Happy 7th birthday to the Health Business Blog

The Health Business Blog turns seven years old today. Continuing a tradition I established with birthdays one, two, three, four, five and six, I have picked out a favorite post from each month. Thanks for continuing to read the blog!March 2011: Why you shouldn't feel good about paying a low price for wet AMD treatmentRepackaging Avastin seems like a harmless, clever  trick to save thousands on Lucentis. But now that the world has decided that the price point for a wet AMD treatment is $20 or so who is going to bother developing a new treatment for wet AMD? I’ve already seen situations where companies chose to drop development of early stage compounds in this therapeutic area because they are afraid they can’t make money.April 2011: Are decision support tools turning doctors into idiots?Some physicians are reluctant to used computerized decision support (CDS) tools because they fear loss of respect from patients and colleagues. I prefer physicians who uses sophisticated decision aids such as SimulConsult, which allows physicians to extend their expert knowledge to make differential diagnoses of rare conditions that even excellent, experienced specialists may see rarely in the course of a career. Point of care information tools such as UpToDate also enhance evidence based practice.May 2011: How to start an adult discussion of MedicareNow is a good time to take a deep breath and entertain a serious discussion about the future of Medicare.  It would be nice if party leadership and voters would steer the debate in a more constructive direction. In my view, that would start with the articulation of a few consensus points, such as: the Medicare financial crisis is here now --solutions can't wait, Medicare is unfair to the younger generation, and Medicare cost containment doesn't have to be a zero-sum game.June 2011: Harvard Pilgrim CEO Eric Schultz speaks with the Health Business BlogI sat down with Eric for a videocast on a wide range of health care business topics. In this first of four segments we discuss the role of health plans in influencing cost and quality, what HPHC brings to Accountable Care Organizations (ACOs), and whether there’s any difference between the current shift toward global payments and what we witnessed in the 1990s.July 2011: What's the difference between Colgate Total Gum Defense toothpaste and regular Total?The new Total Gum Defense toothpaste lists the same ingredients and makes the same claims as regular Total. I asked a dentist and even a periodontist, but they didn't think there was any difference.Finally I called Colgate customer service to ask my question. Judging from how quickly they came up with an answer, this is clearly a question they’ve been receiving a lot. The rep pointed to two differences:

• The formulation is milder –using a different type of hydrated silica
• The flavor is less minty –presumably making it more tolerable for those with sensitive gums

August 2011: Niche blockbusters: The next drug cost crisis?For quite a while  rising drug costs were a major driver of medical inflation. Big pharma was rolling out lots of “me too” products in existing drug classes that could be prescribed widely. In a normal market, having lots of competition might drive prices down. But not in health care, where third party reimbursement and the need to obtain a doctor’s prescription subvert the usual supply and demand relationship. The cost threat today stems from "niche blockbusters" --very expensive treatments that reach $1 billion in sales despite serving few patients.Creative entrepreneurial and policy responses are needed to contend with this emerging phenomenon.September 2011: What the Talmud teaches about drug company gifts to doctorsI heard a Rabbi discuss the prohibitions against bribes in Jewish law. He shared the Talmudic insight that “a gift blinds the eyes of the wise” and taught that this refers not just to obvious bribes but even to small, innocent-seeming gestures that appear too insignificant to influence another person but that actually do cause a conflict of interest. I told him this sounded very similar to contemporary relationships between pharmaceutical companies and prescribing physicians, where small gifts like pens and take-out lunches are tools of the trade –viewed as innocuous by their recipients but seen as a good investment by the givers.Turns out this observation has been explored in greater depth in the Journal of Medical Ethics.October 2011: VC funding drops for biotech, medical devices. Should we worry?VC funding for biotech and medical devices is way down. That's a serious problem for entrepreneurs in those fields and poses longer term problems for larger drug and device companies and consumers. But there are substantial near term opportunities in health care services and health information technology, which I outline.November 2011: Dr. David Blumenthal on life after ONC (podcast interview)At the Partners Connected Health Symposium I sat down with Dr. David Blumenthal, former National Coordinator for Health Information Technology. We discussed the unfolding impact of his work on Meaningful Use, the role of the patient, health IT in the UK, and the future of health IT funding considering the partisan divide in Washington.December 2011: Is $10,000 a lot of money? Not in health careIt was quite a few gaffes ago, but you may still remember Mitt Romney's offer to bet Rick Perry $10,000 during a presidential debate.According to the dominant storyline, $10,000 is a sum so vast that only a really rich person like Romney could contemplate offering it up. Mentioning $10,000 somehow proves Romney is out of touch. But $10,000 is actually a very relevant figure for a discussion of health care policy, and it’s a figure the electorate should get used to discussing.  I list several examples of what $10,000 represents in the US health care environment including six months of family health insurance in Massachusetts, two months of Avastin, and a typical employer's annual contribution to an employee's health insurance costs.January 2012: Nursing shortage. Is it a case of crying "wolf?"How many times have you read about the staggering shortage of nurses? It’s routine to see numbers in the hundreds of thousands tossed around –representing the seemingly insatiable demand for nurses from an aging population. I’ve always been suspicious of these estimates. The latest news about how nurses are having a hard time finding jobs has reinforced my perception.February 2012: Lab tests in health risk assessments help spot diabetes, high cholesterol and kidney diseaseEmployer-sponsored health risk assessments that include laboratory tests appear to do a remarkably good job of identifying diabetes, high cholesterol and chronic kidney disease even within an insured, well-educated population. The study (Value of Laboratory Tests in Employer-Sponsored Health Risk Assessments for Newly Identifying Health Conditions: Analysis of 52,270 Participants), published in PLoS ONE, was conducted by Quest Diagnostics medical director Harvey W. Kaufman, MD and colleagues.In this podcast interview, Dr. Kaufman sheds light on the findings and implications.--Thanks again for reading the blog!