Category: Policy and politics

Could it happen here?

published date
January 12th, 2007 by

Eli Lilly has halted construction of a new insulin plant in Virginia to focus its resources on biotech products, it says. States have tried hard in recent years to lure pharmaceutical manufacturing facilities. After all, what could be better than having a big-spending drug company put down roots in your state? Unfortunately, things can change in a hurry.

Massachusetts politicians from both sides of the aisle have been patting themselves on the back for luring BMS to the state to build a biotech plant. A lot of public money is being committed on the assumption of a guaranteed payback. As I’ve mentioned (Let’s hope BMS can keep Hummingbird’s wings flapping!) I hope it doesn’t turn into a white elephant.

I guess we’ll have to think of another reason to oppose single payer

published date
January 8th, 2007 by

If there’s one thing everyone hates about single payer health systems it’s waiting lists for treatment. The trade-off is that costs are lower in single payer systems and everyone has access to care.

We can rationalize the situation in the US by saying we’ve decided not to make the trade-off. We’ve decided as a country that we don’t wan to “ration” health care or artificially limit its supply. Assuming you have access to the system you should be able to get as much care as needed to make you better.
But maybe there isn’t a trade-off. The US spends more on health care per capita and as a percent of GDP than anywhere else in the world. Massachusetts is the highest spender in the US. And Boston is the capital of the state and of its health care system.

Yet according to a new study reported in the Boston Globe (Dangerous delays to see skin doctors; Hub patients wait longest, study says), patients in Boston wait an average of 10.5 weeks to see a dermatologist for a “changing mole” –perhaps the closest thing in dermatology to an emergency. At the Brigham and Women’s Hospital, patients wait 3.5 months on average for a routine visit!

No one can really figure out what’s going on, especially when Boston has so many dermatologists.

  • Some physicians say the data must be wrong
  • Others cite the expansion of cosmetic services
  • Others blame it on the high percentage of researchers

In any case, no one’s accountable. (By the way this is not the first time physician access in Boston has been shown to be wanting.)
Just for kicks, I had a look at the UK’s National Health Service website, which has detailed, up-to-date information on waiting times by specialty. I looked at the “Provider Based Hospital Waiting Times for 1st Outpatient Appointments: England,” and checked the “Effective length of wait from receipt of GP written referral request to first Outpatient attendance (weeks). I’m not expert in reading these tables –so maybe I’m reading something wrong– but according to my calculations:

  • 37% of patients were seen in under 4 weeks
  • 63% in under 8 weeks
  • 98% in under 13 weeks

These numbers aren’t directly comparable with the Boston statistics. Still, it shows something terribly wrong with health care in my fair town.

More secondary drug trading fallout

published date
January 4th, 2007 by

Over a year ago drug wholesaler Cardinal Health announced it would stop trading drugs in the secondary market. Such trading was a lucrative sideline for Cardinal, offering the potential for much higher margins than the traditional wholesaling business. On the other hand it opened up the possibility of letting counterfeit drugs into the supply chain.

Recently, then New York Attorney General (now Governor) Eliot Spitzer settled a suit with Cardinal, which included an $11 million payment and additional changes in the company’s business practices. I heard about this from Attorney Eric Turkewitz, who represents counterfeit drug victim Tim Fagan. Some unsavory aspects of Cardinal’s conduct came out as a result of the suit. The upshot is that when Cardinal assessed the risks of secondary trading it focused too heavily on risks to its reputation and too little on the risks to patients.

You can read more on the topic here and here on Turkewitz’s blog.

Suspicious survey

published date
January 3rd, 2007 by

I received an email today from Acurian, asking me to take a “brief and confidential market research survey” to “assess the prevalence of specific types of cardiovascular and heart-related conditions.” It made me a little suspicious. An email survey isn’t exactly the best way to assess prevalence of such conditions. Meanwhile Acurian is in the business of recruiting patients for clinical trials.

To entice people to participate there is the promise of a raffle for three prizes: $200, $100, and $50 for a whopping $350 in total. The first question asks for:

“Your E-mail… so that we may contact you if you are a $200, $100, or $50 raffle winner.”

I decided to take the survey without providing my email address. I don’t care about the raffle and I didn’t want to attach my email address to my results.

The survey asks whether I have certain heart conditions (e.g., heart failure, atrial fibrillation), what medications I take to treat the conditions, what procedures I’ve undergone, whether I’ve had a heart attack or stroke, and what might motivate me to participate in a clinical trial or prevent me from doing so.

Then there are some specific demographic questions including zip code, age, income, insurance status and race.

I filled everything in and then hit “Submit Survey.” My survey was rejected because I didn’t provide my email address. It made me wonder –are they really so worried I might miss out on the raffle? Or are they building their database of potential trial participants?

My email address plus what I’d included in my survey plus a cursory search on Google would be enough to identify me and build a substantial file. There are no specifics given about a privacy policy or how the information will be used beyond the statement that the survey is confidential.

I’m going to write to the the CEO and ask what is going on. Stay tuned.

“I’ll have what she’s having”

published date
January 2nd, 2007 by

FDA plans to allow cloned meat, according to the Wall Street Journal:

[T]he Food and Drug Administration said it couldn’t find any differences between meat and milk from healthy conventionally bred adult cattle, pigs and goats and that from healthy cloned animals and their offspring. As a result, the agency said it would probably allow the meat and milk of these cloned animals and their offspring to be sold without any special labeling to alert consumers.

Here’s what we can look forward to (from an earlier Washington Post article)

Farmers and companies that have been growing cloned barnyard animals from single cells in anticipation of a lucrative market say cloning will bring consumers a level of consistency and quality impossible to attain with conventional breeding, making perfectly marbled beef and reliably lean and tasty pork the norm on grocery shelves.

I’m not the only one who thinks this is a little whacked:

“The government talks about being science-based, and that’s great, but I think there is another pillar here: the question of whether we really want to do this,” said Carol Tucker Foreman, director of food policy at the Consumer Federation of America.