Vermont health summit and BIDMC Levy as hero

Two Items of note.

 Globe columnist Kevin Cullen’s piece on BIDMC CEO Paul Levy generates half of the letters page in the Globe today. The rest of the page was filled with outrage over the AIG bonuses.

 In the column, Cullen describes Levy asking hospitals nurses and techs to accept salary and benefits cuts.

He looked out into a sea of people and recognized faces: technicians, secretaries, administrators, therapists, nurses, the people who are the heart and soul of any hospital. People who knew that Beth Israel had hired about a quarter of its 8,000 staff over the last six years and that the chances that they could all keep their jobs and benefits in an economy in freefall ranged between slim and none.

“I want to run an idea by you that I think is important, and I’d like to get your reaction to it,” Levy began. “I’d like to do what we can to protect the lower-wage earners – the transporters, the housekeepers, the food service people. A lot of these people work really hard, and I don’t want to put an additional burden on them.

“Now, if we protect these workers, it means the rest of us will have to make a bigger sacrifice,” he continued. “It means that others will have to give up more of their salary or benefits.”

He had barely gotten the words out of his mouth when Sherman Auditorium erupted in applause. Thunderous, heartfelt, sustained applause.

Also, both WBUR and the Globe had lengthy stories on the White House regional health forum in Vermont yesterday.  More on that coming up.


The business of Partners v. Partners as a group of non-profit teaching hospitals

Consider Monday’s Globe op-ed from Dr. James J. Mongan, CEO of Partners HealthCare, on how to cut costs.

…(W) e are not the only state experiencing healthcare cost increases; this is a national issue, and there are no villains or easy answers to the problem.


A recent Boston Globe series on pricing and Partners: ” A handshake that made healthcare history

Partners HealthCare was born in 1993, but its powerhouse potential didn’t fully hit home until 2000. That’s when the emerging giant cut a quiet deal with Blue Cross to ratchet up insurance costs across the state. Nothing in Massachusetts healthcare has been the same since.

In trying to figure whether there is contradiction or synergy between these two items, I came across NH-based Kevin Pho, a Nashua blogging doc has his own ideas about the Partners and heatlh care costs.  

I don’t blame Partners for maximizing their revenue. They know that no other city in the country can boast two nationally ranked academic institutions, and take advantage of that fact to bully the insurance companies. It’s smart business.

Those that are unhappy with the situation – insurance companies, competing hospitals, and health policy wonks looking to control health care costs – need to rein in patient demand for their services. Educate the public that community hospitals can provide care equal to, or better than, MGH and the Brigham in routine cases.

Taxing health benefits?

The NY Times has a story about the Obama team considering some kind of tax on health benefits.

 The Obama administration is signaling to Congress that the president could support taxing some employee health benefits, as several influential lawmakers and many economists favor, to help pay for overhauling the health care system.

The proposal is politically problematic for President Obama, however, since it is similar to one he denounced in the presidential campaign as “the largest middle-class tax increase in history.” Most Americans with insurance get it from their employers, and taxing workers for the benefit is opposed by union leaders and some businesses.

 The reliable, D.C.-based Alliance for Health Reform tells you all about taxes and health insurance in this primer:

The United States tax system subsidizes the purchase of employer-sponsored health insurance for more than 160 million non-elderly people at a “cost” of approximately $200 billion a year. This tax subsidy is a major reason why most Americans have health insurance coverage through either their own employer or that of a family member. In recent months, the tax treatment of health insurance has gained a lot of attention – both during the presidential campaign and in health reform debates in Congress.

What is the current tax treatment of employer-sponsored health insurance? How does the tax treatment of health insurance impact employers? How does it impact employees? Do some workers benefit more than others from the current tax subsidies? Does altering the tax treatment of health insurance have the potential to expand or diminish coverage? Will cost containment efforts lead policy makers to consider altering the tax treatment of health insurance?

In addition to David Blumenthal of the MGH/Partners Institute for Health Policy, the group  takes note of the following local experts:

Two from Harvard

David Cutler

Professor Cutler served on the Council of Economic Advisers and the National Economic Council during the Clinton Administration and has advised the Presidential campaigns of Bill Bradley, John Kerry, and Barack Obama. Among other affiliations, Professor Cutler has held positions with the National Institutes of Health and the National Academy of Sciences. Currently, Professor Cutler is a Research Associate at the National Bureau of Economic Research and a member of the Institute of Medicine. NYTimes story featuring DC

Katherine Baicker, PhD

Professor of Health Economics in the Department of Health Policy and Management at the Harvard School of Public Health.  She is a research associate at the National Bureau of Economic Research. 


Jonathan Gruber, Massachusetts Institute of Technology.

Dr. Gruber’s research focuses on the areas of public finance and health economics.



Action for single payer advocates and money for young scientists

Money for scientists:    The Mass Life Sciences Center is giving away money — and not just to expanding biotech companies. The program is also trying to fill in some of the gaps left by flat NIH funding. So, young scientists should check out their latest “new investigator” offering – applications due April 17. The board approved a second round of funding for this program in late February.  

 The 2009 New Investigator Solicitation seeks to spur innovative new research and advance the careers of new investigators who are working on cutting-edge life sciences research at Massachusetts research institutions. A successful applicant will receive a grant of $100,000 per year for up to two years.

Single Payer update:  This came across my desk from single payer advocates at MassCare yesterday afternoon:

Next Tuesday in Burlington Vermont, Massachusetts Governor Deval Patrick and Vermont Governor Jim Douglas will convene a New England Health Summit as part of President Obama’s national push for health reform.

While Governor Douglas has now invited single payer advocacy groups from Vermont – including Physicians for a National Health Program and the Vermont Citizens Campaign for Health – Governor Patrick has not included any single payer groups on his invitation list from Massachusetts.

Please call and/or email the Governor’s office and ask them to include Mass-Care, Massachusetts Physicians for a National Health Program, and the Massachusetts Nurses Association in this important dialogue about the future of our health care system…

At the recent White House summit on health reform, no single payer advocate was invited until thousands of messages reached the White House, including word that doctors were going to protest on the sidewalk. At the last minute, two single payer supporters were invited…

 Two hours later, this arrived:

 At 5:30PM, we received an invitation from Governor Patrick’s Office of Government Affairs.


Wednesday Bloody Wednesday in MA for drug and device makers?

 (Sorry, U2 played in the tiny Somerville Theater last night.)

State regulators yesterday approved the final details of a new regulation limiting gifts from drug companies to docs. Liz Kowalczyk of the Globe explains it here.

The regulations, approved by the Public Health Council, are intended to implement a law passed last summer to restrict interactions between physicians and drug and device companies. Legislators have said the regulations are intended to control costs by reining in unnecessary prescribing of expensive drugs and to make doctors’ potential conflicts of interest transparent to the public.

Any company doing business in Massachusetts must comply with the regulations.

After the Public Health Department staff proposed the regulations, objections were raised by dozens of interest groups and lawmakers. Consumer groups and some legislators wanted even stricter restrictions on the behavior of companies and their salespeople, such as requiring disclosure of all research payments.

Many companies said the proposal went too far and would discourage firms from doing business in Massachusetts. Convention and hotel executives said the rules would scare away companies from sponsoring continuing medical education courses for physicians, which bring millions of dollars into Boston.

What will that look like for industry?  Mass Medic, the state’s trade group for medical device makers offers this picture. So does stent maker Boston Scientific.

Consumer groups support the law. Here are a few of the objections: PHRMA, BIO

TO WATCH: It will be interesting to see how the state enforces this part of the law now that they’ve broken clinical trials into two groups.  From the Globe:

There are two substantive changes, however. Companies will have to disclose payments to doctors and hospitals for research designed to promote a particular product, sometimes called “seeding trials”; funding for research aimed at answering a scientific question will still not have to be disclosed. 

Getting it wrong: Overdiagnosis and research fraud

Prostate cancer overdiagnosed? MGH docs Michael J. Barry and Albert J. Mulley Jr. of the Medical Practices Evaluation Center comment on study in a Journal of the National Cancer Institute. This from the AP story in the NY Times.

Why is overdiagnosis such a concern? Because finding an early tumor forces men to choose among contested treatments — ”watchful waiting,” surgery, hormone therapy, radiation. And because some treatments can cause incontinence and impotence, men whose tumors wouldn’t have been a threat can suffer serious side effects for no gain.

Springfield doc made up research? From the Globe:

Dr. Scott S. Reuben, who works at Baystate Medical Center in Springfield, has published dozens of articles on “multimodal analgesia,” an important and emerging area of anesthesiology involving use of more than one type of drug to relieve post-surgical pain and foster faster recovery.

Last May, during a routine review of research summaries that were to be presented at the hospital’s research week, physicians discovered that the research Reuben intended to present had not been approved by an internal hospital review board that oversees research on patients, Dr. Hal Jenson, Baystate’s chief academic officer, said yesterday.

That discovery led to a full-scale investigation by the hospital, which was completed in January. The investigation uncovered 21 published papers over 13 years in which Reuben made up some or all of the data, Jenson said.

 For more on this topic, check out the HHS Office of Research Integrity. There, I found a recent decision involving a Luk Van Parijs, the MIT professor fired in 2005 research fraud.

BHN exclusive: Partner’s Glaser on getting HIT right

             Partners HealthCare has been way ahead on getting computers to bedsides and into the hands of doctors. Partners CIO John Glaser, the man in charge of putting that system in place, spoke to BHN last week.

           The technology can be used to do a lot of good, he said. HIT can eliminate duplication, catch medical errors and an improve access to data. But, he suggests health reformers might want to be more realistic about how long it will take to wire the system and how much money it will save.

            Glaser also notes that HIT designers need to ensure that systems actually make it easier for busy doctors and nurses to run their practices and deliver quality care. In some cases, providers complained that systems added to their work. “That becomes a complicated and potentially problematic scenario,” Glaser said.

Here are a few other comments. For more, click below for audio.

EXPECTATIONS: “If you don’t get the expectations right, you will assume certain things will happen and you will try to accomplish them and you may not be able to. “

COST SAVINGS:  “It is unlikely that health care information technology will singlehandedly reverse the cost problem and it won’t solve the access problem. So we ought to be thoughtful about how potent a tool it really is.”

 For more on Glaser’s ideas, see his piece in the January issue of the Journal of Health Care Management  entitled: “Implementing electronic health records: 10 factors for success.” (BHN can only get to you to abstract.)

Strategies for maximizing the value of an EHR implementation include: Establishing clear strategies, objectives, and plans for EHR implementation. Including managers and clinicians in discussions on ways to tie the EHR in with the organization’s strategy and areas requiring improvement. Continually measuring performance of EHR-enabled processes. Investing in critical infrastructure. Maintaining efficient and effective IT governance.

March 11 update: Groopman also raises questions about cost savings in the Wall Street Journal.



Health reform, single payer and our fair city

One well-established group of health reformers is feeling shut out of the current debate – single-payer advocates. That Canadian-style approach would set up a “public or quasi public” national health insurance program.  

Here’s a Newsday column complaining about it.  Public Citizen’s Health Research Group also comments here. For a local perspective see Mass Care.

Two major advocates of the approach are based here in Cambridge: doctors David Himmelstein and Steffie Woolhandler, aka the Himmelhandlers. (They’re a couple.) The Harvard doctors helped found Physicians for a National Health Plan.

Here’s the group’s description of their approach — which does not have a lot of support in Washington but is worth considering. Also, a PubMed search on either of the above names will bring up their ample research into the approach.  

Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private.

Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($7,129 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 47 million completely uninsured and millions more inadequately covered.

The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.

Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.

 Fairness and Accuracy in the Media says the lack of news stories on single-payer amounts to a “blackout.”  I might not word it so strongly. It just isn’t on the table, so no one is writing about it.

Double enormous: Harvard celebrates new stem cell rule

 From today’s Globe:

 “This will be an enormous relief, because of the enormous constraints under which we’ve operated,” said Douglas Melton, co-director of the Harvard Stem Cell Institute, one of the places where research has continued because of collaboration between scientists, hospitals, and donors. “What I very much hope is that researchers who have been unable to study these cells will now be excited by the fact they are accessible and can be used in labs all over the US.” 

Stories by Gareth Cook of The Boston Globe, winner of the 2005 Pulitzer “for explaining, with clarity and humanity, the complex scientific and ethical dimensions of stem cell research.”

Can the Watchmen save Boston doctors from conflicts of interest?

Health Wonk Review is a “roving digest” of notable blogs entries about health policy. 

This week, Medicaid Front Page hosts, with an entry that would make my comics-reading son happy – The “Watchmen Edition.” Each entry is linked to one of the superheroes in this movie, which is opens today. (My contribution  earned Dr. Jim Kim a Nite Owl comparison.)

 It may take a superhero to sort out our health care system. Today’s Globe has yet another story about another MGH child psychiatrist under investigation. Dr. Jeffrey Bostic allegedly promoted the use of Forest Laboratories’ antidepressants while accepting $750,000 in fees for talks he made about the drugs. The FDA has not approved the drugs for children and the company has admitted to withholding negative research about Celexa and kids.

 (Note – It is illegal for drug companies to promote off-label (non-FDA approved) uses for their drugs. But it is legal for doctors to prescribe a drug like Celexa for children, even though it may not have been tested or approved by the FDA for that purpose. In other words, off-label promotion is banned, but off-label use is tolerated. )

From the Globe:

In a complaint unsealed last week in US District Court in Boston, prosecutors allege that New York-based Forest Laboratories Inc. illegally marketed the drugs Celexa and Lexapro for use in children by paying kickbacks, including lavish meals and cash payments disguised as grants and consulting fees, to induce doctors to prescribe the drugs. They also say the company misled doctors and the public by failing to disclose the results of a negative study.

In the 34-page complaint, prosecutors said that from 1999 to 2006, Dr. Jeffrey Bostic, director of school psychiatry at the hospital, gave more than 350 Forest-sponsored talks and presentations in 28 states, many of which addressed pediatric use of Celexa and Lexapro…. The government said that Bostic became “Forest’s star spokesman in the promotion of Celexa and Lexapro for pediatric use” and that the company paid him more than $750,000 between 2000 and 2006 for his presentations.

Bostic declined to be interviewed, but the hospital gave the Globe a statement describing him as a “highly regarded practitioner and educator in the field of psychiatry.”


Here’s where the Teen Titans come in. (Okay, you’re not a teen in med school but…)

Duff Wilson at the NY Times has a story this week on medical students at Harvard and elsewhere who are opposed to the commercialization of medical schools.


In a first-year pharmacology class at Harvard Medical School, Matt Zerden grew wary as the professor promoted the benefits of cholesterol drugs and seemed to belittle a student who asked about side effects.

Mr. Zerden later discovered something by searching online that he began sharing with his classmates. The professor was not only a full-time member of the Harvard Medical faculty, but a paid consultant to 10 drug companies, including five makers of cholesterol treatments.


I’ve been writing about this stuff for a long time. For some of my work see:

 November 2003, Nature Medicine: The Color of Money: As the line between academia and industry blurs, conflict-of-interest issues have gone from black and white to all shades in between.

 Science for Sale : A Harvard researcher could profit from a product he “independently” reviewed for the National Institutes of Health. The scientific community, dependent on corporate money, has no clear way to handle such conflicts. The Boston Phoenix, April 29, 1999.

 The doctor and his implants: Can doctors with financial ties to medical products put a patient’s best interests ahead of their own? Or do potential payoffs cloud their medical judgment? The News & Observer, March 31 1994.




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