Michael Cannon is hosting Cavalcade of Risk this week and he’s posted a diverse collection of risk-related links at The Cato Institute blog – good end of week reading.
Insurance reform – Is insurance due for a regulatory overhaul? The move to an Optional Federal Charter appears to be gathering steam. To help you stay informed on the topic of insurance reform, Networks Financial Institute at Indiana State University has recently launched an online Insurance Regulatory Modernization resource. It is designed to serve as a clearinghouse for resources relevant to insurance regulation and reform.
Health care debate – Kaiser Family Foundation has compiled Viewpoints: The Health Care Debate. This is a series of interviews with leaders of organizations representing health care providers, insurers, policymakers, employers, labor unions and consumers sharing their views on shortcomings in the nation’s health care system and how it could be improved. Interviews are available in video, podcast or transcript formats.
Prescription promos – Merrill Goozner notes that the pharmaceutical industry is trying to eliminate the practice of showering physicians with gifts and trinkets emblazoned with drug brand names. (We’ve previously discussed promotional efforts based on dining and pom poms.) Goozner suggests the voluntary ban should be broader, and notes that it doesn’t get to the most significant ways that drug companies influence doctors. He suggests additional practices that should be banned.
Kudos to Jottings By an Employer’s Lawyer – Michael W. Fox just celebrated his 6 year blogoversary yesterday – his informative and excellent law blog is one of our regular reads – we’re happy he keeps on keeping on. Congrats, Michael!
Physician humor – although we don’t think it is a medical specialty often called upon for work-related injuries, we can’t resist posting the Colorectal Surgeon Song (video). It’s a silly but amusing ditty performed by popular Canadian comic duo Bowser & Blue.
Posts Tagged ‘pharmaceutical industry’
Cavalcade of Risk and a news roundup
Thursday, July 17th, 2008Big Pharma’s Charity: It’s Better to Give and Receive
Thursday, June 29th, 2006Let’s say someone offers to pay you to do some research about their product. You set up a non-profit research entity and deposit their hefty check. What would your goal be: to prove the product ineffective? to discourage people from using it? Not likely. But how would you determine the extent to which the source of your funds contaminates the research? Would it help clarify matters if the donor gave you some stock in the company and paid you to educate other doctors about their product?
If you like murky waters, you’ll love big pharma’s contributions to the charitable trusts set up by docs around the country. In a fascinating article by New York Times reporter Reed Abelson (registration required), we read that charities established by doctors are the recipients of money to fund research: not research in the abstract, but research pertaining to the use of products manufactured by the donors themselves. This arrangement, while not inherently illegal, is loaded with potential conflicts of interest. Call it business as usual in the world of medicine.
When Charity and Profits Intersect
Abelson writes about Dr. Maria Rosa Costanzo, who made a presentation to cardiologists at a conference in March. She touted a $14,000 blood filtering device, which her research demonstrated was more effective (albeit more expensive) than intravenous diuretic drugs at removing excess fluid from patients with heart failure.
Although outside researchers raised questions about the study’s conclusions, the doctor was convinced. “We believe these results challenge current medical practice and recommendations.” She predicted many patients might benefit. Dr. Costanzo did disclose to the audience that she was a paid consultant with stock in the device’s maker, a Minnesota company called CHF Solutions. But she omitted another potentially important detail: CHF Solutions was also one of the largest donors to the nonprofit research foundation that had overseen the study. The company contributed about $180,000 in 2004.
In addition, Dr. Costanzo did not bother informing her listeners that the nonprofit entity conducting the research, the Midwest Heart Foundation, was in turn an arm of the for-profit medical group outside of Chicago where Dr. Costanzo and more than 50 of her fellow doctors treat heart patients — in many cases using products and drugs made by CHF Solutions and other big donors to their charity. Although the CHF Solutions filter has not yet won wide acceptance across the country, for physicians at Dr. Costanzo’s medical group, it is the device of choice.
If you check out the foundation’s website, you’ll see that they promote their ability to “offer our patients access to the most progressive cardiovascular treatments and preventative strategies, giving them the same opportunities as patients at university hospitals.” In other words, patients can access the latest technologies, even before they have been formally approved by the FDA. As good as this sounds, I would be surprised if the doctors disclose their financial interests to their patients. These patients might have second thoughts if they knew that the research is potentially biased from the outset.
Contaminated Thinking?
The more the Insider probes the decision-making process in medicine, the more questions we have. Why do doctors prescribe some drugs more than others? Why has oxycontin proved so popular among doctors treating workplace injuries? Why do drug companies hire ex-cheerleaders (with no background in science) to sell drugs to doctors? Do doctors think about the potential conflict between their own financial interests and the products they recommend to their patients? The ultimate question, of course, is whether patients are getting the best possible treatment, with the most effective medications, or whether the interests of the patients are subordinated to the financial interests of the doctors.
There are no easy answers. We like to think of charity and good medicine as matters of the heart. But in the world of American medical care, when you scan the doctor’s chest, you just might see something that looks less like a heart and more like a wallet.
States ask drug firms to report gifts to individual physicians
Sunday, February 29th, 2004In an attempt to control rising drug costs, four states – Maine, Nevada, New Mexico, Vermont – have legislation requiring pharmaceutical representatives to report on marketing expenditures to physicians. Ten other states are currently considering such legislation, while six other states have rejected similar legislation.
“The first step state lawmakers are taking is requiring companies to report how much sales representatives are spending and what they’re spending it on. Sponsors of these bills acknowledge that they may not immediately lower costs, but new laws could cause a budget shift with less spent on marketing and more spent on samples, medical education support and research and development.”
While both the AMA and the pharmaceutical industry have had ethical guidelines in place since 1990, some don’t think that these guidelines go far enough when considering the expenditures involved. In 2003, drug companies spent $21 billion on marketing versus $32 billion on research and development.
The Center for Policy Alternatives reports that:
“Drug manufacturers spent more than $16 billion on direct marketing to doctors in the United States during 2001. That amounts to more than $19,000 per physician per year. This money is largely spent on visits to doctors by drug manufacturer sales representatives, called “detailers.” The job of a detailer is to promote the latest, most expensive brand name drugs.”
“Drug companies increased spending on marketing to doctors by 74 percent between 1997 and 2001, according to the U.S. General Accounting Office. The drug industry employed 87,892 detailers in 2001, an increase of 110 percent from the 41,855 employed in 1996. During that period, the drug industry sales force grew from one detailer for every 19 doctors to one detailer for every nine physicians in America.”
More on state efforts to control prescription drug costs and the impact of prescription drug costs on workers compensation.
