Hospitals consolidation: Brill says yes, new Massachusetts AG says no

From Shirley Leung’s Monday column in the Globe:

partnersNo judge or jury delivered a verdict on the Partners HealthCare settlement Monday, but we didn’t need either after Attorney General Maura Healey’s three-page court filing.

She thinks the deal stinks, and if given the chance, she would bring an antitrust suit to block Partners’ efforts to expand. And just like that, the 43-year-old rising political star dared to rock the biggest boat in Massachusetts health care. In the wake of her threat, Healey left a list of winners and losers.

From Steven Syre’s column in today’s Globe:

Maura Healey has been on the job less than a week, but we don’t have to wonder where she stands on the biggest health care conflict in Massachusetts.

And, a Q. & A. from Steven Brill, author of “America’s Bitter Pill: Money, Politics, Backroom Deals and the Fight to Fix Our Broken Health System. That book looks at focuses on the debate over the Patient Protection and Affordable Care Act. But it also returns to Brill’s indictment of high hospitals costs that filled an entire issue Time magazine in 2013. His solution looks very much like a combination of the Kaiser Permanente insurer-plus-provider approach and the Partners’ plan.

HLM: Why will this consolidation approach work to curb costs where other reforms have failed?

Brill: The reason this idea may work is it is going to happen without my writing about it. It’s going to happen. The question is, do we seize that momentum, turn it around jujitsu- style and attach a whole bunch of regulations to it?

I really started thinking about this after my [heart] surgery. I decided: New York Presbyterian, it’s a damn good place and the guy who runs it is a good guy. [Later] I was watching a panel including Toby Cosgove [CEO of Cleveland Clinic] and someone said: You’re gobbling up Cleveland and your market share is way too high.

Cosgrove said, the FTC would never let us have too much of a market share. I’m thinking, this guy Cosgrove, he’s a celebrated surgeon, a war hero. He seems like a pretty good guy to me. The idea the he wants to control and provide healthcare all over Ohio, why is that such a bad thing?partners-logopartners-logo

Storify: Brigham and Women’s Hospital doctor Davidson fatally shot

Good-bye Boston Globe health section. For real this time.

download
front globeLast time The Boston Globe said it was shutting down its health and science page, it didn’t, really. The weekly section migrated to Monday’s G, a daily tabloid. Now, G is gone and so is the section. The new broadsheet feature sections debuted today and Monday’s theme is “Family.”

What this means in the age of digital newspapers is not clear. We hope the paper will be able to skip the old news and services stories that sometimes dominated the G section and focus on the great health and science reporting to be found both in print and online. Like this:

The dean of one of America’s top medical schools was stunned.Jeffrey Flier, who presides over Harvard Medical School, had just finished reading a story about the televised death of a man in a New York emergency room, a death aired
without the family’s permission.

ss
“How could this be allowed to happen?” the incredulous dean recently tweeted from @jflier.

Four minutes later came a reply tweet from Dr. Gerard Doherty, chief of surgery at Boston Medical Center. “The same group is filming a trauma series at your place (MGH) and ours (BMC) right now. On balance — good public education.” 

The exchange highlights the roiling debate over privacy rights, with TV crews capturing the drama and pathos in hospital emergency rooms amid the most vulnerable patients.

The issue is especially timely as network news crews are camped in three of Boston’s big teaching hospitals filming a show expected to air later this year.

And, maybe a link on the health section on the homepage? As it is, you need to click on the “News” crumb at top to get to the Health and wellness page. And, maybe keep the content on that page up to date? The lead story is from 12/27.

Yale’s Dr. Ross and the promotion of me-too meds

From ProPublica on me-too meds. Yale’s Dr. Joseph Ross gets a quote in this story. , Vox offers a summary of his NEJM piece on digital marketing to docs. More here on his work into the accuracy of clinical trial registries.

Here’s the NEJM abstract: Pharmaceutical marketing can lead to overdiagnosis, overtreatment, and overuse of medications. Digital advertising creates new pathways for reaching physicians, allowing delivery of marketing messages at the point of care, when clinical decisions are being made.

From ProPublica

Vying for Market Share, Companies Heavily Promote 2018 Me Too’ Drugs

by Charles Ornstein and Ryann Grochowski Jones ProPublica, Jan. 7, 2015, 2 p.m.

propub logoThis story was co-published with the New York Times’ The Upshot.

For more than five decades, the blood thinner Coumadin was the only option for millions of patients at risk for life-threatening blood clots. But now, a furious battle is underway among the makers of three newer competitors for the prescription pads of doctors across the country.

The manufacturers of these drugs 2014 Pradaxa, Xarelto and Eliquis 2014 have been wooing physicians in part by paying for meals, promotional speeches, consulting gigs and educational gifts. In the last five months of 2013, the companies spent nearly $19.4 million on doctors and teaching hospitals, according to ProPublica’s analysis of federal data released last fall.

The information, from a database known as Open Payments, gives the first comprehensive look at how much money drug and device companies have spent working with doctors. What it shows is that the drugs most aggressively promoted to doctors typically aren’t cures or even big medical breakthroughs. Some are top sellers, but most are not.

Instead, they are newer drugs that manufacturers hope will gain a foothold, sometimes after failing to meet Wall Street’s early expectations.

“They may have some unique niche in the market, but they are fairly redundant with other therapies that are already available,” said Dr. Joseph Ross, an associate professor of medicine and public health at Yale University School of Medicine. “Many of these, you could call me-too drugs.”

In almost all cases, older, cheaper products are available to treat the same conditions. Companies typically try to differentiate the new drugs by claiming they are easier to use; carry fewer side effects; work faster than competitors; or have medical advantages.

The makers of Pradaxa, Xarelto and Eliquis, for example, say their drugs are at least as effective as Coumadin for certain conditions but do not require routine blood tests or limitations on what patients can eat. (Patients taking Coumadin, also known as warfarin, shouldn’t eat grapefruit or cranberries and have to limit green leafy vegetables in their diet.)

Officials at the Centers for Medicare and Medicaid Services, which administers Open Payments, and the Pharmaceutical Research and Manufacturers of America, the drug industry trade group, said they had not analyzed the data in order to rank spending by drug.

When told of ProPublica’s analysis, John Murphy, PhRMA’s assistant general counsel, said drug makers’ spending should be seen not only as a marketing strategy, but also as a way of ensuring the best treatment options for patients. “On paper, a drug may not look like it is monumentally better than another drug, but to an individual patient, it might be,” Mr. Murphy said.

* Note: General Payment figures do not include royalties. Source: Centers for Medicare and Medicaid Services, Food and Drug Administration, ProPublica reporting

According to ProPublica’s analysis, Victoza, a diabetes medication made by Novo Nordisk, was the drug associated with the most payments to doctors, by dollar amount. The company spent more than $9 million on physician interactions related to Victoza in the last five months of 2013, excluding research payments and royalties, which relate more to drug development than marketing. (ProPublica created a tool that lets you look up any drug, device or company and compare it with any other.)

Victoza, through a once-a-day injection, helps lower blood sugar among diabetics, but researchers and advocacy groups have said drugs of its class carry an increased risk of thyroid cancer and pancreatitis. Dr. Todd Hobbs, chief medical officer of Novo Nordisk in North America, said the company’s spending reflected Victoza’s newness and the need to address such safety concerns.

“We just received a huge amount of interest and questions and need for education,” Hobbs said, referring to inquiries by health care professionals, particularly primary care doctors. “You see the fruits of that in this report.”

Eliquis, the anticoagulant jointly marketed by Bristol-Myers Squibb and Pfizer, ranked second in its link to spending on physicians, with nearly $8 million, our analysis showed. In a statement, the companies said their spending helps ensure physicians understand the appropriate use of Eliquis. Because the drug is prescribed by physicians in different specialties, the statement said, “it is critical to have a speaker program that adequately provides robust education to these physicians.”

The drug associated with the third-most payments to doctors was Brilinta, a different type of blood thinner made by AstraZeneca that vies for sales with Plavix, which is now available generically. In an email, AstraZeneca said it had identified Brilinta as one of its “key platforms for growth” and increased speaker and research spending on it. “Physicians are also indispensable partners in our efforts to bring new medicines to patients,” the company said.

ProPublica has tracked drug companies’ payments to doctors since 2009 through a searchable database called Dollars for Docs. But this covers only 17 companies, most of which have been compelled to release this information under legal settlements with the government. It has no information from medical device makers.

The list of most promoted drugs featured many recent arrivals: 14 of the top 20 were approved by the Food and Drug Administration since 2010. Some treat similar conditions, including diabetes, schizophrenia and chronic obstructive pulmonary disease, so the competition among them is fierce. “They’re fighting over the same doctors, I guarantee you,” said Rhonda Greenapple Simoff, founder of a consulting firm that advises pharmaceutical companies in Bernardsville, N.J.

Largely absent from the top of the list were drugs that cure disease, such as a new class of hepatitis C treatments, or those that significantly extend life, particularly for cancer patients. If a drug is either the first to treat a disease or is much better than existing drugs, said Dr. Sidney Wolfe, the founder and now senior adviser to Public Citizen’s Health Research Group, “they ‘sell themselves’ on the merits of their unique benefits.”

According to ProPublica’s analysis, a few of the most heavily promoted drugs, including Samsca, which treats low sodium levels in the blood, have serious side effects that came to light after their approval by the federal government. The manufacturers of several others, including Copaxone, Latuda, Xarelto, Daliresp and Humira, have been faulted by the F.D.A. for improper promotion.

Subsys, approved in 2012 to treat cancer pain, ranked 23rd in spending on doctors. It’s often prescribed for off-label, or unapproved, uses; in November, The New York Times reported that some of the doctors paid the most to promote the drug had disciplinary or legal troubles. In a statement to The Times, Insys Therapeutics, the drug’s maker, said its marketing of Subsys was appropriate.

The medical device associated with the most payments to doctors was Intuitive Surgical’s da Vinci surgical robot system, which the company has marketed as an effective, less invasive option for an array of procedures. Critics have complained that the device is needlessly expensive and overused, and say it has been linked to patient complications and deaths.

Intuitive spent nearly $12.8 million on physician interactions to promote the robot in the last five months of 2013, not including royalties and research. The spokeswoman Paige Bischoff said in an email that about half of the company’s outlays for education and training were “pass through” spending: Surgeons or hospitals paid the company for services, and the company, in turn, paid doctors to provide them.

Dr. Robert Takla, an emergency room physician in the Detroit area, earned about $75,000 in the last five months of 2013 by delivering promotional talks about several of the most heavily marketed anticoagulants and blood thinners, particularly Brilinta, according to Open Payments.

He said he enjoys speaking on behalf of companies and thinks he offers a different perspective than cardiologists and internists 2014 the usual prescribers of the drugs 2014 because he treats complications of blood clots in the emergency room.

Dr. Takla said he reviews clinical studies before deciding to speak for a drug and turns companies down when he isn’t impressed. He said he no longer spoke on behalf of Pradaxa because of what he characterized as public backlash against it, driven by a spate of lawsuits against its manufacturer, Boehringer-Ingelheim. (The company agreed to pay $650 million last year to settle the suits.) He accepts fees to speak about Xarelto, a drug he has taken himself for a deep vein thrombosis.

“It’s a very fertile and very robust marketplace right now,” he said of the anticoagulants.

News applications developer Mike Tigas contributed to this report.

Methodology: How we calculated company payments to doctors

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for their newsletter.

Founder of Brookline’s long-gone “Bread and Circus” store dies

Scan_20150105 (2)

From BU student-run vegetarian restaurant, 1976

Considered this headline: Author of “The Cancer Prevention Diet” dies of cancer. But, that’s not really fair. He was 88. And, the link between cancer risk and diet is worth considering.

If you wanted brown rice or whole wheat bread in the 1970s, you had to go to a place like Michio Kushi’s  Bread & Circus in Brookline. Back then, they were called health food stores.  At the same time, co-ops in Allston and Cambridge were evolving from pre-order operations to storefronts. “Diet for Small Planet” put the politics in vegetarianism.

The Harvest Co-op still exists. They even sell meat. But places like Bread & Circus were long ago eaten alive by Whole Foods. Large corporations bought up everything from Celestial Seasoning teas to The Tempeh Works in Western Mass. A recent New Yorker restaurant review celebrated the demise of the hippy vegetarian cuisine in a particularly mean-spirited way. 

Remember carob? And those people who swore not only that carob tasted just like chocolate but also that it was better for you? In the seventies, there was a certain kind of restaurant, usually vegetarian—which had its epicenter at Moosewood, in Ithaca, New York, or somewhere on the Pearl Street Mall, in Boulder, Colorado—that gloatingly served “health food.” These hippie outposts abounded with wood tones, ferns, loving sentiment, and sprouts. They didn’t really care about presentation or what was trendy, but they did believe in the healing power of the legume.

fruit-photoCarob was bogus and nasty. But making fun of bean sprouts is cliche. (And dated –See Annie Hall.) The food at Moosewood is tasty and “those people” changed the way we eat for the better. Today, there is a renewed interest in the politics of food, with an emphasis on support for local farms and awareness of the impact of production on climate change.  Now it’s hipsters, not hippies, who are the brunt of food-obsession jokes. In Portlandia, Fred and Carrie are a little gentler in their mockery of modern-day PC foodies. On this coast, police officers characters on the TV show Brooklyn Nine-Nine smirk as they investigate a robbery at a chocolate milk bar. Drink up boys. Turns out those hipsters are on to something.

Crumbs of pleasure: How to carry on after an unspeakable loss #grief

Tips on how to survive a sudden, life-altering loss.IMG_0376 Sleep, sing, love. go outside and ban perfection.

More from the CommonHealth blog.

In 2014 I became a widow, and my two young children lost their father. Needless to say our perspective and priorities have shifted radically.

Last year at this time, my New Year’s resolutions revolved around carbs, and eating fewer of them. This year, carbs are the least of my worries. My resolutions for 2015 are all about trying to let go of any notion of perfection and seek what my mother calls “crumbs of pleasure” — connection, peace and actual joy on the heels of a life-altering tragedy that could easily have pushed me into bed (with lots of comforting carbs) for a long time.

Designed to saves lives: Cholera, Haiti and the MASS Design Group’s latest clinic

The New York Times reports on the latest effort by the Boston-based MASS Design Group,  a cholera clinic in Haiti designed to so that natural ventilation — sea breezes — will lower transmission. Cholera reportedly arrived with aid workers after the island’s devastating earthquake. The story appears in the “Well Design” column, which reports on architecture and health care.

The clinics here are simple, even handsome. Instead of constructing hermetic shields in the form of airtight, inflexible hospital buildings, the architects took advantage of Haiti’s Caribbean environment, exploiting island cross breezes to heal patients and aid caregivers.

It’s not clear yet how well the clinics will work. They open soon. If they turn out right, they could serve as relatively light-footed models for other struggling countries that lack resources for high-end Western-style hospitals.

Building Better Builders from MASS Design Group on Vimeo.

Follow

Get every new post delivered to your Inbox.

Join 75 other followers

%d bloggers like this: