A SOCIALIST GOVERNMENT AND ITS SOCIALIZED HOSPITALS CANNOT EVEN HANDLE EMERGENCIES
In the Australian State of Victoria
"EMERGENCY patients at Victorian regional hospitals are worse off under Labor with more than 1000 people in the past quarter waiting at least 12 hours for a bed. An analysis of Department of Human Services figures reveal country patients fared better under the Kennett government. In the September quarter, 1076 Victorians endured delays of more than 12 hours on trolleys compared with 48 in the corresponding period in 1999. Hospitals in Geelong, Ballarat and Bendigo were three of the most affected by the blowout.
Opposition health spokesman David Davis attributed the rise to the closure of hospital beds throughout Victoria. "Patients are banking up on trolleys in emergency departments because the Bracks Government has closed beds in public hospitals," Mr Davis said. "This is not the failing of one hospital, it is the inability of the Bracks Government to manage country hospitals and their emergency departments." Mr Davis said the figures did not include patients who died after extended waiting periods in emergency departments and those who were transferred to another hospital or had discharged themselves without being treated. "This is not the full story," he said. "Mr Bracks needs to come clean about the full number of patients facing these types of delays."
Geelong Hospital had the biggest rise, from just five patients in the September quarter of 1999 to 397 in the same period last year".
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Monday, January 10, 2005
Sunday, January 09, 2005
DRUG COMPANIES HELP THE POOR OF THE WORLD
So, distinguished international medical experts accuse companies in the developed world of putting profits over people. Millions of the world's poorest people are dying each year, they maintain, because of this alleged "10/90 Gap" in global health research priorities. But there is less to these charges than meets the eye.
Rates of sickness and death are tragically higher in poor countries than they are in the rich countries. But can these higher rates of morbidity and mortality be chiefly blamed on the selfishness of rich pharmaceutical companies? An interesting new report, Diseases of Poverty and the 10/90 Gap, by the London-based International Policy Network (IPN) sheds considerable light on this question....
First, are 90 percent of the diseases that afflict poor people in the developing world really being ignored by pharmaceutical company researchers? IPN points out that, according to WHO data, tropical diseases (trypanosomiasis, Chagas disease, schistosomiasis, leishmaniasis, lymphatic filariasis, onchocerciasis) account for only 0.5 percent of deaths in high-mortality poor countries and only 0.3 percent of deaths in low-mortality poor countries.
Furthermore, many treatments already exist for many of these diseases. Schistosomiasis is treated with praziquantel for 30 cents a dose; onchocerciasis can be controlled with ivermectin (which is being provided free of charge by its manufacturer Merck & Co. for as many people as needed, for as long as needed). Lymphatic filariasis is treated successfully with a combination of ivermectin and albendazole (which are being donated free by Merck and SmithKline Beecham). Note that these treatments were not developed by WHO or MSF researchers, but by profit-making private companies.
This leaves leishmaniasis, trypanosomiasis (sleeping sickness), and Chagas disease without really effective treatments. If these horrific tropical diseases are not the main causes of suffering and death among the poor in the developing world, what is?
Tuberculosis, malaria, and HIV/AIDS account for nearly 18 percent of the disease burden in the poorest countries. Effective methods of prevention and treatments exist for these diseases. Diarrheal diseases kill 1.8 million people each year and acute lower respiratory infections kill 2 million children under five annually. Vitamin A deficiency blinds 500,000 children per year. Again, cheap and effective treatments for these diseases already exist. About 25 percent of people in low-mortality poor countries also die of such "rich country diseases" as heart attacks and cancer. Current research on these diseases will benefit people in poorer countries as their disease profiles converge on those of today's rich countries.
As the IPN report notes, poor countries "currently benefit from drugs that were originally developed for wealthier markets"—treatments such as vaccines for polio, pertussis (whooping cough), diphtheria, and measles, and drugs to treat tuberculosis, HIV/AIDS, pneumonia, and many others. In fact, 90 percent of the products on the WHO's list of 319 essential medicines were originally discovered and/or developed by private companies in wealthier countries.
So if effective medicines are in fact available that could save millions of lives and avert much suffering among the world's poorest people, why are so many of them still sick and dying? In a word, poverty. The abject poverty in which billions are mired is chiefly sustained by bad government economic policies. By adopting better economic policies, governments in poor countries would go a long way toward improving the health of their citizens. In addition, governments often impose high tariffs and taxes on medicines. For example, taxes account for 55 percent of the retail cost of medicines in India, 34 percent in Nigeria, 33 percent in Pakistan, 28 percent in China, and 24 percent in Mexico. And finally, in nearly all of the poorest countries, public expenditures on the military vastly outstrip those on health care.
"The health problems faced by the world's poorest populations are not caused by a lack of drugs specifically related to their problems and diseases," notes IPN. "The real problem is ensuring that these populations can actually access vital medicines." It turns out that the best way to address public health needs is through the profit motive. The IPN report correctly concludes: "A global R&D treaty, in which the profits of pharmaceutical companies are heavily taxed and their intellectual property rights undermined, would be almost certain to have the unintended consequence of effectively turning off the tap of innovation that is essential to dealing with the world's changing health problems." That would hurt the rich, but it would hurt the world's poor even more.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
So, distinguished international medical experts accuse companies in the developed world of putting profits over people. Millions of the world's poorest people are dying each year, they maintain, because of this alleged "10/90 Gap" in global health research priorities. But there is less to these charges than meets the eye.
Rates of sickness and death are tragically higher in poor countries than they are in the rich countries. But can these higher rates of morbidity and mortality be chiefly blamed on the selfishness of rich pharmaceutical companies? An interesting new report, Diseases of Poverty and the 10/90 Gap, by the London-based International Policy Network (IPN) sheds considerable light on this question....
First, are 90 percent of the diseases that afflict poor people in the developing world really being ignored by pharmaceutical company researchers? IPN points out that, according to WHO data, tropical diseases (trypanosomiasis, Chagas disease, schistosomiasis, leishmaniasis, lymphatic filariasis, onchocerciasis) account for only 0.5 percent of deaths in high-mortality poor countries and only 0.3 percent of deaths in low-mortality poor countries.
Furthermore, many treatments already exist for many of these diseases. Schistosomiasis is treated with praziquantel for 30 cents a dose; onchocerciasis can be controlled with ivermectin (which is being provided free of charge by its manufacturer Merck & Co. for as many people as needed, for as long as needed). Lymphatic filariasis is treated successfully with a combination of ivermectin and albendazole (which are being donated free by Merck and SmithKline Beecham). Note that these treatments were not developed by WHO or MSF researchers, but by profit-making private companies.
This leaves leishmaniasis, trypanosomiasis (sleeping sickness), and Chagas disease without really effective treatments. If these horrific tropical diseases are not the main causes of suffering and death among the poor in the developing world, what is?
Tuberculosis, malaria, and HIV/AIDS account for nearly 18 percent of the disease burden in the poorest countries. Effective methods of prevention and treatments exist for these diseases. Diarrheal diseases kill 1.8 million people each year and acute lower respiratory infections kill 2 million children under five annually. Vitamin A deficiency blinds 500,000 children per year. Again, cheap and effective treatments for these diseases already exist. About 25 percent of people in low-mortality poor countries also die of such "rich country diseases" as heart attacks and cancer. Current research on these diseases will benefit people in poorer countries as their disease profiles converge on those of today's rich countries.
As the IPN report notes, poor countries "currently benefit from drugs that were originally developed for wealthier markets"—treatments such as vaccines for polio, pertussis (whooping cough), diphtheria, and measles, and drugs to treat tuberculosis, HIV/AIDS, pneumonia, and many others. In fact, 90 percent of the products on the WHO's list of 319 essential medicines were originally discovered and/or developed by private companies in wealthier countries.
So if effective medicines are in fact available that could save millions of lives and avert much suffering among the world's poorest people, why are so many of them still sick and dying? In a word, poverty. The abject poverty in which billions are mired is chiefly sustained by bad government economic policies. By adopting better economic policies, governments in poor countries would go a long way toward improving the health of their citizens. In addition, governments often impose high tariffs and taxes on medicines. For example, taxes account for 55 percent of the retail cost of medicines in India, 34 percent in Nigeria, 33 percent in Pakistan, 28 percent in China, and 24 percent in Mexico. And finally, in nearly all of the poorest countries, public expenditures on the military vastly outstrip those on health care.
"The health problems faced by the world's poorest populations are not caused by a lack of drugs specifically related to their problems and diseases," notes IPN. "The real problem is ensuring that these populations can actually access vital medicines." It turns out that the best way to address public health needs is through the profit motive. The IPN report correctly concludes: "A global R&D treaty, in which the profits of pharmaceutical companies are heavily taxed and their intellectual property rights undermined, would be almost certain to have the unintended consequence of effectively turning off the tap of innovation that is essential to dealing with the world's changing health problems." That would hurt the rich, but it would hurt the world's poor even more.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, January 08, 2005
HOW PUBLIC MEDICINE KILLED THE SICK BRITISH BABY
Below is a correspondence I had with a regular reader of my blogs -- a medical specialist who works in an American public hospital -- about the case I reported two days ago -- where a baby ill with meningitis was shuffled from British public hospital to British public hospital and ended up dying:
JR:
If it had been my son he would be alive today. I would have taken him to a top private hospital only a short drive away from me that I use from time to time and I would only have had to raise an eyebrow for tests to be done, drips to be used if indicated and precautionary antibiotics administered. And he would of course have been admitted and kept under observation until his temperature came down.
Under the British NHS I would have no power to ensure any of that and it would not be (and was not) done
Reader:
Ditto: [For non-American readers: "Ditto" is an American way of indicating strong agreement]
I don't in any way approve of the system as it it - I am just being the devil's advocate - many serious and life-threatening diseases - like pneumonia and meningitis - start out as colds. And children with fevers often have seizures - usually not serious. The first few days are not surprising - but the long ambulance ride etc was truly unacceptable.
And of course, when the child is not getting better - most medical people would take another look.
And herein IS the major problem: we call it "polydoctoritis" If there was anything close to good care nearby, the parents would have been counseled that "it's most likely a cold, BUT- here is what to look for" and call us back IF. And the same doctor (or someone else in the same grop) most likely would see the child.
And this IS the most serious problem - when a new doctor sees the patient, he "starts from scratch" - he doesn't really know that the child may be worse than he was just a few hours earlier. In medicine, "watchful waiting" is an important thing - and experienced doctors and nurses can make observations that just can't be made by less experienced people, and people who have seen the child for the first time.
Also, an important part of pediatric practice is evaluation of the parents - parents that appear as nervous wrecks or hypochondriacs may not be taken seriously in a busy practice.
Unfortunately, in the US, many of these types of patients end up in emergency rooms, and waiting many hours to be seen. Having a readily available family doctor is a luxury that is difficult for many to find. Of course, free enterprise would solve this overnight - but Government forces are resisting this.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Below is a correspondence I had with a regular reader of my blogs -- a medical specialist who works in an American public hospital -- about the case I reported two days ago -- where a baby ill with meningitis was shuffled from British public hospital to British public hospital and ended up dying:
JR:
If it had been my son he would be alive today. I would have taken him to a top private hospital only a short drive away from me that I use from time to time and I would only have had to raise an eyebrow for tests to be done, drips to be used if indicated and precautionary antibiotics administered. And he would of course have been admitted and kept under observation until his temperature came down.
Under the British NHS I would have no power to ensure any of that and it would not be (and was not) done
Reader:
Ditto: [For non-American readers: "Ditto" is an American way of indicating strong agreement]
I don't in any way approve of the system as it it - I am just being the devil's advocate - many serious and life-threatening diseases - like pneumonia and meningitis - start out as colds. And children with fevers often have seizures - usually not serious. The first few days are not surprising - but the long ambulance ride etc was truly unacceptable.
And of course, when the child is not getting better - most medical people would take another look.
And herein IS the major problem: we call it "polydoctoritis" If there was anything close to good care nearby, the parents would have been counseled that "it's most likely a cold, BUT- here is what to look for" and call us back IF. And the same doctor (or someone else in the same grop) most likely would see the child.
And this IS the most serious problem - when a new doctor sees the patient, he "starts from scratch" - he doesn't really know that the child may be worse than he was just a few hours earlier. In medicine, "watchful waiting" is an important thing - and experienced doctors and nurses can make observations that just can't be made by less experienced people, and people who have seen the child for the first time.
Also, an important part of pediatric practice is evaluation of the parents - parents that appear as nervous wrecks or hypochondriacs may not be taken seriously in a busy practice.
Unfortunately, in the US, many of these types of patients end up in emergency rooms, and waiting many hours to be seen. Having a readily available family doctor is a luxury that is difficult for many to find. Of course, free enterprise would solve this overnight - but Government forces are resisting this.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, January 07, 2005
THE TENNCARE MELTDOWN CONTINUES
With buckpassing all round
The state is paying too much to the managed care organizations that administer services under TennCare, says the chairman of the committee that oversees the troubled program. "We're paying a high price to stabilize this program," said state Sen. Roscoe Dixon, D-Memphis, chairman of the TennCare Oversight Committee. "In my view, they are ripping off the state to get paid this much money to push paper with no real risk."
Former Gov. Don Sundquist shifted the financial risk of providing health care to TennCare recipients from private insurers to the government in July 2002. He said the change was needed to help stabilize TennCare after two of its biggest plans collapsed. Last year, the insurers that administer TennCare, known as managed care organizations, or MCOs, were paid $263 million to administer most of the $8.7 billion program for the state. After taxes paid back to the state, the seven plans ended up with $211 million to pay claims for most of the 1.3 million poor, disabled and uninsurable Tennesseans on TennCare.
TennCare administrators say they are doing more than just paying claims and, according to a Kaiser Foundation study, are paid far less than administrators in states such as Illinois, Florida and New York. BlueCross BlueShield of Tennessee, which handles the biggest TennCare plans, operates at an after-tax reimbursement rate of under 7 percent, according to company vice president Ron Harr. For that, Blue-Cross and other TennCare plan administrators must perform a variety of tasks that go beyond typical claims payments for self-insured employers, he said. "We handle 1.4 million calls a year at BlueCross for TennCare, and there is certainly a much higher level of intensity of services we provide than what we do for the state employees' plan, for instance," Harr said. "We are very proud of our administrative efficiency."
When TennCare plans were at risk, BlueCross barely broke even, and most insurers lost money. The state was forced to take over two of the biggest plans - Access MedPlus and Universal Care of Tennessee - when they collapsed and were unable to pay their bills. Most of the major health insurers such as Cigna, United Healthcare and Aetna declined to participate in TennCare.
For now, Gov. Phil Bredesen is focused on getting relief from court orders to allow more limits and preauthorization of benefits and enrollees in the state health program. Bredesen said the court decrees restrict the ability of TennCare plans to deliver managed care. Without such relief, the governor said he is considering replacing the TennCare program with a more traditional Medicaid plan to help save money.
TennCare officials say they hope to eventually pare what is paid to the managed care organizations that deliver health care to one of every four Tennesseans. "We couldn't do everything at once," Finance and Administration Commissioner David Goetz said. "The MCOs are needed to manage the changes. We consciously delayed the idea of restructuring the MCOs until next spring because we wanted to get the reforms in place and up."
Under the original TennCare program, managed care organizations were paid a flat fee for each enrollee and were responsible for managing the health care of each of their subscribers. As administrative service organizations, the TennCare plans pay hospital and doctor bills and submit their expenses to the state for reimbursement. "There is no doubt today we are suffering the ill effects from not being under some type of risk arrangement," TennCare Director J.D. Hickey said. "We are seeing expenses on the managed care side that we would not see otherwise."
Source:
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
With buckpassing all round
The state is paying too much to the managed care organizations that administer services under TennCare, says the chairman of the committee that oversees the troubled program. "We're paying a high price to stabilize this program," said state Sen. Roscoe Dixon, D-Memphis, chairman of the TennCare Oversight Committee. "In my view, they are ripping off the state to get paid this much money to push paper with no real risk."
Former Gov. Don Sundquist shifted the financial risk of providing health care to TennCare recipients from private insurers to the government in July 2002. He said the change was needed to help stabilize TennCare after two of its biggest plans collapsed. Last year, the insurers that administer TennCare, known as managed care organizations, or MCOs, were paid $263 million to administer most of the $8.7 billion program for the state. After taxes paid back to the state, the seven plans ended up with $211 million to pay claims for most of the 1.3 million poor, disabled and uninsurable Tennesseans on TennCare.
TennCare administrators say they are doing more than just paying claims and, according to a Kaiser Foundation study, are paid far less than administrators in states such as Illinois, Florida and New York. BlueCross BlueShield of Tennessee, which handles the biggest TennCare plans, operates at an after-tax reimbursement rate of under 7 percent, according to company vice president Ron Harr. For that, Blue-Cross and other TennCare plan administrators must perform a variety of tasks that go beyond typical claims payments for self-insured employers, he said. "We handle 1.4 million calls a year at BlueCross for TennCare, and there is certainly a much higher level of intensity of services we provide than what we do for the state employees' plan, for instance," Harr said. "We are very proud of our administrative efficiency."
When TennCare plans were at risk, BlueCross barely broke even, and most insurers lost money. The state was forced to take over two of the biggest plans - Access MedPlus and Universal Care of Tennessee - when they collapsed and were unable to pay their bills. Most of the major health insurers such as Cigna, United Healthcare and Aetna declined to participate in TennCare.
For now, Gov. Phil Bredesen is focused on getting relief from court orders to allow more limits and preauthorization of benefits and enrollees in the state health program. Bredesen said the court decrees restrict the ability of TennCare plans to deliver managed care. Without such relief, the governor said he is considering replacing the TennCare program with a more traditional Medicaid plan to help save money.
TennCare officials say they hope to eventually pare what is paid to the managed care organizations that deliver health care to one of every four Tennesseans. "We couldn't do everything at once," Finance and Administration Commissioner David Goetz said. "The MCOs are needed to manage the changes. We consciously delayed the idea of restructuring the MCOs until next spring because we wanted to get the reforms in place and up."
Under the original TennCare program, managed care organizations were paid a flat fee for each enrollee and were responsible for managing the health care of each of their subscribers. As administrative service organizations, the TennCare plans pay hospital and doctor bills and submit their expenses to the state for reimbursement. "There is no doubt today we are suffering the ill effects from not being under some type of risk arrangement," TennCare Director J.D. Hickey said. "We are seeing expenses on the managed care side that we would not see otherwise."
Source:
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, January 06, 2005
THE LATEST GLORY OF SOCIALIZED MEDICINE
Where nobody cares and nobody takes responsibility
A baby boy died of meningitis after being passed from doctor to doctor before it was finally diagnosed - too late to save him. Harvey Slocombe, only six months old, fell ill on December 12. His parents, James Keat and Karen Slocombe, from Frome in Somerset, rang NHS Direct and were told to take him to Shepton Mallet Community Hospital in Somerset.
On the way, NHS Direct re-routed them to Wells and District Hospital, a further ten miles away, because there were not any doctors free at Shepton. At Wells a doctor diagnosed a viral infection and discharged him. "We didn't know what the problem was so we believed the doctor and took Harvey home," Ms Slocombe said.
His condition deteriorated so they took him to Frome Victoria Hospital, where another doctor dismissed their fears, then to the Royal United Hospital in Bath. Mr Keat said: "We told a consultant paediatrician that we thought it could be meningitis but he just said: `You have a perfectly healthy baby. Take him home.' Because three doctors had told us the same thing, we took him home." But on December 14 they called an ambulance, which took him back to Bath.
He could not be admitted to a paediatric unit in Bristol due to a shortage of beds and was taken 60 miles to the University Hospital of Wales in Cardiff. There a scan revealed that the baby was brain dead, and his life support machine was switched off. Tests showed that he had died of bacterial meningitis. "If meningitis had been diagnosed early and the doctors had done everything but he had still died, I might be able to accept it. He wasn't given that chance," Mr Keat said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Where nobody cares and nobody takes responsibility
A baby boy died of meningitis after being passed from doctor to doctor before it was finally diagnosed - too late to save him. Harvey Slocombe, only six months old, fell ill on December 12. His parents, James Keat and Karen Slocombe, from Frome in Somerset, rang NHS Direct and were told to take him to Shepton Mallet Community Hospital in Somerset.
On the way, NHS Direct re-routed them to Wells and District Hospital, a further ten miles away, because there were not any doctors free at Shepton. At Wells a doctor diagnosed a viral infection and discharged him. "We didn't know what the problem was so we believed the doctor and took Harvey home," Ms Slocombe said.
His condition deteriorated so they took him to Frome Victoria Hospital, where another doctor dismissed their fears, then to the Royal United Hospital in Bath. Mr Keat said: "We told a consultant paediatrician that we thought it could be meningitis but he just said: `You have a perfectly healthy baby. Take him home.' Because three doctors had told us the same thing, we took him home." But on December 14 they called an ambulance, which took him back to Bath.
He could not be admitted to a paediatric unit in Bristol due to a shortage of beds and was taken 60 miles to the University Hospital of Wales in Cardiff. There a scan revealed that the baby was brain dead, and his life support machine was switched off. Tests showed that he had died of bacterial meningitis. "If meningitis had been diagnosed early and the doctors had done everything but he had still died, I might be able to accept it. He wasn't given that chance," Mr Keat said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, January 05, 2005
DOUBLE STANDARDS ABOUT DRUGS .... AND MUCH ELSE
The government will allow you to risk your life for the sake of recreation by sky-diving, mountain climbing or any number of other dangerous activities. But it will not allow you to risk your life for the sake of avoiding arthritis pain by taking Vioxx. There is no principle behind such differences in government policy. No one has to show that some particular medication is more dangerous than some particular recreation in order to get the medication banned while the recreational activity is allowed to go on. Businesses that conduct dangerous recreational activities are not being denounced for "corporate greed" by making money at the risk of other people's lives. But such charges are flung around regularly about pharmaceutical companies -- and are taken seriously in the media.
The sad fact is that many issues that are argued as if they were matters of principle are in fact only matters of attitude. We are used to hearing denunciations of "unsafe" drugs, cars, water, and various other things that crusaders and the media happen to have singled out. This has created attitudes, rather than anything that could be dignified as a principle. Far more dangerous things not only escape criticism but are even promoted by some of the same people who create hysteria over more fashionable fears.
The banning of the insecticide DDT is a classic example. Unsubstantiated claims of dangers to human beings from using DDT have led to bans on this insecticide in many countries around the world, leading to a resurgence of mosquitoes carrying malaria, whose documented deaths have been in the millions. It is attitude, not principle. An attitude of reverence has been created for Rachel Carson by the environmental movement because she claimed that DDT would wipe out song birds by its effects on their eggs. Yet she has probably been responsible for more deaths of human beings than anybody without an army.
One death in a boxing ring will set off loud demands to ban that sport but hundreds of deaths from boating accidents will elicit no such response. Nor are such gross double standards confined to safety issues. Americans will be denounced for greed and materialism by people from countries where individuals do not donate nearly as high a percentage of their incomes as Americans do, nor volunteer a fraction as much time to philanthropic causes as Americans do. Moreover, there will be a chorus of Americans on the left echoing the foreign charges.
Politicians who give away the taxpayers' money to social programs will be lionized in the media for their "compassion." But many businessmen across the country, who each donate millions of dollars of their own money to help the less fortunate, get no such praise, if they are mentioned at all. Facts don't matter to those for whom principles don't matter, however loudly those principles may be proclaimed. Many so-called "thinking people" do remarkably little thinking. Much ingenuity may go into articulating and rationalizing their attitudes toward business, the police, American society, etc., but these are still attitudes rather than principles.
This is not to say that there is no consistency in their behavior. There is great consistency but it is consistency with a particular vision of the world rather than consistency with proclaimed principles of safety, equality, or morality. That vision casts them in the role of wiser and nobler people -- defenders of the downtrodden, protectors of the environment, advocates of peace and opponents of war. There is always some crusade that requires their superior wisdom and virtue to be imposed on others. Particular attitudes towards particular things that happen to be in vogue among those who wrap themselves in the mantle of chic virtue serve as a badge of identity, showing who is one of the special Us rather than the more ordinary Them. This is heady stuff and they are not going to give it up for anything so mundane as facts or logic or principles. The best that the rest of us can do is to stop calling their ego trips idealism.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
The government will allow you to risk your life for the sake of recreation by sky-diving, mountain climbing or any number of other dangerous activities. But it will not allow you to risk your life for the sake of avoiding arthritis pain by taking Vioxx. There is no principle behind such differences in government policy. No one has to show that some particular medication is more dangerous than some particular recreation in order to get the medication banned while the recreational activity is allowed to go on. Businesses that conduct dangerous recreational activities are not being denounced for "corporate greed" by making money at the risk of other people's lives. But such charges are flung around regularly about pharmaceutical companies -- and are taken seriously in the media.
The sad fact is that many issues that are argued as if they were matters of principle are in fact only matters of attitude. We are used to hearing denunciations of "unsafe" drugs, cars, water, and various other things that crusaders and the media happen to have singled out. This has created attitudes, rather than anything that could be dignified as a principle. Far more dangerous things not only escape criticism but are even promoted by some of the same people who create hysteria over more fashionable fears.
The banning of the insecticide DDT is a classic example. Unsubstantiated claims of dangers to human beings from using DDT have led to bans on this insecticide in many countries around the world, leading to a resurgence of mosquitoes carrying malaria, whose documented deaths have been in the millions. It is attitude, not principle. An attitude of reverence has been created for Rachel Carson by the environmental movement because she claimed that DDT would wipe out song birds by its effects on their eggs. Yet she has probably been responsible for more deaths of human beings than anybody without an army.
One death in a boxing ring will set off loud demands to ban that sport but hundreds of deaths from boating accidents will elicit no such response. Nor are such gross double standards confined to safety issues. Americans will be denounced for greed and materialism by people from countries where individuals do not donate nearly as high a percentage of their incomes as Americans do, nor volunteer a fraction as much time to philanthropic causes as Americans do. Moreover, there will be a chorus of Americans on the left echoing the foreign charges.
Politicians who give away the taxpayers' money to social programs will be lionized in the media for their "compassion." But many businessmen across the country, who each donate millions of dollars of their own money to help the less fortunate, get no such praise, if they are mentioned at all. Facts don't matter to those for whom principles don't matter, however loudly those principles may be proclaimed. Many so-called "thinking people" do remarkably little thinking. Much ingenuity may go into articulating and rationalizing their attitudes toward business, the police, American society, etc., but these are still attitudes rather than principles.
This is not to say that there is no consistency in their behavior. There is great consistency but it is consistency with a particular vision of the world rather than consistency with proclaimed principles of safety, equality, or morality. That vision casts them in the role of wiser and nobler people -- defenders of the downtrodden, protectors of the environment, advocates of peace and opponents of war. There is always some crusade that requires their superior wisdom and virtue to be imposed on others. Particular attitudes towards particular things that happen to be in vogue among those who wrap themselves in the mantle of chic virtue serve as a badge of identity, showing who is one of the special Us rather than the more ordinary Them. This is heady stuff and they are not going to give it up for anything so mundane as facts or logic or principles. The best that the rest of us can do is to stop calling their ego trips idealism.
More here
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, January 04, 2005
KUDLOW ON DRUG IMPORTATION FROM CANADA
I think he has missed the main point -- that most "Canadian" drugs are actually manufacured on the same production lines that produce "American" drugs and that the higher prices in the USA are what underpin American drug research. But I may be missing something so I reproduce his post plus two of the comments on it:
"Drug reimportation is a terrible idea. 30 million Canadians cannot supply enough drugs for 300 million Americans. Leaving alone the safety issue (re-imported drugs are not produced under the auspices of the FDA), doing it wouldn't even save American consumers that much, after all the necessary bureaucracy is put in place. Two excellent articles on this theme, one from Rick Weiss in the Washington Post, and one from Laura Gilcrest at CBS Marktewatch, go into more depth. The more details emerge, the more it looks like generic drugs, US-made, are the way to go".
Comments:
AB said...
I don't think importing price controls from Canada is the answer to bringing down America's drug costs. Any initiative that squeezes drug companies profits could have the unintended consequence of hindering the incentives to develop new drugs. I would love it if this argument were refocused on two fronts:
1) making the FDA more efficient and thereby less costly for the pharmaceutical companies to get new drugs approved; and
2) putting more pressure on foreign governments that are controlling the prices of drugs in their respective countries to start paying their fair share of the R&D costs of existing drugs. As it stands now, Americans are paying a much higher percentage of the R&D costs for most drugs than the rest of the world, especially more than countries like Canada that do not allow drugs companies to operate in a free market.
These two initiatives would each allow drug companies to reduce the price of their drugs in the U.S. without negatively impacting drug companies' profit margins and without reducing the incentives for drug companies to develop new drugs.
Jake said...
In Canada, there is a $250,000 limit on pain and suffering awards. As a consequence, drugs are cheaper in Canada. In Mexico, it is unheard of to sue the drug companies. As a consequence, drugs are 50% cheaper in Mexico. If Bush's tort reform bill was passed, it would have a dramatic effect on drug prices.
More here
I think he has missed the main point -- that most "Canadian" drugs are actually manufacured on the same production lines that produce "American" drugs and that the higher prices in the USA are what underpin American drug research. But I may be missing something so I reproduce his post plus two of the comments on it:
"Drug reimportation is a terrible idea. 30 million Canadians cannot supply enough drugs for 300 million Americans. Leaving alone the safety issue (re-imported drugs are not produced under the auspices of the FDA), doing it wouldn't even save American consumers that much, after all the necessary bureaucracy is put in place. Two excellent articles on this theme, one from Rick Weiss in the Washington Post, and one from Laura Gilcrest at CBS Marktewatch, go into more depth. The more details emerge, the more it looks like generic drugs, US-made, are the way to go".
Comments:
AB said...
I don't think importing price controls from Canada is the answer to bringing down America's drug costs. Any initiative that squeezes drug companies profits could have the unintended consequence of hindering the incentives to develop new drugs. I would love it if this argument were refocused on two fronts:
1) making the FDA more efficient and thereby less costly for the pharmaceutical companies to get new drugs approved; and
2) putting more pressure on foreign governments that are controlling the prices of drugs in their respective countries to start paying their fair share of the R&D costs of existing drugs. As it stands now, Americans are paying a much higher percentage of the R&D costs for most drugs than the rest of the world, especially more than countries like Canada that do not allow drugs companies to operate in a free market.
These two initiatives would each allow drug companies to reduce the price of their drugs in the U.S. without negatively impacting drug companies' profit margins and without reducing the incentives for drug companies to develop new drugs.
Jake said...
In Canada, there is a $250,000 limit on pain and suffering awards. As a consequence, drugs are cheaper in Canada. In Mexico, it is unheard of to sue the drug companies. As a consequence, drugs are 50% cheaper in Mexico. If Bush's tort reform bill was passed, it would have a dramatic effect on drug prices.
More here
Monday, January 03, 2005
HOORAY! ONE GOVERNMENT CUTS BACK ON BUREAUCRATS
It's a start -- and hopefully an example for others
The future of hundreds of health jobs in NSW is still in doubt, the day after the State Government officially slashed the number of area health services from 17 to eight. Nearly six months after Health Minister Morris Iemma announced the merger of health services, NSW Health employees, mainly working in administrative roles, are waiting to hear if their jobs are safe. Health Services Union assistant secretary Peter Mylan said about 625 positions were expected to be lost, but the Government has kept employees in the dark. "No one is aware of what the future will bring," he said. "We have raised with them, prior to Christmas, the concerns of our members and their handling of this. They are not having real frank discussions with us."
The Department of Health has confirmed administrative jobs will be reduced over the next two years. "Staff should be reassured that there will be no forced redundancies," a spokeswoman said. She said the new chief executives of the eight larger area health services will report to NSW Health this month on changes to staffing levels and "projected savings".
Mr Mylan said employees were anxious and the Government should have alleviated concerns before Christmas. "We have been advised that in the latter part of January we will be consulted with," he said. The Government has predicted that the amalgamation of the area health services will direct about $100 million into frontline health services.
The health department's spokeswoman said the merger would also reduce administrative duplication and inefficiencies, improve the distribution of the health workforce and increase the numbers of doctors, nurses and hospital beds. The new area health services are South Western Sydney, South Eastern Sydney/Illawarra, Western Sydney, Northern Sydney/Central Coast, Hunter/New England, North Coast, Greater Western and Greater Southern
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
It's a start -- and hopefully an example for others
The future of hundreds of health jobs in NSW is still in doubt, the day after the State Government officially slashed the number of area health services from 17 to eight. Nearly six months after Health Minister Morris Iemma announced the merger of health services, NSW Health employees, mainly working in administrative roles, are waiting to hear if their jobs are safe. Health Services Union assistant secretary Peter Mylan said about 625 positions were expected to be lost, but the Government has kept employees in the dark. "No one is aware of what the future will bring," he said. "We have raised with them, prior to Christmas, the concerns of our members and their handling of this. They are not having real frank discussions with us."
The Department of Health has confirmed administrative jobs will be reduced over the next two years. "Staff should be reassured that there will be no forced redundancies," a spokeswoman said. She said the new chief executives of the eight larger area health services will report to NSW Health this month on changes to staffing levels and "projected savings".
Mr Mylan said employees were anxious and the Government should have alleviated concerns before Christmas. "We have been advised that in the latter part of January we will be consulted with," he said. The Government has predicted that the amalgamation of the area health services will direct about $100 million into frontline health services.
The health department's spokeswoman said the merger would also reduce administrative duplication and inefficiencies, improve the distribution of the health workforce and increase the numbers of doctors, nurses and hospital beds. The new area health services are South Western Sydney, South Eastern Sydney/Illawarra, Western Sydney, Northern Sydney/Central Coast, Hunter/New England, North Coast, Greater Western and Greater Southern
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Sunday, January 02, 2005
BOYCOTT THE LAWYERS
Doctors are irate over malpractice. But they have not yet gone as far as Shakespeare, who suggested killing all lawyers. Still, at a meeting of the American Medical Association last summer, a surgeon from South Carolina proposed that doctors not treat lawyers who sue doctors. And while calmer voices dismissed the proposal, it highlighted the friction between lawyers and doctors that sometimes strains the patient-doctor relationship when lawyers seek medical care....
The proposal by the surgeon from South Carolina that doctors should simply refuse to treat lawyers runs counter to the popular image of altruistic doctors who are supposed to treat all patients, without regard to their occupations or beliefs. But the reality is that in nonemergency situations, doctors are free to choose their patients, just as patients are free to select their doctors. No oath, including the two most famous, those of Hippocrates and Maimonides, compels a doctor to treat a patient, said Dr. David J. Rothman, an expert on medical oaths who teaches medical students at Columbia....
The American Medical Association says there is a malpractice crisis in 20 states. In those states, the group says, some doctors no longer provide certain high-risk services like emergency and trauma care and delivering babies, or they have stopped practicing altogether. The A.M.A. also cites data from the National Association of Insurance Commissioners showing a 750 percent increase nationally in malpractice insurance premiums since 1975. For some specialists, the annual insurance premium exceeds $200,000.
In addition to those who say there's no way they can hide their profession, lawyers in a spot check seemed to favor one of two strategies in seeking care. Those in one group try to avoid identifying themselves as lawyers on doctors' intake forms. Physicians, they believe, often become anxious in treating lawyers. As patients, they say, they may be subjected to overtesting because of their profession, and thus risk having unnecessary procedures. But other lawyers are emphatic in letting the doctor know their occupation: They believe the extra tests they may get will lead to better care.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Doctors are irate over malpractice. But they have not yet gone as far as Shakespeare, who suggested killing all lawyers. Still, at a meeting of the American Medical Association last summer, a surgeon from South Carolina proposed that doctors not treat lawyers who sue doctors. And while calmer voices dismissed the proposal, it highlighted the friction between lawyers and doctors that sometimes strains the patient-doctor relationship when lawyers seek medical care....
The proposal by the surgeon from South Carolina that doctors should simply refuse to treat lawyers runs counter to the popular image of altruistic doctors who are supposed to treat all patients, without regard to their occupations or beliefs. But the reality is that in nonemergency situations, doctors are free to choose their patients, just as patients are free to select their doctors. No oath, including the two most famous, those of Hippocrates and Maimonides, compels a doctor to treat a patient, said Dr. David J. Rothman, an expert on medical oaths who teaches medical students at Columbia....
The American Medical Association says there is a malpractice crisis in 20 states. In those states, the group says, some doctors no longer provide certain high-risk services like emergency and trauma care and delivering babies, or they have stopped practicing altogether. The A.M.A. also cites data from the National Association of Insurance Commissioners showing a 750 percent increase nationally in malpractice insurance premiums since 1975. For some specialists, the annual insurance premium exceeds $200,000.
In addition to those who say there's no way they can hide their profession, lawyers in a spot check seemed to favor one of two strategies in seeking care. Those in one group try to avoid identifying themselves as lawyers on doctors' intake forms. Physicians, they believe, often become anxious in treating lawyers. As patients, they say, they may be subjected to overtesting because of their profession, and thus risk having unnecessary procedures. But other lawyers are emphatic in letting the doctor know their occupation: They believe the extra tests they may get will lead to better care.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, January 01, 2005
THE NATIONAL HEALTH SERVICE IN SCOTLAND IS DIRE
People are being driven to desperation and all the politicians do is blame one-another
A growing number of Scots are turning to the private sector for a range of procedures. Shona Robison, SNP health spokeswoman, said people were frustrated at having to wait for NHS treatment. She said: "I know for some elderly people it is a heart-breaking decision to have to use their life-long savings to get a hip operation, but they are just waiting far too long on the NHS. I think this shows how badly the executive has failed."
Carolyn Leckie, health spokeswoman for the Scottish Socialist Party, said: "The NHS was created for the people, and if people are being forced to turn to private healthcare this totally defeats the purpose." David Davidson, Tory health spokesman, said people were increasingly paying for medical care to achieve an improved quality of life. "The elderly in particular are willing to use their savings to gain an improved lifestyle, but it is their choice." A British Medical Association spokesman said: "Scots are entitled to choose to go private if they wish, although they should have access to free NHS healthcare and services of a certain standard."
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
People are being driven to desperation and all the politicians do is blame one-another
A growing number of Scots are turning to the private sector for a range of procedures. Shona Robison, SNP health spokeswoman, said people were frustrated at having to wait for NHS treatment. She said: "I know for some elderly people it is a heart-breaking decision to have to use their life-long savings to get a hip operation, but they are just waiting far too long on the NHS. I think this shows how badly the executive has failed."
Carolyn Leckie, health spokeswoman for the Scottish Socialist Party, said: "The NHS was created for the people, and if people are being forced to turn to private healthcare this totally defeats the purpose." David Davidson, Tory health spokesman, said people were increasingly paying for medical care to achieve an improved quality of life. "The elderly in particular are willing to use their savings to gain an improved lifestyle, but it is their choice." A British Medical Association spokesman said: "Scots are entitled to choose to go private if they wish, although they should have access to free NHS healthcare and services of a certain standard."
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, December 31, 2004
DOCTORS DRIVEN TO DESPERATE TACTICS
Doctors around the country are increasingly using methods popularized by labor unions to gain leverage in their fight against rising premiums for malpractice coverage. Over the past few years, their tactics have included large-scale marches, limiting treatment to emergencies or suspending service altogether. The doctors have not always been successful in gaining insurance changes, but experts say the pressure has helped move the issue up on the political agenda.
Maryland doctors have tried to galvanize support for changing how state courts judge damages in malpractice cases. Last month, about 50 doctors in Prince George's County declined nonemergency cases for a day. A similar number in Washington County refused to schedule nonemergency appointments for a week. In February 2003, most of New Jersey's 20,000 physicians took part in a slowdown for several days, canceling routine checkups and rescheduling elective surgery in one of the nation's largest walkouts ever by doctors. Emergency rooms were inundated with patients, and a rally in Trenton drew 4,000 doctors. About a dozen general and cardiac surgeons took "leaves of absence" in Wheeling, W.Va., in January 2003 as higher malpractice premiums came due, halting most surgery at three local hospitals.
In Maryland, the doctors have helped generate the pressure that led Gov. Robert L. Ehrlich Jr. to call a special session of the Legislature, set to convene on Tuesday. "There hasn't been a single state that's enacted major tort reform without physician job action," said Dr. Manuel A. Casiano, who has been practicing in Frederick for more than 15 years. Randall Bovbjerg, a researcher at the Urban Institute who follows malpractice issues, said physician activism "has become progressively more widespread" as managed care has squeezed doctors' reimbursements and made it harder to pass on their higher costs.
Doctors have traditionally concentrated on their medical practices and left the lobbying to professionals. But doctors say they now have little choice but to resort to direct action, especially as the influence of the American Medical Association has declined. Dr. Gregory Saracco, a surgeon in Wheeling, said that before taking action, doctors in West Virginia had been making little headway in getting the attention of state officials. "The governor wouldn't talk to us for a month," said Dr. Saracco, who was president of the Ohio County Medical Society at the time. "The day the leaves of absence started, I was in his office that very afternoon." The governor quickly put together a package to overhaul the system, and the surgeons began returning to work after two to three weeks.
Doctors are potentially subject to antitrust complications if they are seen to be colluding. They are careful to say they have made their decisions on job actions individually or within their practice. Carlton Carl, director of media relations for the Association of Trial Lawyers of America, a group that opposes doctors over changes in tort law, describes the doctor protests as strikes or job actions. "Clearly, this is an organized effort by the A.M.A. and state medical associations," Mr. Carl said. "It raises serious antitrust issues. And the denial of even nonemergency care is questionable for a doctor."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Doctors around the country are increasingly using methods popularized by labor unions to gain leverage in their fight against rising premiums for malpractice coverage. Over the past few years, their tactics have included large-scale marches, limiting treatment to emergencies or suspending service altogether. The doctors have not always been successful in gaining insurance changes, but experts say the pressure has helped move the issue up on the political agenda.
Maryland doctors have tried to galvanize support for changing how state courts judge damages in malpractice cases. Last month, about 50 doctors in Prince George's County declined nonemergency cases for a day. A similar number in Washington County refused to schedule nonemergency appointments for a week. In February 2003, most of New Jersey's 20,000 physicians took part in a slowdown for several days, canceling routine checkups and rescheduling elective surgery in one of the nation's largest walkouts ever by doctors. Emergency rooms were inundated with patients, and a rally in Trenton drew 4,000 doctors. About a dozen general and cardiac surgeons took "leaves of absence" in Wheeling, W.Va., in January 2003 as higher malpractice premiums came due, halting most surgery at three local hospitals.
In Maryland, the doctors have helped generate the pressure that led Gov. Robert L. Ehrlich Jr. to call a special session of the Legislature, set to convene on Tuesday. "There hasn't been a single state that's enacted major tort reform without physician job action," said Dr. Manuel A. Casiano, who has been practicing in Frederick for more than 15 years. Randall Bovbjerg, a researcher at the Urban Institute who follows malpractice issues, said physician activism "has become progressively more widespread" as managed care has squeezed doctors' reimbursements and made it harder to pass on their higher costs.
Doctors have traditionally concentrated on their medical practices and left the lobbying to professionals. But doctors say they now have little choice but to resort to direct action, especially as the influence of the American Medical Association has declined. Dr. Gregory Saracco, a surgeon in Wheeling, said that before taking action, doctors in West Virginia had been making little headway in getting the attention of state officials. "The governor wouldn't talk to us for a month," said Dr. Saracco, who was president of the Ohio County Medical Society at the time. "The day the leaves of absence started, I was in his office that very afternoon." The governor quickly put together a package to overhaul the system, and the surgeons began returning to work after two to three weeks.
Doctors are potentially subject to antitrust complications if they are seen to be colluding. They are careful to say they have made their decisions on job actions individually or within their practice. Carlton Carl, director of media relations for the Association of Trial Lawyers of America, a group that opposes doctors over changes in tort law, describes the doctor protests as strikes or job actions. "Clearly, this is an organized effort by the A.M.A. and state medical associations," Mr. Carl said. "It raises serious antitrust issues. And the denial of even nonemergency care is questionable for a doctor."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, December 30, 2004
Fear Mongering At The FDA
First, let's get this straight: There's no new evidence that naproxen, the active ingredient in over-the-counter Aleve and prescription Naprosyn, causes an increase in heart attacks. There is, however, strong evidence that the U.S. Food and Drug Administration did the drug industry equivalent of yelling, "Fire!" in a crowded theater. On Monday, the FDA turned a halted clinical trial into a very scary warning about Aleve. As reported here on Tuesday morning, there was no reason for a warning, and, in fact, naproxen might well be safe.
The National Institutes of Health announced Monday that it had halted a clinical trial testing whether naproxen and Celebrex, an arthritis pill made by Pfizer, might prevent Alzheimer's disease. Another NIH study testing Celebrex as a cancer preventative had found that the drug increased the risk of heart attacks, and patients were dropping out of the Alzheimer's study in droves. Because of the worries about Celebrex and the problems holding onto patients, the Alzheimer's study was halted. In the Alzheimer's study, though, there was no increase in heart risk for long-term Celebrex users. There was a slight increase in heart risk for naproxen users, but the increase was so small that it may have been a chance occurrence. It was not the kind of data on which decisions involving many thousands of patients should have been made.
The FDA apparently didn't see it that way. In its statement, it said, "Preliminary information from the study showed some evidence of increased risk of cardiovascular events, when compared to placebo, to patients taking naproxen." Then it warned patients to use Aleve only according to the directions on the label--sensible advice, but ominous given the circumstances.
None of this would have sounded so scary if it weren't for Merck's recall of Vioxx, the biggest-selling drug ever to be pulled from the market. Vioxx works by inhibiting the same enzyme as Celebrex. When results emerged showing Vioxx doubled the risk of heart attack and stroke, scientists had been presenting clinical and theoretical arguments as to why Vioxx might cause heart problems for three years. No such wellspring of criticism exists with naproxen, which is marketed by Bayer as Aleve....
Even if it had been statistically significant--that is, not due to chance--the heart risk with naproxen was only about 50%, according to the NIH. In contrast, the negative results for Vioxx and Celebrex showed a doubling or tripling of risk--about the same increase in cardiovascular risk as with obesity or smoking.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
First, let's get this straight: There's no new evidence that naproxen, the active ingredient in over-the-counter Aleve and prescription Naprosyn, causes an increase in heart attacks. There is, however, strong evidence that the U.S. Food and Drug Administration did the drug industry equivalent of yelling, "Fire!" in a crowded theater. On Monday, the FDA turned a halted clinical trial into a very scary warning about Aleve. As reported here on Tuesday morning, there was no reason for a warning, and, in fact, naproxen might well be safe.
The National Institutes of Health announced Monday that it had halted a clinical trial testing whether naproxen and Celebrex, an arthritis pill made by Pfizer, might prevent Alzheimer's disease. Another NIH study testing Celebrex as a cancer preventative had found that the drug increased the risk of heart attacks, and patients were dropping out of the Alzheimer's study in droves. Because of the worries about Celebrex and the problems holding onto patients, the Alzheimer's study was halted. In the Alzheimer's study, though, there was no increase in heart risk for long-term Celebrex users. There was a slight increase in heart risk for naproxen users, but the increase was so small that it may have been a chance occurrence. It was not the kind of data on which decisions involving many thousands of patients should have been made.
The FDA apparently didn't see it that way. In its statement, it said, "Preliminary information from the study showed some evidence of increased risk of cardiovascular events, when compared to placebo, to patients taking naproxen." Then it warned patients to use Aleve only according to the directions on the label--sensible advice, but ominous given the circumstances.
None of this would have sounded so scary if it weren't for Merck's recall of Vioxx, the biggest-selling drug ever to be pulled from the market. Vioxx works by inhibiting the same enzyme as Celebrex. When results emerged showing Vioxx doubled the risk of heart attack and stroke, scientists had been presenting clinical and theoretical arguments as to why Vioxx might cause heart problems for three years. No such wellspring of criticism exists with naproxen, which is marketed by Bayer as Aleve....
Even if it had been statistically significant--that is, not due to chance--the heart risk with naproxen was only about 50%, according to the NIH. In contrast, the negative results for Vioxx and Celebrex showed a doubling or tripling of risk--about the same increase in cardiovascular risk as with obesity or smoking.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, December 29, 2004
The Painkiller Panic
Needed: A rational discussion on Vioxx, Celebrex and Aleve.
If there's silver lining to the sudden rash of unsettling news about painkillers, it's that just maybe it will force the American body politic to think twice about whether it really wants to destroy the pharmaceutical industry through an excess of litigation and reactionary over-regulation. If it were just Vioxx that caused occasional cardiovascular problems, after all, it would be easier to convince the ignorant and the opportunistic--i.e., likely jurors and Congressmen--that the FDA and the drug industry had erred so badly with a widely taken drug that truly drastic measures should be taken with both.
But now that Celebrex and Aleve (also known as naproxen) have joined the list of drugs that might--we stress might--cause cardiovascular problems, people may be forced to come to terms with the fact that all drugs have side effects, especially when taken in large doses and over the long term. We already knew that more than 15,000 people die--yes, die--annually from gastrointestinal bleeding caused by drugs like naproxen and ibuprofen, the side effect newer drugs like Vioxx and Celebrex were designed to avoid.
Of course, drugs also have huge benefits. And this page has long argued that in almost all cases the right people to weigh them against the risks are doctors and patients, not courts and regulators.
One of the most frustrating things about the latest news on painkillers is that almost none of the people reporting it understand the concept of relative risk--i.e., that a doubling of adverse events like heart attacks still doesn't mean that event is very likely. A doubled risk might well be a chance worth taking, especially if the baseline risk is low to begin with and the drug's benefits are significant for the patient in question. All of us implicitly accept this proposition with chemotherapy, for example, which poisons the entire body to kill a few cancer cells.
Why shouldn't we look at painkillers the same way? If you suffered from disabling arthritis and understood that your baseline risk for heart attack or stroke over a given time period was less than 1%, you might be willing to accept a doubling to a mere 1.5%. That's in fact what the study leading to the withdrawal of Vioxx in September found: 7.5 events per 1,000 in the placebo groups versus 15 per 1,000 among those taking the drug (and only after 18 months at a high dose).
Think patients don't actually approach their treatment this way? Consider Dave Ellis, who was featured in a Journal news story on Tuesday. The 66-year-old Mr. Ellis, who has suffered for 30 years from degenerative arthritis in his spine, says he dreads the day two months from now when his supply of Vioxx runs out. "If I look at the numbers, I just don't feel I'm at risk," said Mr. Ellis, who has no family history of heart disease. Is Mr. Ellis an ignorant rube duped by drug industry advertising? No, he's a retired pharmacist.
The numbers on Celebrex and Aleve are likewise no reason for unnecessary alarm. In one trial patients taking very high doses of Celebrex experienced a 2.5-fold increase in the rate of cardiovascular events versus those on placebo. Other studies, including the one now raising the alarm about Aleve, have shown no risk. In that trial--which had Aleve, Celebrex and placebo groups--patients on Aleve saw a 50% increase in cardiovascular events. But we're talking about only 70 events (including 23 deaths) out of a sample of 2,500 patients who were already over 70 years old. We don't even know yet if that's significant in a statistical sense.
There is no reason to assume the Aleve alarm will pan out in other studies. But one of the ironies here is that it shows there never was solid evidence to prove that older-generation anti-inflammatories of its class were safer than the newer Cox-2 inhibitors, as has been asserted everywhere in recent months by critics accusing the drug industry of pursuing profits on newer patented drugs when patients would have been better off taking generics. The likes of Drs. Marcia Angell, Eric Topol, and David Graham have been shown up for the Luddites they are, willing to make grand pronouncements about the public health with nothing more than their anti-industry reflexes to support them.
Meanwhile, Merck's decision to withdraw Vioxx is looking worse by the day. It was irresponsible vis-a-vis the public health because the drug provided relief some patients couldn't find elsewhere, and because the extreme measure has made a rational national discussion about drug risk that much harder. Withdrawal was also irresponsible toward Merck's shareholders because it has placed Vioxx in a different class when it comes to litigation--needlessly conceding the drug has no place in the pharmacopeia--from drugs that shouldn't be withdrawn but which may carry similar risks.
We understand our hopeful scenario above--that the latest news on Aleve may ultimately prove an antidote to anti-drug industry hysteria--may not be the way things pan out. For the moment, America's trial lawyers are emboldened by all the blood in the water. If there are many people outside this publication putting the risks in proper perspective, we haven't seen them.
But the possibility that Aleve (and who knows, maybe ibuprofen?) can have cardiovascular effects should change the political and legal environment in which the Vioxx drama plays out. By now just about every adult in America has experienced the near-miraculous healing powers of one non-steroidal anti-inflammatory or another for at least one episode of acute pain. We're guessing they won't want to find themselves without the option of relief should they ever be in pain again.
Source
[The above article would have made an even stronger point if it had mentioned that aspirin too has some dangerous side-effects -- such as stomach bleeding]
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Needed: A rational discussion on Vioxx, Celebrex and Aleve.
If there's silver lining to the sudden rash of unsettling news about painkillers, it's that just maybe it will force the American body politic to think twice about whether it really wants to destroy the pharmaceutical industry through an excess of litigation and reactionary over-regulation. If it were just Vioxx that caused occasional cardiovascular problems, after all, it would be easier to convince the ignorant and the opportunistic--i.e., likely jurors and Congressmen--that the FDA and the drug industry had erred so badly with a widely taken drug that truly drastic measures should be taken with both.
But now that Celebrex and Aleve (also known as naproxen) have joined the list of drugs that might--we stress might--cause cardiovascular problems, people may be forced to come to terms with the fact that all drugs have side effects, especially when taken in large doses and over the long term. We already knew that more than 15,000 people die--yes, die--annually from gastrointestinal bleeding caused by drugs like naproxen and ibuprofen, the side effect newer drugs like Vioxx and Celebrex were designed to avoid.
Of course, drugs also have huge benefits. And this page has long argued that in almost all cases the right people to weigh them against the risks are doctors and patients, not courts and regulators.
One of the most frustrating things about the latest news on painkillers is that almost none of the people reporting it understand the concept of relative risk--i.e., that a doubling of adverse events like heart attacks still doesn't mean that event is very likely. A doubled risk might well be a chance worth taking, especially if the baseline risk is low to begin with and the drug's benefits are significant for the patient in question. All of us implicitly accept this proposition with chemotherapy, for example, which poisons the entire body to kill a few cancer cells.
Why shouldn't we look at painkillers the same way? If you suffered from disabling arthritis and understood that your baseline risk for heart attack or stroke over a given time period was less than 1%, you might be willing to accept a doubling to a mere 1.5%. That's in fact what the study leading to the withdrawal of Vioxx in September found: 7.5 events per 1,000 in the placebo groups versus 15 per 1,000 among those taking the drug (and only after 18 months at a high dose).
Think patients don't actually approach their treatment this way? Consider Dave Ellis, who was featured in a Journal news story on Tuesday. The 66-year-old Mr. Ellis, who has suffered for 30 years from degenerative arthritis in his spine, says he dreads the day two months from now when his supply of Vioxx runs out. "If I look at the numbers, I just don't feel I'm at risk," said Mr. Ellis, who has no family history of heart disease. Is Mr. Ellis an ignorant rube duped by drug industry advertising? No, he's a retired pharmacist.
The numbers on Celebrex and Aleve are likewise no reason for unnecessary alarm. In one trial patients taking very high doses of Celebrex experienced a 2.5-fold increase in the rate of cardiovascular events versus those on placebo. Other studies, including the one now raising the alarm about Aleve, have shown no risk. In that trial--which had Aleve, Celebrex and placebo groups--patients on Aleve saw a 50% increase in cardiovascular events. But we're talking about only 70 events (including 23 deaths) out of a sample of 2,500 patients who were already over 70 years old. We don't even know yet if that's significant in a statistical sense.
There is no reason to assume the Aleve alarm will pan out in other studies. But one of the ironies here is that it shows there never was solid evidence to prove that older-generation anti-inflammatories of its class were safer than the newer Cox-2 inhibitors, as has been asserted everywhere in recent months by critics accusing the drug industry of pursuing profits on newer patented drugs when patients would have been better off taking generics. The likes of Drs. Marcia Angell, Eric Topol, and David Graham have been shown up for the Luddites they are, willing to make grand pronouncements about the public health with nothing more than their anti-industry reflexes to support them.
Meanwhile, Merck's decision to withdraw Vioxx is looking worse by the day. It was irresponsible vis-a-vis the public health because the drug provided relief some patients couldn't find elsewhere, and because the extreme measure has made a rational national discussion about drug risk that much harder. Withdrawal was also irresponsible toward Merck's shareholders because it has placed Vioxx in a different class when it comes to litigation--needlessly conceding the drug has no place in the pharmacopeia--from drugs that shouldn't be withdrawn but which may carry similar risks.
We understand our hopeful scenario above--that the latest news on Aleve may ultimately prove an antidote to anti-drug industry hysteria--may not be the way things pan out. For the moment, America's trial lawyers are emboldened by all the blood in the water. If there are many people outside this publication putting the risks in proper perspective, we haven't seen them.
But the possibility that Aleve (and who knows, maybe ibuprofen?) can have cardiovascular effects should change the political and legal environment in which the Vioxx drama plays out. By now just about every adult in America has experienced the near-miraculous healing powers of one non-steroidal anti-inflammatory or another for at least one episode of acute pain. We're guessing they won't want to find themselves without the option of relief should they ever be in pain again.
Source
[The above article would have made an even stronger point if it had mentioned that aspirin too has some dangerous side-effects -- such as stomach bleeding]
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, December 28, 2004
BUNIONS TRUMP FRACTURED HIPS -- IN BRITAIN, OF COURSE
The arrogance and inhumanity of a welfare-State bureaucrat is worse than even a writer of fiction would dream up. Americans be warned!
"A surgeon, David Grace, had a backlog of 16 urgent cases. These included six people with broken hips. Now a broken hip is a serious and very painful injury. It does, of course, immobilise you. You have to lie still. You are in absolute agony unless you are very strong painkillers. This, I suspect, is not very good for anyone but especially for the elderly women who are most prone to break their hips. The condition causes them and their families fear and worry. If you are left hardly able to move for hours or days on end, you have a high risk of bed sores. This is, without doubt, an emergency. The operation to fix the hip should take place within a day or two.
So David Grace had six of these cases and 10 other cases to deal with. He went to the chief executive of his hospital trust and asked for help in clearing this backlog. She was insistent that he should not do so. She demanded that, instead, that he should operate on bunions. Grace believes - and it is hard to think of any other explanation - that this was because the chief executive wanted to meet a government target for treating non-urgent operations within nine months.
I would ask anyone to consider how they would feel if, say, their elderly mother or grandmother was lying in agony in hospital and she was left to wait for six days or more because the trust insisted on treating bunions? It is beyond shocking. It should make us think about the widespread assumption that the "public service" ethic is really so profound and reliable. Heaven help those who rely on the NHS. Heaven forgive those who expect the poor to do so.
Next time a cabinet minister boasts about reduced waiting lists, remember these six people with broken hips, lying in bed in agony, waiting to be treated in order to achieve the boast of which the minister is so proud.
But it gets more worrying still. For his impertinence is refusing to do what the chief executive told him, the trust leaned on him. An investigation was started into his 'personal and professional conduct'. He has since been exonerated. But think of the implication: that trying to treat those who need emergency treatment is not merely discouraged, it is likely to damage your whole career".
From the Adam Smith Blog
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
The arrogance and inhumanity of a welfare-State bureaucrat is worse than even a writer of fiction would dream up. Americans be warned!
"A surgeon, David Grace, had a backlog of 16 urgent cases. These included six people with broken hips. Now a broken hip is a serious and very painful injury. It does, of course, immobilise you. You have to lie still. You are in absolute agony unless you are very strong painkillers. This, I suspect, is not very good for anyone but especially for the elderly women who are most prone to break their hips. The condition causes them and their families fear and worry. If you are left hardly able to move for hours or days on end, you have a high risk of bed sores. This is, without doubt, an emergency. The operation to fix the hip should take place within a day or two.
So David Grace had six of these cases and 10 other cases to deal with. He went to the chief executive of his hospital trust and asked for help in clearing this backlog. She was insistent that he should not do so. She demanded that, instead, that he should operate on bunions. Grace believes - and it is hard to think of any other explanation - that this was because the chief executive wanted to meet a government target for treating non-urgent operations within nine months.
I would ask anyone to consider how they would feel if, say, their elderly mother or grandmother was lying in agony in hospital and she was left to wait for six days or more because the trust insisted on treating bunions? It is beyond shocking. It should make us think about the widespread assumption that the "public service" ethic is really so profound and reliable. Heaven help those who rely on the NHS. Heaven forgive those who expect the poor to do so.
Next time a cabinet minister boasts about reduced waiting lists, remember these six people with broken hips, lying in bed in agony, waiting to be treated in order to achieve the boast of which the minister is so proud.
But it gets more worrying still. For his impertinence is refusing to do what the chief executive told him, the trust leaned on him. An investigation was started into his 'personal and professional conduct'. He has since been exonerated. But think of the implication: that trying to treat those who need emergency treatment is not merely discouraged, it is likely to damage your whole career".
From the Adam Smith Blog
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Monday, December 27, 2004
Drug regulations cause millions of deaths each year: "Over-reaching FDA regulations have caused the premature deaths of millions of Americans, according to research scientist Mary J. Ruwart, Ph.D., who also said federal regulations passed in 1962 are responsible for more than 80 percent of the cost of today's prescription drugs. Ruwart, who is senior instructor with Burnet, Texas-based Sci-Com and adjunct associate professor of biology at the University of North Carolina in Charlotte, presented her findings on November 8 before the 2004 annual meeting of the American Association of Pharmaceutical Sciences in Baltimore, Maryland. Instead of protecting Americans from unsafe drugs, Ruwart said, 'these particular regulations, the 1962 Kefauver-Harris Amendments, have proven to be more deadly than all of the drug toxicity that occurred before their
passage.'"
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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passage.'"
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
YOUR GOVERNMENT DEMANDS THAT YOU SUFFER
"A Virginia doctor has become the latest victim of the government's crusade to enforce federal drug laws that make it difficult for sufferers of chronic pain to obtain effective medication able to ease their distress. Dr. William E. Hurwitz may face life in prison for prescribing medication to sufferers of chronic pain as a result of the federal government successfully prosecuting him ...
A very large number of Americans -- some estimates run as high as 50 million -- suffer from recurrent, often debilitating pain. Hurwitz was one of the leading advocates of prescribing very high doses of pain medication necessary to relieve their suffering.
In the case, the government took the position that Hurwitz was running a "pill mill" for profit and that it was necessary to prosecute him and other pain doctors in order to stem the growing use of OxyContin and other potent prescription painkillers. Prosecutors claimed that Dr. Hurwitz fraudulently earned about $900,000 from 1999 to 2002, by supplying prescription narcotics to 500 pain patients. He charged a $1,000 initiation fee for each patient plus monthly fees between $150 and $250. But the government glossed over the fact that, for this modest fee, Hurwitz's patients had 24-hour access to his services and they never paid him for any of their drug prescriptions. He screened them for drug abuse and, indeed, required that they sign a treatment agreement which included drug testing. He dropped patients for non-compliance or for re-selling the drugs he prescribed.
None of the three patients' deaths were attributable to Hurwitz's treatment or drugs prescribed by him. One patient's death is not even claimed to have been drug-related; it was caused by the underlying disease of pancreatitis. Another patient's death was undetermined and the third case was due to a tragic error committed by a pharmacy that dispensed morphine instead of the drug that Hurwitz had prescribed.
It was a small criminal element among Hurwitz's largely blue collar patients whom he was trying to help that scammed him. Once they were arrested, they turned against Dr. Hurwitz in a plea agreement with the government to escape punishment. Dr. Hurwitz's compassion greatly assisted the government prosecutors. He did not immediately cut off patients he discovered were addicts or had criminal histories. He took the position that the abrupt termination of pain medication needed by patients would be "tantamount to torture." Unfortunately, that was exploited by some.
As a consequence of the Hurwitz trial, doctors will now view every pain patient they see with suspicion and as a potential criminal or undercover government agent. Pain patients will now find it even more difficult to find a doctor willing to treat them and risk the fate of William Hurwitz.
More here:
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
"A Virginia doctor has become the latest victim of the government's crusade to enforce federal drug laws that make it difficult for sufferers of chronic pain to obtain effective medication able to ease their distress. Dr. William E. Hurwitz may face life in prison for prescribing medication to sufferers of chronic pain as a result of the federal government successfully prosecuting him ...
A very large number of Americans -- some estimates run as high as 50 million -- suffer from recurrent, often debilitating pain. Hurwitz was one of the leading advocates of prescribing very high doses of pain medication necessary to relieve their suffering.
In the case, the government took the position that Hurwitz was running a "pill mill" for profit and that it was necessary to prosecute him and other pain doctors in order to stem the growing use of OxyContin and other potent prescription painkillers. Prosecutors claimed that Dr. Hurwitz fraudulently earned about $900,000 from 1999 to 2002, by supplying prescription narcotics to 500 pain patients. He charged a $1,000 initiation fee for each patient plus monthly fees between $150 and $250. But the government glossed over the fact that, for this modest fee, Hurwitz's patients had 24-hour access to his services and they never paid him for any of their drug prescriptions. He screened them for drug abuse and, indeed, required that they sign a treatment agreement which included drug testing. He dropped patients for non-compliance or for re-selling the drugs he prescribed.
None of the three patients' deaths were attributable to Hurwitz's treatment or drugs prescribed by him. One patient's death is not even claimed to have been drug-related; it was caused by the underlying disease of pancreatitis. Another patient's death was undetermined and the third case was due to a tragic error committed by a pharmacy that dispensed morphine instead of the drug that Hurwitz had prescribed.
It was a small criminal element among Hurwitz's largely blue collar patients whom he was trying to help that scammed him. Once they were arrested, they turned against Dr. Hurwitz in a plea agreement with the government to escape punishment. Dr. Hurwitz's compassion greatly assisted the government prosecutors. He did not immediately cut off patients he discovered were addicts or had criminal histories. He took the position that the abrupt termination of pain medication needed by patients would be "tantamount to torture." Unfortunately, that was exploited by some.
As a consequence of the Hurwitz trial, doctors will now view every pain patient they see with suspicion and as a potential criminal or undercover government agent. Pain patients will now find it even more difficult to find a doctor willing to treat them and risk the fate of William Hurwitz.
More here:
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, December 25, 2004
MERRY CHRISTMAS!
To all those who come by here on this great day
And may all those who recognize Jesus as Lord always walk in his wisdom
The danger of too much caution: "If we are to balance drug safety, innovation in research and development, and the availability and price of new medicines, we must find a way to make regulators accountable for costly errors of all kinds. One way would be to create a vigorous, independent agency ombudsman that could compel regulators to act in the public interest. The office would have to possess the following attributes: (1) independence from the agency and the FDA commissioner; (2) access to independent expertise in relevant disciplines, including medicine, pharmacology, science, regulation, and law; and (3) the power to levy sanctions against FDA employees found to be responsible, individually or collectively, for flawed decisions or policies that constitute severe, avoidable errors."
Banning competition won't get us better hospitals: "Something very odd is happening in the hospital industry. A relatively new kind of hospital, called the specialty hospital, is emerging that seems to be more efficient and produce better health outcomes than existing general hospitals. But instead of welcoming this innovation, policy makers are trying to ban the innovation. Specialty hospitals are typically smaller than traditional general hospitals and focus on a few specific areas of care such as orthopaedic surgery or heart care. They typically offer a higher level of care than general hospitals because specialization allows them to be more effective and efficient."
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, December 24, 2004
WHY THE FDA MUST BE MORE OF A HINDRANCE THAN A HELP
In his recent op-ed essay for 'The New York Times' (December 21, 2004), Goozner advances some of the classic myths about government. First, he tells us, "To make rational choices, doctors and consumers need the F.D.A. and other agencies to be independent arbiters of not just the safety and efficacy of new drugs and devices, but of their relative medical usefulness and economic viability." He continues his myth-perpetuation by announcing that "the medical oversight system needs a new ethic-one that scrupulously adheres to a standard that says its studies and decisions have been made entirely free of commercial bias and conflicts of interest."
Our true believer in the power of government to solve all our pharmacological problems quickly gives a hint as to why it is all a dream: "Sadly, that is very far from the situation today. Drug and device companies sponsor most clinical trials; F.D.A. advisory panels are larded with scientists tied to private companies; corporate user fees help finance the F.D.A. that is conducting reviews; doctors get most of their medical information either from sales representatives of drug companies or corporate-sponsored continuing medical education; and the companies are given primary responsibility for post-marketing safety surveillance of their own products."
Goozner mentions these obstacles to the possibility of impartiality and objectivity of government policy-making as if they were something only in place "today." And thus he charges ahead enthusiastically with the na‹ve notion that "To break these ties, there needs to be an independent arm of F.D.A. that contracts with independent clinicians and scientists for the final testing of all new drugs and medical devices." He proposes that "After a company submits its drug application based on safety and early efficacy trials, this arm would design the protocols to learn not just if the new drug is effective versus a placebo, but how it compares to other therapies and how it can be most effectively used. At the same time, the F.D.A. agency would need an adequately financed post-marketing system that would follow through on a drug's safety, using information and financing independent of the drug manufacturers."
These are all pseudo-noble notions and while they fall way short of justifying what the F.D.A. is supposed to be doing at its idealistic best, there is an omission in Goozner's discussion that amounts to out-and-out malpractice: He fails to discuss either the very famous argument of economist Sam Peltzman, of the University of Chicago, concerning the drug lag problem or the Nobel Prize-winning idea of Professor James M. Buchanan of George Mason University called "public choice theory."
Anyone who still has the temerity to propose that government is the solution to problems associated with drug manufacturing and marketing has the moral and professional obligation to discuss these two basic objections to such an idea. The drug lag argument shows that even following the intentions of the legislators who created the Food and Drug Administration, the results are going to be disastrous. Yes, one can always call up such rare victories as the banning of thalidomide (though even this one is no slam dunk when the details are considered). But as Aristotle taught us some 2600 years ago, "One swallow does not a summer make."
In fact, the F.D.A.'s policies produce even greater health hazards than anyone could imagine it averting. The reason is pretty simple: By insisting on certain types of tests for drugs that are being slated for manufacture-routinely requiring the impossible of proving a negative ("No one will be put at risk from this drug")-Americans are often prevented from gaining access to very effective means to fend off life-threatening diseases. The country thus lags behind many others and only those rich enough to visit these others are able to overcome this obstacle to their likely medical recoveries.
The merits of this argument are, of course, in the details. Yet it has gained considerable credibility over the last five or so decades and anyone who promotes greater powers for the F.D.A. needs to discuss it. The same holds for Buchanan's theory of public choice, one he developed with Gordon Tullock in their book, 'The Calculus of Consent' (University of Michigan Press, 1962). In 1985 Buchanan received the Nobel Prize in economics for this work and anyone who is proposing that outfits such as the F.D.A. can escape the inherent problem of bias would have to address his work.
Contrary to the suggestion by all those who propose to solve problems via government-namely, that all we really need is better people and more stringent rules-public choice theorists argues that inherent in the process of government regulation we invariably find the triumph of vested interest. Bureaucrats, including the most honorable scientists who might be hired to work in government agencies, are inclined to bolster their own special purposes and goals-some call this their "selfish interests"-and the way the welfare state works there simply is no way to curtail any of this. The dynamics of the nearly-unbound democratic system are such that government must respond to those in the constituency who exert the most clout. This is the most natural way of its operation. So it is sheer fantasy to hope that new people or rules will manage to circumvent it all.
But, instead of at least hinting at such problems with his proposal, Mr. Goozner charges ahead zealously, failing to raise any of the well-established skeptical concerns with what he wishes for, holding out the myth of government regulators as "independent arbiters."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
In his recent op-ed essay for 'The New York Times' (December 21, 2004), Goozner advances some of the classic myths about government. First, he tells us, "To make rational choices, doctors and consumers need the F.D.A. and other agencies to be independent arbiters of not just the safety and efficacy of new drugs and devices, but of their relative medical usefulness and economic viability." He continues his myth-perpetuation by announcing that "the medical oversight system needs a new ethic-one that scrupulously adheres to a standard that says its studies and decisions have been made entirely free of commercial bias and conflicts of interest."
Our true believer in the power of government to solve all our pharmacological problems quickly gives a hint as to why it is all a dream: "Sadly, that is very far from the situation today. Drug and device companies sponsor most clinical trials; F.D.A. advisory panels are larded with scientists tied to private companies; corporate user fees help finance the F.D.A. that is conducting reviews; doctors get most of their medical information either from sales representatives of drug companies or corporate-sponsored continuing medical education; and the companies are given primary responsibility for post-marketing safety surveillance of their own products."
Goozner mentions these obstacles to the possibility of impartiality and objectivity of government policy-making as if they were something only in place "today." And thus he charges ahead enthusiastically with the na‹ve notion that "To break these ties, there needs to be an independent arm of F.D.A. that contracts with independent clinicians and scientists for the final testing of all new drugs and medical devices." He proposes that "After a company submits its drug application based on safety and early efficacy trials, this arm would design the protocols to learn not just if the new drug is effective versus a placebo, but how it compares to other therapies and how it can be most effectively used. At the same time, the F.D.A. agency would need an adequately financed post-marketing system that would follow through on a drug's safety, using information and financing independent of the drug manufacturers."
These are all pseudo-noble notions and while they fall way short of justifying what the F.D.A. is supposed to be doing at its idealistic best, there is an omission in Goozner's discussion that amounts to out-and-out malpractice: He fails to discuss either the very famous argument of economist Sam Peltzman, of the University of Chicago, concerning the drug lag problem or the Nobel Prize-winning idea of Professor James M. Buchanan of George Mason University called "public choice theory."
Anyone who still has the temerity to propose that government is the solution to problems associated with drug manufacturing and marketing has the moral and professional obligation to discuss these two basic objections to such an idea. The drug lag argument shows that even following the intentions of the legislators who created the Food and Drug Administration, the results are going to be disastrous. Yes, one can always call up such rare victories as the banning of thalidomide (though even this one is no slam dunk when the details are considered). But as Aristotle taught us some 2600 years ago, "One swallow does not a summer make."
In fact, the F.D.A.'s policies produce even greater health hazards than anyone could imagine it averting. The reason is pretty simple: By insisting on certain types of tests for drugs that are being slated for manufacture-routinely requiring the impossible of proving a negative ("No one will be put at risk from this drug")-Americans are often prevented from gaining access to very effective means to fend off life-threatening diseases. The country thus lags behind many others and only those rich enough to visit these others are able to overcome this obstacle to their likely medical recoveries.
The merits of this argument are, of course, in the details. Yet it has gained considerable credibility over the last five or so decades and anyone who promotes greater powers for the F.D.A. needs to discuss it. The same holds for Buchanan's theory of public choice, one he developed with Gordon Tullock in their book, 'The Calculus of Consent' (University of Michigan Press, 1962). In 1985 Buchanan received the Nobel Prize in economics for this work and anyone who is proposing that outfits such as the F.D.A. can escape the inherent problem of bias would have to address his work.
Contrary to the suggestion by all those who propose to solve problems via government-namely, that all we really need is better people and more stringent rules-public choice theorists argues that inherent in the process of government regulation we invariably find the triumph of vested interest. Bureaucrats, including the most honorable scientists who might be hired to work in government agencies, are inclined to bolster their own special purposes and goals-some call this their "selfish interests"-and the way the welfare state works there simply is no way to curtail any of this. The dynamics of the nearly-unbound democratic system are such that government must respond to those in the constituency who exert the most clout. This is the most natural way of its operation. So it is sheer fantasy to hope that new people or rules will manage to circumvent it all.
But, instead of at least hinting at such problems with his proposal, Mr. Goozner charges ahead zealously, failing to raise any of the well-established skeptical concerns with what he wishes for, holding out the myth of government regulators as "independent arbiters."
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, December 23, 2004
VIOXX: AVOIDING A STUPID RESPONSE
Merck’s recall of Vioxx has led to calls for reform of the FDA’s drug approval process. While it’s true that the FDA’s approval process should be changed to better insure the health of all Americans, the question is what kind of reform is needed. In order to make the drug approval process more effective, we must first understand the problems facing the pharmaceutical market.
Many critics of the pharmaceutical industry point to the sale of “unsafe” drugs and the delay in recalling drugs, such as Vioxx, as an argument for creating a PASDA or “Post Approval Drug Safety Agency” to continue monitoring drugs after they have hit the market. Others believe that FDA policies make approval too difficult, not too easy. Every scientist who has studied the FDA carefully has found that delays in approval, mostly since the FDA policy change in 1962, which required approval for effectiveness as well as safety, have led to increased numbers of deaths. That is, more people have died waiting for drug approval than have been saved by having “safer” drugs available. One estimate is that the benefits of FDA safety regulation are between 500 and 1000 injuries (not deaths) avoided per year, while the cost of FDA delay is between 2,100 and 12,000 lives lost per year because of the unavailability of useful drugs during the approval process.
Patients have also lost out because the expense of drug approval means that some other wise promising drugs will not be worth developing at all. And the high cost of the FDA approval process, about $800 million per approved drug, means that once approved, drugs are more expensive than would be the case if the FDA process were quicker and cheaper.
If the response to the Vioxx episode leads to increased delays and costs in approval of new drugs, then this real problem in the industry will become worse. More consumers will suffer because of slower approval of new drugs, and some will suffer additionally because some drugs will not be worth inventing and developing, given the high cost of the process. The cost and hence the price for approved drugs will also increase.
An additional problem that many see in the pharmaceutical market is the high price of drugs, particularly the difference in price between the United States and Canada. While there are many reasons for this difference, one study has found that about one-half of the disparity in price is caused by the higher cost of litigation in the U.S.
These three problems-delay in recalling harmful drugs, slow and expensive approval of new drugs, and price differentials caused by litigation-seem unrelated, but they could be solved by a coordinated set of policies:
1. Create a PADSA, with the responsibility for monitoring drugs that have been approved and removing harmful drugs such as Vioxx from the market. Such drugs would then be recalled sooner, and any harm would be limited.
2. Because there would be less danger if a harmful drug is approved, since the PADSA would detect harmful drugs sooner, there would be less need for pre-marketing scrutiny of drugs, and we could return to a situation where the FDA examined drugs for safety but not effectiveness, allowing the market and the PADSA to determine which safety-approved drugs would be sold. This would lead to more drugs being developed and sold, and to lower prices for drugs. The PADSA would ensure that the overall safety of drugs would not be reduced.
3. Finally, because the PADSA would remove harmful drugs from the market, we would not need to rely on tort lawyers to discover unsafe drugs. Thus, the role of the tort system could be reduced, and FDA approval could become a “safe harbor” protecting approved drugs from lawsuits.
This set of coordinated policies, adopted together could go a long way towards improving the functioning of our pharmaceutical market and could provide more drugs at lower prices and reduced risk for consumers. If handled properly, the Vioxx incident could lead to reforms that will provide great benefits for consumers; if handled poorly, it may lead to great harms.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Merck’s recall of Vioxx has led to calls for reform of the FDA’s drug approval process. While it’s true that the FDA’s approval process should be changed to better insure the health of all Americans, the question is what kind of reform is needed. In order to make the drug approval process more effective, we must first understand the problems facing the pharmaceutical market.
Many critics of the pharmaceutical industry point to the sale of “unsafe” drugs and the delay in recalling drugs, such as Vioxx, as an argument for creating a PASDA or “Post Approval Drug Safety Agency” to continue monitoring drugs after they have hit the market. Others believe that FDA policies make approval too difficult, not too easy. Every scientist who has studied the FDA carefully has found that delays in approval, mostly since the FDA policy change in 1962, which required approval for effectiveness as well as safety, have led to increased numbers of deaths. That is, more people have died waiting for drug approval than have been saved by having “safer” drugs available. One estimate is that the benefits of FDA safety regulation are between 500 and 1000 injuries (not deaths) avoided per year, while the cost of FDA delay is between 2,100 and 12,000 lives lost per year because of the unavailability of useful drugs during the approval process.
Patients have also lost out because the expense of drug approval means that some other wise promising drugs will not be worth developing at all. And the high cost of the FDA approval process, about $800 million per approved drug, means that once approved, drugs are more expensive than would be the case if the FDA process were quicker and cheaper.
If the response to the Vioxx episode leads to increased delays and costs in approval of new drugs, then this real problem in the industry will become worse. More consumers will suffer because of slower approval of new drugs, and some will suffer additionally because some drugs will not be worth inventing and developing, given the high cost of the process. The cost and hence the price for approved drugs will also increase.
An additional problem that many see in the pharmaceutical market is the high price of drugs, particularly the difference in price between the United States and Canada. While there are many reasons for this difference, one study has found that about one-half of the disparity in price is caused by the higher cost of litigation in the U.S.
These three problems-delay in recalling harmful drugs, slow and expensive approval of new drugs, and price differentials caused by litigation-seem unrelated, but they could be solved by a coordinated set of policies:
1. Create a PADSA, with the responsibility for monitoring drugs that have been approved and removing harmful drugs such as Vioxx from the market. Such drugs would then be recalled sooner, and any harm would be limited.
2. Because there would be less danger if a harmful drug is approved, since the PADSA would detect harmful drugs sooner, there would be less need for pre-marketing scrutiny of drugs, and we could return to a situation where the FDA examined drugs for safety but not effectiveness, allowing the market and the PADSA to determine which safety-approved drugs would be sold. This would lead to more drugs being developed and sold, and to lower prices for drugs. The PADSA would ensure that the overall safety of drugs would not be reduced.
3. Finally, because the PADSA would remove harmful drugs from the market, we would not need to rely on tort lawyers to discover unsafe drugs. Thus, the role of the tort system could be reduced, and FDA approval could become a “safe harbor” protecting approved drugs from lawsuits.
This set of coordinated policies, adopted together could go a long way towards improving the functioning of our pharmaceutical market and could provide more drugs at lower prices and reduced risk for consumers. If handled properly, the Vioxx incident could lead to reforms that will provide great benefits for consumers; if handled poorly, it may lead to great harms.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, December 22, 2004
FDA SHOULD STICK TO MONITORING SAFETY
They might get it right if they did
Is anyone watching the store? Consumers ask that question when it appears that no one is accountable for how a business is being managed. It's a question many now ask about how the Food and Drug Administration (FDA) monitors drug safety.
On Friday, the maker of Celebrex announced that the pain reliever might be linked to increased risks of heart attacks and strokes - the same issues that caused Vioxx, a drug in the same class, to be withdrawn. More than a dozen of the world's most popular medicines have been challenged this year by new studies and scientists who say the FDA is failing to protect the public. The stakes couldn't be higher. Vioxx alone may have caused more than 30,000 deaths, David Graham, an FDA whistleblower and safety expert, told Congress last month.
To be sure, all drugs carry risks. But how much trust can Americans have in the FDA when a government survey finds that two-thirds of its scientists lack confidence that the agency adequately monitors safety, and 18% say they'd been pressured to recommend a drug over their reservations?
The FDA's job is to make sure the benefits outweigh the risks and that physicians and patients are aware of both. But the agency often operates in the dark, particularly after a drug is approved, putting the public at risk. It has seven times the number of employees working on new-drug approvals than it does on safety issues after a drug is OK'd.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
They might get it right if they did
Is anyone watching the store? Consumers ask that question when it appears that no one is accountable for how a business is being managed. It's a question many now ask about how the Food and Drug Administration (FDA) monitors drug safety.
On Friday, the maker of Celebrex announced that the pain reliever might be linked to increased risks of heart attacks and strokes - the same issues that caused Vioxx, a drug in the same class, to be withdrawn. More than a dozen of the world's most popular medicines have been challenged this year by new studies and scientists who say the FDA is failing to protect the public. The stakes couldn't be higher. Vioxx alone may have caused more than 30,000 deaths, David Graham, an FDA whistleblower and safety expert, told Congress last month.
To be sure, all drugs carry risks. But how much trust can Americans have in the FDA when a government survey finds that two-thirds of its scientists lack confidence that the agency adequately monitors safety, and 18% say they'd been pressured to recommend a drug over their reservations?
The FDA's job is to make sure the benefits outweigh the risks and that physicians and patients are aware of both. But the agency often operates in the dark, particularly after a drug is approved, putting the public at risk. It has seven times the number of employees working on new-drug approvals than it does on safety issues after a drug is OK'd.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
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