Lilly’s New Alzheimer Drug Fails Its Major Clinical Trials, But Stock Goes Up Anyway.

In God we trust. All others must bring data.

Yesterday, our local paper reprinted a piece from the Associated Press with the title, “Alzheimer’s drug promising.”  To me, this was a typical   example of what I call “press release medical reporting.”  The question I asked of myself and of the article was,  “how much is being promised.”  In my opinion, the answer is, “not very much,” but to the investment community to which this news release was being reported, it was enough to raise the stock prices of the manufacturer, Eli Lilly.  As a physician, I am not jumping up and down.  As an individual whose family was savaged for over three decades by Alzheimer’s disease, I am annoyed.  Let’s take a look at what is behind this commercial enthusiasm. Continue reading “Lilly’s New Alzheimer Drug Fails Its Major Clinical Trials, But Stock Goes Up Anyway.”

Why Do We Physicians Still Practice So Much Ineffective Medicine?

How Not to Treat Idiopathic Pulmonary Fibrosis.

One of the first things I wrote about on these pages was the importance of having good evidence backing up what we doctors do to people, and how commercial editorial policies of medical journals have at least the potential of denying doctors and their patients timely knowledge of information that might inform their medical choices. I thought of that article again when I looked at one of the several email news summaries I get from various organizations.

One of the highlighted items that caught my eye was a report that “Combination therapy for pulmonary fibrosis appears to increase risk of death [and] hospitalization.” Several of the diseases I used to treat included pulmonary fibrosis and were notoriously difficult to manage. I clicked the “More…” button and was led to this week’s New England Journal of Medicine. The article provides a stunning example of how we physicians still allow ourselves to be led down the garden path of ineffective medical care. Continue reading “Why Do We Physicians Still Practice So Much Ineffective Medicine?”

I Love My Socialized Medicine.

I am less happy with private-sector managed confusion.

As I may have mentioned in these pages before, I am the beneficiary of socialized medicine in America. Yes, your tax dollars, supplemented by my lifetime of Medicare premiums (already spent on someone else) have been paying for my health care for the past year. Fortunately for you, I am in pretty good shape at the present time. Even better for me, the Supplemental Premiums paid into the kitty by my fellow United Healthcare Seniors are now paying my monthly gym fee through the Silver Sneakers program. That’s $30 or more a month I can spend on gin. I for one am in love with government-run socialized medicine.

Regular Medicare was easy for me. Uncle Sam signed me up automatically for the classic plan. It’s the private sector part of Medicare that is giving me fits. Picking a private Medicare supplement to cover copays and deductibles was relatively easy because UofL (my former employer) partially subsidizes only a single program for its retirees, and because of their feud with Humana, does not provide any support for Medicare Managed Care that might provide drug coverage. The University had earlier abandoned their promise to retirees that they would contribute to drug insurance coverage. (Ironic for an institution that aspires to be a drug company itself– or perhaps very smart.) We are on our own for drugs. Continue reading “I Love My Socialized Medicine.”

Kentucky Medicaid is a Mess.

Slow-Payments or No-Payments for medical care.

A week ago I was pretty tough on a possibly hypothetical physician who was said at a Frankfort hearing to have abandoned two child patients because one of the three new Kentucky Medicaid Managed care vendors had not paid him for three months. What is not hypothetical is that the Medicaid system is now in shambles. There are now four independent Medicaid managed care systems in Kentucky plus original Medicaid itself to deal with. Each of these has its own bureaucracy and unique systems. Thats a lot of different hoops for physicians and other healthcare providers to jump through. I have no doubt all are pulling their hair out. By all accounts, all three new vendors are in the pay-slow, pay-low mode. Cynics will point out that this is an easy way for an insurer to make a profit. After all, even Kentucky government uses the gimmick of paying healthcare providers late as a way to balance the books and make it look like they have actually been doing their jobs.

It is easy to assume that the three new managed care companies are to blame. That does not easily explain why all three seem to have failed at the same time, or why they appear successful in other states in which they work. When I worked in Kentucky Medicaid in the 1990s during my first-ever sabbatical and later as a faculty fellow, it was clear to me that there were major inadequacies in the state’s Medicaid computer systems and their ability to transfer and analyze information. I hope things have improved since then. Remember that all information about eligible beneficiaries, hospitals, and other providers has to be transferred to the managed care companies and continually updated so they know who to pay and for what. The three vendors have been silent publicly, but I will bet a martini in your favorite Louisville bar that internally they are struggling to interface with the state’s system. When you consider that each hospital and doctor’s office may also have their own computer system, it is no surprise that Kentucky Medicaid is staggering under its own weight and complexity. I hope we can pull out of this death spiral of cost and confusion. I still expect the state and providers to hold patients harmless, but that cannot continue infinitely. What a mess! Continue reading “Kentucky Medicaid is a Mess.”

Not One Public Penny More for Lipitor®

It is often said facetiously that the true measure of the success of an advertising campaign is that it compels its target to buy something that is not needed.  By this measure, the pharmaceutical industry is the true master of the craft.  What else explains the high proportion of the industry’s budget that goes to advertising and marketing spending more for ads than research!  But that is a subject for some future blog or comment below.  What I will highlight today is the stunningly successful campaign of the industry to induce us to pay $billions for overpriced brand-name drugs when the exact same drug (or one that is as or more safe and effective) is available for a small fraction of the price as a generic product.

What got me going today is the latest of a long series of full page ads in my local newspaper urging me to apply for Pfizer’s $4-CoPay Card that allows me to begin or continue to take brand-name Lipitor® to lower my cholesterol.  The CoPay Card promises an out-of-pocket cost to me of from $4 to $50 per month for perhaps one year.  The savings depends on whether or not I have prescription drug coverage as part of my health insurance, and how low my co-pays are.  As usual, those without any health insurance pay the highest prices.  Those of our neighbors do not have anyone negotiating discounts for them are stuck being billed for the full amount of whatever the healthcare industry thinks it can get away with. Continue reading “Not One Public Penny More for Lipitor®”

Safer to Buy Your Prescription Drugs in Canada?

I clipped an article from the Courier journal in December, 2010 entitled, “Pfizer issues 4th Lipitor recall” that was released by the Associated Press.  Although I had planned to focus on articles from the new year, a subsequent article about a recall of multiple products by Johnson & Johnson made the pair fair game.

The Lipitor recall was the most recent of a series reacting to an “uncharacteristic” odor.  The smell is blamed on a wood preservative often applied to wood pallets that might have been used to transport products.  The article quotes Pfizer that the use of such chemicals in the shipment of its products is prohibited.  (Are we are left to assume that the chemical tainted the pills in some other as yet unknown manner?)

The article goes on to mention that over 360,000 bottles of Lipitor have been recalled so far; that Lipitor is the best-selling prescription drug in the US; that other drug companies such as Johnson and Johnson have had trouble with smelly pills; and that the risk of serious harm from this particular contamination is remote.

The story about Johnson and Johnson is quite interesting.  As reported by Wall Street Journal and other sources,  Johnson & Johnson recalled tens of millions of packages of over 40 different medicines in 2010.     According to Reuters, at least one American Johnson & Johnson manufacturing plant “was closed to fix quality control lapses, including unsanitary conditions.”  The recall has generated citations from federal regulators and criticism by congress because of the “phantom” nature of the recalls.  This is a far cry from the actions of McNeil during the Tylenol poisoning incident in 1982 which brought  the Johnson & Johnson subsidiary praise for its bold and definitive response.

Continue reading “Safer to Buy Your Prescription Drugs in Canada?”