At Harvard, heroes and villians, sugar and supplements

screen-shot-2017-01-16-at-9-04-30-pmGary Taubes’ sugar takedown continued in the NYTimes SundayReview, including reference to the late Fred Stare, founder of the nutrition department at the Harvard School of Public Health. In the 1970s Stare was  reportedly paid to exonerate sugar in journal supplement, “Sugar in the Diet of Man,

STATNews refers to the case of another Harvard doctor, this one who found himself on the wrong side of a supplement maker. 

The jury trial had momentous implications for the future of research into the safety of weight-loss and muscle-building pills; for the freedom of academics to speak out about matters of public health; and for our ability to learn what’s in the supplements on our kitchen counters.

Tonight! Meet the #STATnews team at The Burren pub in Somerville #science

Science in the News was started by Harvard students who wanted to help explain complex issues to the public. The group has expanded beyond that to events like:

Tonight! Science by the Pint with The STAT Team

The (sometimes messy) science of communicating sciencesbtp_spring2017_1pg

Monday, January 9, 6:30-8:30pm at The Burren (247 Elm Street, Somerville) (directions)

Are you interested in learning more about what the field of science journalism looks like from the inside? Panelists from the Boston-based publication STAT will discuss what led them to a career in health and science journalism, as well as the challenges and value of investigating and reporting in this field. Small group discussions will follow the panel, so you’ll have a chance to ask questions and bring up topics you want to discuss. Members of the panel will represent a broad range of careers within science journalism, including reporting, editing, social media, marketing, multimedia, and graphic design.

About STAT (from statnews.com): STAT is a new national publication focused on finding and telling compelling stories about health, medicine, and scientific discovery. We produce daily news, investigative articles, and narrative projects in addition to multimedia features. We tell our stories from the places that matter to our readers – research labs, hospitals, executive suites, and political campaigns.

 

Massachusetts #universal health coverage effort carries on

Here in Massachusetts, life goes on in terms of universal coverage.From The Boston Globe:

Health-insurance sign-ups are running ahead of expectations as the Massachusetts Health Connector wraps up the second month of the three-month open-enrollment period, according to Louis Gutierrez, executive director.

The Connector, a state agency that serves people who don’t obtain health insurance through an employer, has drawn in more than 27,600 new enrollees since open enrollment began Nov 1. And Gutierrez expects to see many more before the sign-up period ends on Jan. 31.

WBUR reports that coverage may change:

imgrese head of the Massachusetts Health Connector, Louis Gutierrez, says no matter what happens with the ACA, the Connector is committed to providing affordable coverage, as it has since the state’s own health care overhaul went into effect in 2006. Since then, the ACA has helped the state expand its Medicaid and Medicare programs.

Gutierrez is hesitant to guarantee enrollees will get to keep the exact coverage they signed up for this year, regardless of what happens in Washington. “I can’t make commitments about things I can’t personally control,” he said.

From today’s Boston Globe: Partners and Trump, health costs and another expensive drug

STAT News reports that Partners Healthcare CEO Dr. David Torchiana was among the health care executive who met with President-elect Donald Trump Wenesday. 

Torchiana has been among those arguing that repeal of the law could disrupt millions of families who have relied upon it for insurance coverage.

“De-insuring 20 million people, many of whom were probably Trump vPHS_Logooters, is a pretty difficult thing to do politically,” Torchiana said in November, according to the Boston Globe. “Figuring out what the pathway is to altering the ACA and doing so in a way that actually doesn’t increase the cost of health care is pretty difficult. There’s not a simple policy solution to it.”

Torchiana did not reveal what he said about the Affordable Care Act to Trump. Partners spokesman Rich Copp told STAT that Torchiana was invited by the president-elect. “They had a conversation that touched on a wide range of health care policy issues, including affordability, access, quality and biomedical research,” Copp said.

$370,000 drug

Also,  Adam Vacaro of the buiness section reports that Biogen Inc.’s new drug “to treat a rare  genetic disorder in children will be priced at about $375,000 a year per patient — its most expensive medicine ever — the Cambridge biotech company said Wednesday.”

File_000Worth noting that drug companies were once so reluctant to make drugs for rare disease that Congress had to pass The Orphan Drug Act to entice them. It seems that now they just charge a lot of them.  Could it be that these rare diseases the low-hanging fruit for the developers of biologics?

Worth revisiting former Globe reporter Steve Heuser’s 2009 piece on how Genzyme sought out patients around the world with a rare condition and convinced governments to pay the full-price for the drug–  $160,000 a year.

Jose Gonzalez felt indescribably lucky that his little girl, wasting away beneath hibiscus vines in Central America, had been found. But for Genzyme, it wasn’t luck. It was another step in a remarkable business strategy: In countries from Colombia to Taiwan to Libya, the Cambridge firm has compiled an extraordinary track record of searching out patients like Tania, providing desperately needed treatment, and then successfully pressing their governments, even poor ones, to pay full price for the most expensive drugs in the world.

That strategy has helped Genzyme bring in more than $1 billion a year on Cerezyme alone, and to develop an arsenal of similarly expensive drugs for other rare diseases. And Costa Rica would soon learn a lot about Genzyme’s determination to be paid when it considered the cost of saving Tania Gonzalez, how it would drain resources from other patients, and decided that its answer was “no.”…

What (Genzyme)  won’t do is offer a discount. Although discounts are becoming more common on pharmaceuticals sold in lower-income countries, Genzyme follows a “full price or free” model, and works hard to be sure it’s the former.

“If you’re going to give on the price someplace, everyone’s going to ask for a deal, and then you’ve got a massive mess – so from day one, it was one price,” said Alison Taunton-Rigby, a former Genzyme executive who was with the company when it began setting its price policy.

Geoff McDonough, current head of the division that sells Cerezyme, says the policy allows the company to maintain the profit margin needed to research future drugs, while also keeping a door open for the truly impoverished.

“We’ve chosen a way here that’s been consistent across the company, and has met the specific needs and complexities of patients suffering from very rare diseases,” he said.

It is a balancing act, he says, that amounts to an “extreme example” of a discounting policy: the company currently provides the drug free to more than 300 patients worldwide.

Back to Partners, this time on costs

 letter from BU’s Alan Sager on the many confusing interpretations of health that is health care costs in Massachusetts:

David Torchiana,  president and CEO of Partners HealthCare, once again has recited Commonwealth Fund analyses of federal survey data showing that Massachusetts health insurance premiums are a lower share of median income than prevails nationally (“First, do no harm”).

But federal data on actual health spending contradict Torchiana. Massachusetts health spending per person was 36 percent above the US average, the highest in the world. After deducting Medicare and Medicaid dollars, private Massachusetts health costs per person were 40 percent above the US average, an excess of $11 billion over national average costs. Meanwhile, median income here was only 20 percent above the US average.

 

 

 

Kaiser Health News: Increase in health insurance exchange enrollment mirrors some state programs, including Massachusetts

Phil Galewitz of Kaiser Health News reports that enrollment increases for federal exchanges  mirror “activity on several state-run Obamacare exchanges, according to figures obtained from states independently by Kaiser Health News. Minnesota, with more than 54,000 enrollees as of Monday, capturedoubled the number of sign-ups it had at the same time last year. Colorado, Massachusetts and Washington had enrollment growth of at least 13 percent compared to a year ago.

“Because of the new administration and the high likelihood of changes coming to the ACA, it is creating a sense of urgency” for people to enroll, said Michael March and, director of communications for the Washington Health Benefit Exchange. Enrollment exceeded 170,000 customers on the Washington exchange as of this week, up 13 percent compared to same time a year ago.

Other state exchanges saw moderate increases: Connecticut, 3 percent; Idaho, 4 percent; Maryland, 1 percent. California’s enrollment is about same as a year ago. Rhode Island’s enrollment dropped to 27,555 from 31,900 for the same period last year. State exchange officials cited a drop in customers who were automatically renewed because UnitedHealthcare dropped out.

About 12.7 million people enrolled in the state and federal exchanges for 2016 coverage at the end of the previous enrollment season. HHS predicted in October that an additional 1.1 million people would sign up for 2017 coverage. Burwell said Wednesday that her department is sticking with that projection, even though “the headwinds have increased” since the election.

Obamacare, now in its fourth open enrollment season, took some heavy blows this year after several big insurers — including UnitedHealthcare, Humana and Aetna — withdrew from many marketplaces for 2017 because of heavy financial losses. At the same time, remaining insurers increased premiums by 25 percent on average.

All of that, plus a changed political climate in Washington, was expected to dampen enrollment. While the surprise presidential election outcome may have been the primary force for changing those expectations, other factors also have fueled enrollment growth this fall, state officials pointed out in interviews.

More people who don’t qualify for government subsidies are buying health plans on the exchanges because it’s an easier way to compare available plans in one place. Noting that trend, Premera Blue Cross in Washington recently stopped selling individual coverage off the exchange.

In Minnesota, higher government subsidies — which reduce premiums for people with lower incomes — is the main reason why more people have signed up, according to Allison O’Toole, CEO of MNsure, the state-run exchange. The subsidy amount is tied to the cost of the second-lowest silver plan on the exchange, so as premiums rise for that plan, the subsidy rises too. Premiums soared by an average 50 percent in Minnesota for second-lowest silver.

Another factor driving earlier enrollment in that state was caps set by several Minnesota insurers on the number of new enrollees they would accept. People signed up earlier to make sure they could get the plan they wanted, according to O’Toole.

Minnesota’s growth is surprising because one of its biggest carriers, Blue Cross and Blue Shield of Minnesota, stopped selling its most popular health plan on the exchange. That forced about 20,000 people to change insurers or switch from Blue Cross’ PPO, which has a broad provider network, to its HMO plan with a narrower network.

In Colorado, the 18 percent increase in enrollment so far has exceeded officials’ expectations, said Luke Clarke, the spokesman for Connect for Health Colorado, the state exchange. “We had an office pool and no one picked a number that high,” he said. “It was a healthy surprise,” particularly because premiums increased in the state by about 20 percent on average.

Conservatives warn it’s still too early for Obamacare supporters to celebrate.

“I suspect that some states saw big increases because local advocacy groups were able to tell their constituents that they should enroll before Trump is sworn in and Republicans take over Congress — thereby pretty much guaranteeing that they get a full year’s coverage regardless of what Republicans might do on repeal,” said Joe Antos, a health economist with the American Enterprise Institute, a conservative think tank.

Under that scenario, large enrollment increases this fall might be followed by a dropoff in January over the 2016 numbers and the final enrollment tally could end up similar this year’s, he said. Antos noted the true enrollment figures will be known once people pay for their coverage and stay enrolled for the full year.

“As with everything related to ACA,” Antos said, “it’s easy to find a happy story if you squint hard enough and don’t wait for the enrollment process to complete — or the plan year to end.”

Should #STAT take ads from drug industry lobbyists at #PhRMa?

While acknowledging the quality of the reporting at STAT — and the search for new revenue  to support good journalism — Health News Review wonders why The Boston Globe life science spin-off has to take ads from the pharmaceutical industry’s top lobbying group.

Some STAT readers might see PhaRMa as a champion of just another health-related indstat-phrma-sponsorshipustry, like medical software or consulting services.  Others question the industry’s research, pricing and marketing practices as evidence of a commitment to profits over healing and access.

So, HNR argues that the ads allow the “industry to buy juxtaposition to messages that often call their practices into question.”  

Worth noting that my STAT newsletter arrives with different sponsors on different days. Last week’s included J&J, Amgen, a life science software maker, or none at all.

From HNR:

I am sure that STAT allows no editorial influence by this or any other sponsor. Their hard-nosed coverage of pharmaceutical industry news is top notch…

 

But I do not praise their front office decision to accept this sponsorship deal. It startles me and bothers me every time I see that PhRMA logo on the STAT newsletter. And I think it could raise legitimate questions in discerning readers’ minds.  Journalism ethics dictates that one should strive at all costs to avoid even the appearance of a conflict of interest. Was it necessary for STAT to enter into this sponsorship deal?  STAT just introduced a premium subscription plan.  I hope that works for them; maybe it will generate enough income so that they wouldn’t feel compelled to swim in the murky waters of the PhRMA sponsorship deal…

Certainly PhRMA is thrilled with STAT saying “Yes” –  allowing them to buy their way into regular appearances in the STAT newsletter. This is a foot in the door for an industry to buy juxtaposition to messages that often call their practices into question. It would be understandable if any reader’s head was spinning with thoughts of “What’s going on here?”

From Health Leaders: Shame, fear and medical errors

From a recent talk 978-080703330-2at Harvard by Danielle Ofri, MD, author of What Doctors Feel.

Ofri’s talk centered on one emotion, shame, which she said overwhelms many doctors and is a major reason many medical errors go unaddressed.

When errors are not acknowledged, even those without bad outcomes, no one learns from them, she said. And, there is little incentive for doctors to point out their shortfalls. “We want to look like we know what we are doing. When in doubt, pretend. That’s what I learned in my internship. “

Click here for full story from Health Leaders Media 

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