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5 posts from June 2013


Pharmaceutical Marketing Abuses: A Conversation With Dr. Adriane Fugh-Berman (July 10, 2013)

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Recently the French government fined Sanofi $53 million for what it called a smear campaign against a competitor drug manufacturer.   Ranbaxy was fined $500 million, in part, for making false statements to the FDA.   Last year the pharamaceutical industry in sum paid out $5.5 billion to resolve fraudulent marketing practices.  These included $3 billion in fines against GlaxoSmithKline (GSK) and $762 million against Amgen.   When these settlements were reached eight of the top 10 global pharmaceutical companies were under "corporate integrity agreements"  (that require companies to report compliance activities via an independent monitor for five years).   With governments recouping only a portion of drug company profits via these marketing practices many say pharma simply views the fines as a cost of doing business.  (The day the GSK fine was announced, the largest of its kind in history, GSK's stock price actually closed up).

During this 23-minute interview Dr. Fugh-Berman discusses the types and pervasiveness of pharmaceutical marketing abuses, the public health consequences thereof, the adequacy of corporate integrity agreements and other efforts that promise to curb abuse (e.g., the Physician Payment Sunshine Act), her views regarding direct to consumer advertising, Pharmed Out's efforts to better educate (or insulate) physicians, patients and other consumers from marketing manipulation.    

Dr. Adriane Fugh-Berman is an Associate Professor in the Department of Pharmacology and Physiology Images[7]and in the Department of Family Medicine at Georgetown.   She is also Director of PharmedOut a research and education project that promites rational prescribing and exposes the effect of pharmaceutical marketing on prescribing practices.  Previously, Dr. Fugh-Berman was a medical officer in the Contraception and Reproductive Health Branch of the National Institute for Child Health and Human Development at the NIH.  Dr. Fugh-Berman is the former chair of, and currently writes a column for, the National Women’s Health Network and she has appeared on 20/20, the Today Show and every major news network.  Dr. Fugh-Berman graduated from Georgetown University School of Medicine and completed a family medicine internship in the Residency Program in Social Medicine at Montefiore Hospital in the Bronx.

For information regarding PharmedOut see: http://www.pharmedout.org/.


The Importance of Advanced Care Planning: A Conversation with Charlie Sabatino (June 28, 2013)

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The lowlight during the 2009-2010 ACA debate was Governor Palin's invention of "death panels" (PolitiFact's 2009 "Lie of the Year") in response to a proposal to allow Medicare to pay physicians whom voluntarily counsel patients about advanced care planning or directives.   The fear mongering was so convincing the proposal was dropped by the Congress and later, via rule making, by the White House.  The facts remain that while far and away most Americans die of a long term chronic, eventually fatal ilness/es, according to AHRQ, Pew and others only approximately twenty to thirty percent of Americans have an advanced directive or a living will including those severely or terminally ill.  

During this 28-minute discussion Mr. Sabatino discusses the importance and benefits of advanced care planning and the various types of advanced care directives (living wills, durable power of attorney, POLST, and others), reasons for our hesitancy in planning for advanced illness and completing directives, limitations (e.g., portability problems) and operational challenges.  He notes specifically advanced care planning is not a one time conversation or a check the box exercise.  He describes what steps are being taken to improve advanced care planning, for example through opportunities presented via the movement towards electronic health/medical records.       

Charlie P. Sabatino is the Director of the American Bar Association’s Commission on Law and Mail[1]Aging where he is responsible for research and education in health law, long‑term care, guardianship and capacity issues, surrogate decision‑making, legal services delivery for the elderly and professional ethics.  He has written extensively on capacity issues, surrogate decision-making and advance care planning.  Mrs. Sabation is also an Adjunct Professor at Georgetown University Law Center, currently serves as a legal consultant to the National POLST Paradigm Task Force and is a board member of the Coalition to Transform Advance Care.  Mr. Sabatino is a Fellow and former president of the National Academy of Elder Law Attorneys.  He received his A.B. from Cornell, his J.D. from Georgetown and is a member of the Virginia and D.C. bars.

For ABA information on advanced care planning and directives see:  http://www.americanbar.org/groups/law_aging/resources/consumer_s_toolkit_for_health_care_advance_planning.html and for Respecting Choices information see: http://www.gundersenhealth.org/respecting-choices.


Dr. William Rogers Discusses Providing Healthcare for the Homeless (June 12, 2013)

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The homeless of course suffer substantial health problems.  The CDC estimates nearly half have one or more chronic health condition (e.g., heart disease, diabetes, cancer), two in five have a mental health diagnosis/es, one-fourth suffer substance abuse, one-third are alcohol addicted.  One 2005 study showed shocking mortality rates, the median age of death was 45.  Over half do not have health insurance - though homeless adults will become eligible in 2014 for Medicaid coverage in states that agree to expand their Medicaid program under the ACA (about half the states) to 133 percent of the federal poverty level ($15,200). 

During this 24-minute podcast, Dr. Rogers explains how/why he became involved in caring for the homeless.  He discusses the magnitude of the problem, explains the purpose and evolution of the Carpenter's Shelter, the services he provides its patients (as well as care he provides for other homeless Alexandria residents), his frustrations when attempting to find provider for patients needing more intensive care, e.g., surgeries, expectations for Virginia in expanding Medicaid coverage under the ACA in January 2014 and what that would mean for Carpenter's.   

Dr. Rogers operates a free medical clinic at the Carpenter's Shelter for the homeless in Alexandria, Virginia.  Dr. Rogers is also the Director of the Physicians Regulatory Issues Team at the Centers for
Medicare and Medicaid Services (CMS) and is also a member of Georgetown University ospital medical staff working in the Emergency Department and teaching residents and medical students.  He too holds the rank of Colonel in the US Air Force and is the Operational Medical Director for the National Park Service, National Capital Area.  Before joining CMS, Dr. Rogers served as the Mail[1] (2)Regional Director for an ED staffing company responsible for four EDs in Virginia employing 50 physicians.  Dr. Rogers is a member of the American College of Emergency Physicians (Fellow) and the federal Emergency Care Coordinating Committee.   Dr. Rogers received his medical degree from the University of Virginia. 

Listeners with an interest in Carpenter's Shelter see: http://www.carpentersshelter.org/.

For more general information see, for example, the National Healthcare for the Homeless Council's website at: http://www.nhchc.org/


The ACA and Hospital Consolidation: A Conversation with Dr. Paul Ginsburg (June 12, 2013)

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In 2009, or the year before the Affordable Care Act passed, the Herfindahl-Hirschman Index (used by the FTC and the DoJ) defined hospital ownership as "highly concentrated" in over 80% of the 380 MSAs (Metropolitan Statistical Areas).  Since passage of the ACA, a law that among other things strongly encourages care continuity and coordination between/among providers, hospital mergers and acquisitions continued unabated with over 100 in the past year alone (and over 500 between 2007 and 2012).  This matters because studies commissioned by the Robert Wood Johnson Foundation and others show hospital market consolidation generally results in higher prices. 

During this 27-minute podcast, Dr. Ginsburg discusses the current state of hospital market concentration and what effect this has on hospital pricing and quality.   He describes the impetus for the ACA encouraging care integration, what effect this has on hospital as well as physician group practice consolidation (both horizontally and vertically), what upsides there are to a less silo-ed industry, effects of similar consolidation within the payer/insurance industry and what are or should be appropriate federal efforts to best regulate mergers and acquisitions within the healthcare industry.   

Dr. Paul Ginsburg is President (and Founder) of the Center for Studying Health System Change (HSC).  The HSC conducts research to inform policymakers and other audiences about changes in
organization, financing and the delivery of health care.  Prior to HSC Dr. Ginsburg served as the founding Executive Director of the Physician Payment Review Commission (now the Medicare Images[1]Payment Advisory Commission).  Dr. Ginsburg was a Senior Economist at RAND and served as Deputy Assistant Director at the Congressional Budget Office (CBO). Before that he served on the faculties of Duke and Michigan State universities.   He has been named to Modern Healthcare’s “100 Most Influential Persons in Health Care” eight times.  He is founding member of the National Academy of Social Insurance, a Public Trustee of the American Academy of Ophthalmology and serves on Health Affairs’ editorial board.  He earned his doctorate in economics from Harvard University.


Tim Jost Discusses State Health Insurance Exchanges (June 3, 2013)

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The centerpiece of the Affordable Care Act are the state health insurance exchanges where individuals beginning October 1st will be able to buy health care insurance with coverage beginning January 1st.   There are numerous questions regarding how and how well the exchanges will function.  For example, how may insurance plans will participate in each state, how competetive will these marketplaces be or what premiums participating plans will charge and how many individuals will purchase health insurance through the exchanges. 

During this 28-minute telephonic interview Professor Jost describes generally how the exchanges will operate, what challenges they face including, for example, adequate participation (particularly among young adults), concern regarding employers self-insuring to avoid ACA mandates, the status of the SHOP exchanges, how related ACA coverage provisions may have been/might be improved and expectations for how well the exchanges will operate in their first year.  

Professor Tim Jost holds the Robert L. Willett Family Professorship of Law at the Washington and Lee University School of Law.  Prior to Professor Jost taught for twenty years at Ohio State University where he held appointments in the law and medical schools.  He is a coauthor of a casebook, Health Law, used widely throughout the US.  He is also the author or editor of Health Care at Risk, A Critique of the Consumer-Driven Movement; Health Care Coverage Determinations:  An International Comparative Study; Readings in Comparative Health Law and Bioethics; Medicare and Medicaid Fraud and Abuse; and, Regulation of the Health Care Professions.   Professor Jostt[1]Jost blogs regularly for Health Affairs, i.e. he has analyzed virtually every rule and guidance issued by the departments of Health and Human Services, Labor, and Treasury implementing Title I of the Affordable Care Act.  These can be found at: http://healthaffairs.org/blog/author/jost/.   Professor Jost is an elected member of the Institute of Medicine, the American Law Institute, and the National Academy of Social Insurance.  He is a member of the American Society of Law and Medicine, the American Health Lawyers Association, the American Society of Comparative Law, and the American Bar Association.