Category: Policy and politics

Location, location, location or Price solves everything?

published date
November 17th, 2006 by

Location, location, location or Price solves everything?

In $4 drug program imitated, criticized, the Boston Globe quotes experts downplaying the impact of Wal-Mart’s program to offer $4 generic drugs. To summarize the arguments:

  • It doesn’t include brand name drugs
  • It doesn’t include most generics
  • It won’t help people who have insurance
  • And this one from Harvard Business School Professor Regina Herzlinger, “Location, location, location. The footprint of Wal-Mart is nowhere near as large as the drugstores.”

But as I’ve argued before, it doesn’t make sense to look at Wal-Mart’s move so narrowly.

  • By making people realize that powerful prescription drugs can be had at OTC prices, Wal-Mart will make it easier for people to forego prescription coverage. Why should routine expenses be covered by insurance anyway? It’s expensive and cumbersome to administer and dulls consumers’ shopping instincts. Do people with insurance really want to pay more just for their co-pay than the Wal-Mart cash price? I doubt it. Rather than being irrelevant for people with insurance, the program makes individuals (and employers) realize that a traditional pharmacy benefit isn’t indispensable
  • The program covers a relatively small number of drugs, but even the current list isn’t insignificant. Even if the list doesn’t expand, doctors will start writing prescriptions for those medications because patients will ask them to do so. But I think the most likely path is for the low-cost drug list to expand, even if not everything ends up priced at $4
  • Brand name medications have the most to lose. What would accelerate the erosion of branded statin Lipitor faster than really cheap generic statins? The value of newer, branded drugs over generics often isn’t as high as the current price ratio would suggest. Making that ratio even more dramatic by reducing the price of generics is going to make life tough on the branded players

Reggie Herzlinger plucked the “Location, location, location” saying from the real estate industry. But there’s another, even more powerful concept from real estate: “Price solves everything.”

I think Wal-Mart knows exactly what it’s doing.

Is Medsphere betraying the open source community?

published date
November 12th, 2006 by

Is Medsphere betraying the open source community?

Fred Trotter of GPL Medicine is unhappy about the behavior of Medsphere.

Medsphere is arguably the most famous VistA vendor. However, some in the VistA community have wondered why Medsphere, which touts itself as an open source company, has not released their improved code back to the community. I and other VistA community members have been concerned that Medsphere might have made a proprietary product around VistA. I have been publically commenting about this for quite some time.

Apparently, there’s a nasty legal dispute under way between Medsphere and its founders. Trotter explains why he’s on the founders’ side. Go have a look at what he has to say.

Blown Away

published date
November 9th, 2006 by

Blown Away

Using a regular blow dryer, or better yet a modified one called the LouseBuster, does a better job of killing lice and destroying their eggs than chemicals or combing. The blow dryers seem to dry out the lice, killing them. It’s not the type of treatment that lice are likely to evolve resistance to, either. I’m happy about the results, because I’m against hysterical anti-lice policies.

The best blow drying technique, according to MedPage Today was to use the LouseBuster:

The most effective hot-air method was the LouseBuster machine, invented by some of the researchers, in combination with a coarse comb attachment on the hose. It delivered twice the air volume of a handheld hair dryer and eradicated significantly more lice and eggs than comb control.

The authors have filed patents on the LouseBuster, so I’m not sure we can completely trust this research. I also found the discontinuation statistics interesting:

  • 2% among the 54 patients tested with the bonnet-style dryer,
  • 4% in the 26 participants treated with the handheld blow dryer using hair divided into 10 sections,
  • 4% among the 27 children treated with the handheld blow dryer and hair in 20 sections,
  • 13% of the 15 children treated with the wall-mounted dryer, and
  • 0% in both of the 18-patient LouseBuster groups.

I’m guessing users of the LouseBuster weren’t allowed to give up!

Biogen CEO talks sense

published date
November 3rd, 2006 by

Biogen CEO talks sense

I’m at the Harvard Business School alumni health care conference today and enjoyed the talk by Biogen CEO Jim Mullen. He made some key points about risk.

He wants us to regain perspective on risk. The “safe and effective” mantra doesn’t make sense. Actually drugs are inherently unsafe, even OTC products. Instead we should look at the risk of unforeseen outcomes (i.e., adverse events) versus the risk of forgoing therapy.

Naturally he offered the example of Biogen’s Tysabri, an effective drug against MS that can cause a deadly brain infection. From the FDA’s perspective, keeping the drug off the market was good because it meant avoiding harm, but patients looked at it differently: many wanted Tysabri back because they were willing to take the risk.

PS –I’ve recently been told of MS Patients for Choice, which is organizing patients to get their views across to the FDA,

One MS patient, a statistician, testified to an FDA advisory group that after ““winning” the 1 in 1000 lottery and getting MS he was willing to take Tysabri and embrace the 999 in 1000 chance that he wouldn’t develop fatal complications.

I found myself in strong agreement with him.