Boston news from #BIO2015: Will old labs make good housing? Do expensive drugs reduce health costs?

Over here in Kendall Square, pharma has invested a lot of money in buildings that look like they were designed by Ikea. If this bubble is about to burst, as suggested below, the city could use some nice low-rise housing.

This story also includes the argument that pricey drugs save the system money by, for example, curing HepC patients and keeping them out of the hospital. Will the push by insurers to pay for effectiveness put some numbers to that claim?

More From Robert Weisman.

PHILADELPHIA — The funding model for drug development is under severe strain as venture capitalists shift money to safer investments, the US government bankrolls less basic research, and a backlash builds against high-priced medicines, a panel of biotechnology industry leaders warned Monday.

Joshua Boger, founder and former chief executive of Vertex Pharmaceuticals Inc. in Boston, said drug companies should be enjoying a reputation for helping the health care system to save money by keeping patients healthy and out of the hospital.

“We’re the cost-lowering part of the medical world, and instead we’ve taken on the role of the whipping boys on cost. And it’s just not true.” Boger said.

Health insurers and lawmakers have complained about the high cost of new specialty medicines such as the hepatitis C drug Sovaldi, which can cost $1,000 per pill. Vertex itself charges more than $300,000 per patient each year for a drug that treats some cystic fibrosis patients

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New Yorker: Former NEJM editor dismisses placebo claims

Arnold Relman writes in this week’s New Yorker.  He argues that researchers claiming placebos can cure are driven by “substantial financial support for their anti-establishment views”  from NIH and private donors. From the letter’s page:

There is simply no evidence that physical diseases, such as cancer,  atherosclerosis, or organ disorders, can be cured or measurably improved by  placebos. Experienced physicians know that sympathetic concern and reassurance  can often allay subjective symptoms—at least temporarily—but only appropriate  medical treatment has a chance of curing physical disease. I suspect that the  main reason advocates of “alternative medicine” like Kaptchuk are receiving such  a friendly reception in many leading medical schools these days is that there is  substantial financial support for their anti-establishment views from one part  of the National Institutes of Health and from a few very wealthy private donors.

NHS: Maybe they fund fruit fly research too

Not to knock  my UK colleagues, but –would it be fair to say that maybe the headlines of some British newspapers are not the best source of information about England’s National Health Service?

 More demonizing of CMS nominee Donald  Berwick – who has said he “loves” the UK plan — in a column in today’s Globe, under the headline:” Dangerous to our health.”

 …(T)hose who have to live with the NHS and its “bottlenecks’’ don’t always find them so admirable. The British press has been reporting horror stories about the realities of government-run health care. Some recent headlines give a sense of the coverage:

“Overstretched maternity units mean mothers face a 100-mile journey to have baby.’’

“Hundreds of patients died needlessly at NHS hospital due to appalling care.’’

“Cash-strapped NHS trust introduces rationing for common children’s conditions.’’

“Standard of care in some wards ‘would shame a third world country.’ ’’

“Stafford Hospital caused ‘unimaginable suffering.’ ’’

No one can deny that America’s health care system is flawed in many ways. But when it comes to the standard that matters most — the quality of health care provided — our haphazard, expensive, insurance-based system towers above the NHS.

The comments are rolling in:

One reader says:

  Normally, a (Jeff) Jacoby column should be taken with a few tons of salt when it comes to facts. But this one really is flawed beyond belief. I have met many Brits during my travelsand, while they will complain about the NHS, I have never met any that thought it should be done away with. When I explained how our “free market” health system actually worked they tend to react with horror. When I tell them about Republican criticisms of the NHS in the United States they usually say they are ridiculus. General overall health in Britian, they tell me, is pretty good as a result. And no one fears denial of care based on ability to pay or bankruptcy because of illness.

As for the rather shocking headlines, I decided to check them out–one is from a blog (we all know the truth value of most political blogs), two are from the Daily Mail, a tabloid paper famous for supporting fascists before the war and at least one was based on tory party propoganda from the recent election. Two were from the Daily Telegraph, derisively known as the torygraph and connected with Rupbert Murdoch. One was from the Sunday Times (the Staffordshire Hospital story) which referred to the conditions at that hospital an “anamoly”, led to a clearing house of the management of that hospital and is leading to a review of accredidation of hospital managers.

 Another offers a conflicting view of the stats. The numbers indicate international rankings:

 Per capita costs, in dollars:
#1 US: 4361.
#16 UK: 1754.
http://www.nationmaster.com/graph/hea_hea_car_fun_tot_per_cap-care-funding-total-per-capita

Infant mortality, per 100,000 live births:
#26 UK: 5.01
#37 US: 6.37
http://www.geographyiq.com/ranking/ranking_Infant_Mortality_Rate_aall.htm

Life expectancy: years, men–women
US: 77–81
UK: 77–82
http://unstats.un.org/unsd/demographic/products/socind/health.htm

Cancer deaths: per 100,000
#9 US: 321.9
#16 UK: 253.5
http://www.nationmaster.com/graph/hea_dea_fro_can-health-death-from-cancer

Poll results from the UK: preferences, percentages
Prefer the UK’s National Health Service: 89.9%
Prefer the US system: 10.1%
http://www.guardian.co.uk/commentisfree/poll/2009/aug/14/nhs-health

A quick ride in the Googlemobile presents a more mixed picture than does Mr Jacoby, who dwells on the UK system’s imperfections while ignoring ours. And one of his statistics seems disputable, if not actually wrong. Meanwhile, for all its problems, UK citizens overwhelmingly choose their system over ours. The huge number of MRI machines in this country are extraordinarily lucrative investments, costly to the system, duplicate facilities, and are of largely unproven utility in improving health care outcomes. Our increased performance of, and reliance on, diagnostic tests, too, may or may not reflect better care; it may reflect a dearth of primary care and an increased reliance on hospital emergency rooms.

 

Lots of New England in the NE Journal of Medicine

The latest NEJM includes lot of New Englanders:

Researchers from Harvard asked – What motivates “whistleblowers” who report health care fraud?

This study identified several commonalities in whistle-blowers’ experiences. Generally, whistle-blowers’ first move was to try to address problems internally; they became litigators either accidentally (while pursuing other claims) or as a last resort. The most prevalent motivations reported were personal values and self-preservation rather than financial incentives. These findings provide a number of useful insights into the qui tam mechanism as a tool for addressing health care fraud.

MIT’s Jonathan Gruber comments on costs.

In summary, analysis by both the Congressional Budget Office and the CMS actuary show that the ACA (Affordable Care Act) will substantially reduce the federal deficit, only slightly increase national medical spending (despite an enormous expansion in insurance coverage), begin to reduce the growth rate of medical spending, and introduce various new initiatives that may lead to more fundamental reductions in the long-term rate of health care cost growth. The ACA will not solve our health care cost problems, but it is a historic and cost-effective step in the right direction.

Jon Kingsdale from the Commonwealth Connector  on health insurance exchanges.

I believe in exchanges’ potential to help manage competition. But I’m a realist: I know that controversies will arise over their proper function and mission. The opponents of change will try to hobble exchanges, market skeptics will try to convert them into purely regulatory schemes, and even when exchanges succeed in increasing transparency and demand for value, other critical links must be forged in the supply chain of managed competition. After all, an accessible, customer-friendly, easy-to-use market is still only as good as the products it offers. Whether an insurance exchange looks more like a Walmart than a flea market will depend on whether doctors organize themselves into efficient, patient-responsive systems of care. In the United States, reforming the organization and delivery of medical care has always been the biggest challenge in the struggle to produce better care at sustainable cost.

 

A team led by folks from the Dartmouth Institute for Health Policy and Clinical Practice asks – in places where patient receive much more care that usual, are the patients sicker or are they being overtreated?

To address this question, we followed Medicare beneficiaries for 2 years before and 3 years after a move and found that a move to a region with a higher intensity of practice as compared with a move to a region with a lower intensity of practice was associated with greater increases in diagnostic testing, the number of recorded chronic conditions, and HCC risk scores, with no apparent survival benefit.”

Berwick: More Dr. Death mongering

The Globe’s Susan Milligan reports today on the attempt by Republicans to tag Harvard professor Donald Berwick as a death merchant.  Berwick runs a research program that looks at ways to cut waste and improve health care services.  He is up for the job as head of The Center for Medicare and Medicaid Services, an agency that has the power to make major changes in the way health care is funded and delivered.   

… GOP’s senators are making it clear they plan to turn Berwick’s confirmation hearings into a forum for continuing debate over the newly-minted health care overhaul law. Republicans believe hammering at the law will help them win seats in the fall’s midterm elections.

Senate Republican leader Mitch McConnell of Kentucky said on the Senate floor last night that Berwick is an “expert on rationing.’’

By lauding the United Kingdom’s National Health System, McConnell said, Berwick “is applauding a system where care is delayed, denied, or rationed.’’

 At one time, only insurance companies and hosptials  balked at changes in the way we pay for care. The social conservatives stuck to abortion. Now, all that has changed. For more on that see the November 30 issue of The New Yorker  for a story on the Karen Ann Quinlan case — “The Politics of Death.”  Jill Lepore talks about how a hospital ethics panel had to decide whether the comatose women could ever recover. As she put it “These ethics committees are now better known as death panels.”

 The New Yorker has a pay wall so if you don’t have a subscriptions, it’s off to the library. You can read the abstract first.

 The Quinlan case marked a fundamental shift in American political history: in the decades since Quinlan, all manner of domestic-policy issues have been recast as matters of life and death—urgent, uncompromising, and absolute. Mentions Pope Paul VI’s “Of Human Life” and the Roe v. Wade decision in 1973. Two years later, the Quinlan case brought the end of life into the halls of government. In the wake of Roe and Quinlan, a very small but by no means inconsequential number of people have come to believe that Congress, the President, the courts, and assorted unnamed bureaucrats are plotting to deny medical care to the very sick and the very old, to babies born with deformities, to the elderly and infirm, to the ailing and the poor, to the disabled and insane. Most recently this conspiracy theory hijacked health-care reform.

 

 

Local Battles over Health Care Costs, Quality and Coverage

Health reform is about controlling costs, improving the quality of care and expanding coverage.  Here’s  how all that is playing out in New England this week:

 Barbra Rabson, executive director of the non-profit Massachusetts Health Quality Partners offers details on a new statewide quality of care report on WBUR’s Commonhealth blog.

While MHQP is only one of many organizations in the state that is dedicated to advancing the quality and safety of health care, we have the longest track record of public reporting, so, with six years of data behind us, what can we say about the quality of patient care in Massachusetts?

 Nurses picket Tufts and BMC over staffing levels (in case you missed the full-page ad in the Globe.)

 The registered nurses of Boston Medical Center’s East Newton Campus and Tufts Medical Center, who are represented by the Massachusetts Nurses Association, are taking the unprecedented step of conducting joint informational picketing outside their respective facilities on Feb. 11, 2010 to protest what they believe are dangerous changes in RN staffing levels, which will result in nurses caring for too many patients at one time and could compromise the quality of patient care.

 From the Globe: Gov wants to review increases in health care costs and premiums

 Governor Deval Patrick is seeking sweeping authority to review and reject rates charged by hospitals, physician groups, medical imaging centers, and insurers, in a broad new effort to make health care more affordable, particularly for smaller companies and their workers.

If you can pick through the foaming at the mouth comments on the story, you’ll find BIDMC head Paul Levy offering the unenthusiastic hospital point of view.

WBUR’s Commonhealth, again, gets reaction.

Both Lora Pellegrini, acting president and CEO of the MA Association of Health Plans, and Lynn Nicholas, president and CEO of the MA Hospital Association argue — not surprisingly — that the governor’s plan may not address the thorniest problems contributing to rising costs.

 

 From AP: Maine lawmakers consider lifetime coverage limits

AUGUSTA, Maine –One of the strongest supporters of a bill to prohibit health insurance companies from setting annual and lifetime limits on the amounts they will pay couldn’t be at a legislative hearing on the measure Wednesday because he has cancer and was getting a blood transfusion.

Since Richard “Rocky” D’Andrea’s cancer was discovered in 2008, the 63-year-old Limerick man also found out that his insurance policy carried a $250,000 lifetime cap, his wife Theresa told the Insurance and Financial Services Committee. Now the couple are struggling to keep their house. Their credit cards are maxed and they’ve spent all of their savings and retirement, she said.

After paying a combined 60 years in taxes and years of insurance premiums, “we are in financial ruin,” D’Andrea said. “We are asking ourselves who will answer our call for help.”

Theresa D’Andrea joined others in asking the committee to endorse a bill similar to one of the major health insurance proposals under consideration in Congress. Insurance companies say eliminating the caps will have a cost that would be reflected in higher premiums.

 

New Report Card on Massachusetts Hospitals

The Joint Commission, which inspects and accredits hospitals, released its annual report on quality of care. The non-profit group – which some say is a little too close to the industry it judges – looks at care for heart attacks, pneumonia and a list of other ailments.

Check on individual hospitals here.

An incomplete look at area hospitals finds that The Brigham and Women’s Hospital got high marks for heart attack care. So did Cape Cod hospital, which also ranked high for knee and hip replacements. (Retirees = more procedures == better outcomes? ) The Cambridge Health Alliance, a small network of clinics and hospitals , does well on care for pneumonia. The Faulkner – where the Brigham sends many routine surgery patients – does poorly on pneumonia but does well on heart care and infection control.

The Joint Commission, which inspects and accredits hospitals, released it’s annual report on quality of care. The non-profit group – which some say is a little too close to the industry it judges – looks at care for heart attacks, pneumonia and a list of other ailments.

Check on individual hospitals here.

An incomplete look at area hospitals finds that The Brigham and Women’s Hospital got high marks for heart attack care. So did Cape Cod hospital, which also ranked high for knee and hip replacements. (Retirees = more procedures == better outcomes? ) The Cambridge Health Alliance, a small network of clinics and hospitals , does well on care for pneumonia. The Faulkner – where the Brigham sends many routine surgery patients – does poorly on pneumonia but does well on heart care and infection control.