Category: Policy and politics

Missing the point on biogenerics

published date
December 18th, 2006 by

A Boston Globe article, Lobbyists focus on safety in debate over generic drugs, describes the positions taken by the biotech industry and generic industry over proposals to create a regulatory pathway for generic versions of biotech drugs. In essence:

  • Biotech manufacturers want generic players to conduct extensive clinical trials before gaining regulatory approval. According to their association, “Unlike a pharmaceutical product, where you can simply demonstrate that you have the same chemical formula and you don’t need the clinical data, a follow-on biologic is a very, very different process.” Obviously this will drive up the cost of entry dramatically and delay the introduction of new products.
  • Generic manufacturers admit there is something to the argument, but they want legislation to explicitly authorize biotech generics.

Generic versions of chemically based drugs have helped keep drug spending under control, and there’s an implicit assumption that the only way to control biotech prices is with biogenerics. However, there is another way, as I’ve discussed in A better idea than biogenerics:

  • Allow biotech drugs to be approved and marketed as they are now, without price regulation
  • After patent expiration or after a certain number of years on the market, regulate price. The price could be based on cost of goods, a percent of the previous selling price, or some other mechanism

Biotech and generic company lobbyists aren’t going to be interested, but lobbyists for taxpayers should be!

Cracking down on abusive medical debt collection practices

published date
December 18th, 2006 by

Thank goodness for the Boston Globe. The four-part series on Debtors’ Hell that ran over the summer highlighted the abusive nature of the debt collection business. Now, at least some Massachusetts counties are responding.

The headlines from the summer series more or less tell you what you need to know:

  • Part 1: Preying on Red-Ink America. No mercy for consumers
  • Part 2: A Court System Compromised. Dignity faces a steamroller
  • Part 3: Enforcers’ might goes unchecked
  • Part 4: National Crisis, Official Silence. Regulators, policy makers seldom intervene

One of the articles in part four, For some, a bitter remedy for overdue medical dental bills, described the following, all-too-common situation:

When Marcy Armington objected to her obstetrician’s bill, believing her health insurance should cover the $300 balance due for the birth of her daughter, she had no idea that such a common dispute would leave her vulnerable to the ”The Hubbard Law Office Experience.”

That would be attorney Richard R. Hubbard of Uxbridge. Hubbard sued Armington on behalf of Dr. Thomas A. Spina of Hopedale – though the suit listed the wrong address, so she knew nothing about it. Last March, two Worcester County sheriff’s deputies came to her Milford home to take her car. To keep it, Armington had to pay $983, to cover the $383 court judgment and the $600 sheriff’s fee.

Debt collection is a very sleazy business to begin with as the series describes—

Constables…carry badges and have arrest powers — yet are untrained and unmonitored. [M]any do the dirty work of property seizure for some of the most aggressive debt collectors in the state… In Boston, 88 of the 186 constables have criminal arrest records of one kind or another…

–so I’m not surprised that debt collectors would try these tactics. But what’s appalling to me is that unpaid, contested medical bills are considered legitimate debt and that sheriffs so willingly participate. Anyone in the medical field knows bills are often just plain wrong and almost always hard to understand.

There’s still nothing like front-page exposure in a big city newspaper to effect change. The Globe reported today that sheriffs in three large counties are no longer seizing cars to repay medical and dental expenses, nor when the amounts owed are less than $1500. Those changes have been enough to drop seizures by half, which tells you something about how common these cases are.

As previously reported, medical bills are a major contributor to bankruptcy filings. Even people with health insurance can end up in BK if they encounter a serious, prolonged illness. One reason is that medical care is expensive. Another is that administrative errors, bureaucratic indifference, and aggressive “debt” collection are enough to drive people over the edge.

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.