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Tag Archives: News Commentary

Zyprexa's Going To Get A Lot More Expensive

In this NY Times Business article, it appears that Eli Lilly is going to agree to pay $1.4 BILLION to settle criminal and civil charges that it engaged in questionable marketing campaigns for the antipsychotic drug Zyprexa. According to court documents, Lilly suggested that doctors use Zyprexa to sedate unruly nursing home patients and to treat disruptive children, even though it is FDA approved to treat schizophrenia and agitation associated with bipolar disorder. The article states that Lilly wanted to settle the case so that Lilly isn’t barred from the Medicare and Medicaid programs – which account for a large portion of its income. In 2007, Zyprexa had sales of $4.8 billion. In 2008, prescriptions for Zyprexa declined, but the sales increased because Lilly raised the prices on Zyprexa. Depending on the dose, the drug can cost up to $25/pill. “Off label” use of any drug is entirely acceptable under FDA guidelines – manufacturers just can’t “officially” market their products for those uses (wink wink). Doing “napkin” mathematics, $4.8 billion in sales divided by $15 per pill is about 320 million doses of medication. Divide that by each person getting 365 doses of Zyprexa in a year and there are about 900,000 patients on this medication each year. Yet, according to the article, “a series of landmark studies in recent years have cast doubt on that long-held view and suggested that Zyprexa is no better than older drugs that sell for far less.” Why are doctors prescribing this stuff?

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The Future Under Socialized Medicine?

According to a Yahoo News article (similar article in the Washington Post) a medical records software upgrade in the VA Hospital computer system put the lives of all hospitalized veterans at risk late last year. According to the article, the “computer glitch” caused patients to get the wrong medications, to receive the wrong doses of medications, to experience delays in treatment, and to receive blood thinning medications for longer than the doctor had ordered them. The VA was quick to point out that it was not aware of any patient injuries from the “computer glitch,” but the article noted that the VA also tried to “keep the problems quiet” and didn’t initially notify the patients involved in the mix-up. The article also quotes Dr. Bart Harmon, a former Pentagon chief medical information officer, as saying that “the VA’s problems could become more common as more hospitals and doctors’ offices move toward electronic records.” The VA system currently includes 153 medical centers and cares for 5.5 million patients. What’s going to happen if a similar system becomes responsible for 5756 hospitals and more than 1 billion patient care visits every year under “socialized medicine”? Giving unnecessary infusions, delaying care, and trying to “keep problems quiet” aren’t included on the quality indicators list the the government’s “Hospital Compare” web site. Oh – I forgot. It doesn’t matter. The government won’t put its own hospitals up there for everyone to compare, anyway.

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Where's the Handbasket?

I got two e-mails today asking for a comment on two recently publicized court cases. They both tie in to one common theme: It’s pretty clear where our medical system is headed – now it’s just a matter of the vehicle we’re going to use to get there. The one to the right is probably the most common one used to get to this destination. One involved the California Supreme Court’s decision to bar emergency physicians from “balance billing” in the emergency department. Before this decision, there was a tension between emergency physicians who wanted to be paid fairly and insurers like United FraudCare that want to charge patients as much in premiums as possible while paying as little as possible to the medical providers so that they can keep earning their $45 billion per year and maintain their #35 ranking on the Fortune 500. [wp_campaign_3] Emergency physicians refused to sign on with the insurers given the low compensation that was being offered. Then, when an insured patient was seen in the emergency department, the emergency physicians received some of their fee from the insurer and “billed” the patient for the “balance” of the fee – hence the term “balance billing.”   Now, the California Supreme Court’s decision states that even if the emergency physicians have no agreement with the insurer, they have to take what the insurer pays them as compensation. Emergency physicians can’t bill the patients for the “balance.” If the providers deem that the emergency physician’s services are worth 25 cents, that is what the physicians have to take. The physicians can try to get the remainder of their fee back from the insurers. Patients can’t get billed for it. Of course, if the insurers don’t pay the remainder, what recourse do physicians have? Nothing. Can’t stop treating the insurer’s patients. Federal EMTALA statutes state that emergency departments have to provide an evaluation and stabilizing treatment to EVERYONE. So if emergency physician groups don’t like it, they are stuck filing more lawsuits and paying more lawyers’ fees to try to get paid fairly. The other case involved a rheumatologist who was forced to pay $400,000 because he allegedly “refused” to pay for a sign-language interpreter for a deaf patient. The physician was only making $49 per visit from Medicare, but would have to pay $150 to $200 per visit for a sign language interpreter. Instead, the physician used the patient’s family and used written notes to communicate with the patient. The patient sued the physician for discrimination under the Americans With Disabilities Act. My opinion of both of these cases is that they are a good thing. Kidding aside. I really am glad that they are happening. Think about the effects of cases like these. How many emergency physicians are going to want to work in California? I know I wouldn’t even think about a job offer there – knowing that I would likely be able to collect little to nothing for my services because the California Supreme Court held that some magical contract is created between all emergency physicians and all insurers and that those contract terms de facto provide insurers with unlimited bargaining power. Once service contracts run out with the hospitals, I foresee a lot of hospitals having a difficult time staffing their emergency departments. Care will suffer, people will die on waiting room floors, public outrage will force immediate change. How many private practitioners are going to want to accept deaf patients into their practices? If we’re talking about providing translation in general, how many physicians will want to accept anyone that doesn’t ...

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United "FraudCare"

According to MSNBC, United HealthCare just paid $50 million to settle New York Attorney General Andrew Cuomo’s claims that United HealthCare manipulated its own proprietary pricing database to set an unreasonably low “fair market value” for medical care. By doing so, it is alleged that UHC forced its insureds to pay more out of pocket costs when using “out of network” providers – to the tune of tens of millions of dollars. No criminal actions have been filed, but class action lawsuits are reportedly already in the works. Other insurers are in the sights of several state Attorneys General. A New York Times article about the suit and the basis behind the suit is here. Also some interesting discussion going on at Newsvine.com. The question I have is … with a company that has revenues of $45 billion, is a $50 million settlement enough to dissuade similar actions in the future? That’s like a person who makes $100,000 per year agreeing to pay a fine of $100 – not exactly a big hit in the pocketbook. Instead, why not disgorge all of UHC’s revenues for a couple of years? How about a fine of $50 billion instead of $50 million? I can’t think of a better example of a corporate “never event” – can you? If providers shouldn’t be paid for things that should “never” occur, neither should the insurers.

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Awwww Nuts!

Those of us with diverticulitis and diverticulosis have some good news. According to this article in JAMA, patients with diverticulosis can eat nuts and popcorn. Contrary to the widely held belief that the little pieces of nuts and popcorn will get caught in the diverticula and cause an infection, this study of 47,000 men showed that eating peanuts and popcorn was actually prevented flares of diverticulitis! Those patients who ate the highest amount of popcorn had a 28% decrease in the incidence of diverticulitis and those patients who ate the most nuts had a 20% decrease in the incidence of diverticulitis. Now hush up and pass the popcorn. This movie just got better. Hat tip to this month’s Consultant magazine.

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Essential Medical Items

While traversing the blogosphere, I saw this article up on the Chicago Tribune Health Blog about what should be the “Essential Items for Your Medicine Cabinet.” Included are things such as gauze, tape, thermometer, alcohol wipes, antihistamines, and decongestants. Then I got to thinking. What are the essentials in my medicine cabinet? Many of the things on the Chicago Tribune list are included. I didn’t see the need for some of them … like the thermometer. If your fever is 101 or 104 does it make a difference? You’re going to take Motrin. I also think that other essentials need to be added. Here’s my list … Gauze. Lots of it. It always seems like that when bleeding starts, it doesn’t want to stop. You can use it to clean stuff out of wounds and to dress the wounds. ACE bandages. Can hold the gauze in place and apply pressure to stop the bleeding. Also useful to apply pressure to sprains/strains, etc. QR Powder or something similar. When gauze and pressure won’t stop bleeding, this stuff is a good backup. You can get it over the counter. Tape. The cloth or “silk” tape is the best. I carry tape with me in my truck and in my backpack. You’ll need something to attach the dressings to the skin, right? Cloth or silk tape can also be twisted up to form pretty strong “MacGyver” twine in a pinch. Crazy Glue. Not medical advice, but the “glue” that doctors use to fix cuts is quite similar to Crazy Glue. There is also a “liquid Band-Aid” you can get over the counter. Hemostats. You can get them online fairly cheaply and they come in handy for a lot of things. These are similar to the instruments that doctors use to put in stitches. Alligator forceps are incredibly useful for getting things out of tight places. Some doctors use them to get things out of noses and ears. Saline Solution. You can use the eye solution to rinse stuff out of your eyes and can even use it in a pinch to clean out wounds if you don’t have running water. I also keep a can of Wound Wash Saline in my truck. Trauma Shears. One of those “don’t leave home without them” things for me. Again, you can get them very cheap online. Here’s one site. Tweezers. For pulling out my nasal hairs. Nasal decongestant. Either Afrin or Neo-Synephrine or their generic equivalents. Nasal Rinse Kit. I love these things and they work better than any medicine your doctor can prescribe to you for sinus pain or congestion. Naphcon-A. An eye decongestant/anti-histamine. Either it or it’s generic equivalent is great for most causes of itchy or irritated eyes. Benadryl. Can be used for allergic reactions and is also an ingredient in several sleep aids. Hydrocortisone cream. Helps stop itching on irritated skin. Zanfel Poison Ivy Cream. This stuff is expensive. There are other less expensive generic brands at most pharmacies. Pain reliever(s) of choice. Antiseptic wipes/gel. Anything I’m missing?

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