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?”
My discussion of the reporting on the extremely high rate of major spinal fusion surgery in Louisville has generated its own follow-up. On Jan 17, Courier-Journal reporter Patrick Howington contributed a front-page article about the legal battle of five Louisville orthopedic surgeons over an estimated $60 million in royalty fees.
Wow! The Chamber of Commerce must be proud. This is the kind of big-time health care and research money on which Louisville’s city fathers, and its business and university communities have pinned their hopes for the future. So why am I embarrassed over this? Should I be? Would I be if the money were coming to me? I think there is plenty of embarrassment to go around.
It is embarrassing for me as a physician to see other physicians fighting so publicly over money. While certainly within their legal rights, this dispute over money by these professionals reminds us that even for physicians, the practice of medicine is at its base a business. There has always been an inherent tension in the patient-physician relationship: what is best for the patient may not always be what is best for the physician. The professional ideal resolves any such conflicts in favor of the patient. As more and more outside players insert themselves between and around the patient-physician relationship, the vectors of tension become more complex and more difficult to resolve. I predict we will increasingly appreciate such policy difficulties as the structure of our healthcare system changes. Our debates over capitation, managed care, or physicians as employees provide examples where the nature of the patient-physician relationship has been tested. During the last year in Louisville, several prominent contract battles between insurance companies, doctors, and hospitals continues to disrupt the vulnerable contract between patients and their physicians. Continue reading “Battles Royale in Louisville”
On the second day of the new year, the front page of the Courier Journal highlighted the fact that one of our local hospitals was third in the United States in the number of spinal fusions performed. Since the Louisville business community has identified generating healthcare revenues as a top long-term strategic priority, the headline could easily be interpreted as a success story. However, the full-page article by John Carreyrou and Yom McGinty reprinted from the Wall Street Journal was not very flattering. (The article is not present on the Courier Journal website, but is available on the Wall Street Journal’s.)
The article emphasized the multibillion-dollar annual market and the medical controversy over when and if this extremely expensive major surgery should be done. Also highlighted were the large amounts of royalty money paid by the manufacturers of surgical equipment directly to surgeons who make the decision to operate. The article reported that five of the surgeons at my local hospital received more than seven million dollars in less than a year from the manufacturer of the implants used in the surgery. This was in addition to the clinical charges billed. It was reported that total Medicare reimbursements for spinal fusion at my local hospital were almost $48 million. The article proposes, and I and would have to agree, that the amounts of money involved are enough to distort the medical decision-making process. Since the hospital and doctors involved are part of our academic medical center, one might also reasonably assume that young physicians in training will perceive these activities as the standard of care.
There is not room here today to summarize the medical literature pertaining to spine surgery for disc disease and arthritis. Suffice it to say, most national organizations of general physicians and rheumatologists are arguing for fewer operations than in the past. In my own career as a rheumatologist, I personally recommended spine surgery for only three patients with arthritis. It is possible for you to suspect that I think too much spine surgery is being done in general. The hospital and doctors involved will likely offer their own explanations: indeed I think they will need to.
What I do want to talk about today, is the methodology that brings such observations to the forefront. It has been called study of “small area variations.” You see these kind of studies all the time. They were popularized by Dr. Jack Wennberg and the group at Dartmouth. I have always been drawn to this approach because the mapping of results appeals to my visual sense. For example, here is one of the earliest health policy studies I ever did. Continue reading “Area Variation. Is Doing the Most a Good Thing?”
Has anything in health care improved for the better for us patients… for anyone?
Over 10 years ago as we approached the new millennium I was finishing an intensive Health Policy Fellowship. As a synthesis of all I had seen and learned from an insider’s perspective, I penned a vision of what I thought healthcare should look like in the next century. It was more a statement of some twenty principles and directions rather than specifics. We are now a full decade into the 21st century so it seemed a good time to take a look at my old roadmap. Perhaps it is a measure of my current pessimistic state of mind, but I am not immediately able to declare progress towards any of the goals I envisioned. In fact, it seemed at first blush that despite all the money and best efforts of public and private interests, that most of the items on my wish list were getting worse.
What do you think? Please prove me wrong. Help me indentify something good that has happened to us as collective patients. Is anyone better off? If so, who? Convince me that we are not irreversibly lost in a status quo of decreasing access to healthcare of uncontrollable cost, and of unknowable quality.