Soaring Insulin Prices Highlight Broken Pharmaceutical Policy.

Just business– or greed?  You be the judge.ky-medicaid-insulins-2015-treemap-lg

Discovered and patented almost 100 years ago, insulin is a critical drug for the treatment of both childhood Type I and adult onset Type II diabetes mellitus.  Diabetes is a costly disease for our society in more ways than one.  In 2015, the cost to the Kentucky Medicaid program for insulin alone annualizes to $101.8 million.  Insulin consumed 9.1% of Kentucky Medicaid’s entire non-hospital drug expense while making up only 1.1% of all prescriptions.  In 2013, the last year in which Medicare Part-D drug utilization data are available to me, insulin consumed 7.3% of total Medicare reimbursement for drugs in Kentucky costing a total of $141.8 million.  In both federal programs, insulin consumed a larger portion of the drug budgets in Kentucky than nationally.  A review of several reasons why insulin has become so expensive illustrates what is very wrong with our national drug policy. Continue reading “Soaring Insulin Prices Highlight Broken Pharmaceutical Policy.”

Who Paid UofL’s Legal Bills In Its Dispute With Norton Healthcare?

Why does it matter?

[The University responds. See Addendum and comment.]

The dispute over control if not ownership of Children’s Hospital was a traumatic event for our community. It damaged the reputation of the hospital. The cost of the consequent litigation must also have been great. My guess is that the financial cost to both parties must have been in the millions of dollars.  Although details of the legal strategies are masked behind attorney-client privilege, as a state institution, the amounts paid by the University of Louisville to its attorney, Stites and Harbison of Louisville, are subject to open records inquiry – and so I asked. What I learned was both surprising and of concern. Even with heavily discounted legal fees, the cost of their confrontational and ultimately unsuccessful initiative was more than the University anticipated.  Additionally, the bills provide insights  into the internal financial management of the University.

In short, the University admits to paying for only about one third of the many months of formal court proceedings itself, all of which were within the first 15 months of a 29 month period. The University has not yet been willing to disclose where the money for the majority of billing periods came from, or who wrote the checks. I have been dependably informed, but have not yet confirmed, that the money came from the University of Louisville Foundation and University of Louisville Physicians, Inc. (ULP).  This litigation came at a time of considerable turmoil at the University of Louisville, including the turnover of senior administrative personnel.  It is possible to speculate that lack of consensus over the University’s path in this matter played a significant role.  How this litigation was directed and financed offers a window into the administrative and financial workings of the University and illustrates the background from which today’s lack of confidence in the presidency of Dr. James Ramsey arose. Continue reading “Who Paid UofL’s Legal Bills In Its Dispute With Norton Healthcare?”

Only 24% of Reporting UofL Faculty Support President James Ramsey.

Many fewer supporters in undergraduate units.
Re-boot of reputation desired.

I attended the Wednesday meeting of the Faculty Senate of the University of Louisville where the most anticipated topic on the agenda was the upcoming vote of no confidence in the leadership of James Ramsey by the Board of Trustees.  At an earlier meeting, individual senators were asked to discuss with their fellow unit faculty how their representatives – and in particular their faculty appointee to the University Board of Trustees – should cast their official votes.  In summary, only 24% of the faculty whose votes were reported recommended that the faculty trustee oppose a vote of no-confidence.  Reciprocally, 64% overall recommended a vote of no confidence, and 11% abstained from giving an opinion..

The discussion of a vote of no confidence was originally planned for a closed session limited to only senators and from which from which both news media and other faculty were to be excluded.  Apparently because of objections from the American Association of University Professors and number of faculty members (including me), the discussion was held in public in front of at least three or four television cameras and an unknown number of reporters.  Approximately 50 of the 64 Senators were in attendance and about 28 guests also signed in.  In the time available, only senators were recognized to speak.  There is no doubt that the public nature of the discussion altered its conduct and content.  A few senators noted they were uncomfortable speaking before the cameras, and concerns about retaliation were in evidence.  Most senators present remained silent during general discussion.  Those that did speak were polite, respectful, and earnestly honest.  Most of their comments have been rather fully quoted elsewhere, some with video,  and I will not repeat them here. (I recommend the Courier-Journal.  WDRB-Television . Insider Louisville.  WLKY-Television.)  Individuals spoke up both for- and against recommending a vote of no-confidence.  A minority of commenters were supporters of President Ramsey, a handful ardently so.  In my view, the more convincing arguments were made by those who believe that President Ramsey has been unable to reverse the cascade of worse-than-unfortunate events that is dragging the University down, and would be to unable to turn things around and take us into a better future. Continue reading “Only 24% of Reporting UofL Faculty Support President James Ramsey.”

Yesterday’s Explosion of UofL News.  Not All Good.

Do things always have to get worse before they get better?  When then can it ever end?

Yesterday was a busy news day for the University of Louisville.  While I was writing my own article in the afternoon, every journalist in town who has been following the drama within UofL’s administration these past many months was publishing new material!  I envy their information gathering network and their ability to publish something virtually every day.  Nonetheless, it appears that I was prescient with my own comments.  In truth, I would like to think I have been stirring the pot a little.  I will take the liberty of stepping through some of the points I made yesterday as a framework for catching up.

Headlines in today’s issues of the Courier-Journal by Andrew Wolfson, Insider Louisville by Joe Sonka, and WDRB Television by Chris Otts include the following:

  • The settlement between the Justice Resource Center and a variety of other parties over the statutory racial makeup of the Board of Trustees was made public.  This appears to turn upside down the timetable of any discussion of a vote of no-confidence in President Ramsey for both the Faculty Senate and the Board of Trustees.  The process of appointing new minority trustees has been initiated.
  • The agenda of next Wednesday’s Faculty Senate meeting makes it official that the Senate leadership intends for its discussion of the no confidence vote to be held in secret.  This has elicited criticism, including from me.
  • Governor Bevin has unilaterally acted to decrease current state funding to universities by 4.5%.  This move was followed immediately by a declaration from the Attorney General that such a move was illegal and that his office would file a lawsuit to reverse it.
  • Acting University Provost Professor Neville Pinto was named as the permanent University Provost following a limited internal search, also drawing faculty criticism.
  • President Ramsey’s crisis management team continues to put out puff-pieces in an effort to offset continuous bad press.

The downside of all the above is that the University will be drawn out further in its institutional agony.  The upside is that additional time has become available for a systematic, transparent, and reliable survey of the faculty concerning their opinion of the leadership of President James Ramsey.  I will elaborate on this new information below. Continue reading “Yesterday’s Explosion of UofL News.  Not All Good.”

What Does the Faculty Think About UofL President James Ramsey?  Does It Matter?

April is the cruelest month.

It is going to be a busy and certainly controversial month at the University of Louisville.  On April 6, the UofL Faculty Senate – the highest governing body of the University’s faculty – will have its last scheduled meeting before the meeting of the Board of Trustees later this month on April 20.  At the Trustee’s meeting, the Board will re-consider its postponed vote of no confidence in the presidency of James Ramsey.  An aborted effort last March 1st to proceed with such a vote was aggressively blocked on procedural grounds by longtime Ramsey supporters.  I am told that the President’s Office has retained an expensive outside crisis-management consultant.  (I wonder who is paying for this, don’t you?)

Those who have declared their intention to cast a vote of no confidence are being categorized as “dissidents.”  Demonizing one’s opponents is a strategy often resorted to when other arguments prove insufficient. We see examples in the papers every day. I am forced to ask, how can a majority or even a near-majority of the Board be called dissidents?  Would it then follow that if President Ramsey does receive a vote of no confidence, that his supporters would be the dissidents?  I have listened to the language used by both sides.  In contrast to the professional, restrained, and respectful language used by those Trustees unhappy with the current direction of the University, Ramsey’s supporters are becoming even more shrill resorting to personal character attacks. These smack of desperation.  I am not alone in this perception.

By accounts, the vote will be a close one.  Not every one of the 20 trustees has expressed how they plan to vote.  None of the three trustees representing faculty, staff, or students has done so.  It even remains possible that Governor Bevin will name two new trustees who would then be asked to vote on the President’s performance even before they had their required orientation, and certainly before they had any opportunity to observe events as a Trustee. I cannot find evidence that the Postsecondary Nominating Committee has begun their statutory process, but obvious Ramsey supporters are already standing in line to be noticed. Stacking the Board with Ramsey supporters would be a bald political move that would only perpetuate the current weakness of the University’s position. Using the excuse that the Board is illegally constituted to support Ramsey in his understandable efforts to hang on is hypocritical in the extreme. Continue reading “What Does the Faculty Think About UofL President James Ramsey?  Does It Matter?”

Legislative Tinkering With Needle-Exchange Program: Bad Idea.

hep-c-reported-ky-2013I learned today that the Republican-controlled Kentucky Senate passed a bill that would prohibit health facilities that currently run needle-exchange programs from giving out more needles than they receive from the substance-addicted people participating in the program.  Only “one-for-one” exchanges would be allowed. The primary goal of any needle-exchange program is to prevent the spread of hepatitis, HIV, or other blood-borne infection that occurs when iv-injecting drug users share their equipment.  Whether or not a program is successful is measured by changes in new infection rates.  Kentucky could use a little help in that department. As of 2013, for at least the previous 4 years Kentucky led the nation in new reported cases of Hepatitis-C.  That is not a place we want to be, including for reasons I will discuss below. The price we pay in gold and human misery is colossal, whether one abuses drugs or not!  The 2013 data set from the CDC is the most recent available to me.  I must assume that things only got worse since then.

Prohibition and moralizing did not work for alcohol either.
It appears that many if not most of the Senate opponents of needle exchange programs in general are driven by puritanical or judgmental motives.  There are certainly valid reasons to try to remove used needles and syringes from public spaces to avoid accidental injury, but that can and should be an independent initiative. The successful needle-exchange program in Louisville has made great progress in approaching a one-for-one exchange rate.  The last thing we need in Kentucky is to have any of our towns or cities follow Austin, IN into the HIV and hepatitis blasted Hell out of which it will take several generations to climb.

Kentucky’s sons and daughters of families of all political parties are today sharing needles and other bodily fluids with HIV and hepatitis virus-infected individuals. One need not be a committed substance-injecting addict to be exposed.  Healthcare workers are also at risk from needle-sticks. Our goal is to keep as many people healthy as we can through both prevention and treatment.  Neither approach is easy, but that is not a reason not to try.  Austin had the same warning we are being given now, but did little or nothing effective to stave off disaster.  We need to do better. Moralizing will not do the trick.  We must allow public health professionals to exercise their professional opinions based on best available evidence. Continue reading “Legislative Tinkering With Needle-Exchange Program: Bad Idea.”

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Emerging Research About Zika Virus.

Not just any virus – Worse on the fetus than we thought!
Abortion debate brought to the forefront.

Medical scientists have been racing to understand the epidemic of Zika virus worldwide but particularly, because of the rapidity of spread and the number of persons infected, in the Western Hemisphere. Much is still unknown, there is no effective treatment or vaccine, diagnostic tests are not readily available, and there appear to be substantial’ morbidities to developing fetuses and adults alike. The disease is known to be spread by mosquitoes, through sexual contact, and probably blood transfusion. It is not surprising that concern over Zika virus is changing people’s travel plans including to the 2016 Summer Olympics in Rio de Janeiro, Brazil.  It is causing aditional and justifiable concern to pregnant women and their partners, especially those without access to contraception or safe abortion. Continue reading “Emerging Research About Zika Virus.”