The Health Care Blog

HAPPY NEW YEAR

Thanks for reading THCB in 2003. I'm off to see if my knee will hold up to a little gentle snowboarding. See you next week and happy 2004.

INTERNATIONAL/INDUSTRY--British Surgeons' Private Fees Highest in World, really?

And in a fun story at the end of the year, Reuters claims that in their private practice British Surgeons charge the Highest fees in the World. Now I know a little about this given that my father was, until...

TECHNOLOGY: Paying for online consults

This fairly routine article about the very slow growth in online (email) consults had one line that made me sit up and pay attention. The payment obstacle may be lowered Jan. 1, when the American Medical Association creates a reimbursement...

PHARMA: The Cholesterol Wars

This won't be much new news for those of you who've been following the various commentators here on THCB about the war between Lipitor and Crestor, but The Motley Fool website has a good summary of the statin market called...

HEALTH PLANS: HSAs and Doctors Letting Patients Skip Co-Pays

In a bit of end of year silliness I got involved in the comments over at Robert Prather's post at Insults Unpunished about HSA's in the new Medicare bill. There's no doubt that HSA's have a greater chance of success...

THANKYOU

I'll say more in my personal end of year message, but for now, thanks for reading THCB and Merry Christmas, Chunakah, Kwanza or other mid-winter fertility ritual to you! Back next week!

POLICY: Medicaid as the vehicle for Republican health reform?

So please welcome yet another anonymous contributor, this one we'll call Jones the Policy Wonk. The Wonk took exception to my recent post which suggested that "big" health care reform would be absent in the next administration whether it was...

POLICY: First decent Medicare Bill polling data

The first decent poll I've seen on the Medicare bill is out from Harris, and the seniors hate it. No one under 40 has a clue about the bill (really!) but those over 65: --are disappointed it passed by 51%...

HEALTH PLANS/POLICY: Why is the individual market such a mess?

Following my post last week on the individual and small group insurance market, the Anonymous Academic declared some of his political colors by saying this: I haven't followed the situation in California, but I am familiar with the situation in...

POLICY: Dean and Clark's health care plans don't amount to much

Over at Don Johnson's Businessword, he profiles the health care proposals of Democratic front-runners Howard Dean and Wesley Clark. Now my astute guess is that no Democrat could come up with a proposal that Don would like while remaining a...

PBMs: Even the New York Times notices rebate deals are a little odd

As the careful regular reader will note, I've always been hazy on what value the PBM brings to the health care party. My old IFTF colleagues Ian Morrison and Robert Mittman were at least partially responsible for making sure some...

INDUSTRY: Forrester's predictions for the year ahead

If you click on Forrester Research's FirstLook Archive you'll see their predictions for next year and some other interesting stuff. They think this will be the year of the EMR (or at least the start of its mainstream appearance) and...

HEALTH PLANS/POLICY: Health insurance for individuals is a big mess, and HSAs won't help, probably.

Right. A little housekeeping. I've been under the cosh the last week or so, and you'll see some evidence of the massive project I'm working on showing up in TCHB over the coming weeks. I can't tell you exactly what...

PHARMA: NEJM reports that combo therapy works for BPH

The NEJM reports a 5 year study that shows that a combo therapy of Finasteride (Proscar) and Doxazosin works better than either alone on improving the lives of men with an enlarged prostate. Here's the news from the AP if...

PHARMA: The Industry Veteran takes on Crestor and the Anonymous Cardiologist

I didn't think that the Industry Veteran would just ignore the comments from the Anonymous Cardiologist or the Anonymous Academic, and he doesn't disappoint. Unlike the Academic, at least he's convinced that the Cardiologist is a doctor not a Crestor...

PHARMA: More on Pfizer from another new source.

So we've had an industry veteran, a cardiologist and now the Anonymous Academic makes his (or her) way onto the THCB platform to talk about, what else, statins. I barely have to write or think about this subject any more!...

QUALITY/PHARMA: Getting patients to take the right meds is not easy

This post is tangentially related to the back and forth I'm having with DB's Medical Rants about evidence-based medicine. I owe DB a follow up to his post in which I will (hopefully) explain that capturing information about medical care...

PHARMA: Yet more views on Crestor v Lipitor v The Lancet

Ooh, this is getting fun. I have a new mole on the Astra-Zeneca, Crestor, Lancet, Lipitor et al issue that I've blogged about here and here. The story so far is that AZ's Crestor is selling more slowly that some...

PHARMA: Lucky old MedImmune...

A company called Aviron developed FluMist, a nasally-delivered live flu vaccine. My friend (and now top VC) Vera Kallmeyer was the CFO during Aviron's early stage and she rather cleverly did a deal that sold rights to FluMist in Korea...

POLICY: Inciting trouble! RangelMD, Steffi and flying off the handle!

Every so often I run into someone, usually a doctor or someone else in healthcare who should know better, who just loses control when faced with a proposal they don't like about health reform, and it's usually got the words...

POLICY: Private health in the UK muddies the American waters.

I commented in response to a post in DB 's Medical Rants about a piece written by the libertarians at the Adam Smith Institute about private health care in the UK. (Don't worry--they're nice gentle British libertarians with no guns!)....

PHARMA: Pfizer Begins Limits on Sales to Canada

Pfizer is a client of Harris, who I told you last week confirmed my suspicions that seniors in the US were demonizing the pharma industry. Well having said it would act Pfizer is now ignoring Harris' warnings and is putting...

PHARMA: Canadians concerned about tail wagging dog

I had a fascinating conversion with Katherine Binns, my old colleague at Harris Interactive yesterday. I'll relay much more about it anon, but Harris surveys every player in health care in depth often. One thing that is clear from their...

QUALITY: Why doesn't evidence-based medicine happen in practice? Now with UPDATE

I'm involved in a whole scad of research at the moment about why American medical care isn't working as well as it could. Obviously there are many many factors involved, but one of them is the general problem that, in...

INDUSTRY: First Healthsouth sentence is a juicy one

OK. I give in and I'm talking about Healthsouth again. An assistant controller, Emery Harris, gets 5 months at Club Fed and has to pay back $100K in the first sentence of the HealthSouth scandal. Extrapolating up, my guess is...

BLOGS: Health care blogs in the press

Several health care bloggers including me were recently interviewed by the San Antonio News-Express about health care blogging. They were a little upset not to find a Matt Drudge among us, but not as upset as I was not to...

INDUSTRY: HMA fights back

HMA, who's stock dropped 10% on Monday following a downgrade from a UBS analyst (after a great bull run) fought back. In a statement HMA claimed that UBS was retaliating after HMA fired it as its investment bank due to...

TECHNOLOGY: HIMSS' view of what's hidden in the Medicare bill & the UK really starts up

There's quite a bit of tech push buried in the Medicare bill, but it's mostly demonstration projects. Go take a look at the summary by HIMSS and wonder what could be done if just some of the money used to...

PHARMA: $1.7bn R&D for a new drug? Surely you jest, Bainies?

In an study in the news yesterday Bain, the big management consulting firm, said that the cost of bringing a drug to market was $1.7bn. I've heard the $7-800m number many times before and scoffed but this one made me...

TECHNOLOGY: Mass. docs say one thing do another

A recent Mass medical society survey shows that doctors view computers as a necessity for their office work but are not using them much in their clinical care. Slightly more concerningly, despite the fact that overwhelming percentages think that they...

QUALITY: Why are we caring about medical errors now?

In my background for the post last week on paying for Quality, I came across some of the more recent work by Michael Millenson, who wrote the great Demanding Medical Excellence. Millenson is not only a smart guy who tells...

POLICY: Bush signs Medicare bill, declares victory, goes home

Well he went back to the White House anyway.... So the Medicare bill is signed into law, and Bush used the occasion to point out that a poor diabetic who couldn't afford $6,000 in drugs and needles will now only...

INDUSTRY: HMA stock down 10%

Stock in Health Management Associates, a chain of mostly rural hospitals, was down 10% after a downgrade from UBS today. HMA's stock has actually had a decent run up of over 40% since June, and with the Medicare bill favoring...

PHARMA: More on A-Z, Crestor, statins, heart disease . . .

And in a follow-up to Friday's post about Crestor, I was alerted to this interview with Astra-Zeneca President David Brennan in which he claims that Crestor's slower than forecast sales are due to an overabundance of free samples that they'd...

FRIDAY FUNNY: Triumph

Totally off topic for health care, and not at all polite (YES THERE IS NAUGHTY LANGUAGE AND LOTS OF CRUDITY IN THIS) but Triumph the Insult Comic Dog's "I keed" video is a hysterical spoof of the current music scene....

QUALITY: Paying for medical excellence (and I do mean "paying")

One of the best books on health care ever, second only to Paul Starr's The Social Transformation of American Medicine is Michael Millenson's Demanding Medical Excellence. In his tracing of the history of health care quality, Millenson demonstrated how organized...

INDUSTRY/POLICY: It's 1990 again, and the autos want a solution for health care

Back in 1990 when I first got into this health care policy stuff a guy called Walter Maher was going around saying that we needed a government single payer system. Nothing too unusual in that other than Maher was head...

PHARMA: More on Crestor and Astra-Zeneca

One of the great fun things about doing this blog is meeting people via email who have interesting insights. Of course sometimes I feel like an investigative journalist as I can't always reveal my sources. That's the case with the...

PHARMA/PBM: Three tier formularies work

In a New England Journal of Medicine article called The Effect of Incentive-Based Formularies on Prescription-Drug Utilization and Spending a team from Harvard found that three-tier formularies work. Three tier formularies are what PBMs and health plans introduced in response...

PHARMA: Lipitor v Crestor

Forbes is running a wacky poll to see if people think that Crestor can take on Lipitor. Lipitor should hit $9 billion in sales this year. Early indications are that Crestor is struggling but the poll results show some support...

TECHNOLOGY: PSA tests unnecessary, but it's typical for Medicare?

Medpundit points to a new study that questions the use of the PSA prostate test among the elderly. As I learned via Family Medicine Notes, of positive PSA tests, some 7 in 10 are false positives (or at least don't...

INDUSTRY: Employer based health insurance--pay more, get less

Part of the reaction from employers to rising health care costs has been to push more co-payments, higher deductibles and larger out-of-pocket maximums onto employees. This has been viewed as an easier approach than increasing share of premium contribution, even...

POLICY: Health Care Costs 101

Occasionally you see a really dumb article. Not wrong, just dumb. This one in the NY Times last week asks Who Controls Health Care Costs?. It wonders why Republicans would promote private plans as a solution to controlling Medicare costs...

PHARMA: The AMA goes out on a limb on DTC ads

While some doctors have been complaining about DTC ads for a while, surveys show that they don't really mind too much, and that when patients ask for a drug the doctors often prescribe it. Finally the AMA has come up...

INDUSTRY: Tenet suit alive again

It looks like the defamation suit from the CEO of a Tenet hospital is back on. Update: More details here.

INDUSTRY: Tom Scully's had enough

The New York Times is shocked, "shocked!" to find that a senior administration official is going to retreat to a bigger salary in the private sector. Even more amazingly the official concerned is Tom Scully the head of CMS. Frankly...

QUALITY: Helmet doesn't save young skier

A 13 girl died this weekend after skiing into a tree at Alpine Meadows near Lake Tahoe. I'm a very keen skier and snowboarder and, although I wasn't close to dying, I tore 3 ligaments in my knee after snowbaording...

INDUSTRY: Who'll make money in Medicare?

Just to quickly point out that the boost for health plans in the Medicare bill goes into effect next year rather than in 2006, so as the LA Times notes in this article called Medicare Reform May Be a Tonic...

QUALITY: Kaiser cheaper and better than the NHS, says NHS

A study in the BMJ said, apparently with the approval of the UK health minister John Reid, that Kaiser Permanete provided better care than the UK's NHS at better overall value and similar cost! This follows an academic report that...

PHARMA: Statins good but no better than aspirin?

Today's NY times gets very excited about the ability of statins to lower cholesterol and therefore reduce the risk of heart disease. In particular they cite the improvement you get from getting LDL below the consensus "normal" levels. Of course...