HealthCommentary

Exploring Human Potential

A National Disgrace: Immigrant Children Imprisoned – # Growing

Posted on | September 21, 2018 | No Comments

Source: NYT, 9/12/2018

Are Wars on Cancer and Alzheimers a Good Substitute for a National Health Plan?

Posted on | September 20, 2018 | No Comments

Lipitor Revenue

Mike Magee

Arguably, the pharmaceutical “age of the blockbusters” ended nearly 20 years ago with Pfizer’s hostile takeover of Warner-Lambert which rewarded them richly with the nation’s 5th statin, Lipitor. In 2006, it delivered almost $13 billion in revenue, and yet the company was in a full blown panic, as reflected in the firing of their CEO that year, because the 2012 patent cliff was fast approaching, and large biologics for small audiences were overtaking small chemical drugs for the multitudes.

Despite the promises of genetic optimists like NIH’s Francis Collins, and “personalized medicine” entrepreneurs at Stanford, and Columbia, and U Penn and hundreds of other academic medical palaces, the reality was this:

  1. Pharmaceutical discoveries had collapsed.
  2. Genetic and stem cell cures were over selling their promise and under selling the risk. (see Jesse Gelsinger case)
  3. Funding for cures for diseases – especially those affecting older white male senators and congressman – were exploding, but public health funding was nowhere to be found.

The War on Disease has always appealed to Americans. “Defeat disease like we defeated the Nazi’s”, was the battle cry, “and health will be left in the wake.” Why do the hard work of preventing disease by investing time and energy in nutrition, education, housing, a clean environment, gun-control, and human empathy when you can just rest content in the belief, promoted by medical scientists, that cures for dreaded diseases are just around the corner.

Case in point, Nixon’s “War on Cancer”, promised to deliver in the 70’s – except it’s more likely to be in 2070 than 1970. We’re now repeating the folly with Alzheimer’s Disease, promising a fix by 2025. The year Lipitor went off patent, the HHS push for expanded Alzheimer’s funding began in earnest. By 2016, NIH funds to study the disease approached $1 billion, a 56% increase over the prior year. By 2018, the National Institute of Aging (NIA), a middle of the pack agency solidly in the center of the NIH’s 27 institutes and centers, became the 5th largest institute with an appropriation of $2.6 billion.

NIH’s Francis Collins says, “Our continued investment will pay dividends for the millions of families affected by Alzheimer’s.” Others aren’t so sure. Long time University of Washington aging researcher Matt Kaeberlein notices a pattern of “following the money.” He says, “Nearly everyone I know is putting the words ‘Alzheimer’s disease’ in their grants in an effort to tap into the money.” Alzheimer researcher Samuel Gandy at the Icahn School of Medicine is even more pessimistic. He says, “I am convinced that we are destined to fail to make the 2025 goal and therefore look like we have failed at our promise.”

Former NIH director Harold Varmus, also feels the shadow of Nixon’s “War on Cancer” in setting a date for a breakthrough at 2025. He says, “No one denies the enormous need to make progress against Alzheimer’s. (But) I wish a date were not attached.”

What has been left unsaid is that the American belief, launched in the wake of WW II with the support of the AMA and America’s pharmaceutical industry, that a free-enterprise assault on disease was a reliable substitute for national health planning, universal coverage, and investment in the social determinants of health, has been proven naïve and false. What we have needed all along is a comprehensive national health plan for this country.

Cardinal Bernardin to Trump on Health and the Lost Children.

Posted on | August 31, 2018 | No Comments

Source: Wash Post 8/27/2018

For health professionals, committed to healing, providing health, and keeping families and communities whole, the many actions of President Trump are deeply offensive on multiple levels – but none more than the deliberate separation of immigrant children from their parents. According to the Washington Post, 528 children remain separated and 23 of these are under the age of 4. This affront to our humanity and our profession can not stand.

Cardinal Bernardin addressed a gathering of AMA members shortly before he died in 1996 and made the case that health was integral to human potential and that doctors and nurses and all health professionals played a pivotal role in assuring the survival of a caring society.

Were he alive today, he would not be silent in the face of this President and those in leadership who have gone invisible and mute in the face of a clear threat to our democracy and our humanity.

Bernardin’s guiding philosophy was a “consistent ethic of life.” In addressing health leaders, he said, “Because of its central importance to human dignity, I have felt a special responsibility to devote a considerable amount of attention to health care at both the local and national levels…grounded in the respect we owe the human person. To defend human life is to protect the human person … the core reality in Catholic moral thought.”

Bernardin would likely be especially offended by President Trump’s callousness and cavalier branding with insult and vulgar labels. Of this, he might repeat his words, “Attitude is the place to root an ethic of life…We cannot urge a compassionate society and vigorous public policy to protect the rights of the unborn and then argue that compassion and significant public programs on behalf of the needy undermine the moral fiber of the society or are beyond the proper scope of governmental responsibility.”

The images of children, forcibly separated from their desperate parents, would have been unthinkable to the Cardinal as he approached his death in Chicago two decades ago. “The dignity and value of human persons is a basic value …. [L]et it be said that the energizing vision of healthcare must be this commitment to the dignity of human persons.” Those were his words then.

How will each of us bear witness now?

Why Is Lamar Alexander (R-TN) Confused?

Posted on | August 23, 2018 | 1 Comment

Mike Magee

The Medical-Industrial Complex in the United States is expert at feigning cross-sector competition while quietly signaling to members that there is plenty of graft and profit in the $4 trillion (20% of GDP) for all. The net output, more evident than it ever was in the days of ’90 era “Harry and Louise” efforts, is a hidden syndicate and a confused Congress and public.

Consider the sham battle currently between Pharmacy Benefit Managers (PBMs), health insurers and PhRMA. Their public finger pointing at each other disguises a deep financial conspiracy that is more than skin deep. The goal is to profit while you confuse. And it’s working.

One frustrated health care lobbyist complained this week, “There’s a reluctance to push Congress in one direction or another until we understand where they’re going.” Wake up call: You’ll never understand – that’s the whole idea.

Sen. Lamar Alexander (R-TN) is chair of the Senate Health Committee and is as confused as everyone else wondering aloud whether we need PBMs at all. Answer: NO. Why? PBM’s are the offspring of Merck, CVS, and UnitedHealthcare who decided that their was money to be made, shaving off the top, in data manipulation and supposed cost-containment.

Don’t be fooled by the fact that PBMs have their own lobbying association now – the Pharmaceutical Care Management Association or PCMA. They’ll spend about $6 million this year on confusion campaigns. But the top guys – CVS Health, Express Scripts, and UnitedHealth Group – have ponied up another $6 million themselves individually – all while their parent companies fund PhRMA and the health insurers who they are supposedly opposing. Can you spell “collusion?”

Trump and HHS Secretary Alex Azar could learn a thing or two from the various Medical-Industrial Complex sectors about the “art of distraction”. They’ve been able over two decades to get Americans to spend twice the amount of all other developed nations on health services while mothers and children die in childbirth at astounding rates, white male survival curves have turned south, and hospitals have become the 4th leading cause of preventable death in the U.S.

Instead of getting drawn into the faux-battle between PBMs and their hidden parents, or debating how to buy cheaper drugs from Canada, we need to stop with the incremental reform and just get on with a total reboot.

For pharmaceuticals for example, here are three easy steps:

1.  Governmental aggregate purchasing.

2.  Value based evaluation of an essential drug list by independent government experts who are unconflicted.

3.  Annual prices set for all drugs on the list using a system of “reference pricing” as they do in Europe and Canada.

Key Question For Catholic Hierarchy: “Is Celibacy The Problem?”

Posted on | August 17, 2018 | 8 Comments

Mike Magee

In the British Medical Journal in 1950, “expert” Dr. S.L. Simpson stated without evidence that “It is perhaps of clinical interest that for every one case of organic impotence that comes my way, I see at least 10 of psychological impotence.”  Three decades later I published a paper in the journal UROLOGY titled “Psychogenic Impotence: A Critical Review”. In that paper I argued for the use of scientific nomenclature (“erectile dysfunction” versus “impotence”), additional research to define the physiology and pathophysiology of erectile function and dysfunction, and for the demystification and greater transparency around this essential bodily function.

As is clearly evident in this week’s stunning disclosures of system-wide abuse touching thousands of young lives in Pennsylvania, is that the Catholic Church’s problem is systemic. The three failings that victimized those suffering from erectile dysfunction, namely sloppy nomenclature, weak or absent research and non-transparency, have now trapped leaders of the Church in a downward spiral.

The critical question that remains unanswered is whether the Church’s practice of enforced abstinence from sexual activity, either by skewing selection for the priesthood, or by subsequent creation of deviant behaviors and a range of mental illnesses, creates an unacceptable risk for the future priests and for their parishioners.

Words matter in science. Celibacy? What exactly does it mean? It is a religious, not a scientific term, surrounded by controversy. It is derived from the Latin word “caeleb” which means single. Some interpret it to mean “unmarried”; others define it as “refraining from sexual intercourse”; and others still believe a celibate life commits one to refraining from all sexual life including masturbation and sexual ideation. This lack of basic agreement on the meaning of fundamental definitions, as with the definition of “impotence”, cripples scientific research from the onset.

If the nomenclature is weak, so is the body of research. What passes for research in this field, on both sides of the argument, is as weak and unsubstantiated as was Dr. Simpson’s opinions on “psychological impotence” in 1950. Research has been hampered by limited access to the priests who are the subjects, poor study design, and rapid labeling of scientists who would dare tread into this dangerous minefield. As a result, we really don’t know whether mandating control over expression of one’s natural sexuality results in higher rates of sexual abuse, mental illnesses including depression and crippling anxiety, and higher then normal levels of drug and alcohol abuse compared to comparative control subjects.

Finally there is non-transparency with its clear record of institutionalized cover-up, information released in bits and pieces under duress, secrecy and the force of litigation which could threaten the Church’s survival.

So, drawing on my past experience, and as a Roman Catholic who would like to see the Church survive and become healthy, here are my suggestions to the Church’s leadership.

First, make your priests available to researchers to rigorously and scientifically study the connection, if any, between mandated restrictions on adult sexual function and abnormal sexual behaviors and mental illness. As a derivative of this research, as occurred in the study of erectile function, rigorous scientific terminology to define the meaning of “celibacy” will be well defined.

Second, commit to the publication of these peer reviewed studies, whether positive or negative results.

Finally, should it be determined that this practice of restricted sexual expression places the priests themselves and their parishioners at risk, commit to eliminating mandatory sexual abstinence as a prerequisite for entry into the priesthood.

If careful scientific examination is able to establish that the risks associated with this practice far out distance the benefits, have the courage to admit and correct the error, which is certainly the road that Christ would travel.

When coders lose their jobs.

Posted on | August 15, 2018 | No Comments

Mike Magee

With health care now consuming close to 1 of every 5 dollars in America, it comes as no surprise that the sector is a major employer. No surprise either that many of those jobs deliver zero benefits when it comes to patient care. In fact, there are now 16 health care jobs for every one physician, and 8 of those 16 are non-clinical.

Were we to proceed with a centralized health insurance system, while preserving local choice and autonomy over care delivery, estimates are that we would shave up to $1 trillion off of our nearly $4 trillion annual health care expenditure. Of course that means many insurance agents, coders, billers, and data specialists would lose their jobs. What’s to become of them?

Likely they would follow the money. But how might that $1 trillion be best spent? The best answer is embedded in the startling fact that the U.S. is the only developed nation that spends more on health care than all other social services combined. These services – including housing, education, transportation, environmental protection, sanitation, safety and security –are all proven determinants of health.

Our under-investment in these societal underpinnings reflects the fact that we have spent the last 75 years fighting disease rather that promoting health. Long shot cures for a thin sliver of our population attract outsized resources, while the basics receive the cold shoulder and the stiff upper lip.

The low hanging fruit is all around us waiting to attract some of those coders and billers to fields that actually contribute to health rather than to the furtherance of human debt and destruction.

Let’s take one example: Transportation for the elderly. 52 million people, or 16% of the American population, are over 65.  Of these, 30% have skipped their doctor appointments citing transportation problems as the cause. Missed appointments cost the health sector $200 per incident and $150 billion annually by one estimate.

There are 76.4 million Baby Boomers with 10,000 crossing the age 65 threshold every day. By 2030, 21% will be over 65, and over 1/5 will be non-drivers, and 1/5 have no children to lend a hand.

Last year, one enterprising health sector veteran saw an opportunity and seized it. Mark Switaj, a 15-year emergency medical technician who had come through Boston College and Georgetown University created RoundTrip based in Philadelphia. Contracting with local providers and insurers, his computerized Uber like patient transportation system was able to deliver a 4% no-show rate.

Mark’s business is growing rapidly. He’s doing well by doing good. Imagine if we were able to re-direct that $1 trillion we’re wasting on non-real work in health care and apply it to community infra-structure. That would change America.

Will the Health Care Bubble Burst in 2019?

Posted on | August 7, 2018 | 4 Comments

source

Mike Magee

In the dead heat of the summer of 2018, we’re experiencing an epic  “non-real fight” over “non-real work” with potential real consequences in 2019.

The initial battle lines were drawn some months back when Jeff Bezos, Warren Buffett and Jamie Dimon recognized a unique opportunity to dip into the wasteful troughs of American healthcare and targeted the control center of the Medical-Industrial Complex – the Pharmacy Benefit Manager. The PBM’s with original parentage from Merck, United Healthcare and CVS, are fast at work formalizing the rules of the syndicate game with hidden kickbacks that deal in everyone…except the patient.

Amazon, Berkshire and JP Morgan sees big money and a truck load of “non-real work” in the pushing and reshuffling of pills, data, and cash, and correctly is in the process of seizing opportunity. It’s a  “Why not us?” moment.

In response to Amazon’s move and CVS/Caremark’s grab for insurer Aetna, Cigna has made a play for Express Scripts. All this bottom-feeding capitalism understandably attracted Carl Icahn who has now launched a shareholder move to squelch the Cigna move (probably because he has shorted his position with Express Scripts.)

Icahn’s open letter states, “When Cigna entered into this agreement several months ago I believed a $60 billion purchase price made no sense, but there were at least arguments that could be made by management to try to persuade us into thinking that it was not completely ridiculous. These arguments now disappear in light of certain material events of the last month, such as Amazon’s almost certain entrance as a competitor to Express Scripts and the government’s direct challenge to the highly flawed rebate system. As a result, Express Scripts’ earnings will almost certainly be seriously diminished, but even more importantly, Express Scripts will be existentially challenged, i.e., their very existence might well come into question over the next few years.”

Carl is right about the existential challenge to Express Scripts, but wrong about the reason. It’s not Amazon’s competitive advantages in moving product, but disruption on a far greater scale that is the threat. The “health care bubble” now consumes 1 in 5 American dollars and is about to burst in three doable steps:

1. Single Payer: Centralizing purchase of universal insurance will shave 15% off the health care bill and relegate the Aetna’s and Cigna’s to government contracting and provision of supplemental health plans to cover services outside the basic benefit package.

2. Reference Pricing of Pharmaceuticals: Forget buying drugs from Canada. Instead do what Canada and all the European governments do. Set standard pricing annually for your list of approved drugs based on an average of seven or eight nation’s prices around the world.

3. Eliminate DTC advertising: Like every other nation in the world, a ban on this practice will radically decrease demand for pharmaceuticals, and secondarily challenge the concept that “fighting disease” is the same as “achieving health.”.

These three actions will not only disrupt PBM scheming on behalf of the Medical Industrial Complex, it will eliminate the need for their very existence. As for the “bubble”, plan to see $1 trillion of the current $4 trillion annual spend reallocated (wisely we hope) to other purposes over the next 2 to 4 years.

As for the “non-real workers” (there are 18 health care employees for every one doctor, and ½ of these are non-patient care related), you need not worry. They will follow the money elsewhere.

Carl Icahn is right but for all the wrong reasons. Amazon is neither salvation nor threat here. At best he’s a future government contractor. It’s the bubble with fall-out disruptive reform solutions waiting in the wing that he should be watching.

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