Employers and Healthcare: “Which Frogs A-Leaping?”

At “Healthcare Renewal” (hcrenewal.blogspot.com) Brown University’s Dr. Roy Poses recently posted a thought-provoking piece about the Leapfrog Group, an employer group that has made its reputation pushing for higher quality care.  Poses points out that nearly 30% of the members of Leapfrog are healthcare corporations, and notes that this might skew their view of healthcare’s goals:
 

“One would expect that companies who make money by providing health care goods and services may have different ideas about health care costs and quality than companies who do not do any health care related business” said Poses in his post.

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Quote of the Week: Do You Agree or Disagree?

From a review of The
Truth About Health Care
, by David Mechanic. The review is written by Rob Cunningham and appears in Health Affairs,
September/October 2007.

“At some point
we as a nation will have to decide whether we wish to design our health care
system primarily to satisfy those who profit form it or to protect the health
and welfare of all Americans.” Mechanic speculates that “anything is possible if the public begins to appreciate how little it gets for what
it really pays.” But even as reform begins to rise again on the political
agenda, the preponderance of the evidence in this book says that a
majority of American prefer pluralism and individual liberty to the
tedious business of working together . . .”

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Bespoke Knees

Bloomberg recently
announced that the Food & Drug Administration has bestowed its blessing on
a new “gender-specific” knee implant. Manufactured by Smith & Nephew, the new knee is designed to fit the
“unique anatomy” of a female. This is not the first knee- for- women-only. Last
year the FDA approved a similar knee made by Zimmer Holdings, the company that
takes credit for what it describes as a “bespoke knee” for women.

Will the new devices
allow women to function better? "In
theory, yes, but the evidence isn’t there," Kimberly Templeton, an
associate professor of orthopedic surgery at the University of Kansas Medical
Center and a spokesperson for the
American Academy of Orthopaedic Surgeons told U.S. New & World Report. Sheryl Conley, Zimmer’s chief marketing officer explained
seven studies now underway will look at patient satisfaction and range of
motion. Preliminary data will be available in a year or so.

In the meantime, these
couture knees for women are fetching twice as much as the plain-vanilla knees
that, until recently, were used for both men and women. But this is not the
FDA’s concern.

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Responding to Comment on “The FDA Betrays Its Mandate”

Gregory—

Sorry I’ve been so slow in responding; I was traveling last
week. I completely agree that doctors should not be making a profit on anemia
injections or cancer drugs that they deliver in their offices. They should, of
course, be paid for their time and the skill involved in administering the
injection or drug. But they should not be making a profit on the product
itself—inevitably that creates a potential conflict of interest (even if it is
subconscious) when a doctor decides what drug to prescribe.

The real problem is that drugmakers are willing to give
doctors discounts which then let doctors bill insurers at the full rate and
pocket the “discount.”In the 19th century we learned about the problems
associated with letting doctors become pharmacists—it’s ironic that we have to
learn the same lesson all over again.

Wall Street, Cancer and the FDA: A Cautionary Tale

Only in America do physicians who evaluate new drugs need bodyguards. You may have read about the brouhaha surrounding Provenge, a vaccine designed to extend the lives of men suffering from late-stage prostate cancer. In March, a Food and Drug Administration (FDA) advisory panel voted 13 to 4 to recommend approval. The next day, shares of Dendreon, the drug’s sponsor, doubled. But shareholders did not celebrate for long. Two of the dissenting votes were cast by the panel’s two prostate cancer specialists: Sloan-Kettering’s Howard Scher and the University of Michigan’s Maha Hussain. And they did not just vote “no”—following the hearing, both wrote to the FDA arguing that Dendreon offered no solid evidence that Provenge works.
   
The FDA listened. And in May it told the company it wouldn’t approve the drug until it had more data. That is when the two oncologists began receiving threatening e-mails, phone calls, and letters. Many were anonymous

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