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Better Health
BigGovHealth
Biotech Blog
BrandweekNRX
CA Medicine man
Cafe Pharma
Campaign for Modern Medicines
Carlat Psychiatry Blog
Clinical Psychology and Psychiatry: A Closer Look
Conservative's Forum
Club For Growth
CNEhealth.org
Diabetes Mine
Disruptive Women
Doctors For Patient Care
Dr. Gov
Drug Channels
DTC Perspectives
eDrugSearch
Envisioning 2.0
EyeOnFDA
FDA Law Blog
Fierce Pharma
fightingdiseases.org
Fresh Air Fund
Furious Seasons
Gooznews
Gel Health News
Hands Off My Health
Health Business Blog
Health Care BS
Health Care for All
Healthy Skepticism
Hooked: Ethics, Medicine, and Pharma
Hugh Hewitt
IgniteBlog
In the Pipeline
In Vivo
Instapundit
Internet Drug News
Jaz'd Healthcare
Jaz'd Pharmaceutical Industry
Jim Edwards' NRx
Kaus Files
KevinMD
Laffer Health Care Report
Little Green Footballs
Med Buzz
Media Research Center
Medrants
More than Medicine
National Review
Neuroethics & Law
Newsbusters
Nurses For Reform
Nurses For Reform Blog
Opinion Journal
Orange Book
PAL
Peter Rost
Pharm Aid
Pharma Blog Review
Pharma Blogsphere
Pharma Marketing Blog
Pharmablogger
Pharmacology Corner
Pharmagossip
Pharmamotion
Pharmalot
Pharmaceutical Business Review
Piper Report
Polipundit
Powerline
Prescription for a Cure
Public Plan Facts
Quackwatch
Real Clear Politics
Remedyhealthcare
Shark Report
Shearlings Got Plowed
StateHouseCall.org
Taking Back America
Terra Sigillata
The Cycle
The Catalyst
The Lonely Conservative
TortsProf
Town Hall
Washington Monthly
World of DTC Marketing
WSJ Health Blog
DrugWonks Blog
07/03/2007 02:23 PM |
While we are on the subject of the Fear Factory (leftist academics, medical journals and journalists) the grudging coverage of the safety of anti-depressants and their value in reducing suicide should be noted. Last week it was the NEJM deciding to publish slowly and silently a study that pregnant women could use antidepressants will little risk to their infants and a media that barely reported the results. This week it was yet another large and careful observational study -- this time by Greg Simon from Group Heath of Puget Sound -- showing that far from causing suicide, antidepressants actually reduce the risk thereof.
Setting aside the abject coverage of these important studies, the attack on the safety of SSRIs needs to be re-examined from top to bottom. We have been told that for marketing purposes companies have buried the real dangers of drugs, that direct to consumer advertising pushes people to take medicines that they do not need but are unsafe, that industry sponsored research and medical conferences are corrupting and not informative.
But now the results of following the purists are clear. We did follow the sage counsel of the Jerry Avorns, Sid Wolfes, Marcia Angells, David Healys and Jerome Kassirers of the world. We ignored the studies showing clinical benefit of SSRIs and embraced their distrustful view of medicine which was based not on science but on the belief thata because drug companies are commercial enterprises neither their products or information cannot be trusted and that any relationship they enter into corrupts those who engage in them.
We have seen the results with SSRIs. The blog PurePedantry does an excellent job of laying out the human consequences of following a medical regimen “free†of industry involvement. They cite another article in the American Journal of Psychiatry that looked at the trends in the number of kids getting SSRIs in the wake of creating an industry free zone: A more sobering perspective on these data gives cause for concern.
An article -- also in the American Journal of Psychiatry - traced what happened to prescribing of SSRIs after the fear mongering and linked it to suicide rates:
"Pharmacoepidemiological studies examining the relationship between trends in sales or prescription fills of SSRIs have consistently shown a relationship between increases in SSRI prescription rates and declines in adolescent suicide rates. On the basis of those studies, one might expect that the adolescent suicide rate would begin increasing in the wake of the FDA advisory after a decade of steady decline."
Less marketing, less detailing, less CME. More regulation and warnings. But the void is filled by self promoting quacks like Gary Null, Scientology fronts, trial lawyers, and angry critics who use anecdotal material to rant about corporate influence. And the result? Fewer patients and more death. It happened with depression and it is happening with schizophrenia and manic depression. We need more corporate involvement, not less, to advance the public health and save lives.
http://scienceblogs.com/purepedantry/2007/07/the_fda_warning_on_antidepress.php
Read More & Comment...
Setting aside the abject coverage of these important studies, the attack on the safety of SSRIs needs to be re-examined from top to bottom. We have been told that for marketing purposes companies have buried the real dangers of drugs, that direct to consumer advertising pushes people to take medicines that they do not need but are unsafe, that industry sponsored research and medical conferences are corrupting and not informative.
But now the results of following the purists are clear. We did follow the sage counsel of the Jerry Avorns, Sid Wolfes, Marcia Angells, David Healys and Jerome Kassirers of the world. We ignored the studies showing clinical benefit of SSRIs and embraced their distrustful view of medicine which was based not on science but on the belief thata because drug companies are commercial enterprises neither their products or information cannot be trusted and that any relationship they enter into corrupts those who engage in them.
We have seen the results with SSRIs. The blog PurePedantry does an excellent job of laying out the human consequences of following a medical regimen “free†of industry involvement. They cite another article in the American Journal of Psychiatry that looked at the trends in the number of kids getting SSRIs in the wake of creating an industry free zone: A more sobering perspective on these data gives cause for concern.
An article -- also in the American Journal of Psychiatry - traced what happened to prescribing of SSRIs after the fear mongering and linked it to suicide rates:
"Pharmacoepidemiological studies examining the relationship between trends in sales or prescription fills of SSRIs have consistently shown a relationship between increases in SSRI prescription rates and declines in adolescent suicide rates. On the basis of those studies, one might expect that the adolescent suicide rate would begin increasing in the wake of the FDA advisory after a decade of steady decline."
Less marketing, less detailing, less CME. More regulation and warnings. But the void is filled by self promoting quacks like Gary Null, Scientology fronts, trial lawyers, and angry critics who use anecdotal material to rant about corporate influence. And the result? Fewer patients and more death. It happened with depression and it is happening with schizophrenia and manic depression. We need more corporate involvement, not less, to advance the public health and save lives.
http://scienceblogs.com/purepedantry/2007/07/the_fda_warning_on_antidepress.php
Read More & Comment...
07/03/2007 01:55 PM |
The article today in the WSJ about a “link†between ALS and statin drugs underscores how much of epidemiology is nothing but statistical self-gratification that has grown exponentially in the hopes of seducing self-important medical journals who in turn seek to whet the appetite of journalists looking for peril in every pill.
The ALS-statin connection could have been addressed easily by asking if there was an overall increase in the incidence or prevalence in ALS since the widespread use of statin drugs beginning in the 1980s, particularly among the elderly. There are careful registry data in virtually every Western country in the world on ALS patients, some dating back to the 1920s that capture every new case of ALS and measure against increases in total populations and various demographic characteristics.
ALS incidence and prevalence is virtually unchanged since the beginning of the century. So if statins have a direct causative effect it would have shown up by now. Why no one, let alone the author of the WSJ article did not ask this simple question is beyond me.
Now more interesting is the fact that Beatrice Golomb, who is studying the evil effects of statins, claims to have found a link between low cholesterol levels and violence Indeed, there are a handful of articles that claim to have seen this association after doing some data dredging. (Uh, maybe they should control for age since most crime is committed by young people and most young people have...low cholesterol, duh.) And they NIH is giving her money?
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=11104842&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus
I can’t wait to the lawsuits flying around the claims that statins cause violent behavior. They WILL come.
Meanwhile, shame on WSJ's Jacob Goldstein and WHO's Ralph Edwards for even proposing that this is anything more than a coincidence. You give me four million data points and I will show you that there is a relationship between Jacob Goldstein and half the pregancies in Passaic, NJ.
http://blogs.wsj.com/health/2007/07/03/data-crunching-hints-at-risk-of-cholesterol-drugs/ Read More & Comment...
The ALS-statin connection could have been addressed easily by asking if there was an overall increase in the incidence or prevalence in ALS since the widespread use of statin drugs beginning in the 1980s, particularly among the elderly. There are careful registry data in virtually every Western country in the world on ALS patients, some dating back to the 1920s that capture every new case of ALS and measure against increases in total populations and various demographic characteristics.
ALS incidence and prevalence is virtually unchanged since the beginning of the century. So if statins have a direct causative effect it would have shown up by now. Why no one, let alone the author of the WSJ article did not ask this simple question is beyond me.
Now more interesting is the fact that Beatrice Golomb, who is studying the evil effects of statins, claims to have found a link between low cholesterol levels and violence Indeed, there are a handful of articles that claim to have seen this association after doing some data dredging. (Uh, maybe they should control for age since most crime is committed by young people and most young people have...low cholesterol, duh.) And they NIH is giving her money?
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=11104842&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus
I can’t wait to the lawsuits flying around the claims that statins cause violent behavior. They WILL come.
Meanwhile, shame on WSJ's Jacob Goldstein and WHO's Ralph Edwards for even proposing that this is anything more than a coincidence. You give me four million data points and I will show you that there is a relationship between Jacob Goldstein and half the pregancies in Passaic, NJ.
http://blogs.wsj.com/health/2007/07/03/data-crunching-hints-at-risk-of-cholesterol-drugs/ Read More & Comment...
07/03/2007 07:42 AM |
NICE = the National Institute for Clinical Excellence -- the United Kingdom's center for deciding which medicines will be reimbursed. But more and more Britains are calling it by another, more descriptive acronym -- NASTY: Not Available So Treat Yourself.
To that end, allow us to recommend a new op-ed in the Journal of Life Sciences, "Strange Bedfellows."
Here's a taste:
"The politics of healthcare make strange bedfellows. Nearly 15 years ago, most health insurance plans opposed Hillary Clinton when she tried to give American healthcare a makeover in the image of the European and Canadian system. Back then, insurers blasted the Clinton plan as government takeover of medical decision-making based on cost considerations.
Last month, the presidential hopeful and the insurers stood shoulder-to-shoulder in support of giving the federal government the same power government agencies in single-payer systems have to determine what new medicines and services to pay for or not, based on what a government agency decides are cost-effective. In essence, both Clinton and the health care lobby want the government to engage in the practice of medicine.
What's changed? Clinton has always regarded government as the best arbiter of value for medicine. Health plans, now that they have a stake in Medicare, want the government to make across-the-board decisions about reimbursement. Now the Medicare Payment Advisory Commission, the independent federal body established to advise Congress on issues affecting Medicare, has endorsed a specific approach. It wants an independent entity to sponsor credible research on comparative effectiveness of health care services and disseminate this information to patients, providers and public and private payers.
The model, believe it or not, is Britain's National Institute for Clinical Excellence, which reviews comparative effectiveness of new and often expensive medicines in the way the Medicare Payment Advisory Commission and Senator Clinton envision. Steven Pearson, a senior fellow with the insurance industry lobbying group America's Health Insurance Plans, thinks that the British approach is an example of leadership and courage. As such, it's worth looking at the decision process our nation should follow in deciding how, whether and in what circumstances it will pay for a medicine."
Here's a link to the entire article:
http://cmpi.org/archives/2007/07/strange_bedfellows.php
And for those of you who like to read ahead, here's the article's concluding paragraph:
"Personalized medicine gives doctors and patients control over healthcare decisions while comparative effectiveness, as it is now defined, will increase government control over the choices doctors and patients make in the future. The battle over the value of medicine and who decides what is valuable will determine who controls healthcare in America over the next decade. That explains why Clinton and the insurance lobby are allies in the effort to give government more control over these important choices in the years ahead." Read More & Comment...
To that end, allow us to recommend a new op-ed in the Journal of Life Sciences, "Strange Bedfellows."
Here's a taste:
"The politics of healthcare make strange bedfellows. Nearly 15 years ago, most health insurance plans opposed Hillary Clinton when she tried to give American healthcare a makeover in the image of the European and Canadian system. Back then, insurers blasted the Clinton plan as government takeover of medical decision-making based on cost considerations.
Last month, the presidential hopeful and the insurers stood shoulder-to-shoulder in support of giving the federal government the same power government agencies in single-payer systems have to determine what new medicines and services to pay for or not, based on what a government agency decides are cost-effective. In essence, both Clinton and the health care lobby want the government to engage in the practice of medicine.
What's changed? Clinton has always regarded government as the best arbiter of value for medicine. Health plans, now that they have a stake in Medicare, want the government to make across-the-board decisions about reimbursement. Now the Medicare Payment Advisory Commission, the independent federal body established to advise Congress on issues affecting Medicare, has endorsed a specific approach. It wants an independent entity to sponsor credible research on comparative effectiveness of health care services and disseminate this information to patients, providers and public and private payers.
The model, believe it or not, is Britain's National Institute for Clinical Excellence, which reviews comparative effectiveness of new and often expensive medicines in the way the Medicare Payment Advisory Commission and Senator Clinton envision. Steven Pearson, a senior fellow with the insurance industry lobbying group America's Health Insurance Plans, thinks that the British approach is an example of leadership and courage. As such, it's worth looking at the decision process our nation should follow in deciding how, whether and in what circumstances it will pay for a medicine."
Here's a link to the entire article:
http://cmpi.org/archives/2007/07/strange_bedfellows.php
And for those of you who like to read ahead, here's the article's concluding paragraph:
"Personalized medicine gives doctors and patients control over healthcare decisions while comparative effectiveness, as it is now defined, will increase government control over the choices doctors and patients make in the future. The battle over the value of medicine and who decides what is valuable will determine who controls healthcare in America over the next decade. That explains why Clinton and the insurance lobby are allies in the effort to give government more control over these important choices in the years ahead." Read More & Comment...
07/03/2007 07:08 AM |
You cannot escape the responsibility of tomorrow by evading it today.
-- Abraham Lincoln
When the government issues health care statistics there are usually two general responses from the constituencies that are influenced – “this shows a problem,†or “the study is flawed.†And what ensues is a blame game, a political, polemical battle of op-eds and spin. What rarely happens is that all sides consider the implications of the numbers and use them to advance the public health. There are many examples of this, perhaps the best known being the debate over the Part D drug benefit.
But a new study, just released by the Center for Medicare and Medicaid Services (CMS), is breaking the mold. And it’s about time. The report, based data on Medicare patients who died from heart failure between July 2005 and June 2006, ranks hospitals as to whether they fall above or below the average and the results are available and searchable on a federal Web site (www.hospitalcompare.hhs.gov) that compares mortality rates among the nation's more than 4,000 medical facilities.
Needless to say, those scoring well crowed and those falling below the national average started the spin cycle. Examples were not hard to find – that’s not news. What is important to discuss, on the other hand, is how some hospitals dealt with their below-average ranking. As I searched through the CMS database, I was surprised to find Baylor All Saints Medical Centers at Fort Worth Texas on the “below average†side. Having followed Baylor Health Care System over the years for a variety of reasons, I decided to look a little closer.
Here's the rest of the story:
Download file
The take-away?
"... if we want people to take more responsibility for their own health – those in the business of health care must as well. Do as I say, not as I do just doesn’t cut it when it comes to advancing America’s health."
The price of greatness is responsibility.
-- Winston Churchill Read More & Comment...
-- Abraham Lincoln
When the government issues health care statistics there are usually two general responses from the constituencies that are influenced – “this shows a problem,†or “the study is flawed.†And what ensues is a blame game, a political, polemical battle of op-eds and spin. What rarely happens is that all sides consider the implications of the numbers and use them to advance the public health. There are many examples of this, perhaps the best known being the debate over the Part D drug benefit.
But a new study, just released by the Center for Medicare and Medicaid Services (CMS), is breaking the mold. And it’s about time. The report, based data on Medicare patients who died from heart failure between July 2005 and June 2006, ranks hospitals as to whether they fall above or below the average and the results are available and searchable on a federal Web site (www.hospitalcompare.hhs.gov) that compares mortality rates among the nation's more than 4,000 medical facilities.
Needless to say, those scoring well crowed and those falling below the national average started the spin cycle. Examples were not hard to find – that’s not news. What is important to discuss, on the other hand, is how some hospitals dealt with their below-average ranking. As I searched through the CMS database, I was surprised to find Baylor All Saints Medical Centers at Fort Worth Texas on the “below average†side. Having followed Baylor Health Care System over the years for a variety of reasons, I decided to look a little closer.
Here's the rest of the story:
Download file
The take-away?
"... if we want people to take more responsibility for their own health – those in the business of health care must as well. Do as I say, not as I do just doesn’t cut it when it comes to advancing America’s health."
The price of greatness is responsibility.
-- Winston Churchill Read More & Comment...
07/02/2007 05:00 PM |
Since Michael Moore regards Al Qaida as a bunch of freedom fighters this story from Britain's Daily Mail about the UK terrorists should make him and drugwonks "friends" in the blog world giddy with delight...
"Terror ringleader' is brilliant NHS doctor
An Iraqi junior doctor and a brilliant neurologist working for the NHS are among the suspects being quizzed over the series of bomb attacks across Britain, it emerged today."
And oh yes, there was a controlled explosion carried out at the Royal Alexandra Hospital.
Our prayers and thoughts are with the citizens of the UK.....
Read here
Read More & Comment...
"Terror ringleader' is brilliant NHS doctor
An Iraqi junior doctor and a brilliant neurologist working for the NHS are among the suspects being quizzed over the series of bomb attacks across Britain, it emerged today."
And oh yes, there was a controlled explosion carried out at the Royal Alexandra Hospital.
Our prayers and thoughts are with the citizens of the UK.....
Read here
Read More & Comment...
07/02/2007 08:42 AM |
The NY Times has a editorial today supporting a government registry that would require drug companies to report all gifts it gives to doctors that might be construed as influencing their prescribing behavior. Here's the justification the Times editorial board gives for supporting this intrusion into the privacy of doctor's lives:
"As Gardiner Harris reported in The Times last week, one drug company invited doctors to a weekend training session in Orlando, Fla., to learn how to give marketing lectures to other doctors for an asthma medicine. The enticement was free airfare, a rental car and hotel room, plus a $2,700 stipend."
Enticement? How about covering travel expenses and professional time. As for the allegation that docs were "influenced". Where is the data and where is the evidence of patient harm.
Since Americans now get their information on health from major media outlets I would propose another registry: A list of all reporters who get bonuses for writing articles that "break" stories that affect people's perception of public health institutions or drug safety. It would be wrong, wrong, wrong for the New York Times or any paper to reward a reporter with a cash bonus for writing an article just because it caused a ruckus on public health matters, say for instance, an article about the financial ties of the advisory committees for the FDA. I mean a financial reward for an article on financial ties shaping decisions. I mean that would be so hypocritical as to be....ironic.
The Times should just clean it's own house or tend to it's own garden.
http://www.nytimes.com/2007/07/02/opinion/02mon2.html?_r=1&oref=slogin Read More & Comment...
"As Gardiner Harris reported in The Times last week, one drug company invited doctors to a weekend training session in Orlando, Fla., to learn how to give marketing lectures to other doctors for an asthma medicine. The enticement was free airfare, a rental car and hotel room, plus a $2,700 stipend."
Enticement? How about covering travel expenses and professional time. As for the allegation that docs were "influenced". Where is the data and where is the evidence of patient harm.
Since Americans now get their information on health from major media outlets I would propose another registry: A list of all reporters who get bonuses for writing articles that "break" stories that affect people's perception of public health institutions or drug safety. It would be wrong, wrong, wrong for the New York Times or any paper to reward a reporter with a cash bonus for writing an article just because it caused a ruckus on public health matters, say for instance, an article about the financial ties of the advisory committees for the FDA. I mean a financial reward for an article on financial ties shaping decisions. I mean that would be so hypocritical as to be....ironic.
The Times should just clean it's own house or tend to it's own garden.
http://www.nytimes.com/2007/07/02/opinion/02mon2.html?_r=1&oref=slogin Read More & Comment...
07/02/2007 08:12 AM |
Here's MedPac's upbeat message on how evidence based medicine will revolutionize health care. It will lead to
"[increased] federal administrative spending relative to current law" due to "increasing the capacity to examine the comparative effectiveness of health care services," and "[improved] decision making by patients, providers, and payers" due to "information on the comparative effectiveness of health care services."
Cut to the Subcommittee on Health of the House Committee on Ways and Means hearing on developing a new reimbursement system for Erythropoiesis-stimulating Agents (ESAs), for a reality check. In particular, the statement of Alan S. Kliger, M.D., President, Renal Physicians Association, Rockville, Maryland on "Variability in ESRD Patient Hemoglobin Levels"
"Recent studies warn that kidney failure patients should not have high blood counts, noting that a group of patients with high blood counts in general carried a higher risk than patients with lower blood counts. But my experience with one of my patients shows how patient-centered care sometimes should deviate from guideline-advised care. I have a 52-year-old patient who is in kidney failure. When his blood count is less than 36 percent, he feels tired and washed out and experiences chest pain. When EPO raises his blood count to 38 percent, he feels like a healthy man; he functions better and feels more productive. The differences are so prominent to him that he tells me what his blood count is before I have a chance to measure it. For this particular patient, a higher blood count is what he needs in order to function normally. My patient knows that the recent studies warn about the long-term side effects of these higher blood counts, but he also knows he needs these levels to function normally. His choice and mine for enough EPO to maintain higher blood counts is the right choice.
RPA believes that in the recent discourse on national coverage of EPO, the critical issue of variability of individual patient response to EPO dose has been understated. As we have noted in correspondence to CMS, attempts to assess or quantify individual sensitivities (i.e. responsiveness) to EPO at a narrow level have not been successful.
Therefore, there is no single, predictable response to a given dose of EPO, a fact that accounts for the wide range in individual responses to treatment. As a result, in the aggregate it is physiologically not rational to tailor a normal distribution of patient responses to a payment limit: such a paradigm cannot be successful in delivering optimal treatment with sophisticated agents to complicated patients.
Payment limits structured in this fashion place emphasis on the wrong arm of therapy: emphasis should be placed rather on reducing the number of patients with low hematocrits/hemoglobins (<30%/10 gm/dL). "
http://waysandmeans.house.gov/hearings.asp?formmode=detail&hearing=573
MedPAC and the rest of the comparative effectiveness club are ignoring the human consequences of one size fits all decisions such as these or the denial of cancer and Alzheimer's care in the UK, Canada, Australia. The focus is on the structure of the center, the funding, furniture, color schemes, resumes, etc.
The comparative effectiveness movement will, like the Clinton health plan, be undone, by it's arrogance, high-handedness and contempt for the doctor-patient relationship. Read More & Comment...
"[increased] federal administrative spending relative to current law" due to "increasing the capacity to examine the comparative effectiveness of health care services," and "[improved] decision making by patients, providers, and payers" due to "information on the comparative effectiveness of health care services."
Cut to the Subcommittee on Health of the House Committee on Ways and Means hearing on developing a new reimbursement system for Erythropoiesis-stimulating Agents (ESAs), for a reality check. In particular, the statement of Alan S. Kliger, M.D., President, Renal Physicians Association, Rockville, Maryland on "Variability in ESRD Patient Hemoglobin Levels"
"Recent studies warn that kidney failure patients should not have high blood counts, noting that a group of patients with high blood counts in general carried a higher risk than patients with lower blood counts. But my experience with one of my patients shows how patient-centered care sometimes should deviate from guideline-advised care. I have a 52-year-old patient who is in kidney failure. When his blood count is less than 36 percent, he feels tired and washed out and experiences chest pain. When EPO raises his blood count to 38 percent, he feels like a healthy man; he functions better and feels more productive. The differences are so prominent to him that he tells me what his blood count is before I have a chance to measure it. For this particular patient, a higher blood count is what he needs in order to function normally. My patient knows that the recent studies warn about the long-term side effects of these higher blood counts, but he also knows he needs these levels to function normally. His choice and mine for enough EPO to maintain higher blood counts is the right choice.
RPA believes that in the recent discourse on national coverage of EPO, the critical issue of variability of individual patient response to EPO dose has been understated. As we have noted in correspondence to CMS, attempts to assess or quantify individual sensitivities (i.e. responsiveness) to EPO at a narrow level have not been successful.
Therefore, there is no single, predictable response to a given dose of EPO, a fact that accounts for the wide range in individual responses to treatment. As a result, in the aggregate it is physiologically not rational to tailor a normal distribution of patient responses to a payment limit: such a paradigm cannot be successful in delivering optimal treatment with sophisticated agents to complicated patients.
Payment limits structured in this fashion place emphasis on the wrong arm of therapy: emphasis should be placed rather on reducing the number of patients with low hematocrits/hemoglobins (<30%/10 gm/dL). "
http://waysandmeans.house.gov/hearings.asp?formmode=detail&hearing=573
MedPAC and the rest of the comparative effectiveness club are ignoring the human consequences of one size fits all decisions such as these or the denial of cancer and Alzheimer's care in the UK, Canada, Australia. The focus is on the structure of the center, the funding, furniture, color schemes, resumes, etc.
The comparative effectiveness movement will, like the Clinton health plan, be undone, by it's arrogance, high-handedness and contempt for the doctor-patient relationship. Read More & Comment...
07/02/2007 06:46 AM |
Does that headline look familiar? Of course, you see it all the time in headlines about "new poll findings." But, as any savvy drugwonk knows, you can get any answer you want depending on how you ask the question.
So we decided to see what some New Yorkers know -- or think they know -- about a couple of health care issues in our latest podcast.
Have a look:
http://cmpi.org/archives/2007/06/what_do_people_really_know_abo.php
If you have questions that you'd like us to ask in our next podcast, please send them along by commenting via this blog. Read More & Comment...
So we decided to see what some New Yorkers know -- or think they know -- about a couple of health care issues in our latest podcast.
Have a look:
http://cmpi.org/archives/2007/06/what_do_people_really_know_abo.php
If you have questions that you'd like us to ask in our next podcast, please send them along by commenting via this blog. Read More & Comment...
06/29/2007 12:02 PM |
“All animals are equal, but some animals are more equal than others.†A famous line from a famous book with a famous lesson – they’re not.
Today that lesson needs to be relearned. Case-in-point, a Canadian judge’s apparent belief that all patents are equal, but some patents are less equal than others.
Specifically, pharmaceutical patents.
But first a point of order – this is not about the position of the Government of Canada, which is very good on these issues. This is about the actions of an activist judge – the Honourable Mr. Justice Hughes, of the Federal Court of Canada.
It’s about a patent case brought by Novopharm (the large Canadian generics company) against Eli Lilly (the large American pharmaceutical company). But the issue is considerably broader and the precedent is frightening not only for innovator pharmaceutical firms – but for the future of Canadian public health.
The issue, relative to a pharmaceutical patent, “… is the sufficiency of the disclosure in the patent itself…†Judge Hughes’ decision has created a requirement that “… the advantage must be plainly and fully set out in sufficient detail so as to enable a person skilled in the art to know and appreciate what they are.†That is, the judge found that it is “mere rhetoric†to only state the advantages of the invention in the patent specification.
And get this – Judge Hughes ruled on an argument that wasn’t even made by Novopharm. He invented and then ruled on his own argument.
Here's a link to Judge Hughes’ June 5, 2007 decision:
http://decisions.fct-cf.gc.ca/en/2007/2007fc596/2007fc596.html
(PS/ A Canadian appellate court chastised Judge Hughes' decision.)
A couple of crucial points:
Eli Lilly Canada Inc. v. Novopharm Limited raises a significant new question of law and represents a significant shift in the requirement for disclosure in patent applications that has an immediate impact on presently pending applications and patents-in-force in Canada.
Judge Hughes’ ruling is out of step with Canadian law; it violates international IP treaties (TRIPS, PCT), and makes Canada an outlier among all developed and developing countries.
For example, the Patent Cooperation Treaty (PCT) provides for the requirements of a patent specification and states that the “description shall disclose the invention in a manner sufficiently clear and complete for the invention to be carried out by a person skilled in the art.†Considering that Canada is a member of the PCT, it seems that the Federal Court has now made Canada non-compliant with its treaty obligations.
Furthermore, by applying this “super-sufficiency†requirement to a certain class of improvement patents (so-called “selection†patents); the decision also violates the nondiscrimination clauses of TRIPS. TRIPS requires that the standards of patentability for all technology must be the same. In addition, by applying this requirement only to selection patents, the legal requirements in Canada now improperly establish a higher standard of patentability for this type of innovation in contravention of the non-discriminatory clauses of TRIPS.
And, even worse, the Court of Appeals in Canada has created a practice of dismissing any adverse ruling against the pharmaceutical patent as being moot if the generic obtains its marketing approval before the appeal can be heard. So, a generic challenger has their day in court and a full opportunity to appeal a ruling. The innovator pharmaceutical company has their day in court with the first challenger and if there is an adverse ruling will have no opportunity to appeal. To further exacerbate matters, the Court of Appeals has also held that once the first generic challenger has prevailed subsequent challengers should also be granted an approval.
So much for checks and balances.
These actions are manifestly unfair to the research-based pharmaceutical industry and will chill pharmaceutical innovation in the Great White North. This illegal and unfair attitude, if it continues unfettered or unquestioned, will lead to fewer innovative pharmaceutical products being made available to Canadians.
Ah, those pesky unintended consequences. Read More & Comment...
Today that lesson needs to be relearned. Case-in-point, a Canadian judge’s apparent belief that all patents are equal, but some patents are less equal than others.
Specifically, pharmaceutical patents.
But first a point of order – this is not about the position of the Government of Canada, which is very good on these issues. This is about the actions of an activist judge – the Honourable Mr. Justice Hughes, of the Federal Court of Canada.
It’s about a patent case brought by Novopharm (the large Canadian generics company) against Eli Lilly (the large American pharmaceutical company). But the issue is considerably broader and the precedent is frightening not only for innovator pharmaceutical firms – but for the future of Canadian public health.
The issue, relative to a pharmaceutical patent, “… is the sufficiency of the disclosure in the patent itself…†Judge Hughes’ decision has created a requirement that “… the advantage must be plainly and fully set out in sufficient detail so as to enable a person skilled in the art to know and appreciate what they are.†That is, the judge found that it is “mere rhetoric†to only state the advantages of the invention in the patent specification.
And get this – Judge Hughes ruled on an argument that wasn’t even made by Novopharm. He invented and then ruled on his own argument.
Here's a link to Judge Hughes’ June 5, 2007 decision:
http://decisions.fct-cf.gc.ca/en/2007/2007fc596/2007fc596.html
(PS/ A Canadian appellate court chastised Judge Hughes' decision.)
A couple of crucial points:
Eli Lilly Canada Inc. v. Novopharm Limited raises a significant new question of law and represents a significant shift in the requirement for disclosure in patent applications that has an immediate impact on presently pending applications and patents-in-force in Canada.
Judge Hughes’ ruling is out of step with Canadian law; it violates international IP treaties (TRIPS, PCT), and makes Canada an outlier among all developed and developing countries.
For example, the Patent Cooperation Treaty (PCT) provides for the requirements of a patent specification and states that the “description shall disclose the invention in a manner sufficiently clear and complete for the invention to be carried out by a person skilled in the art.†Considering that Canada is a member of the PCT, it seems that the Federal Court has now made Canada non-compliant with its treaty obligations.
Furthermore, by applying this “super-sufficiency†requirement to a certain class of improvement patents (so-called “selection†patents); the decision also violates the nondiscrimination clauses of TRIPS. TRIPS requires that the standards of patentability for all technology must be the same. In addition, by applying this requirement only to selection patents, the legal requirements in Canada now improperly establish a higher standard of patentability for this type of innovation in contravention of the non-discriminatory clauses of TRIPS.
And, even worse, the Court of Appeals in Canada has created a practice of dismissing any adverse ruling against the pharmaceutical patent as being moot if the generic obtains its marketing approval before the appeal can be heard. So, a generic challenger has their day in court and a full opportunity to appeal a ruling. The innovator pharmaceutical company has their day in court with the first challenger and if there is an adverse ruling will have no opportunity to appeal. To further exacerbate matters, the Court of Appeals has also held that once the first generic challenger has prevailed subsequent challengers should also be granted an approval.
So much for checks and balances.
These actions are manifestly unfair to the research-based pharmaceutical industry and will chill pharmaceutical innovation in the Great White North. This illegal and unfair attitude, if it continues unfettered or unquestioned, will lead to fewer innovative pharmaceutical products being made available to Canadians.
Ah, those pesky unintended consequences. Read More & Comment...
06/29/2007 07:40 AM |
Whichever party wins the White House in 2008, one truth will prevail at FDA – regulators love ambiguity but can learn to embrace predictability.
A second truth is that FDA decisions are and will continue to be based solely on sound science and its impact on the public health. So, whether red or blue is ascendant, FDA will make its decisions based on the facts.
What might change, depending on who occupies the White House and the FDA Commissioner’s Office, is how the FDA views the concept of time. And it could go either way --because there is real time and there’s FDA time.
There’s an old Washington story that goes like this -- Henry Kissinger asked Chinese leader Chou En Lai whether the French Revolution of 1789 had benefited humanity, to which Chou responded: "It's too early to tell."
Chou would have made a great regulator.
Real time is for the world we live in. The clock we watch – for business, certainly, but also for the rest of us. FDA time is the time it takes to get it right (PDUFA notwithstanding) and, unless there's a trebling of the FDA budget, the only real way to meaningfully accelerate FDA actions without compromising quality (read “safety and effectivenessâ€) is through collaboration with academe, with industry, and with hybrids like Ray Woosley's Critical Path Initiative.
Will collaboration continue to be embraced by the next President? By the next FDA Commissioner? This is the crucial question.
A related core issue is predictability – the opposite of ambiguity.
Predictability is power in pursuit of the public health. A case in point is the Critical Path initiative and the ways it can reach out and work with non-government partners via the imminent Reagan-Udall Center (pending in still pensile legislation). But ambiguity is bureaucratic power – and too many regulators accept ambiguity as a replacement for responsibility..
(I also believe that too many folks at pharmaceutical companies accept ambiguity as a replacement for responsibility.)
The coming election, relative to the future of the FDA, is a battle between nascent predictability and insidious ambiguity. So, here’s my idea for a bumper-sticker – “I support the FDA and I vote.†Read More & Comment...
A second truth is that FDA decisions are and will continue to be based solely on sound science and its impact on the public health. So, whether red or blue is ascendant, FDA will make its decisions based on the facts.
What might change, depending on who occupies the White House and the FDA Commissioner’s Office, is how the FDA views the concept of time. And it could go either way --because there is real time and there’s FDA time.
There’s an old Washington story that goes like this -- Henry Kissinger asked Chinese leader Chou En Lai whether the French Revolution of 1789 had benefited humanity, to which Chou responded: "It's too early to tell."
Chou would have made a great regulator.
Real time is for the world we live in. The clock we watch – for business, certainly, but also for the rest of us. FDA time is the time it takes to get it right (PDUFA notwithstanding) and, unless there's a trebling of the FDA budget, the only real way to meaningfully accelerate FDA actions without compromising quality (read “safety and effectivenessâ€) is through collaboration with academe, with industry, and with hybrids like Ray Woosley's Critical Path Initiative.
Will collaboration continue to be embraced by the next President? By the next FDA Commissioner? This is the crucial question.
A related core issue is predictability – the opposite of ambiguity.
Predictability is power in pursuit of the public health. A case in point is the Critical Path initiative and the ways it can reach out and work with non-government partners via the imminent Reagan-Udall Center (pending in still pensile legislation). But ambiguity is bureaucratic power – and too many regulators accept ambiguity as a replacement for responsibility..
(I also believe that too many folks at pharmaceutical companies accept ambiguity as a replacement for responsibility.)
The coming election, relative to the future of the FDA, is a battle between nascent predictability and insidious ambiguity. So, here’s my idea for a bumper-sticker – “I support the FDA and I vote.†Read More & Comment...
06/28/2007 04:58 PM |
Someone with a twisted mind came up with this headline at CNN.com..
FDA bans import of drugged fish from China
Food and Drug Administration announced a ban on the import of five species of seafood from China due to possible contamination with medications.
http://http://money.cnn.com/2007/06/28/news/international/china_fish/?postversion=2007062815 Read More & Comment...
FDA bans import of drugged fish from China
Food and Drug Administration announced a ban on the import of five species of seafood from China due to possible contamination with medications.
http://http://money.cnn.com/2007/06/28/news/international/china_fish/?postversion=2007062815 Read More & Comment...
06/28/2007 12:27 PM |
06/28/2007 07:18 AM |
You have to love the way the NEJM and the NY Times treat the issue of drug safety. Steve Nissen runs a crappy meta-analysis of Avandia's supposed dangers and it's rushed to e-print in advance of a Senate hearing and the close of the markets. The NYTmakes it front page news.
A careful study that shows a very low risk of birth defects among women taking anti-depressants while pregnant...? Why, the very same NEJM sees no reason to stop the presses. No Congressional hearings. No publicity whores running to Nightline to talk about the number of suicides and depressed women who affected by the lack of treatment.
And the NY Times? No front page articles linking anti-depressants to "suicides." Because this time it's for real and this time it's a case of telling pregnant women it's ok to take them. (Kudos to http:// pharmalot.com for being one of the first on the web with the good news)
It's page A16, next to a silly story about a congressional proposal setting up a mandatory registry of all "gifts" drug companies provide to doctors. Listen to how the NY Times reports on this NEJM article:
The findings, appearing in two studies in The New England Journal of Medicine, support doctors’ assurances that antidepressants are not a major cause of serious physical problems in newborns.
"But the studies did not include enough cases to adequately assess risk of many rare defects; nor did they include information on how long women were taking antidepressants or at what doses. The studies did not evaluate behavioral effects either; previous research has found that babies suffer withdrawal effects if they have been exposed to antidepressants in the womb, and that may have implications for later behavior.
“These are important papers, but they don’t close the questions of whether there are major effects†of these drugs on developing babies, said Dr. Timothy Oberlander, a developmental pediatrician at the University of British Columbia, who was not involved in the studies. “There are many more chapters in this story yet to be told.â€
http://www.nytimes.com/2007/06/28/health/28depress.html?_r=1&oref=slogin
Meanwhile, in responding to a similar study last year Oberlander said: "At present, probably the effect of not treating the women's clinical depression is a much bigger issue for mothers and their infants."
http://www.healthfinder.gov/news/newsstory.asp?docid=530794
Maybe we should do a study looking at the effect of being interviewed by the NYT on the quotes researchers give to reporters. We could call it the Nissen Doomsday Effect.
I digress. Notice all the caveats? Now here's the NYT on Avandia:
"The analysis, based on a review of more than 40 existing clinical studies involving nearly 28,000 patients, showed that Avandia significantly increased the risk of heart attacks, compared with other diabetes drugs or a placebo.
Both the study’s lead author and the editors of The New England Journal of Medicine, in which the article appeared, cautioned that the research method used left the findings open to interpretation. But they said the study nevertheless raised important concerns.
And the publication of the study on the journal’s Web site prompted the Food and Drug Administration to issue a public safety alert and advise users of the drug — an estimated million people in this country and two million worldwide — to consult their doctors about the potential cardiovascular risks.
The journal’s editor in chief, Dr. Jeffrey M. Drazen, said: “We view this as the best publicly available data on a very important question. It shows what we regard as a preliminary, but worrisome, signal about cardiovascular toxicity of this drug.â€
http://www.nytimes.com/2007/05/22/business/22drug.html?pagewanted=1&ei=5070&en=dacbc8e498ef3c7d&ex=1183176000
No bias in the media on drug safety. None at all. In light of the increase in teen suicide due to a decline in SSRI use which was triggered by biased reporting, makes you wonder what would happen if drug companies weren't around to provide responsible, peer-reviewed and regulated information about the benefits of their products. And I AM serious about that. Read More & Comment...
A careful study that shows a very low risk of birth defects among women taking anti-depressants while pregnant...? Why, the very same NEJM sees no reason to stop the presses. No Congressional hearings. No publicity whores running to Nightline to talk about the number of suicides and depressed women who affected by the lack of treatment.
And the NY Times? No front page articles linking anti-depressants to "suicides." Because this time it's for real and this time it's a case of telling pregnant women it's ok to take them. (Kudos to http:// pharmalot.com for being one of the first on the web with the good news)
It's page A16, next to a silly story about a congressional proposal setting up a mandatory registry of all "gifts" drug companies provide to doctors. Listen to how the NY Times reports on this NEJM article:
The findings, appearing in two studies in The New England Journal of Medicine, support doctors’ assurances that antidepressants are not a major cause of serious physical problems in newborns.
"But the studies did not include enough cases to adequately assess risk of many rare defects; nor did they include information on how long women were taking antidepressants or at what doses. The studies did not evaluate behavioral effects either; previous research has found that babies suffer withdrawal effects if they have been exposed to antidepressants in the womb, and that may have implications for later behavior.
“These are important papers, but they don’t close the questions of whether there are major effects†of these drugs on developing babies, said Dr. Timothy Oberlander, a developmental pediatrician at the University of British Columbia, who was not involved in the studies. “There are many more chapters in this story yet to be told.â€
http://www.nytimes.com/2007/06/28/health/28depress.html?_r=1&oref=slogin
Meanwhile, in responding to a similar study last year Oberlander said: "At present, probably the effect of not treating the women's clinical depression is a much bigger issue for mothers and their infants."
http://www.healthfinder.gov/news/newsstory.asp?docid=530794
Maybe we should do a study looking at the effect of being interviewed by the NYT on the quotes researchers give to reporters. We could call it the Nissen Doomsday Effect.
I digress. Notice all the caveats? Now here's the NYT on Avandia:
"The analysis, based on a review of more than 40 existing clinical studies involving nearly 28,000 patients, showed that Avandia significantly increased the risk of heart attacks, compared with other diabetes drugs or a placebo.
Both the study’s lead author and the editors of The New England Journal of Medicine, in which the article appeared, cautioned that the research method used left the findings open to interpretation. But they said the study nevertheless raised important concerns.
And the publication of the study on the journal’s Web site prompted the Food and Drug Administration to issue a public safety alert and advise users of the drug — an estimated million people in this country and two million worldwide — to consult their doctors about the potential cardiovascular risks.
The journal’s editor in chief, Dr. Jeffrey M. Drazen, said: “We view this as the best publicly available data on a very important question. It shows what we regard as a preliminary, but worrisome, signal about cardiovascular toxicity of this drug.â€
http://www.nytimes.com/2007/05/22/business/22drug.html?pagewanted=1&ei=5070&en=dacbc8e498ef3c7d&ex=1183176000
No bias in the media on drug safety. None at all. In light of the increase in teen suicide due to a decline in SSRI use which was triggered by biased reporting, makes you wonder what would happen if drug companies weren't around to provide responsible, peer-reviewed and regulated information about the benefits of their products. And I AM serious about that. Read More & Comment...
06/27/2007 05:03 PM |
Lest anyone be uncertain that Peter Rost is not a small-minded person who blogs without regard to the totality of the facts, here is the context of Rost's gleeful pursuit of Pfizer's renewed effort to market Viracept, an "old drug" as the consistently vindictive and inaccurate Rost calls the HIV medicine.
Pfizer, according to Rost, was quick to launch marketing materials regarding Viracept. It's materials were not issued and released INTERNALLY consisted with it's own guidelines and the release was shut down. Therefore Rost cannot contain his glee at the expense of the former employe whom he drew a no-show salary from to the tune of over $600K a year while suing them.
But here are some relevant facts, perhaps, just perhaps.
1. The World Health Organization (WHO), drug companies, drug regulators, NGOs and national governments have been working together to minimise the disruption of antiretroviral therapy to individuals affected by the near-global recall of nelfinavir (Viracept).
Although it was initially thought that the recall only affected Europe following the alerts issued by Roche, the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) and the European Medicines Agency (EMEA) on June 6 th, it has, in fact, affected every country in the world with the exception of the United States and its territories, Canada and Japan.
"A very difficult situation"
On June 14th, WHO issued a statement on the recall, saying that "Roche informed WHO on 8 June 2007 of its global recall of its nelfinavir products (Viracept)." Roche estimates that around 45,000 individuals are affected by the recall globally.
Roche’s International Communications Manager for HIV and Hepatitis, Janet Kettels told aidsmap.com: "This is obviously a very difficult situation, as many people living with HIV/AIDS in the least developed countries do not have easy access to a wide range of alternative treatments."
http://www.aidsmap.com/en/news/EFA4601B-2827-4131-B2E8-6EB722BEE1D9.asp
2. Roche is in Talks With Pfizer Over Viracept Supply Following Recall
As Roche corrects a manufacturing error that resulted in a recall of all batches of its HIV treatment Viracept sold in the European Union (EU) and other world markets, the company is in discussions with Pfizer to supply the antiretroviral as a potential option in expediting the market return of the product, Roche told DID June 20.
www.aidsmap.com
Here's a link to the sludge report.... http://peterrost.blogspot.com/ Read More & Comment...
Pfizer, according to Rost, was quick to launch marketing materials regarding Viracept. It's materials were not issued and released INTERNALLY consisted with it's own guidelines and the release was shut down. Therefore Rost cannot contain his glee at the expense of the former employe whom he drew a no-show salary from to the tune of over $600K a year while suing them.
But here are some relevant facts, perhaps, just perhaps.
1. The World Health Organization (WHO), drug companies, drug regulators, NGOs and national governments have been working together to minimise the disruption of antiretroviral therapy to individuals affected by the near-global recall of nelfinavir (Viracept).
Although it was initially thought that the recall only affected Europe following the alerts issued by Roche, the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) and the European Medicines Agency (EMEA) on June 6 th, it has, in fact, affected every country in the world with the exception of the United States and its territories, Canada and Japan.
"A very difficult situation"
On June 14th, WHO issued a statement on the recall, saying that "Roche informed WHO on 8 June 2007 of its global recall of its nelfinavir products (Viracept)." Roche estimates that around 45,000 individuals are affected by the recall globally.
Roche’s International Communications Manager for HIV and Hepatitis, Janet Kettels told aidsmap.com: "This is obviously a very difficult situation, as many people living with HIV/AIDS in the least developed countries do not have easy access to a wide range of alternative treatments."
http://www.aidsmap.com/en/news/EFA4601B-2827-4131-B2E8-6EB722BEE1D9.asp
2. Roche is in Talks With Pfizer Over Viracept Supply Following Recall
As Roche corrects a manufacturing error that resulted in a recall of all batches of its HIV treatment Viracept sold in the European Union (EU) and other world markets, the company is in discussions with Pfizer to supply the antiretroviral as a potential option in expediting the market return of the product, Roche told DID June 20.
www.aidsmap.com
Here's a link to the sludge report.... http://peterrost.blogspot.com/ Read More & Comment...
06/27/2007 11:41 AM |
Two interesting stories today that both reach the same place -- we need to find ways to get the right medicines to the right people at the right time in the right dose. Let's call it "Pharmonic Convergence."
First story comes from the Pink Sheet and their discussion of FDA's genetic test guidelines.
As reporter David Filmore writes vis-a-vis the FDA's genetic test guidelines:
"The agency drafted the guidance document on pharmacogenetic tests and genetic tests for heritable markers to help shorten development and review times for these products, which are attracting growing attention from the medical community as tools to make more precise disgnoses and, in the case of pharmacogenetic tests, more personalized treatment decisions."
Right now, today such tests exist. It is not, as many will derisively tell you, science fiction. It's science fact. And the fact that most insurance companies don't reimburse for such diagnistic tools is short sighted.
To that point, an article from today's New York Times. Gray Lady scribe Milt Freudenheim reports on a new study by the Integrated Benefits Institute that shows, "Employers that shift too much of the cost of drugs to workers in their company health plans could wind up losing more than they save, through absenteeism and lost productivity, according to a study by health policy researchers."
"Among the 17 employers in the study, conducted by the nonprofit Integrated Benefits Institute, more than half the workers with rheumatoid arthritis were not taking their drugs — in many cases because they considered the out-of-pocket co-payments too high.
As a result, the institute’s study found, the employers incurred $17.2 million in costs from lost productivity, 26 percent more than the estimate of what they would have spent if the workers had taken their arthritis drugs."
The lede of the New York Times article reads, "Health penny wise, medical pound foolish?
Indeed.
Okay -- once more with feeling -- patients (otherwise known as "people," aka "voters") need to be on the right medicines for their conditions. And when payors interpose themselves between doctor and patient, when prescribing decisions are made by accountants (read "evidence-based medicine"), health outcomes decline for the individual and costs go up for the payor.
Let's keep our eye on the prize as we strive to move from acute to a chronic care model for 21st century health care. It's nothing short of critical.
And, after all, that's why we have the Critical Path. Read More & Comment...
First story comes from the Pink Sheet and their discussion of FDA's genetic test guidelines.
As reporter David Filmore writes vis-a-vis the FDA's genetic test guidelines:
"The agency drafted the guidance document on pharmacogenetic tests and genetic tests for heritable markers to help shorten development and review times for these products, which are attracting growing attention from the medical community as tools to make more precise disgnoses and, in the case of pharmacogenetic tests, more personalized treatment decisions."
Right now, today such tests exist. It is not, as many will derisively tell you, science fiction. It's science fact. And the fact that most insurance companies don't reimburse for such diagnistic tools is short sighted.
To that point, an article from today's New York Times. Gray Lady scribe Milt Freudenheim reports on a new study by the Integrated Benefits Institute that shows, "Employers that shift too much of the cost of drugs to workers in their company health plans could wind up losing more than they save, through absenteeism and lost productivity, according to a study by health policy researchers."
"Among the 17 employers in the study, conducted by the nonprofit Integrated Benefits Institute, more than half the workers with rheumatoid arthritis were not taking their drugs — in many cases because they considered the out-of-pocket co-payments too high.
As a result, the institute’s study found, the employers incurred $17.2 million in costs from lost productivity, 26 percent more than the estimate of what they would have spent if the workers had taken their arthritis drugs."
The lede of the New York Times article reads, "Health penny wise, medical pound foolish?
Indeed.
Okay -- once more with feeling -- patients (otherwise known as "people," aka "voters") need to be on the right medicines for their conditions. And when payors interpose themselves between doctor and patient, when prescribing decisions are made by accountants (read "evidence-based medicine"), health outcomes decline for the individual and costs go up for the payor.
Let's keep our eye on the prize as we strive to move from acute to a chronic care model for 21st century health care. It's nothing short of critical.
And, after all, that's why we have the Critical Path. Read More & Comment...
06/27/2007 09:59 AM |
While the comparative effectiveness cabal try to turn patients into cost-centers and forget that you and I real live human beings, the Integrated Benefits Institutes releases a study that brings the human element back to the delivery of healthcare:
"New Integrated Benefits Institute Report Finds Pharmaceutical Cost Shifting Leads to Increased Disability and Lost Productivity
San Francisco – June 27, 2007 – Medical costs, including drug expenditures, have continued to rise much faster than the rate of inflation, causing employers to use strategies to control costs for pharmaceuticals including higher copays, tiered benefit plans and higher deductibles. A new report released today by the nonprofit Integrated Benefits Institute (IBI) reveals that shifting costs to employees doesn’t save employers money and discourages treatment essential to employees’ health-related productivity and quality of life."
Here's a key quote that all the cost-containers in Washington and those who want to set up a comparative effectiveness board should staple to their forehead, carefully, so all the air doesn't escape:
“As employers understand that providing effective, available health care is an investment in human capital that will pay off in real dollars by decreasing overall health-related costs, they may want to rethink their approach to measuring and investing in employee health and productivity,†said Jack Mahoney, MD, medical director at Pitney Bowes. “This is not only good for employers, but employees can benefit from less shifted costs and better health and quality of life.â€
Exactly. Dr. Mahoney articulated the humane, patient centered approach to medicine that the Beltway/Health Affairs/Kaiser/Commonwealth types have turned their backs on. Health care is a human and humane enterprise, not a rationing activity.
Thanks to IBI for restoring a moral and medical compass to the discussion of health care policy.
http://www.ibiweb.org/news/articles/display/7025 Read More & Comment...
"New Integrated Benefits Institute Report Finds Pharmaceutical Cost Shifting Leads to Increased Disability and Lost Productivity
San Francisco – June 27, 2007 – Medical costs, including drug expenditures, have continued to rise much faster than the rate of inflation, causing employers to use strategies to control costs for pharmaceuticals including higher copays, tiered benefit plans and higher deductibles. A new report released today by the nonprofit Integrated Benefits Institute (IBI) reveals that shifting costs to employees doesn’t save employers money and discourages treatment essential to employees’ health-related productivity and quality of life."
Here's a key quote that all the cost-containers in Washington and those who want to set up a comparative effectiveness board should staple to their forehead, carefully, so all the air doesn't escape:
“As employers understand that providing effective, available health care is an investment in human capital that will pay off in real dollars by decreasing overall health-related costs, they may want to rethink their approach to measuring and investing in employee health and productivity,†said Jack Mahoney, MD, medical director at Pitney Bowes. “This is not only good for employers, but employees can benefit from less shifted costs and better health and quality of life.â€
Exactly. Dr. Mahoney articulated the humane, patient centered approach to medicine that the Beltway/Health Affairs/Kaiser/Commonwealth types have turned their backs on. Health care is a human and humane enterprise, not a rationing activity.
Thanks to IBI for restoring a moral and medical compass to the discussion of health care policy.
http://www.ibiweb.org/news/articles/display/7025 Read More & Comment...
06/27/2007 09:28 AM |
From the Daily Sport in the UK
SUBJECT: IF YOU'RE GOING TO BOYCOTT ISRAEL - DO IT PROPERLY!
OK. So I understand that you are ticked off at Israel, and in love with
the Palestinians. That's fine with me, as long as you have truly
weighed all the facts.
So, you want to boycott Israel????? I'll be sorry to miss you, but if
you are doing it - do it properly. Let me help you.
An Israeli company has developed a simple blood test that
distinguishes between mild and more severe cases of Multiple
Sclerosis. So, if you know anyone suffering from MS, tell them to
ignore the Israeli patent that may, more accurately, diagnose their
symptoms.
An Israeli-made device helps restore the use of paralyzed hands. This
device electrically stimulates the hand muscles, providing hope to
millions of stroke sufferers and victims of spinal injuries. If you
wish to remove this hope of a better quality of life to these people,
go ahead and boycott Israel.
Young children with breathing problems will soon be sleeping more
soundly, thanks to a new Israeli device called the Child Hood. This
innovation replaces the inhalation mask with an improved drug delivery
system that provides relief for child and parent. Please tell anxious
mothers that they shouldn't use this device because of your passionate
cause.
These are just a few examples of how people have benefited medically
from the Israeli know-how you wish to block. Boycotts often affect
research.
A new research center in Israel hopes to throw light on brain
disorders such as depression and Alzheimer's disease.
The Joseph Sangol Neuroscience Center in the Sheba Medical Center at
Tel HaShomer Hospital, aims to bring thousands of scientists and
doctors to focus on brain research.
A researcher at Israel's Ben Gurion University has succeeded in
creating human monoclonal antibodies which can neutralize the highly
contagious smallpox virus without inducing the dangerous side effects
of the existing vaccine.
Two Israelis received the 2004 Nobel Prize in Chemistry. Doctors
Ciechanover and Hershko's research and discovery of one of the human
cells most important cyclical processes will lead the way to DNA
repair, control of newly produced proteins, and immune defense
systems.
The Movement Disorder Surgery program at Israel's Hadassah Medical
Center has successfully eliminated the physical manifestations of
Parkinson's disease in a select group of patients with a deep brain
stimulation technique.
For women who undergo hysterectomies each year for the treatment of
uterine fibroids, the development in Israel of the Ex Ablate 2000
System is a welcome breakthrough, offering a noninvasive alternative
to surgery.
Israel is developing a nose drop that will provide a five year flu
vaccine.
These are just a few of the projects that you can help stop with your
Israeli boycott. But let's not get too obsessed with my ducal
research, there are other ways you can make a personal sacrifice with
your anti-Israel boycott.
Most of Windows operating systems were developed by Microsoft-Israel.
So, set a personal example. Throw away your computer!
Computers should have a sign attached saying Israel Inside. The
Pentium NMX Chip technology was designed at Intel in Israel. Both the
Pentium 4 microprocessor and the Centrum processor were entirely
designed, developed, and produced in Israel.
Voice mail technology was developed in Israel.
The technology for the AOL Instant Messenger ICQ was developed in 1996
in Israel by four young Israeli whiz kids.
Both Microsoft and Cisco built their only R. & D. facilities outside
the US in Israel.
So, due to your complete boycott of anything Israeli, you can now
have poor health and no computer.
But your bad news does not end there. Get rid of your cellular phone.
Cell phone technology was also developed in Israel by MOTOROLA which
has its biggest development center in Israel. Most of the latest
technology in your mobile phone was developed by Israeli scientists.
Feeling unsettled? You should be. Part of your personal security rests
with Israeli inventiveness, borne out of our urgent necessity to
protect and defend our lives from the terrorists you support.
A phone can remotely activate a bomb, or be used for tactical
communications by terrorists, bank robbers, or hostage-takers. It is
vital that official security and law enforcement authorities have
access to cellular jamming and detection solutions.
Enter Israel's Net line Communications Technologies with their
security expertise to help the fight against terror.
SO ALL THE NOISE ABOUT THE USA LISTENING TO OUR PRIVATE TELEPHONE
CALLS, YOU SHOULD KNOW IT IS ISRAEL WHO IS DOING THE LISTENING FOR US.
A joint, nonprofit, venture between Israel and Maryland will result in
a 5 day Business Development and Planning Conference next March.
Elected Israeli companies will partner with Maryland firms to provide
innovation to the US need for homeland security.
I also want you to know that Israel has the highest ratio of
university degrees to the population in the world.
Israel produces more scientific papers per capita - 109 per 10,000 -
than any other nation.
Israel has the highest number of startup companies per rata. In
absolute terms, the highest number, except the US. Israel has a ratio
of patents filed.
Israel has the highest concentration of hi-tech companies outside of
Silicon Valley. Israel is ranked #2 in the world for venture capital
funds, behind the USA.
Israel has more museums per capita.
Israel has the second highest publication of new books per capita.
Relative to population, Israel is the largest immigrant absorbing
nation on earth.
These immigrants come in search of democracy, religious freedom or
expression, economic opportunity, and quality of life.
Believe it or not, Israel is the only country in the world which had a
net gain in the number of trees last year.
Even Warren Buffet of Berkshire-Hathaway fame has just invested
millions with Israeli Companies.
So, you can vilify and demonize the State of Israel. You can continue
your silly boycott, if you wish. But I wish you would consider the
consequences, and the truth.
Think of the massive contribution that Israel is giving to the world,
including the Palestinians - and to you - in science, medicine,
communications, security.
Pro rata for population, Israel is making a greater contribution than
any other nation on earth. Read More & Comment...
SUBJECT: IF YOU'RE GOING TO BOYCOTT ISRAEL - DO IT PROPERLY!
OK. So I understand that you are ticked off at Israel, and in love with
the Palestinians. That's fine with me, as long as you have truly
weighed all the facts.
So, you want to boycott Israel????? I'll be sorry to miss you, but if
you are doing it - do it properly. Let me help you.
An Israeli company has developed a simple blood test that
distinguishes between mild and more severe cases of Multiple
Sclerosis. So, if you know anyone suffering from MS, tell them to
ignore the Israeli patent that may, more accurately, diagnose their
symptoms.
An Israeli-made device helps restore the use of paralyzed hands. This
device electrically stimulates the hand muscles, providing hope to
millions of stroke sufferers and victims of spinal injuries. If you
wish to remove this hope of a better quality of life to these people,
go ahead and boycott Israel.
Young children with breathing problems will soon be sleeping more
soundly, thanks to a new Israeli device called the Child Hood. This
innovation replaces the inhalation mask with an improved drug delivery
system that provides relief for child and parent. Please tell anxious
mothers that they shouldn't use this device because of your passionate
cause.
These are just a few examples of how people have benefited medically
from the Israeli know-how you wish to block. Boycotts often affect
research.
A new research center in Israel hopes to throw light on brain
disorders such as depression and Alzheimer's disease.
The Joseph Sangol Neuroscience Center in the Sheba Medical Center at
Tel HaShomer Hospital, aims to bring thousands of scientists and
doctors to focus on brain research.
A researcher at Israel's Ben Gurion University has succeeded in
creating human monoclonal antibodies which can neutralize the highly
contagious smallpox virus without inducing the dangerous side effects
of the existing vaccine.
Two Israelis received the 2004 Nobel Prize in Chemistry. Doctors
Ciechanover and Hershko's research and discovery of one of the human
cells most important cyclical processes will lead the way to DNA
repair, control of newly produced proteins, and immune defense
systems.
The Movement Disorder Surgery program at Israel's Hadassah Medical
Center has successfully eliminated the physical manifestations of
Parkinson's disease in a select group of patients with a deep brain
stimulation technique.
For women who undergo hysterectomies each year for the treatment of
uterine fibroids, the development in Israel of the Ex Ablate 2000
System is a welcome breakthrough, offering a noninvasive alternative
to surgery.
Israel is developing a nose drop that will provide a five year flu
vaccine.
These are just a few of the projects that you can help stop with your
Israeli boycott. But let's not get too obsessed with my ducal
research, there are other ways you can make a personal sacrifice with
your anti-Israel boycott.
Most of Windows operating systems were developed by Microsoft-Israel.
So, set a personal example. Throw away your computer!
Computers should have a sign attached saying Israel Inside. The
Pentium NMX Chip technology was designed at Intel in Israel. Both the
Pentium 4 microprocessor and the Centrum processor were entirely
designed, developed, and produced in Israel.
Voice mail technology was developed in Israel.
The technology for the AOL Instant Messenger ICQ was developed in 1996
in Israel by four young Israeli whiz kids.
Both Microsoft and Cisco built their only R. & D. facilities outside
the US in Israel.
So, due to your complete boycott of anything Israeli, you can now
have poor health and no computer.
But your bad news does not end there. Get rid of your cellular phone.
Cell phone technology was also developed in Israel by MOTOROLA which
has its biggest development center in Israel. Most of the latest
technology in your mobile phone was developed by Israeli scientists.
Feeling unsettled? You should be. Part of your personal security rests
with Israeli inventiveness, borne out of our urgent necessity to
protect and defend our lives from the terrorists you support.
A phone can remotely activate a bomb, or be used for tactical
communications by terrorists, bank robbers, or hostage-takers. It is
vital that official security and law enforcement authorities have
access to cellular jamming and detection solutions.
Enter Israel's Net line Communications Technologies with their
security expertise to help the fight against terror.
SO ALL THE NOISE ABOUT THE USA LISTENING TO OUR PRIVATE TELEPHONE
CALLS, YOU SHOULD KNOW IT IS ISRAEL WHO IS DOING THE LISTENING FOR US.
A joint, nonprofit, venture between Israel and Maryland will result in
a 5 day Business Development and Planning Conference next March.
Elected Israeli companies will partner with Maryland firms to provide
innovation to the US need for homeland security.
I also want you to know that Israel has the highest ratio of
university degrees to the population in the world.
Israel produces more scientific papers per capita - 109 per 10,000 -
than any other nation.
Israel has the highest number of startup companies per rata. In
absolute terms, the highest number, except the US. Israel has a ratio
of patents filed.
Israel has the highest concentration of hi-tech companies outside of
Silicon Valley. Israel is ranked #2 in the world for venture capital
funds, behind the USA.
Israel has more museums per capita.
Israel has the second highest publication of new books per capita.
Relative to population, Israel is the largest immigrant absorbing
nation on earth.
These immigrants come in search of democracy, religious freedom or
expression, economic opportunity, and quality of life.
Believe it or not, Israel is the only country in the world which had a
net gain in the number of trees last year.
Even Warren Buffet of Berkshire-Hathaway fame has just invested
millions with Israeli Companies.
So, you can vilify and demonize the State of Israel. You can continue
your silly boycott, if you wish. But I wish you would consider the
consequences, and the truth.
Think of the massive contribution that Israel is giving to the world,
including the Palestinians - and to you - in science, medicine,
communications, security.
Pro rata for population, Israel is making a greater contribution than
any other nation on earth. Read More & Comment...
06/26/2007 02:28 PM |
Peter's post on his importation briefing is Kafka-esque. You can't make up the kind of rationalizations the pro-importation forces have been reduced to -- because they are driven by polls and pure political objective, not facts, not reason, not concern for public health or safety. I think official Washington has created and thrives on a new form of communication, Truthspeak, where flacks, spin doctors, policy hatchets, et al., will say and do anything that advances their short term interests and/or protects their flank though it may contradict reality or what was said or done the day before. The past -- what once was history -- no longer exists and therefore one is no longer accountable or responsible for deeds or actions other than those in the very present.
This tactic has spread Ebola-like throughout politics as the number of media outlets needing content on a 24/7 basis have multiplied.
The importation forces are lead, not coincidentally by Truthspeaker-in-Chief Rahm Emanuel who turned parsing phrases and weasel words into lethal political weapons for the Clintons. (He's had much less success in helping his buddy, Illinois Governor "Wrong-Way Rod" Blagojevich, have any success in the Prairie State's ill-fated importation schemes.)
If you can convince people to open the US to unsafe practices that don't even save money in Europe -- you can do anything. Well, we hope not. Read More & Comment...
This tactic has spread Ebola-like throughout politics as the number of media outlets needing content on a 24/7 basis have multiplied.
The importation forces are lead, not coincidentally by Truthspeaker-in-Chief Rahm Emanuel who turned parsing phrases and weasel words into lethal political weapons for the Clintons. (He's had much less success in helping his buddy, Illinois Governor "Wrong-Way Rod" Blagojevich, have any success in the Prairie State's ill-fated importation schemes.)
If you can convince people to open the US to unsafe practices that don't even save money in Europe -- you can do anything. Well, we hope not. Read More & Comment...
06/26/2007 07:27 AM |
Just because you say it enough times doesn't make it true.
Most recent example that proves this maxim is the attempt by certain members of Congress -- in this case U.S. Representatives Rahm Emanuel (D-IL), Jo Ann Emerson (R-MO), Rosa DeLauro (D-CT), and Marion Berry (D-AR) -- to hide the facts that drug importation is neither safe nor smart.
The Fearsome Four offer the following reasons why drug importation is a good idea. (We offer the facts in bold -- because the truth must be told boldly.)
The Fearsome Four claim that the same brand name drugs cost 35-55% less in other nations then they do in the US.
That's because the nation's of the EU (and Canada) have price controls that equal choice controls for their citizens. Also, the rest of the world unfairly shirks its responsibilities to shoulder their fair share of the burden of research and development. This is what members of Congress should be up in arms about.
The Fearsome Four say that drug importation has been in place in the European Union (where they call it "parallel trade") for more than 20 years with no safety problems.
Believe it or not, their "source" for this is Peter Rost. For the truth we prefer the European Commission who has identified parallel trade as the weak link in the chain for counterfeiters. It's also convenient (although not responsible) to forget that the British regulatory authorities have recently found counterfeit and substandard medicines in their island kingdom -- courtesy of parallel trade.
The Fearsome Four claim the pharmaceutical industry has imported drugs and sold them in the U.S. for decades. In fact, 40 percent of the drugs consumed by Americans today are made in foreign manufacturing plants.
That's right -- in plants authorized and inspected by the FDA. The Four conveniently omit the fact that their legislation would allow in medicines from plants not approved by the FDA. Oops.
The Fearsome Four claim that prescription drug importation will result in $50 billion in direct savings alone over the next decade, a $10 billion benefit to the federal budget.
For this fact they cite a Congressional Budget Office Study. But what the study actually says is that such a program woyuld reduce the drug spend in the US by .01%. And that doesn't include the monies needed to set up an entirely new, international system for drug regulation.
And finally, the Fearsome Four claim that passage of the Pharmaceutical Market Access and Drug Safety Act will finally assure the security of our drug supply.
Assure the safety of our drug supply? This is the biggest whopper of them all. How will our domestic medicines supply be "safer" when we open our borders to drugs from Estonia, Latvia, Malta, Greece, and Portugal -- to name only a few. Because what the Fearsome Four aren't saying is that "drugs from the United Kingdom" means drugs from all of the 27 EU nations -- many of which have had their own supply chains infiltrated by counterfeits from Russia and elsewhere. They should do their homework.
What happens when pesky facts get in the way of political grandstanding? Good things. Read More & Comment...
Most recent example that proves this maxim is the attempt by certain members of Congress -- in this case U.S. Representatives Rahm Emanuel (D-IL), Jo Ann Emerson (R-MO), Rosa DeLauro (D-CT), and Marion Berry (D-AR) -- to hide the facts that drug importation is neither safe nor smart.
The Fearsome Four offer the following reasons why drug importation is a good idea. (We offer the facts in bold -- because the truth must be told boldly.)
The Fearsome Four claim that the same brand name drugs cost 35-55% less in other nations then they do in the US.
That's because the nation's of the EU (and Canada) have price controls that equal choice controls for their citizens. Also, the rest of the world unfairly shirks its responsibilities to shoulder their fair share of the burden of research and development. This is what members of Congress should be up in arms about.
The Fearsome Four say that drug importation has been in place in the European Union (where they call it "parallel trade") for more than 20 years with no safety problems.
Believe it or not, their "source" for this is Peter Rost. For the truth we prefer the European Commission who has identified parallel trade as the weak link in the chain for counterfeiters. It's also convenient (although not responsible) to forget that the British regulatory authorities have recently found counterfeit and substandard medicines in their island kingdom -- courtesy of parallel trade.
The Fearsome Four claim the pharmaceutical industry has imported drugs and sold them in the U.S. for decades. In fact, 40 percent of the drugs consumed by Americans today are made in foreign manufacturing plants.
That's right -- in plants authorized and inspected by the FDA. The Four conveniently omit the fact that their legislation would allow in medicines from plants not approved by the FDA. Oops.
The Fearsome Four claim that prescription drug importation will result in $50 billion in direct savings alone over the next decade, a $10 billion benefit to the federal budget.
For this fact they cite a Congressional Budget Office Study. But what the study actually says is that such a program woyuld reduce the drug spend in the US by .01%. And that doesn't include the monies needed to set up an entirely new, international system for drug regulation.
And finally, the Fearsome Four claim that passage of the Pharmaceutical Market Access and Drug Safety Act will finally assure the security of our drug supply.
Assure the safety of our drug supply? This is the biggest whopper of them all. How will our domestic medicines supply be "safer" when we open our borders to drugs from Estonia, Latvia, Malta, Greece, and Portugal -- to name only a few. Because what the Fearsome Four aren't saying is that "drugs from the United Kingdom" means drugs from all of the 27 EU nations -- many of which have had their own supply chains infiltrated by counterfeits from Russia and elsewhere. They should do their homework.
What happens when pesky facts get in the way of political grandstanding? Good things. Read More & Comment...
06/25/2007 11:43 AM |
For those of us who enjoy waiting two hours in a doctor's office or using the ER room to getting care because we don't get sick between 10-5, you'll love how the AMA is responding to the grow of retail health clinics:
The American Medical Association should call for a ban on in-store clinics being opened by retail giants like Wal-Mart Stores Inc. and Walgreen Co., several doctors groups urged at the AMA's annual meeting in Chicago on Sunday.
Faced with an onslaught of competition that is forecast to bring several thousand retail health clinics to U.S. consumers, AMA members testified that such clinics are endangering patient care, particularly for children. The doctors say the clinics, largely staffed by advanced-degree nurses and physicians' assistants, are largely unregulated and, therefore, put patients' health at risk.
I have used the Redi-Clinics at Duane Reade and I can tell you MY health was put at risk. I was nearly knocked unconscious by how clean, convenient and excellent the care was. A PA whose previous experience was working at a community health center provided me a flu shot and quick look at my sinuses. She sent a copy of my record via email to me which I shared with my physician. Yeah, a real risk alright.
"There is no more urgent issue than this for the AMA," Dr. Kamran Hashemi, a family physician from South Barrington, said, urging the organization to push for more regulation of retail clinics. "This issue speaks to what all of us do every day in practice." If the AMA does nothing, Hashemi said, "in five years, the chairs [at the AMA] meeting will be filled with representatives from Walgreens, Wal-Mart" and other retail outlets.
It's called competition, Kamran. Get off your chair, change or get out of the way. People in rural areas, who work real jobs, who have sick kids need access to real care in real time, not when it's convenient to doctors who are interested in the status quo. Protectionism is not going to cut it.
http://www.chicagotribune.com/business/chi-clinics_bizjun25,0,4533626.story?coll=chi-business-hed Read More & Comment...
The American Medical Association should call for a ban on in-store clinics being opened by retail giants like Wal-Mart Stores Inc. and Walgreen Co., several doctors groups urged at the AMA's annual meeting in Chicago on Sunday.
Faced with an onslaught of competition that is forecast to bring several thousand retail health clinics to U.S. consumers, AMA members testified that such clinics are endangering patient care, particularly for children. The doctors say the clinics, largely staffed by advanced-degree nurses and physicians' assistants, are largely unregulated and, therefore, put patients' health at risk.
I have used the Redi-Clinics at Duane Reade and I can tell you MY health was put at risk. I was nearly knocked unconscious by how clean, convenient and excellent the care was. A PA whose previous experience was working at a community health center provided me a flu shot and quick look at my sinuses. She sent a copy of my record via email to me which I shared with my physician. Yeah, a real risk alright.
"There is no more urgent issue than this for the AMA," Dr. Kamran Hashemi, a family physician from South Barrington, said, urging the organization to push for more regulation of retail clinics. "This issue speaks to what all of us do every day in practice." If the AMA does nothing, Hashemi said, "in five years, the chairs [at the AMA] meeting will be filled with representatives from Walgreens, Wal-Mart" and other retail outlets.
It's called competition, Kamran. Get off your chair, change or get out of the way. People in rural areas, who work real jobs, who have sick kids need access to real care in real time, not when it's convenient to doctors who are interested in the status quo. Protectionism is not going to cut it.
http://www.chicagotribune.com/business/chi-clinics_bizjun25,0,4533626.story?coll=chi-business-hed Read More & Comment...
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