brothers

The Backlash Against Pharma and The Role of Disease Management

Readers may recall that several physician-leaders have recently authored an article in JAMA recommending that all professional medical associations gradually reduce pharmaceutical and device support funding - except meeting hall exhibits and journal advertising – to zero.

From time to time in the near and distant past, The Disease Management Care Blog has done business with the pharmaceutical industry. It has found the exchange to be honorable for both parties. On the other hand, while serving on Pharmacy and Therapeutics Committees and while in clinical practice, it has witnessed some troubling marketing activities. The DMCB has no easy answers on what the relationship between medicine and pharma should be, but thinks the proposed funding ban described in JAMA won’t be the final word on the matter. It thinks there’s a backlash underway. Once passions cool, a new equilibrium should emerge.

In the meantime, the DMCB was unsurprised that the proposal described above exempts the medical journals. That’s because physicians ‘can easily distinguish these marketing activities from education presentations and are free to ignore them.’ In other words, leafing through the drug ads to get to the JAMA opinion piece should have little impact on the reader.

The DMCB appreciates the irony and sympathizes with the journals’ wish to reduce their readers’ subscription costs with advertising income. On the other hand, it doubts the sponsors of these ads agree that they have little impact on the very readers that the physician-leaders are working so hard to protect from the pharmaceutical and device industry. While it could be argued that the ad content is regulated, the agency charged with that oversight has a spotty tract record. What’s more, there is evidence that journal ads that pass regulatory muster still fall short.

So the DMCB has a suggestion of its own. Since journal editors know how to edit, perhaps they should apply their skill set to developing a higher standard of truth in print advertising that they accept – such as the prominent display of vetted ‘number needed to treat’ data. Alternatively, they could also consider getting in line and falling on the sword as the professional medical organizations.

The DMCB doubts either will happen. In the meantime, the disease management organizations and Pharmacy Benefit Managers have a continuing role to play in objective, ethical and conflict-free coaching of patients and providers about the risks, benefits and alternatives to the use of medications and devices. Given all the atmospherics, however, perhaps it’s time for the industry to think about developing its own set of standards that are reasonable and free of backlash politics. Given its pedigree, the DMCB thinks it could develop a more balanced approach that could help the rest of health care out of this morass.

more things eating things

Sarasota, Florida, March 15.

Congress Taking a Second Look At Changing the Way Health Benefits Are Taxed--Good--But We Can't Tax Our Way to Health Care Reform

As you have heard me say many times, paying for health care reform is the real challenge. An Obama campaign-style health plan will likely cost at least $1.5 trillion over the next ten years.Until I see some constructive progress on how we pay for health care reform I cannot be optimistic the latest health care reform debate is going anywhere.Where we stand today is that the Congress and the

Health Wonk Review Is Up

The Disease Management Care Blog's fav Yogi adage is "You better cut the pizza in four pieces because I'm not hungry enough to eat six." Learn how that kind of logic applies to the current health policy debate and more at Anthony Wright's latest edition of the Health Wonk Review over at the Health Access Blog.

The 'Is Health Care A Right' Debate: How to Tell Which Side Folks Are On

Maybe it was the wine, but the Disease Management Care Blog had an interesting dinner conversation tonight over the 'is health care a right?' debate. The three physicians, two risk management professionals and a chief financial officer didn't answer the question, but we may have come up with a litmus test to figure out which way people are leaning.

If a person believes it is a 'right,' they'll signal it by believing that there should be a mandated and standard insurance 'benefit' (the package of 'medically necessary' services that are covered, such as annual physical exams, CAT scans, chemotherapy for cancer, cardiac stents and transplants with a standard deductable and a standard network). Part of the current health care reform debate is whether there should be a public plan and if all other insurers should compete on the basis of the price (premium) for that benefit package.

For those that are troubled by casting healthcare as a 'right,' they'll signal it by supporting a widely available but optional and minimum insurance benefit. That won't necessarily cover 'medically necessary' services, but they'll like the idea of providing a financial safety net that protects persons against bankruptcy. The role of the other private insurers here would be to provide additional layers of benefit for those persons that can afford it. Examples include covering hospitalizations and catastrophic care needs only with many deductables and a restricted network, while persons can go out and buy options like cancer screening, check ups, lower deductables and less precertification.

For an example of this kind of debate, look here.

the shape i'm in

Chemo has left me uninspired.

Here is a link to a story ("Cancer labs no closer to national standards: Despite fresh doubts about tests in B.C. and damning report on Newfoundland scandal, efforts to set quality benchmarks are stalled.") from today's Globe and Mail that made me grumpy.

The quality and accuracy of cancer testing can be so uneven and no province has been exempt from error. The feds don't feel they need to take any responsibility for resolving the problem:

Federal Health Minister Leona Aglukkaq declined to be interviewed for this story, but her press secretary said in an e-mail the federal government will not become involved because "the regulation of pathologists and laboratories is a provincial and territorial responsibility."

If I weren't already feeling queasy, I would be now.