Tag Archives: health & medicine

adventures in ethics

An influential psychiatrist who was the host of the popular NPR program “The Infinite Mind” earned at least $1.3 million from 2000 to 2007 giving marketing lectures for drugmakers, income not mentioned on the program.

What could possibly go wrong with that? Or with this:

Dr. Goodwin’s weekly radio programs have often touched on subjects important to the commercial interests of the companies for which he consults. In a program broadcast on Sept. 20, 2005, he warned that children with bipolar disorder who were left untreated could suffer brain damage, a controversial view.

“But as we’ll be hearing today,” Dr. Goodwin told his audience, “modern treatments — mood stabilizers in particular — have been proven both safe and effective in bipolar children.”

That same day, GlaxoSmithKline paid Dr. Goodwin $2,500 to give a promotional lecture for its mood stabilizer drug, Lamictal, at the Ritz Carlton Golf Resort in Naples, Fla. In all, GlaxoSmithKline paid him more than $329,000 that year for promoting Lamictal, records given to Congressional investigators show.

What possible part of any of that was even remotely ethically acceptable to Dr. Goodwin?

Prescription Drug Management

Although I’ve been on what amounts to the injured-reserve list for Serious Academic Researchers, I follow developments in my fields, particularly medical ethics and technology. While the August 4th Washington Post article, “Prescription Data Used To Assess Consumers – Records Aid Insurers but Prompt Privacy Concerns” contained no new information for me, it reminded me I just got another idiotic letter from the prescription drug managers for our health insurance plan. I get these letters every couple of months. You probably do, too, if you fill prescriptions at a brick and mortar pharmacy.

The letter cheerfully tells me how much I can save my using mail-order instead of my local pharmacy, and then it usually lists the 4 or 5 drugs I take according to their records. Usually between 1 and 3 of the drugs listed are correct. These drugs also aren’t available through their mailorder service, which I know because I always call about the letter and they tell me I can’t mailorder, as if it were my idiotic idea to try to order them in the first place. The other drugs on the list are usually ones I’ve never even heard of, let alone taken.

I’m sure I’m not the only one this happens to. It isn’t just irritating, it could have a profound impact on our lives, particularly since this data is increasingly available to prospective insurers, life insurers, prospective employers, and the Federal Government. Additionally, a person’s access to health insurance or life insurance or whole fields of employment doesn’t just impact them, it impacts their entire family.

I’m reminded of a lunch at a conference a few years ago. One of the (European) participants at the table mentioned what a vital tool it would be to compile a list of all individuals in the E.U. with “Arab-sounding” names who take anti-depressants (which are, incidentally, described for a wide range of conditions). Presto! Instant watch-list of potential suicide bombers. Chilling. The Americans at the table seemed to feel that this would never happen in the U.S. because of our privacy rules. The sad part was, these were people who should know better, which makes me feel rather hopeless about whether the average person will understand the path we’re on before it’s too late.

In February, the Federal Trade Commission issued an order saying that MedPoint and IntelliScript are consumer reports under the Fair Credit Reporting Act, so the companies must notify insurers that consumers denied insurance on the basis of these reports have the right to request a copy of the report and that errors be corrected. The FTC’s order followed a settlement of allegations that the companies violated the credit-reporting law by failing to provide such notice to insurers.

Bob Gellman, an independent privacy consultant in Washington, said the FTC’s decision not to fine the companies sends “the message that it is okay to ignore the law.” That, he said, “is absolutely outrageous.”

As more health records become electronic, he said, more parties will compete to sell more comprehensive patient data to insurers, driving down data prices. “It will all likely be lawful,” Gellman said, “but consumers will likely continue to have no real meaningful choices if they want insurance.”

Consumer groups have got to speak up and speak up soon about creating a mechanism to audit and correct this kind of data. The unfortunate thing is that, in order to correct an insurance record, the pharmacy needs to be contacted and the doctor or doctors needs to be contacted to confirm a drug was or wasn’t prescribed. Many doctors will find a way to bill this, probably to the insurance company, who will find some way to hold the consumer accountable for the charge for an action that is necessary to clean up their data in the first place.

Someone needs to put this issue into plain language and start a serious national conversation. It’s ever-so-slightly heartening to see articles on the front page of the Post, but that’s not enough to effect change.

I'm willing to believe anything I read

Mice given the equivalent of six to eight cups of coffee a day were less likely to develop a disease similar to multiple sclerosis, a study found.

Researchers hope this could lead to new ways to prevent MS in humans.
The Proceedings of the National Academy of Sciences journal reported that the caffeine appeared to prevent nervous system damage.

See, I told you coffee was an essential food group.

concierge medicine

None of my doctors accept or file insurance, although I get reimbursed by my insurer without any problems. These practices have fee schedules, same day appointments, use email, and assure the patient a 30, 60 or 90 minute appointment. These are not concierge practices, thankfully.

It terrifies me to think about the ripple effect that more and more doctors converting their practices to “concierge” practices will have as more and more doctors with a true patient-focus leave the insurance system – and the poor and least healthy – behind. Concierge medicine, where you pay 25 grand to “join” a practice? That I find seriously troubling, but not surprising in our Market-crazed society. I think that kind of service would have evolved regardless of the HMO situation.

It would figure that now that media attention is on concierge care it doesn’t seek to address the underlying managed care issues that drive doctors to do this, but rather looks at the impact on the insurance companies.

WebMD actually looks at some of the serious implications of this issue in a clear way in Lawmakers Look at ‘Cash-for-Care’ Boutiques: Cash-Only Clinics Avoid Regulations, but Could Undermine the U.S. Insurance Market.

I’m quoting the end of the article because it sums things up nicely:

Some policy makers — mostly republicans — like the way that cash-only medical practices simplify care for doctors and patients. Many, including President Bush, want to expand the use of tax-exempt medical savings accounts that would allow consumers to put money away and spend it later on boutique services of their choosing.

But that policy worries critics, who see the accounts and the boutiques as steps toward a divided health care system where wealthier people can afford to pay cash for better care, leaving everyone else to the mass insurance market. Even worse, they say, the boutiques and specialized plans to pay for them tend to attract healthier people, leaving only the sicker — and more expensive — patients to HMOs and the government.

“‘Concierge care’ is kind a new country club for us rich folks,” says Rep. Fortney (Pete) Stark, a California democrat. “We don’t have to sit around with the riff-raff,” he said.

Almost everyone who spoke on Capitol Hill agreed that the U.S. health system’s financing is rife with waste and that costs are rising beyond control. And most agreed that for some patients, being able to shop around for the best prices for a CAT scan or a mammogram could lower costs.

But Robert A. Berenson, MD, an internist who is now a senior fellow at the Urban Institute think tank, warned against promoting boutique care as a cure-all for the health system. He told lawmakers that Medicare spends 79% of its money on patients with four or more chronic diseases.

Letting people shop only for the care they want would just make it harder to insure those ill people, he says. “It would not make a dent in what is driving our health care spending, which is really spending on the very sick.”

Still, others see the trend as a way to return doctor visits to the days before patients were rushed out the door after seven minutes. “[It’s] an older style of medical practice, a patient-focused approach that used to be the norm,” says Utah republican Sen. Robert F. Bennett.

It seems obvious that the solution is to take a good hard look at the managed care system, but instead I’m sure we’ll somehow end up subsidizing a system that discriminates, denies people basic health services, and deepens the caste system in our country.