Links of the Day: Forbes Special Edition

March 8, 2008

It’s been a while since I posted because of interview and exams, but while I was waiting for my flight yesterday I noticed an issue of Forbes that I thought would be perfect for a post. I am a fan of specialty hospitals as I believe that specialization allows process improvement and eventually leads to learning and the creation of best processes that can be adopted industry-wide (like at Shouldice Hospital with hernia repairs). While it is true that statistics on specialty hospitals get skewed by the specialty hospitals skimming the healthiest patients, I believe the advantages of what these hospitals can offer outweigh the negatives. Obviously, Stark rules and a conflict of interest with physician self-referrals is a major issue, which I think is more an issue of shades of grey rather than black-and-white. The other major argument is that these hospitals take away the cost-shifting ability of traditional hospitals to use the higher margin procedures to subsidize treatments with low or even negative margins. This is a significant issue, but I believe it is one that should be addressed between hospitals and insurers to make sure that no treatment has a negative margin. This can done either by increased reimbursement or process improvement to cut down on the cost of treatment.

Bad Medicine– This cover story asserts that big hospitals are the source of numerous preventable infections and patients receive better treatment at specialty hospitals that focus on a specific type of treatment. Forbes also reports that the big hospitals have attempted to drive specialty hospitals out of business or prevent them from evening forming. A related story about The Heartland Spine & Specialty Hospital sounds a lot like collusion by the hospitals trying to exert near-monopoly powers to keep a specialty hospital out of business. It shouldn’t come as much of a surprise that two Senators in charge of the committee that oversees the finances of government health organizations that denounced this story.

Hospitals’ Nightmare– I believe this was featured as a sidebar to the cover story. It briefly touches on the fight to get insurers not to pay or even stop working with hospitals that do not meet certain infection standards.

Congress Mounts New Attack On Specialty Hospitals– Dan Whelan, the author of the cover story, reports that Congress is poised to repeal the change in regulations from 2006 that allowed the opening of specialty hospitals. As is typical for Congress, they are trying to ban specialty hospitals by adding on a few words onto a much larger piece of legislation.


Links of the Day: February 25, 2008

February 25, 2008

Yahoo! News:
Obesity more dangerous than terrorism: experts– This seems like an argument that someone would make on a blog and we will go along with it as this group estimates that a lack of physical activity causes 1.9 million deaths worldwide. We could question with the methodology, but we agree with the premise so we won’t try to discredit it. Feel free to leave a comment though if you agree or disagree.

Western clinical trials bad for traditional medicine: SAfrican minister– It looks like someone doesn’t want to show how ineffective and costly some treatments are. I support the use of and research into alternative medicines, but to say they shouldn’t be subject to clinical trials is ridiculous. If someone had argued that typical Western medicines shouldn’t require clinical trials, that person would be ripped apart for being in big pharma’s pocket. I think it should run both ways. If you want to support the South African minister, I will leave you with this pearl from the article to ponder:

Tshabalala-Msimang has faced ridicule in the past over her championing of garlic and vegetables to help combat HIV, which affects some 5.5 million South Africans out of a population of 48 million.

Recent United Nations’ data has shown South Africa to have the worst rate of HIV sufferers on the planet. Mbeki has also been criticised for questioning the link between HIV and AIDS in the past.

AT&T, Tenn. create medical info exchange– I’ll go ahead and be one of the millions of people to say it. In the next 10 years, health IT will be THE huge growth industry. AT&T (and every other big company) appears to realize this and is trying to get a piece of the pie. They have entered into an agreement with the state of Tennessee to provide a secure, statewide to transmit patient information between providers. This seems like a good idea and we tend to favor private rather than public/government solutions for any business problem.

Boston Globe:
India’s youths are in perilous grip of a smoking epidemic– This is a disheartening story as despite every person on earth knowing that cigarettes are bad for you people continue to smoke. We’ll let these excerpts tell the story:

There are 120 million smokers in India, half of them younger than 30, the study found. India has a larger population of smokers than any other country in the world except for China.
 [. . .]
According to the findings, for example, 40 percent of tuberculosis cases in India were due to smoking, since smoking converts the disease in the lungs more quickly. Only 2 percent of smokers in India quit the habit, and usually only after falling ill.

New York Times:
Insurance Fears Lead Many to Shun DNA Tests– An interesting look at the potential impact and externalities of DNA tests. It raises a lot of medical, economic, and ethical issues. Definitely worth a read.

Vaccinating Boys for Girls’ Sake?– Some people are attempting to get the well-known HPV vaccine to be given to boys in an attempt to decrease the spread of HPV. They argue that it will decrease the risk of the boys/men getting genital warts and the risk of women developing cervical cancer from sexual intercourse. The question is if it is worth it to give the vaccine to boys since genital warts can be treated. While it would certainly help create herd immunity to decrease the spread of HPV/cervical cancer, the question becomes the incentive for the boys and consideration of financial costs. If every girl were to receive the HPV vaccine, vaccinating boys would be useless in preventing cervical cancer. Then the question is why subject boys to the risks of vaccination with no true benefit and with the added cost. I am assuming that Merck is certainly supportive of vaccinating boys since it will double their potential market. What do you think should be done?

Wall Street Journal:
FDA Approves Avastin for Breast Cancer– The approval came despite the advisory committee voting 5-4 against it, which had felt that the fact that it slowed the progression of breast cancer, but did not increase survival did not provide adequate reason to approve the drug. Now, Genentech has a drug that is approved for lung, colorectal, and breast cancer. In related news, Genentech’s stock is up 10% at opening this morning.

Links of the Day: February 21, 2008

February 21, 2008

Sorry for the abbreviated links of the day, but I was pretty busy today and have to get up very early tomorrow morning to go out of town. 

Yahoo! News:
Cut salt to keep children thin: study– A new study by British researchers indicates that reducing a child’s consumption of salt leads to a decrease in the amount of sugary sodas they consume. This could potentially decrease their risk of obesity, diabetes, hypertension, and a long list of other associated problems. I don’t have much to add to this other than it seems plausible since the only time I ever want a soda is when I’m eating something fairly salty. I am not sure of the science behind it. If anybody knows something about this I would be interested to hear about it.

Strokes among middle-aged women triple– Apparently the number of women having strokes between the ages of 35 and 54 has tripled (~0.5% to ~2%–some rounding obviously) between the periods from 1988-1994 and 1999-2004. While these numbers may not seem that high, it is important to remember that this age group is not associated with having strokes. Researchers also found that the group’s BMI rose from 27 to 29. It seems pretty simple to us: Obesity/Poor diets leads to atherosclerosis/hypertension, which leads to strokes.

Wall Street Journal:
Drug Prices Surge Despite Criticisms On Campaign Trail– This is an excellent article from the Wall Street Journal, which is rapidly becoming my favorite source for medical business information (NEJM will always be tops for actual medical information). I could write a long summary, but I think this paragraph from the article sums it up pretty well:

Pharmaceutical companies increased wholesale prices for the 50 top-selling branded drugs by an average of 7.82% in 2007, after increases of 6.73% and 6.22% in the previous two years, according to Delta Marketing Dynamics Inc., a health-care marketing research company. The most recent increase is almost double the overall U.S. economy’s 4.1% annual inflation rate last year.

The article goes on to suggest some of the reasons including the coming loss of patent protection on some drugs along with the more-interesting attempt to shift demand to a company’s other products that have longer patent protection. This article is definitely worth reading.

Florida Gov. Pushes for Cheaper, Limited Health Insurance– Not wanting to get left behind the other governors who are pushing their own versions of universal health care, Florida governor Charlie Crist has proposed his own version. I suggest that Charlie should go back to the drawing board. Some of the gems from this plan: “one proposed plan wouldn’t even cover hospitalization” and “insurance companies in Florida would be required to sell the cheap plans to anyone who applies — a rule that the industry says could draw lots of sick patients and drive prices up”. The one thing we will commend Crist on is that he is looking at getting rid of certificate of need rules, which hopefully would lead to increase competition driving down prices.

Health Questions for the Candidates– Betsy McCaughey poses some interesting questions for Hillary Clinton and Barack Obama in advance of the March 4th Texas Democratic primary.

Links of the Day: February 20, 2008

February 19, 2008

Yahoo! News:
Hospital ‘code blue’ deadlier at night– This article basically says that if you could pick a time that you definitely don’t want your heart to stop it would be the night shift. The article goes into pretty good detail about possible explanations: fewer staff members or more tired staff. I can definitely understand these as I saw it during my rotations. Unless you have worked consecutive 80+ hour weeks it’s hard to understand how tired you are at 2 AM when someone comes in.

New York Times:
Gentlemen, 5 Easy Steps to Living Long and Well– “The behaviors are abstaining from smoking, weight management, blood pressure control, regular exercise and avoiding diabetes.” Basically, don’t smoke, eat less, and exercise more. As much as the Times (and the authors) would like to make this a big deal, I think this can be applied to the general population. It’s something I always tell people when they ask me for medical advice.

Wall Street Journal:
Glaxo Cuts Prices on AIDS Drugs for the Poor– GlaxoSmithKline has continued its policy of cutting HIV drug prices in third world countries. Not to criticize GSK because this is completely tangential, but as great as this is in terms of PR, I wonder when people will put more focus on eliminating the behaviors that cause the spread of the disease. Without education and proper infrastructure to support those initiatives, the number of people with HIV/AIDS in developing countries will continue to rise (due in part to a statistical twist as these drug programs increase lifespan for HIV/AIDS individuals leading to higher prevalence).

Early Adopters Warm to Retail Clinics, But Public’s Still Cool– We at Health Care Watch have been staunch advocates of in-store clinics and it appears that there is enough demand to sustain the current batch and allow for future growth. However, as one of the commenter notes the post looks at a survey and there can be a big difference between a survey response and real-life decisions. We will continue to follow this story as we think in-store clinics could be a key driver in bringing down health care costs.

Links of the Day: February 18, 2008

February 19, 2008

New York Times:
A Rip-Off by Health Insurers?– A recent study by the New York Attorney General’s office suggests that health care insurance companies have been ripping off everybody (patients and providers). Essentially they found that Ingenix, a company owned by UnitedHealth Group, is used by UnitedHealth Group to determine what they should pay out-of-network physicians. As the article states, this creates an incentive for both companies to keep reimbursements low. One of the fascinating things that Ingenix does is to combine charges for procedures/activities done by NPs and PAs along with those performed by MDs and comes up with an average cost. In a health insurance version of CYA, Ingenix states that the fees are “for informational purposes only”. The article has a little more detail about this so I think it’s worth a read.

Fighting Bedsores With a Team Approach– I’m amazed that this requires a New York Times article, but it’s a fairly serious issue despite how little attention it gets in the hospital. Patients shouldn’t get “bedsores” (aka pressure ulcers) if people on the team are actually paying attention. The article is fairly comprehensive (for a newspaper) in listing the causes of bedsores, but I think another key point is that patients and their families should be aware of this and check/remind the nursing staff when they visit.

Yahoo! News:
Study: Gel fails to stop HIV infection– Another blow to the fight against HIV/AIDS although I am not sure how promising this product was since it doesn’t seem that different in theory than what is used in condoms. The negative result may have been due to the low compliance rate by the test subjects but I think that portends a lack of compliance by potential users if the product was marketed.

Medicare won’t pay hospitals for errors– This talk has been out there for a while so I’m not sure why this is “news”. Perhaps it is new to Medicare. I’m not sure, but anyways it seems like a good idea to use money as an incentive to cut down on medical errors.

Wall Street Journal:
Internists Tell Feds to Lighten Up on Marijuana– This message brought to you by Dr. Cheech & Chong. . .The American College of Physicians is putting some pressure on the federal government to reclassify marijuana by acknowledging its medicinal value. Some of the comments by the readers of that blog are interesting to say the least.

Links of the Day: February 17, 2008

February 17, 2008

It’s been a while since the last post, but I’ve been pretty busy.

Boston Globe:
1 in 10 patients gets drug error– The title basically says it all particularly with the way this study was conducted. One of the conditions for the 6 community hospitals included in the study was that they would not have their name released. The article states the importance of computerized physician order entry (CPOE) systems, which isn’t groundbreaking, but perhaps this will provide some impetus for the government to subsidize the cost of some of these systems since they aren’t economically feasible for many community hospitals or small practices.

New York Times:
China Didn’t Check Drug Supplier, Files Show– Score another for Lou Dobbs and his minions. The Baxter heparin fiasco continues with the revelation that the offending Chinese plant did not have drug certification so the national body did not inspect it. Surprisingly, Baxter hasn’t gotten killed in the stock market yet. It’s declined a little, but not the free-fall that one would expect.

Yahoo News:
Obesity boosts cancer risk, says health review– I love descriptive titles. Basically, a new study found that an increase in BMI is associated with an increased incidence of cancer.

New drug can treat alcoholism: study– Get ready for some direct-to-consumer advertising as a new study found that Revia reduces stress-induced cravings for alcohol. This could offer a solution as many people fall off the wagon when they are under stress.

Links of the Day: January 30, 2008

January 30, 2008

New York Times:
Great Drug, but Does It Prolong Life?– An pretty good review for a mainstream media source on whether statins decrease mortality in the patients who take them. The answer may surprise you.

Kidney Thefts Shock India– This seems like something out of a bad horror movie, but almost 500 Indians have reported that they had their kidneys illegally removed. This will certainly be a news story for not only the human rights issues, but also for those who contend that certain plans that aim to increase the rate of transplants will spur illegal activity like this.

Yahoo! News:
Cold meds send 7,000 kids to hospitals– The headline pretty much says it all here. The only other thing of note in here was that 2/3 of these 7,000 kids took the medicines unsupervised.

Hand gels alone may not curb infections– A new study is calling into question the effectiveness of those alcohol-based sanitizers you see all over the place. I don’t find this particularly surprising as I never really considered these methods particularly thorough, but when you have to see 25 patients cutting off a few minutes per patient might seem like a reasonable thing for some.

Costs for elderly diabetics on the rise in the U.S.– Nothing particularly earth-shattering here, but some new figures about diabetes that may surprise you.

New flu vaccine may not need needles– Good news for those of you with a fear of needles. A team of Korean researchers has been experimenting with ways to deliver a flu vaccine without using a needle. There is still a long way to go, but this seems like promising work. It would certainly be a huge boon in pediatrics.

Wall Street Journal:
Wal-Mart Clinics Close in 23 Stores– Well this should certainly add to the Massachusetts in-store clinic debate. . .New York-based CheckUps has closed 23 of its Wal-Mart based in-store clinics in Florida and 3 other southern states. The article doesn’t say whether this was due to failure of the business model or poor financial decisions. The comments by readers show the wide divide in this area.

The Art of Measuring a Doctor’s Quality– Blog post that raises the issue of how we evaluate doctors. The author doesn’t say much here, but it is an interesting point for discussion.

Boston Globe:
British journal retracts article by Harvard author– Some fallout from an article we previously listed in yesterday’s Links of the Day as a British medical journal retracted a review article about rheumatoid arthritis by a Harvard doctor. We wonder if Harvard will react firing Dr. Lee S. Simon, the offending doctor, or just sweep this under their $34.9 billion rug (subject to crash depending on recent investments).

Links of the Day: January 29, 2008

January 29, 2008

This should have went up yesterday, but unfortunately I had something come up (a 4 hour afternoon nap to catch up for a lost weekend). 

Boston Globe:
Journal investigating duplication allegation against Boston researcher– This particular post focuses on a Boston researcher who is accused of duplicating large portions of a research paper with work done by someone else. The commentary in Naturesuggests that 0.2% of papers were suspected of plagiarism, but as much as 10.5% of suspected duplications involving the same authors. Perhaps this is motivated by a desire to pump out publications to boost their ego as many academics love to talk about how many papers they have published or perhaps it just comes down to money (grants and tenure).

New medicine for what ails hospitals– A look at how hospitals in and around Boston are using process improvement techniques to improve hospital efficiency. Hopefully more hospitals look into this because I have found that hospitals are maddeningly inefficient (and yes, that’s even when I am on the team).

Project to reformulate children’s medicine launched– A non-profit has decided to reformulate children’s medicines to make them safer/more effective. Not much to say here, but still noteworthy.

Yahoo! News:
Cervical cancer vaccine cost-effective: EU agency– This article is almost a week old, but I thought it was interesting as an EU agency determined that the HPV vaccine (both Merck and GlaxoSmithKline have products) is cost-effective against cervical cancer. Britain, France, Germany, Austria, and Italy have already instituted vaccination as part of their national health programs. The current report recommends that girls should receive the vaccine between 12 and 15. I’m not sure how this recommendation will play out in Europe given the outcry from conservatives when the issue was brought up in the United States earlier.

New York Times:
Really? The Claim: Too Much Cola Can Cause Kidney Problems – Another interesting piece out of the NY Times where that looked at a recently published studythat analyzed the relationship between cola consumption and kidney problems. The group found that increased consumption (2+ per day) of colas, which contain phosphoric acid (linked to kidney stones and other problem), increased the risk of chronic kidney disease by 2.3 times.

California Governor’s Plan for Health Care in Trouble– It looks like The Terminator’s health care plan has run into some resistance in the California legislature. Already $14.5 billion over budget, the legislature is poised to reject the proposed universal health care plan. Some of the listed reasons include shifting the cost burden to individuals rather than companies, fighting between the Republicans & Democrats, and political issues (increasing the cigarette tax and offering coverage to illegal residents).

Links of the Day: January 25, 2008

January 25, 2008

Pretty slow news day, but here is what’s out there.

Boston Globe:
Vytorin makers sued over marketing– A suit brought in the name of a 72 year-old grandmother (read: a lawyer she knows or her children) claims that Vytorin essentially overcharged the woman based on claims that Vytorin was more effective than generics. Not surprisingly, most of these charges were paid for by Medicare and the VA. Obviously, she didn’t pay that much money. I have a feeling that if “she” wins this case, most of the money will go to the lawyers, who are looking to make this a class action suit.

New York Times:
Wal-Mart Says More Than Half Its Workers Have Its Health Insurance– After being ripped apart in the media, it appears that Wal-Mart is becoming more aware of these issues. According to this article, 50.2% of its employees are in the company’s health insurance plan and 92.7% have some form of health insurance (including Medicare). Perhaps, the Democrats should look to Wal-Mart if they want to institute universal health care in the US. . .

Health Care Up to Public, Edwards Says– It looks like the New York Times is going to be doing a series of articles on the candidates and their positions. This particular one is about John Edwards and his views on health care. I think this could be an interesting way to examine the candidates instead of just relying on videos going viral on YouTube or having some political pundit try to sway you with his/her rhetoric. In addition, a full text of the interview is available.

Links of the Day: January 24, 2008

January 24, 2008

We’re back finally after issues with Lenovo/China’s Evil Empire and a case of laryngitis (actually both still ongoing, but other computer manufacturers make machines that work and I can type even if I can’t speak). Today’s posting will be relatively short because I’m doing this in the middle of class (review of supply/demand curves).
Cost of health initiative up $400m– It looks like the much-discussed (see almost every other Links of the Day) Massachusetts universal health initiative is running into more problems as the new projected costs have gone up by $400 million for next year.

The biggest driver of the cost increase is projected growth in the number of people signing up for state-subsidized insurance, which now far exceeds earlier estimates.

State and federal taxpayers are expected to bear nearly all of the additional cost.

Governor Deval Patrick, known for his ambiguous “Together We Can” motto and expensive curtains and cars, does not seem concerned with this as he has a source of funding (taxpayers, a very innovative idea), but other policymakers are less enthusiastic about it. The proposed funding increase needs to get legislative approval, but that shouldn’t be a problem in Massachusetts. The original intent of the plan was to bring down the costs of caring for a group that was uninsured at the time. Unfortunately, that has not been the case. For some reason, I think Obama and Clinton(s) will conveniently leave this part out of the universal health care discussion. . .

Wall Street Journal:
Doctors Paid To Prescribe Generic Pills– Do you remember that your physician tried to switch you from a name-brand drug to a generic? Well, he/she may have had some incentives other than the fact that they should be fairly similar (we will make a generic drug post at some point). Some insurers have been paying MDs $100 for each drug they switch from name-brand to generic. It’s an interesting article that talks about the arguments from both sides although I’m sure you can guess that one side argues that it creates improper incentives.

Can Health Access Improve Without More Docs, Nurses?– Interesting argument from AMN Healthcare that the candidates are ignoring the supply part of the health care equation. It seems to me that if we increase the number of providers (assuming they are well-trained) we can create enough competition among them for patients to drive down their prices. The other similar solution would be for physicians at academic institutions not to spend an hour with each patient so they can say they dig into the deep social issues in their patients lives. That way they could see more than 5 patients in an afternoon. Actually, since I’ll be charging people money for my recommendations in a couple years perhaps we should keep the current system and cost structure. . .