Category: Policy and politics

Tissue snatchers?

published date
December 15th, 2006 by

Author Michael Crichton has a disturbing opinion piece in today’s Wall Street Journal (Body Snatchers, 2006) in which he describes a lawsuit over the disposition of prostate tissue samples at Washington University. According to Mr. Crichton,

When [prostate-cancer surgeon] Dr. [William] Catalona left Washington University for Northwestern, he wanted to take… tissues with him. Six thousand patients notified the university that they wished their tissues to go with him. Ignoring the requests of patients, Washington University claimed the tissue collection as its own, and sued Dr. Catalona. In March of this year the district court ruled the collection belonged to the university. Judge Stephen Limbaugh found that the patients had given their tissues to WU as a gift, and therefore the university owned the tissues outright.

Crichton argues that the judge overstepped his bounds and took away patients rights. The ultimate harm will come from patients’ loss of confidence in university research centers.

We only have Crichton’s side of the story here and I don’t find it terribly credible. What does he mean for example that “six thousand patients notified the university that they wished their tissues to go with him?” And why should a researcher be surprised that the university would assert its rights to tissues –or anything else– that was donated to the university? Why, in general, should we trust researchers more (or less) than universities?

I do agree with his last piece of advice (except the lawyer part),

In short, caveat patiens, keep copies of everything you sign, bring a lawyer to every medical appointment, and always, always watch your back

In health care, the rich and powerful really aren’t insulated

published date
December 7th, 2006 by

In health care, the rich and powerful really aren’t insulated

Princeton economist Uwe Reinhardt wrote a letter to the Wall St. Journal last week, tweaking the Journal for espousing market forces in health care in the form of high-deductible plans. After all, writes Reinhardt, corporate executives often receive generous, lifetime health insurance and are even reimbursed for out-of-pocket expenses. Shouldn’t they have “skin in the game,” too?

Today the Journal published a thought-provoking response by Matthew Huggins:

Perhaps the… isolation from the market… makes [corporate executives] ill-suited to oversee the wholesale purchase of health-care services for others. [I]nstead of stripping executives of their… coverage, as Prof. Reinhardt wryly suggests, in furtherance of sounder markets, why not strip them of their predominant role in purchasing health-care services? Reassign such purchasing decisions to individual patients by dismantling the regulations and tax incentives that tend greatly to enhance the relative purchasing power of large employers and governmental bodies.

Another letter by Brian Acker pointed out that we don’t advocate equality in other sectors, so we shouldn’t worry about inequality in health care benefits either.

Actually, there is more equality in access to health care services than there is for most other things. For example, think about disparities in transportation from Boston to Washington:

  • Lots of people don’t have enough money to go. They stay home.
  • Others take the bus
  • Some drive –in cars of various levels of comfort
  • Some fly coach
  • Others fly first class
  • Some (like the executives we talked about earlier) go by private jet

Now think about what happens to someone who needs to go to the hospital in Boston

  • Anyone can go to a top hospital like the Brigham and Women’s or Mass General and be treated pretty much the same. You might get hassled by accounting if you don’t have insurance, but the doctors and nurses don’t tend to give you a hard time based on your economic status
  • If you’re someone special (e.g., a big donor) you might find yourself on a VIP floor at Mass General (though it’s unlikely elsewhere). The room’s not that much better, though, and you probably won’t receive better care. And I’ll go out on a limb and say your chance of having something go wrong due to medical “error” is not much affected by being up there. Maybe you can get access to better or more prominent physicians, but not necessarily. And anyway, do you really know how good or bad they are?

Overall, the rich and powerful are highly constrained in their ability to get exceptional service and quality in health care compared to other spheres in their lives. That’s one reason that corporate executives are interested in improving the quality quality and service levels of the US health care system. They are not insulated from commoners in health care the way they are everywhere else. Unlike Huggins, I wouldn’t take health care purchasing out of their hands just yet.

House moves to stop dextromethorphan abuse

published date
December 6th, 2006 by

House moves to stop dextromethorphan abuse

In the olden days some kids used to chug cough syrup to get high, and apparently they still do. The internet has also heralded the arrival of bulk sellers of raw dextromethorphan. I did a couple quick searches on Google and came up with places to buy and tips for getting high.

The Consumer Healthcare Products Association has been working with the Partnership for a Drug Free America and Community Anti-Drug Coalitions of America to try to cut down on the availability of dextromethorphan. Today the US House of Representatives passed a bill that prohibits the sale of bulk dextromethorphan to anyone other than FDA-registered drug and device producers. It sounds like a reasonable idea and I hope the Senate goes along.

I’m hopeful that the dex problem can be addressed without having to take cough medicines off drug store shelves. I wasn’t thrilled to see Sudafed sales restricted even though I understand why it was done.

There’s more information on dex abuse here (check out the animations) and here.

Pharma apologists are out in force

published date
December 5th, 2006 by

Pharma apologists are out in force

I’ve gotten a chuckle out of the recent round of post-election scare-mongering articles about how the Democrats are going to destroy the pharmaceutical industry. I had the chance to read two that were published on the weekend:

Key assertions in both pieces have been exposed as nonsense by the same newspapers. For example, Epstein writes:

One consequence [of regulation] is that it has become ever harder to persuade companies to invest in drugs that attack diseases or conditions that afflict small populations — thus exposing companies to the charge that they heartlessly put profits before patient health.

Leaving aside for a moment that this “consequence” has occurred under the Republicans, pharma companies have been investing plenty in diseases affecting small numbers of people. They’ve been so successful in charging high prices for drugs for rare diseases that yesterday’s Boston Globe led with a story about how the proliferation of specialty products is a primary driver of the rise in health insurance premiums.

The increasing use of expensive specialty drugs, including powerful treatments developed by Massachusetts biotechnology companies for rare diseases, is making health insurance more expensive for everyone, the state’s major health insurers say.

The Wall Street Journal interview was uncharacteristically amateurish. The interviewer didn’t seem to have any real understanding of the pharmaceutical industry, but rather a reflexive disdain for any government involvement in the market.

Mr. Taurel tells me how his company responded to the Prozac patent loss by raising R&D expenditures to the highest level in the industry. One of its newer products is Xigris, the first-ever treatment for sepsis, a deadly blood infection that kills more than 200,000 Americans annually…

Why didn’t he ask Mr. Taurel to comment on allegations —reported previously in the press— that Xigris isn’t that effective and that Lilly has been using improper practices to influence guidelines and quality measures?

I also liked this line:

Mr. Taurel concedes the government can play a role in funding basic science.

That’s awfully gracious of him. A better question might be whether the pharmaceutical industry can play a role in basic science and drug discovery. The evidence isn’t encouraging.

I too have concerns about overregulation of the pharmaceutical industry. But we need a more nuanced debate. Articles like the Taurel interview and Epstein opinion piece don’t do much to move the debate forward.

Enquiring minds want to know

published date
December 4th, 2006 by

Enquiring minds want to know

Found this disturbing piece in the New York Times:

BILL CLINTON’S identity was hidden behind a false name when he went to New York-Presbyterian Hospital two years ago for heart surgery, but that didn’t stop computer hackers, including people working at the hospital, from trying to get a peek at the electronic records of his medical charts.
The same hospital thwarted 1,500 unauthorized attempts by its own employees to look at the patient records of a famous local athlete, said J. David Liss, a vice president at NewYork-Presbyterian.
The usual approach has been to allow types of personnel who need to see the records to have access and log the results. But logging means nothing without consequences for improper access. What did Columbia do to discipline those who tried improperly to access celebrity charts?
It may be necessary to have a person monitoring the process in real time and denying access in some situations. This is what happened in the era of paper charts for a patient not in the hospital. For a patient in the hospital the chart sat in a rack and if there was a parade of people coming to peek they would have been stopped.