Healthcare Outsider

Anyone who has seen Jim Bunning’s (R-KY) recent antics can tell right away that he must have recently discovered the Jimmy Stewart film “Mr. Smith Goes to Washington.” The crazed, elderly senator has defied colleagues on both sides of the aisle by deciding “enough is enough” and blocking the jobs bill Congress seemed on the verge of passing.

Besides preventing a surprisingly popular measure to extend unemployment benefits to millions of americans, Bunning has allowed an unpopular cut in doctor’s fees for medicare patients to take effect, starting today.The jobs bill included a clause to eliminate the cut because it is expected to force doctors to stop seeing as many Medicare patients. (surprise!) Bunning, as far as anyone can tell, is too busy channeling the fictional Mr. Smith and his efforts to singlehandedly save American decency to notice that he might be destroying it in the process.

-Michael B. Sauter

A study at three major hospitals has revealed that doctors are probably not euthanizing children dying of cancer, thank goodness. The report, which compared parent interviews with statistics of 141 cases of terminal cancer in children, showed that doctors were most likely administering safe doses of morphine to children, despite some requests by their parents to administer lethal amounts to end their suffering. Any subsequent deaths, the report concludes, were likely coincidental, and not due to overdose. We can all breathe easily, knowing our national priority is still that of preserving life at all costs, even if that life is actually just three days of unbearable pain, ending in an undignified and even more horrible death. [NYT]

-Michael B. Sauter

There are twelve major pharmaceutical and biotech firms which dominate the industry worldwide. Their combined market value is over $1 trillion with total  annual sales  of over $500 billion. These firms have developed and marketed most of the global blockbuster drugs. Most of the significant actions take by the FDA and other drug and medical device regulatory bodies involve the medications, devices, and vaccines developed by these firms.

The big twelve companies are  also involved in most of the large product liability actions and class action suits regarding prescription drugs. The largest pharmaceutical firms spend tens of million of dollars in legal fees and lobbying expenses every year to protect the intellectual property they have created and defend themselves when their products have unintended side effects.

The twelve CEOs on this list – the global drugs lords – operate in a heavily regulated industry and have close and often fractious relationships with the governments whose agencies work with them. HCO has looked at each company, its blockbuster drugs, and  its most valuable board members. These members are often not the most well-known people on the boards. They are, however, individuals from the medical community, former regulators, academicians involved in the medical research world, and fixers who serve on large numbers of boards and whose contacts in the world of government and industry are invaluable.

The drug industry is under seige by generics and rising costs of R&D. Many of  the companies on this list have been though substantial restructuring and have fired tens of thousand of people, cutting R&D budgets in the process. This generation of CEOs and board members will shape the rapidly changing industry more than any other group in decades. We will now look at a brief snapshot of the twelve juggernaut companies these men run, the major drugs they produce, and the board members that allows their company to navigate the policy arena.

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Today on HCO’s enormous waste of health care resources of the day (a working title) we look at the national debate over the medical procedure known as stenting. The procedure, which entails implanting a small metal tube, or stent, to open clogged arteries, is by far the most common form of heart surgery. In 2007, in what promised to be the death blow to the practice, The New England Journal of Medicine released a study showing that while stenting could in many cases alleviate some of the pain associated with heart disease, it had no effect whatsoever in improving mortality rates.

It should shock some of you to learn that the aforementioned findings, which have been dubbed “the courage study” apparently did nothing to dissuade cardiologists from performing the surgery. To this day, it is still the most common practice used when dealing with clogged arteries, despite the fact that patients are willingly opting to undergo invasive surgery all evidence suggests won’t help them live any longer, despite the fact that insurance companies and those who pay exorbitant sums to insurance companies would save an estimated $5 billion a year.

Why, you might ask, haven’t we stopped using these expensive coronary stents except in cases where the pain would be unbearable otherwise? The answer: not one player in this game has any incentive to. Coronary surgeons certainly aren’t going to refuse treatment; they make around $900 per surgery, and chances are good a patient will just go to someone else if the doctor refuses to put them under the knife. The Insurance companies would like very much to avoid shelling out the kind of money they do for the expensive and ineffective procedure, but they face the same problem as the cardiologists: when stenting isn’t covered under one plan, people do the (apparently) logical thing and switch to another. The U.S. Government, while it strives to bring insurance costs for the average american down, can’t legally force patients, doctors or insurers to stop choosing and promoting stents. the best they can do is strongly recommend the use of generic heart medication in public service announcements, which, as we all know, americans pay no attention to whatsoever.

And so, we are left with a popular, but essentially useless medical practice which costs everyone lots of money (except for the cardiologists) and which no one has both the means and the desire to do something about. A few hours ago, Former President Clinton checked himself into the hospital because he was experiencing chest pain.  He just went into surgery and is having, wait for it.. two stents put in.

-Michael B. Sauter

Thanks to the wall street journal for info regarding the courage study and a few other odds and ends.

A study recently published in the Journal of the AMA showed that a group of children in their early teens were much more likely to lose substantial weight than those who followed a standard exercise and nutrition regimen.

You, the skeptical reader, may be thinking right now: “fine, they lost weight, but if we’re looking to fight obesity for the sake of long-term health and not improving self-esteem, there’s no way tying a silicon band around our childrens’ stomachs can help prevent common complications of being overweight, right?” Don’t worry, HCO had the same question, but according to the journal, gastric banding was shown to be much more effective in curing metabolic syndrome, a common cause of obesity which leads to high blood pressure and high cholesterol.

Will the Obama administration, which is making our nation’s never-ending obesity problem a priority in his health care agenda, advocate Lap-Band surgery in lieu of preventative measures? A combination of both? Will he force health insurance companies (in whatever state they’re in once the dust of reformation clears) to cover the surgery for kids over a certain BMI?

-Michael B. Sauter

The most recent attempt by house democrats to make progress in the face of a flailing health care bill comes in the form of a standalone measure intended to remove all special exemption from anti-monopoly laws health insurance companies have previously enjoyed.

Democrats believe the bill to be necessary and long-overdue, citing massive and inexplicable rate-hikes by insurers who take advantage of a lack of competitors to do pretty much whatever they please. This is the kind of straightforward piece of legislation which is certain to be mutilated in the the congressional chamber, emerge a bloated, earmarked, unrecognizable mess after six months, and be appropriately shot down in the senate. [KPCC]

-Michael B. Sauter

Billy Tauzin, head of PhRMA, the drug industry lobby, explained in a recent essay at the association’s website that “America’s pharmaceutical research and biotechnology companies will continue to fulfill their mission: finding new treatments and even cures. It is why PhRMA member companies were founded.”

Making money had nothing to do with it.

Healthcare Outsider