaching hospitals do not hav...

Đọc thêm »

CRO's: we don't need Medical Informatics here

After being laid off from a major pharma as part of a large reduction in force, in recent months I've spoken to major CRO's (Clinical Research Organizations) about opportunities in Medical Informatics. CRO's are companies that conduct clinical trials for pharmas under contract as well as perform other drug development-related activities. Here are some of the responses I've received: A senior executive for Biometrics and Data Management at a large CRO with operations in my vicinity: "There's nothing in your <a href="http://home.aol.com/scotsilv/biography.htm">resume</a> of value to a clinical research organization." This was repeated even after I verbally reviewed my background with said individual. (A truly stunning and unforgettable rebuff, the likes of which I'd never heard before.) Unknown hiring manager at another large CRO (via a recruiter): "Just wanted to follow up with you about the [management] position. They sent us an e-mail today communicating that you are a great candidate but just a little too heavy on the Informatics side for this position." So, ironically, one CRO finds nothing of value in the background of a seasoned Medical Informaticist, and another finds "too much" Informatics for a management opportunity. How, one might ask, can someone be "too heavy" on the informatics side in an organization whose lifeblood is clinical data management? Here is the NIH on the value of Medical Informatics, on which they and other organizations spend tens of millions of dollars annually on <a href="http://www.amia.org/resource/acad&training/f1.html">training programs and research</a>: <blockquote>Clinical care, biomedical research and education, and public health administration can be improved by the inclusion of informaticists (in-context information specialists) into work and decision settings. Informaticists are information specialists who have received formal graduate training and practical experience that provides a cross-disciplinary background in both medical science and information science. Their cross training provides a unique perspective on the acquisition, synthesis and application of information to problem solving and program development in clinical and biomedical areas.</blockquote>Do I sense a disconnect here? This experience reflects only two CRO examples, but if this reflects the same kind of trend I've observed in the provider sector, it makes me less incredulous that the pharmaceutical industry is facing significant challenges regarding clinical trials results and post-marketing surveillance, to the point of class-action personal injury lawsuits and Congressional investigation. It may reflect a significant underutilization of talent. The reasons for an apparent blindness to Medical Informatics by providers, pharma and possibly CRO's may reflect lack of knowledge of the field, occupational jealousy or territorial issues by personnel who are unidisciplinary, or basic reactionary thinking. In any case, the repeated observations of healthcare's data management difficulties reflect a significant gap in healthcare leadership's thinking on these issues, in my opinion. -- SS

CRO's: we don't need Medical Informatics here

After being laid off from a major pharma as part of a large reduction in force, in recent months I've spoken to major CRO's (Clinica...

Đọc thêm »

Mapping your way

Mapping your way

We think maps can be useful and fun, so we've designed Google Maps to simplify how to get from point A to point B. Say you're looki...

Đọc thêm »