Survey results lead to Social Media usage

The chronic and constant uncertainty surrounding the Alberta heath care system lately is making a complex situation even more uncertain for the public and professionals. In the face of growing doubts about the direction and destination of the Alberta health care system there is a need for clarity and focus. As part of a project to bring clarity and focus on the roles, responsibilities, relationships, and scope of nursing care in the province, the CLPNA decided to find out what Albertans valued most about professional nursing care.

The CLPNA recent hired my firm, Cambridge Strategies Inc. to perform a “most/least” conjoint on-line survey of over 900 randomly sampled Albertans that tracked and ranked 15 key values around professional nursing care. We also ran a parallel program of the on-line conjoint survey for members of the CLPNA and were delighted to have 1461 participants. The findings are enlightening and should be instructive, reassuring, and empowering to Licensed Practical Nurses working in Alberta today, even with all the turmoil in health care these days.

I say the results should be reassuring to LPNs because the value alignment and priorities of the public’s and those LPNs who took the survey are virtually identical. In other words LPNs believe in the same values and in the same way as the public as to what is important and expected in providing professional nursing care.

So what are those important shared values? In order of priority the most important attributes for professional nursing care are Skilled, Knowledgeable, Caring/Compassion, Thorough, and Ethical care. These values dominate. They are only 33% of the values surveyed, but for 88% of the survey participants’, one of them were the #1 value choice. That means if you want to satisfy 88% of the public’s expectations in how you provide professional nursing care you have to deliver on this five values.

Read the complete “Survey Says” article published in the Spring 2010 issue of CARE magazine.

The good news for LPNs is that these values are the core professional and personal values that you overwhelming subscribe to each and every day on the job. The next big question and challenge is how well are LPNs delivering and communicating their delivery of these values to patients, the public and the power-that-be in making health care policy?

LPNs have to explain to people how they fit into the overall medical model. Clarifying the health care roles of the Doctors to diagnose and design; Nursing administrators and managers to manage and plan; and LPNs to directly deliver care at the bedside, is a key to any successful communication for the LPN profession. Everyone has their role and responsibilities, but the LPN has the opportunity at the bedside to be most effective and efficient in minute-by-minute skilled, knowledgeable, and compassionate care giving. The LPN can and should be a reassuring source for human concern for people in care who are extremely vulnerable, scared and often uninformed or misinformed about what is happening to them and what is being done for them.

Based on the survey results, skilled, knowledgeable, caring, compassionate nursing is what the people of Alberta want. That is what you are, and what you do because it is in your nature. Now you have to make sure to Talk-the-Walk if you are going to get the respect and rewards you deserve. This is how you show commitment to your profession and yourself as a professional. You also need to have conversations with your friends, families, and personal networks so they can understand and value the role, responsibility and relationship of Licensed Practical Nurses in the health care system of Alberta, and the people you serve.

Your message will be clear: Licensed Practical Nurses provide Competent, Committed Care and play an important role in the effectiveness of Alberta’s health care system.

Communicate, communicate, and communicate!! We have worked closely with Linda Stanger, Executive Director of CLPNA and her team in formulating a plan which involves sharing LPN messaging with key audiences including other health care professionals, stakeholders, policy decision-makers, media and Albertans.

In addition to connecting with the mainstream media, we will be using social media as a way to get our message out. The use of social media is cost-effective, immediate, relationship-based, and encourages word-of-mouth communications. Social media efforts will be interactive with you using email, Facebook, Twitter, YouTube, and our CLPNA Blog and website for content and distribution.

Discussing on our Blog: http://blog.clpna.com
Liking us on Facebook: www.facebook.com/CLPNA
Following us on Twitter: www.twitter.com/CLPNA
Watching us on YouTube: www.youtube.com/CLPNA

We will need help from any LPN who wants to be part of the solution to help make this happen. We will be in touch and provide you with training and workshops as well as coaching and mentorship on how to use social media to get our messages out to Albertans. Learning about social media is fun. It is also a very important tool for you professionally and personally. Word of mouth is known to be the most effective method of communication, and LPNs are in the best position to use it.

The bottom line is Licensed Practical Nurses have a lot to be proud of in relation to how you contribute to the well-being of Albertans. The problem is you are too inhibited and reticent to blow your own horns. This has to change. It is not about being brash or boastful. It is about being caring and compassionate. It is about taking the time to explain to patients and other what LPNs do and to assure the public of your skills, knowledge, experience, and capacity to serve the greater good as you do your jobs – day in and day out. That’s exactly what the public wants!

View the original article here

WSIB and the contracted or independent worker (Ontario)

Let’s talk about your issues as a self employed contractor, shall we?

If you are an “employee” your company must by law insure you for workplace related injury. This might explain why so many companies are forcing employees to go on contract, and hiring them back at higher wages in lieu of benefits.

And, this is not necessarily a bad thing for you as the contracted employee. There are tax advantages, and if done right, more protection options in areas of disability coverage that will put you in the driver’s seat. Nortel has proven that group LTD is not the be all and end all, and it should send shock waves through the corporate employees to realize they had better take measure to protect themselves. But we are here to focus now on WSIB.

Perhaps your client is looking to cut back on cost, and by hiring companies and contractors, they can avoid the high premiums of WSIB.

Specifically, what are your issues and shortfalls with the WSIB insurance program?

The best little graph I have seen so far is this one that compares the WSIB situation with that offered by private disability:

Workplace Safety & Insurance Board On the Job Coverage Only (Work Related Injury plus Illness)24 Hour Coverage Injury optional illness coverage at Home, Work or Play. Covers any type of injury or illnessExtended Health (Work Related Only)Extended Health (Blanket Coverage). Alternative to WSIB contracts may offer $10,000 to $100,000 of Accidental Medical Emergency coverage. Group or Individual Extended Health contracts offer blanklet coverage any type of medical coverage to the terms of the contract purchased.Rehabilitation discretion of WSIBReturn to work with Modified Duties*Unlimited Rehabilitation Benefit in good contracts, others limited to the limit within the terms of the contract. *Return to work once client is able to return to work in his own occupation thereafter any occupationWSIB doctor assessment of injury60 day coverage, options for higher sprain & strain coverage or no limit on sprain or strain Non Cancellable contracts with a 30 day wait offer NO limitation on Sprains & StrainsCoverage capped to reflect average industry wage1st year capped at $22, 567.00. Normal Rate for Owner Operator $5.78 per $100 of replacement Income based on net $32,000 of replacement income. Annual Premium $1,849.60Overall Maximum Combined of $6,000 monthly for both Loss of Income and Business Overhead Expense Reimbursement.Coverage based on Gross or Net Taxable Income. Average Rate for Injury Only Coverage $3.76 per day. Annual Premium of $1,349.88 or $112.49/mo. Add Extended Health Coverage Optional. Annual Premium $2,098.68.Long Term Disability to Age 65 or 70 based on any occupation, education, training and skill.Accidental Death & Dismemberment $300,000Accidental Death & Dismemberment up to $500,000Specific to Small Business Owners needsMandatory for Employees, Optional for Business OwnersInflexible to alternate coverage in place.Flexible. Purchase coverage by assessing your overall needs.

 I would add that the best policies will not force you to find a job outside of your occupation. And, this is important as your earnings increase with talent and experience. Why should you flip burgers at $7 per hour, when you have been trained at a specialty for $50 per hour? Why should you be penalized? Short answer – you shouldn’t!

It would seem there is a whole industry surrounding WSIB, it’s pitfalls, the complications of getting it, etc.

I just spoke to a client in his 30’s that was told by WSIB, that should he qualify, the premium would be 8.7% of his wage.

So, if he earned $3000 per month, the premium would be $261 per month.

Wow!

What would he be getting for that $261?

Well, what he is getting may better be described by what he is not getting.

If he was in a car accident outside of work and became disabled – nothing.If he got an illness such as cancer or a heart attack that rendered him disabled – nothing.any other accident outside of work time and duties – nothing again.

The point is, if you are going to insure yourself adequately, why not be in control and be insured for any reason that might cause a disability?

Are you any less in need of money for disability issues not covered by WSIB? No.

As brokers, we are able to access the best disability plans, at the best cost, and these plans are yours.

In other words, good disability policies will be portable, will not be cancellable, and the rates are locked in at the time you take out the coverage.

Some plans can and do pay back a portion of premiums if you cash in, at 25% or 50%, and some allow you to convert them to other forms of income streams at retirement – specifically long term care coverage.

This literally leaves WSIB and it’s offering in the “dust”.

Like all protection, for the money, what is the best value?

Well, it certainly is not the schedule of benefits offered by WSIB.

The company you are contracted with, and that requires you by law to insure yourself, needs to know you are covered. By getting good coverage, they can be given a copy and their liability is over.

WSIB reminds me of an option in life insurance known as AD & D (accidental death and dismemberment).

AD&D will double the amount of insurance if death is caused by accident. So, I suppose if you get diagnosed with cancer, it would be a good idea to drive off the nearest tall bridge to ensure your family gets enough money.

Crazy or what?

Give us a call, and we can take care of your needs properly. 1.866.856.6799

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Conspiracy theory Friday (FDA & CCHIT related)

Two fun things—First, Mark Leavitt says he’s quitting CCHIT in March. He says that he’ll be 60 then and wants to go do other stuff. Of course the cynics among you will say that he’s had enough of being beaten up by David Kibbe and Brian Klepper, and that CCHIT’s role as arbiter of meaningful use has been downgraded by David Blumenthal. Leavitt says in his outgoing email (not on any website I can find but I have a copy)

It also happens that this announcement comes the day after Blumenthal sends out an email to the Health IT world that Vince Kuraitis (at the very least) sees as a direct shot at large health IT vendors whose products don’t play nice with others (i.e. aren’t too interoperable) yet are already CCHIT certified. Here’s Vince’s take on who should have got that email.

Second, the twittersphere has been abuzz with a series of hearings where the FDA has been taking opinions on how and why they should regulate Pharma advertising in social media. this is a non-trivial issue for both sides. Pharma wants to reach patients, patients want those social media players to exist, and the sites need money (which will have to come from Pharma, unless something changes in the space time continuum). I don’t pretend to know the outcome except to remind you all (via Bill Silberg) that a similar meeting was held more than a decade ago and the result was….nothing. no guidance, no policy. 

Matthew: I wish Mark all the best in his next position, where ever life takes him. He's a very smart and competent person, who I have known for almost 20 years, and who has always had tremendous energy and resolve. I'm sure he'll continue to do well. Regards, DCK

Posted by: David C. Kibbe, MD MBA | Nov 13, 2009 1:23:24 PM

Do not underestimate the importance of the FDA's new leadership. For one thing, the FDA has lacked a long term, permanent leader for years and years, making it difficult to form and execute coherent policy. For another, the new Comish and deputy are well liked by the employees, from my inside contacts, and are savvy, activist people. My hopes for them are higher than they have been in a long time.

As for CCHIT, perhaps this is an example of the power of the people after all. I still think the FDA should regulate, at least in general terms, all health-related IT system functions other than simple data storage. There are too many bad, large vendor-driven systems out there which, besides not being interoperable, can be outright dangerous.

Posted by: bev M.D. | Nov 13, 2009 1:45:24 PM

And I should have said that, while poking fun from the sidelines, I dont think that anyone has ever suggested that Mark was not working for the betterment of health care delivery via Health IT. And a leader with his skills and experience will continue to make a contribution somewhere.

Posted by: Matthew Holt | Nov 13, 2009 2:46:07 PM

Agreed. Mark has worked very hard to move things forward in Health IT. I hope he'll find another venue where he can put his considerable talents and positive intentions to good use for us all.

Posted by: Brian Klepper | Nov 13, 2009 3:39:25 PM

1.Too bad! I won't have any more opportunities to write posts like David Kibbe & Mark Leavitt : Openness vs. Opacity.

2. The FDA meeting offered some very interesting presentations and was much more interesting than what I originally expected. I would be very surprised if the new FDA does not come up with recommendations, within the normal DC timeframe (<25 yrs). After announcing originally that there would be no cell phone reception and no WiFi at the hearing on social media (!) , and after blocking CNBC from bringing a camera inside the hearing room, the FDA finally provided real time video streaming of the entire meeting. Extra kudos to @skypen who gave one the very best presentations and created http://fdasm.com where anyone interested in this topic can find all they need.

Posted by: Gilles Frydman | Nov 14, 2009 1:58:38 PM

Mark has worked very hard to forward the agenda of HIMSS vendors that he represents. His agenda has hurt the many EMR vendors that CCHIT has marginated. His agenda has hurt physicians who end up purchasing costlier, bloated, unusable "certified" EHR systems. His agenda has led to the HITECH Act, another cash-for-clunkers scheme which is a Federal mandate which has forced doctors to actually "significantly use" these certified clunkers or else get penalized by big government.

May he RIP, but to cast him as a friend of IT and a friend of health care is misguided. Good riddance Leavitt- go to an island far, far away.

Posted by: Al Borges MD | Nov 30, 2009 4:09:40 AM

An observation immediately jumps off this page, based on the content seen here, folks appear to be hitting the anxiolytics and SSRI's to heavily. Let's not forget there is a half life to using this stuff.

Now back to the business at hand, this page reads like a farewell to a benevolent king. How quick you are to forget that this man operated a business with an intent to make profits without a business license and with a defunct state charter, passing himself off as the panacea for ulcers caused by a lack of certifying body.

Let us think of Mark's resignation as required debridement of a nasty wound. The sugar-coated words of those who have engaged in battle with Mark Leavitt come upon us like a wet to dry dressing that is just too wet. I say tear the bandage off, and let the air at it!

Posted by: Walla Walla | Nov 30, 2009 9:30:16 PM

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PHARMA: Reprieve for Amgen looking doubtful

In a story titled somewhat cryptically Medicare chief stands by anemia move (do they mean he’s trying to become anemic?) Reuters reports that CMS is not backing down from its decision to radically cut payments for anti-anemia drugs for chemotherapy patients. In English this means that Amgen’s Arenesp (& Epogen, though that’s not officially for cancer patients) and J&J’s Procit (which is Epogen re-marketed by J&J) are not going to recover their lost sales from last year.  Those sales began to be lost when studies revealed that the fairly rampant use of those drugs was overuse, and also that they were causing some severe side-effects.

Of course for reasons that we all know (e.g. they have little to do with clinical endpoints and more to do with financial ones), community oncologists have flipped out. I do like the response from Dr. Barry Straube, the chief medical officer at CMS. He said:

Of course the real impact of this was not on patients per se, but on Amgen’s stock price, which has not had the best of years. The little rally late last year was on hopes that CMS would change its mind. I’m afraid that that gravy train looks like it’s over.

What do we do about the anemia drug controversy?

Most doctors and patients would agree the drugs are very helpful for patients when used to correct "severe" anemia, which can be debilitating and even life-threatening. The drugs reduce the need for somewhat risky blood transfusions and can give patients more energy and improve their quality of life.

''These are drugs that were presumed to be entirely safe, given for supportive care and to improve quality of life,'' not to actually treat cancer, said Dr. Eric Winer, director of breast oncology center at the Dana-Farber Cancer Institute in Boston. ''So any concern that they could shorten someone's life are taken quite seriously.''

There is little evidence that the drugs make much difference for patients with "moderate" anemia. Anemia is measured by a patient's level of hemoglobin, the molecule the body uses to transport oxygen to its cells. Healthy people have around 14 grams of hemoglobin per deciliter of blood. Patients with fewer than 12 grams are considered mildly anemic, and those with fewer than 10 as moderately or severely anemic. The labels on the drugs approved by the FDA encourage doctors to aim for a hemoglobin level of 10 to 12.

Critics of the drugs say their increased use has been driven by profit. According to Dr. John Glaspy, director of UCLA's Outpatient Oncology Clinic, one complicating factor is that oncologists make significant revenue buying cancer drugs from manufacturers and charging patients a higher price for receiving the drugs in their offices. That profit motive could influence some doctors' decisions.

Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, told UPI last year that "probably more than a billion dollars is spent on erythropoietin each year, which makes it one of the most expensive cancer drugs." A six-month course of treatment can cost more than $10,000 per patient.

After this issue had started to be reported, U.S. Oncology took an 8-10 million dollar hit in its first-quarter SEC report last year, including reduced pre-tax income due to lower use of anemia drugs. They also were handicapped by CMS stopping the Medicare Demonstration Project which paid chemotherapy providers $130 per report, per infusional-chemotherapy recipient, on a patient's level of nausea, vomiting, pain and fatigue, something that Congress found out that they were supplying free of charge anyway.

A continuance of the Medicare Demonstration Project would have exacerbated existing economic and clinical problems instead of resolving them by increasing the temptations for physicians to overuse injectable drugs and promise to aggravate the economic problems Congress attempted to fix with the new Medicare law.

A New York Times article reported last year that Federal laws bar drug companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients from pharmacies. However, companies can rebate part of the price that doctors pay for drugs, like the anemia medicines, which they dispense in their offices as part of treatment. Doctors receive the rebates after they buy the drugs from the companies, but they also receive reimbursement from Medicare or private insurers for the drugs, often at a markup over the doctors' purchase price.

Although the new Medicare bill tried to curtail this kind of drug concession, private insurers still go along with it. What needs to be done is to remove the profit incentive from the choice of drug treatments. Let's take physicians out of the retail pharmacy business and force them be doctors again!

Posted by: Gregory D. Pawelski | Feb 9, 2008 6:17:12 AM

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Happy Birthday, Viagra!

By Jane Sarasohn-Kahn

It's the drug that raised the profile of medicine in popular culture. It's been hawked by a prominent politician and has been the butt of jokes on late-night TV. It's Viagara, and it's turning 10 today.

The FDA approved the drug on March 27, 1998. Here is the FDA's approval page for it.

Pfizer's Viagra reshaped pharmaceutical marketing in several ways. The company used direct-to-consumer advertising to great effect, and changed the game of DTC by advertising the drug not only in late at night broadcast outlets.

More broadly, the marketing of Viagra bolstered the trend of medicalization of everyday life. Viagra's origin as sildenafil citrate was targeted to cardiovascular medicine. Originally conceived as a heart drug for hypertension and angina, the molecule was, serendipitously, found to be useful in erectile dysfunction.

In 1998, three scientists who studied the dynamics of nitric oxide, the secret sauce in Viagra, won the Nobel Prize.

Jane's Hot Points: One of the most informative primers on Viagra is this book from Meika Loe of Colgate University. In it, she observes that we are Viagra nation where, "our sexual status quo has shifted dramatically." Ten years after Viagra's entry on the health scene, the search remains for a "pink viagra," a version for women. No one can deny the game-changing role that Viagra has played in American health care and in popular culture.

March 27, 2008 in Pharma | Permalink

Here's funny poke at Viagra marketing.

http://www.thrillahill.com/ncfbm.html

HAPPY BIRTHDAY VIAGRA

Posted by: pudn | Apr 4, 2008 5:58:32 AM

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Posted by: luca | Apr 25, 2008 5:13:19 AM

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A me-too strategy for me-too drugs

By DAVID E. WILLIAMS

AstraZeneca appears set to follow Merck into the market for “bio-similars.” (See AstraZeneca may join generic rush.) Congress and the media tend to portray biosimilars are analogous to generic chemistry-based pharmaceuticals, and therefore believe that they will lead to much lower prices as a result of the commoditization of these products. If all goes according to plan, that should cut the price of biologics by 50 to 95 percent as has been the case for generic versions of traditional pharmaceuticals.

Pharma and biotech companies aren’t seeing it this way and neither am I. Although they won’t say so, pharma companies are starting to realize that biosimilars –which unlike traditional generics cannot be subsituted by a pharmacist for a branded product– are really like me-too products within a class of drugs. That’s exactly the model that’s enabled multiple blockbusters within a given class in the mainstream pharma business, and led to higher spending overall. Biosimilars are unlikely to be a lot cheaper than the products they copy, and they will have all the sales and marketing costs associated with a branded product, plus some of the development costs. Don’t be surprised if some biosimilars are actually priced higher than the original products, based on some real or perceived improvement in efficacy or safety. That’s what happened when me-too drugs like Lipitor entered the statin market. (See Generic biologics — or Me Too Drugs 2.0? for more details.)

AstraZeneca won’t be the last company to pursue this strategy. If a regulatory pathway for bio-similars is established in the US, every big pharma will jump on the bandwagon.

If policymakers want to control the cost of biologics, there’s a much simpler and easier way. Simply regulate the price of biologics once their patents expire. That would have several advantages:

It wouldn’t even be that bad for biologics companies. They’d already have earned their profits during the patented life of the product, and would retain 100 percent market share post-patent expiration. They can’t really complain about the government interfering with the free market, considering that patents are granted by the government in the first place.

The only real losers in this plan would be generic biologics companies. Since the industry doesn’t even really exist yet, now is a good time to implement my scheme.

The Potential Fallacies Associated With Me-Too Medications

“But corruption is neither need based nor greed based. It’s simply opportunity based.” -----Billy Tauzin, president and C.E.O. of PhRMA, the pharmaceutical industry’s most powerful lobbying group, as Mr. Tauzin stated in Boston recently.
It has been said by others that the pharmaceutical industry should not have government regulation or interference from our government at all because that would drastically limit if not eliminate innovation as well as our health care choices and options, both from the perspective of the doctor and the patient, so the public has been told often by others. Also what has been stated by this industry that their internal controls prevent wrongdoing? So, according to some, the public’s health would be limited and possibly harmed without the copious innovation of this industry. As with other issues we face as citizens, this is another attempt by these others to apparently install fabricated fear in our minds- void of any proof or reason, and is a fallacy.
As it has turned out, the pharmaceutical industry’s lack of innovation in particular has happened and they have appeared to do this on their own, overall, those innovators and lifesavers.
Over the past several years, those few meds created and FDA approved with true therapeutic advantages happened by discovery with government involvement in over half of these meds with clear clinical advantages for certain patients. Conversely, of the new chemical entities approved lately and developed by drug companies, over 50 percent of these have microscopic therapeutic advantage for patients, so I understand upon information and belief. This inefficient drug development by the pharmaceutical industry has created what is now the dominant development strategy of drug companies, and this strategy is known as the intentional development of what are phrased, ‘me too’ drugs.
These drugs essentially are small molecular variations of the original molecule in a particular class of medications. In other words, they tweak the original molecule in order to obtain patent rights for their now new drug project. This me too objective of drug companies now accounts, I believe, for about 80 percent of the research budgets of drug companies. And because the FDA only requires a potential med to be superior to a placebo in their mandatory clinical trials, usually these me too meds are approved- regardless of their necessity for others, or the need for such drugs.
And me too drugs are selected by the drug company for their potential blockbuster status as well as the speculated growth of a particular market, which means making over 1 billion dollars a year on such a drug, at least. For example, statin drugs, for high cholesterol patients, is a multi- billion dollar market. As a result, there are several statin meds now available for use by doctors to prescribe to their patients. Yet, arguably, me too drugs are all essentially very similar in regards to safety, efficacy, and cost, regardless of the class referred to so often saturated with me too meds, with few exceptions. The differences overall are minor once again with most me too drugs, overall. As aggressive marketers, the makers of these meds are suspected of doing a bit of publication planning, it is suspected, to falsely claim superiority of their newly approved me too drug over all the other drugs in a particular class both during and after the creation of these me too meds. Also, other classes of meds with several me too drugs may include SSRI anti-depressant drugs, as well as those meds for hypertension. There may be a dozen drugs in a particular class of medications that are all essentially the same in regards to their treatment abilities for patients with such disease states that they treat.
Now, there may be cases where a patient tolerates one drug in a class over another for unknown reasons, so in these few cases, some me too drugs occasionally are beneficial for patients for some reason or another, but should absolutely not be a primary objective of the drug companies to create them as often as they do. Instead, true innovation and discovery should be the focus of pharmaceutical companies, and it does not appear to be the focus of the pharmaceutical industry, presently. It appears that, thanks to the Bayh-Dole Act of 1980, they license molecules from those in the academic world, and then proceed with development of another’s creation they claim as their own.
Further vexing is that competition in the pharmaceutical industry amazingly does not and has not been of any financial benefit for the consumer, as competition normally does create. This fact is greatly demonstrated with other industries and is the apex of business operations. This pharmaceutical industry model is an exception, and the reason for this remains an unknown, as far as the etiology of being deprived of this costly environment of drug spending, yet it can be speculated that the me too drug makers claim uniqueness of their me too drug, which is rather deceptive.
This progressive marketing paradigm of the pharmaceutical industry, such as the creation of me too meds solely for their own profit, clearly illustrates their focus on these issues over true research and science, so it seems. Innovation, along with ethics, use to define this pharmaceutical industry. Sadly, it seems this is not the case today, which ultimately and potentially deprives potential treatment methods potentially for the public health if the objectives were focused on their true purpose. Yet hopefully, such historical qualities of drug companies will return some time, in time.
“Most people are other people. Their thoughts are someone else’s opinions, their lives a mimicry, their passions a quotation.” --- Oscar Wilde
Dan Abshear
Author’s note: What has been written was based on information and belief.

Posted by: dan | Jan 23, 2009 6:48:17 PM

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WSIB alternatives in Ontario

Houston, we have a problem!

And the problem for the self-employed and contracted workers in Ontario are the hefty fees that WSIB is charging.

The problem with WSIB is not only  the high rates, but the fact that it covers workplace related incidents – nothing off the job!

What happens when you become disabled at home, or in your car, or anywhere else for that matter?

 The short answer – WSIB will not cover you.

I recently discussed this coverage with a gentleman that was quoted the rate by WSIB at 8.7% of his gross wage. His premium was going to be well over $800 per month just to be able to work! But what if the company you work for has “contracted” you and you cannot seem to convince WSIB to insure you? Are you then effectively unable to produce an income?

No matter what your health, there are companies that we can insure you with that are far superior to WSIB, and the odds of being declined for the accident coverage portion is almost non-existent.

This means no expensive “consultation” with experts and lawyers to appeal your WSIB ruling is required!

We looked at an alternative, well-rounded personal disability plan that covers disability on or off the job, and includes sickness, and the premium was $111 per month – a savings of almost $700.

If WSIB is able to mandate all self-employed workers to have this high-priced cash grab by 2012 there are going to be many angry self-employed families.

It is bad enough the government taxes us in several ways already, but the WSIB premiums may make the other taxes pale in comparison.

I will be working with several others to lobby against this, and I urge you to do the same. Let me know you are unhappy about the WSIB’s plans, and let’s form an alliance to combat this cash-grab.

The bottom line is that the insurance industry has plenty to offer, that makes the offering from WSIB non-competitive indeed.

Please contact me for a review of your disability needs at 1 866 856 6799, extension 201. Located in the GTA, we can personally look after you with old fashioned, face to face service!

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Stanford Med School rejects industry funding for continuing education

Stanford University's medical school announced this week new restrictions on educational contributions by drug and medical device companies, which turn out to be among the strictest in the nation.

The rules are an effort to limit industry influence on physician practice. Currently, the continuing education programs tend to follow the market's needs and not necessarily the best advancements for optimal patient care.

"The school will no longer accept funds from pharmaceutical or device companies that are targeted to specific programs, as industry-directed funding may compromise the integrity of these education programs for practicing physicians," a press release states.

SiliconValley.com reported that "Drug and medical-device company contributions for continuing medical education have surged nationwide from $302 million in 1998 to $1.2 billion in 2006, according to the Accreditation Council for Continuing Medical Education. Stanford officials said about $1.87 million — or 38 percent — of the medical school's budget for continuing education came from industry sources in fiscal 2006-07."

That should be law or common policy (as well as stopping direct to consumer advertising). The industry sponsored CMEs are actually not that bad (esp. when you stay aware that they are biased toward the sponsoring company's product), but they are just so selective in their topics (in my specialty, it is treatment of neuropathic pain, epilepsy, migraine, MS over and over and over and over), instead of having a didactic approach (e.g. symptom based education).

Posted by: rbar | Aug 28, 2008 7:50:12 AM

Good for Stanford! This is long overdue. A difficult decision but the consumer benefits.

Posted by: Jonathan Woodward DC | Aug 28, 2008 8:24:12 AM

Bravo Stanford! AAMC is out front on this one, and hopefully more AMC's will follow...

http://www.aamc.org/newsroom/pressrel/2008/080619.htm

Posted by: Gregg Masters | Aug 28, 2008 2:07:48 PM

The more important thing though is the limited value of CME in general which for the most part right now is like pouring money down a hole.

Posted by: MG | Aug 29, 2008 5:21:57 PM

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The other Michael Jackson mega-mix

By Matthew Holt

Never ones to be shy with an interesting view into celebrity pharmacology (and truth be told responding to a little tickle from me) the inventive folks at PharmaSurveyor have added Michael Jackson to their celebrity drug cocktail page.

It’s an interesting way to show the dangers of multiple drug regimens, and a great way to show off PharmaSurveyor’s computational capabilities of analyzing multiple drug regimens at once. (PharmaSurveyor calls those assessments surveys). You can find it on http://www.michaeljacksondrugs.net/ which has a static picture of Michael Jackson's survey and links to the interactive one on PharmaSURVEYOR.com. (FD I’m an advisor to PharmaSurveyor with a few stock options)

July 6, 2009 in Health 2.0, Pharma, pharmaceuticals, Technology, Web/Tech | Permalink

We've also covered Jackson's medical conditions as well as those of other celebrities. Please have a look.

Posted by: DrB | Jul 7, 2009 7:15:01 AM

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Viagra prescribed more safely online than in regular practice?

They looked at records of questionnaires taken and prescribing decisions made by a licensed, regulated online pharmacy called KwikMed — that is trying very hard to establish itself as ethically and legally different from those fly by night guys whose spam comments will rapidly attach to this post! They looked at the various outcomes and end points including safety and level of counseling and found that the online system produced results as good as or better as those found from a big records review in an unnamed (not surprisingly!) large multi-specialty clinic in Salt Lake City, UT.

Now obviously the ability to create an online questionnaire for specific conditions with clear inclusion/exclusion criteria (like ED or hair loss) means that as clear a picture can be gained in most cases from a good history taken online--and probably the history will be given more honestly by the patient. Plus the rigor of the history is probably better than one taken in a rushed office visit. And then it gets reviewed by a doctor who may recommend another approach but most times agrees and sends the Rx on to be filled.

I met with the Kwikmed folks randomly last week (and yes they were excited about the article). They've got a pretty sizable business in terms of ED drugs and hair loss drugs and are keeping quite a few doctors busy. The next question is can this type of study justify more online prescribing in different drug categories, or of course can they extend online visits into other categories, such as allowing people to order their own lab tests.

They of course think the answer is both. 

Of course, the core savings that Kwikmed delivers is that you don't have to pay for the doctor visit and the prescription, as they bundle it together. When it's a cash visit and a cash prescription as many of those lifestyle drugs are, then it makes sense for the patient. Of course the same is true for those paying in a high-deductible scenario.

But the more general point is that it'a another piece of evidence that at least some medical care can effectively go online at a lower price point than traditional care.

And why not? The world's flat, right?

Why shouldn't every benefit, including pricing leverage, wholesale access to provider or supplier services, and user friendly quality "indicia", be accessible to those in need?

As mentioned elsewhere on THCB in the "The Affordability Factor" [which has been met by silence from the author], why not extend the value of group purchasing to the general public and specifically those not represented by third party "aggregators", e.g., health plan, insurance company, TPA, MSO, MCO, PSN, PHO, OWA, etc? Why does one have to be enrolled in a diminishing benefits health plan or variant thereon in order to benefit from market pricing via purchasing entities?

Why are private plans, and the government the sole beneficiaries of paying $.15 to $.30 on the dollar while the uninsured must operate in the world of retail medicine?

If the web can facilitate legitimate pharmaceutical access, and perhaps encourage a greater level of diagnostic honesty then so be it.

Posted by: Gregg Masters | Aug 8, 2008 12:25:17 PM

Cardio Cocktail have seen great resutls too. Check out www.thecardioshop.com to find out more.

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very interesting and informative post. for more information on viagra check out http://kwikmed.com/prodinfo.asp?p=viagra

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Posted by: viagra | Nov 8, 2009 5:06:49 AM

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Posted by: Rick | Dec 6, 2009 2:39:05 AM

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PHARMA: Finally, a drug site that everyone can approve of!

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What’s up doc?: The ’squabble’ over ’squalene’

A single injection of squalene may not sound like much, unless you look at the pathological, medical evidence

Why is it that many health professionals working in a local hospital refuse to get the new H1N1 flu vaccination?

watch?v=zhQ-Tu4ljEo

The uninjectable suddenly has become injectable

The reason – the inclusion of squalene.

Squalene may be safe in certain environments but rumor has it that it should never, repeat never be “injected”.

Well, if it’s in a flu vaccination, how are we supposed to believe it enters our system – correct – it’s injected!

According to the examiner.com:

Squalene has been shown to cause severe autoimmune disorders like multiple sclerosis, reheumatoid arthritis and Lupus. Furthermore, Blaylock claims this particular vaccine adjuvant is connected to the Gulf War syndrome that killed thousands of soldiers and caused a 200% increase in Lou Gehreg’s disease.

Another issue of similar proportion is that of the Gardasil treatment for teenage girls to prevent cancer.

Is there a pattern here? Are we becoming human guinea pigs?

Who, including which drug companies are we supposed to trust?

And why is the vaccine for pregnant women different than that for the rest of us?

H1N1 is no joke. It seems to be taking it’s toll, and the biggest risk group seems to be teenagers that have not been exposed to this flu that has been around in the past, making the older generation less likely to get sick.

But like a loaded gun, and the effect on those that were injected with squalene in the Gulf war that now have health problems, are we asking for bigger trouble?

Squalene is mixed into the formula for one reason and one reason only – more bang for the buck! It all boils down to the “almighty dollar”.

I’m starting to feel like that human guinea pig, or rat:

A 2000 study published in the American Journal of Pathology demonstrated a single injection of the adjuvant squalene into rats triggered “chronic, immune-mediated joint-specific inflammation,” also known as rheumatoid arthritis.

People don’t know the facts and understand the implications. It reminds me of the insurance industry, where the real issue is finding an agent to trust, and not knowing all the ins and outs. The question is, is the medical word trustworthy when the soldiers of the U.S. military continue to be exploited medically, and in every other way too.

  Shouldn’t we all  start asking the hard questions?

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POLICY/PHARMA: DEA's insane persecution of pain patients continues

Just in case you needed to be reminded that the DEA is a refuge of evil scumbags and needs to be abolished, here's another exhibit (from the good people at DRCNet):

Federal agents arrested Dr. Stephen Schneider, operator of the Schneider Medical Clinic, and his wife and business manager, Linda, on a 34-count indictment charging them with operating a "pill mill" at their clinic. The indictment charges that Schneider and his assistants "unlawfully" wrote prescriptions for narcotic pain relievers, that at least 56 of Schneiders' patients died of drug overdoses between 2002 and 2007, and that Schneider and his assistants prescribed pain relievers "outside the course of usual medical practice and not for legitimate medical purpose."

Darren Baker is another patient who swears by Dr. Schneider. The operator of a tree gardening service, Baker has bone spurs in his knees from years of climbing, and two years ago, he fell out of a tree, shattering both his heels. "They put all kinds of hardware in my heels, and I have to have pain medications just to walk," he said. "With the pain meds, I can't walk real well, but without them, I can't walk, period. Dr. Schneider was the only one who would treat me."

Now, like Sauers, Baker is in search of a doctor. "I haven't found one yet," he said. "I got a list today, but most of them are turning you away if you're associated with Dr. Schneider. If I can't get another doctor, I won't have any option except to retire and go on disability. I take my medicine to be a productive member of society," he said angrily. "I need my meds to survive and pay my bills and fight the daily grind. This really goes against our constitutional rights. How the hell can I pursue happiness lying in bed?"

The DEA has repeatedly lied about its own opiate prescribing guidelines and has gone after soft “targets” like doctors—from whom it can easily steal assets—not to mention people legally dispensing marijuana in states where its legal. And don’t talk to me about “the law”. All Democratic candidates say they’ll stop the DeA raiding med marijuana clinics. Are they advocating that the DEA breaks the law? Perhaps the DEA should arrest them.

Clearly the DEA couldn’t give two shits about the lives of the patients for whom opiates is the effective solution. This organization is beyond salvage and needs to be abolished. Its administrative duties can be absorbed into the (hopefully newly funded and reformed) FDA.

Just one more piece of work awaiting the next rational occupant of the White House…..if we get one.

I agree that the DEA must be restrained in these matters. However, every pharmacist (and I'm a pharmacist) in a particular area can tell you exactly which doctors are are legitimately managing pain, which are completely naive about dishonest patients, and which are running pill mills. Just ask 5 of your local pharmaicsts, and I guarantee you'll discover which are the truly bad eggs.

Posted by: adam | Feb 7, 2008 4:51:05 PM

We do not know enough facts. The DEA does not usually go after people who merely cut corners. They may just call to discuss practices. They usually prosecute docs after people have died of overdoses, in this case 56. I would like to hear more facts or to read the charges. The licensing board also tried to suspend the license, so it is not solely the DEA complaining.

Posted by: Supremacy Claus | Mar 3, 2008 5:11:49 AM

The DEA is an out of control agency. Because of these evil scumbags legitimate pain patients cannot get adequate doses of medication necessary to manage their pain. This agency serves no legitimate purpose and seems to be a repository for sociopaths. A quick google search will reveal millions of websites and posts documenting their corruption and propensity for violence against non violent offenders not to mention stealing assets from innocent victims of this evil agency.

Posted by: j davis | Mar 13, 2008 9:24:02 AM

The DEA is an out of control agency. Because of these evil scumbags legitimate pain patients cannot get adequate doses of medication necessary to manage their pain. This agency serves no legitimate purpose and seems to be a repository for sociopaths. A quick google search will reveal millions of websites and posts documenting their corruption and propensity for violence against non violent offenders not to mention stealing assets from innocent victims of this evil agency.

Posted by: j davis | Mar 13, 2008 9:24:27 AM

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Flacks peddle false "reality"

Such a pity that the NY Times has been so beaten up by the commies amongst us that it actually now feels that it has to point out where Peter Pitts and Janet Trautwein get their money. Although, as per the last time it let Pitts write an op-ed, it didn’t mention his day job as a PR man for pharmaceutical companies. After all, who could be opposed to “Medicine in the Public Interest” — after all it is in the interest of the public to pay for all and any medicine at any price that PhRMA chooses, right?

And let’s not get started on underwriters (for whom Trautwein is the main flack). After all Grace-Marie Turner thinks that they’re the health care heroes! Perhaps they’re heroes because they drive sick people into the uninsured population so that the under-paid clinical staff working in America’s public and community health system get to show their worth by caring for them —even if they’re less heroic than underwriters.

But that’s OK, Pitts & Trautwein can be printed in the NY Times cherry-picking problems with other countries health care systems. Because as we all know there’s absolutely nothing wrong with ours, eh?

And why should Pitts quote the peer-reviewed 2007 Commonwealth Fund study that showed that waiting times for surgery were longer in the US than in the communist hell-hole of Germany, when instead he was able to cite an 11 year old study about longer waiting lists for one specific type of surgery in the Netherlands, which has completely revamped its health care system since then. Something he and Trautwein have helped stop us doing — preserving a dismal status quo they obviously want to maintain.

Those two wouldn’t last 92 seconds in a debate with Uwe Reinhardt or Hillary Clinton.

On the other hand, there’s no letter from Karen Ignagni to make up the trifecta. Did she negotiate some summer vacation time along with her $1.3m salary?

WEIRD

The Times has many faults (too much B.S. about alleged "single-payer") -- but this is NOT one of them. Anyone dumb enough to believe that a Ralph Nader fan wrote that after this tagline --

"The writer is president of the Center for Medicine in the Public Interest, a nonprofit organization that receives financing from pharmaceutical and biotech companies."

deserves to live in the U.K., France or Canada.

This was just freakin' weird.

Posted by: Russell | Aug 15, 2008 11:18:02 AM

Russell--

No, it wasn't weird.

It's part of a pattern at the NYT (where I have worked.)
The lack of discosure on where op-ed writers are coming from is disgraceful.

Posted by: Maggie Mahar | Aug 15, 2008 8:34:18 PM

Madam, with a 1000 respects -- what the heck are you talking about?

Any normal American who has actually worked a real job (e.g., McDonald's) knows when she/he is being spun. As in, when the boss asks for a volunteer -- don't volunteer until the details are known.

Someone who gets $$$ from the pharms is NOT going to oppose the pharms. This is Comm 101, madam.

My God -- I cannot believe valuable electrons are being wasted in stating the plainly obvious. What is next -- there are no illegal immigrants in the USA?

Weird. Just frackin' weird.

Posted by: Russell | Aug 16, 2008 10:32:09 AM

View the original article here

TECH: Drugs & technology--Allscripts and SafeMed

They also have a very cool video called Paper Free health care (I spot some inspiration from the Health 2.0 video!)

I also got the chance to meet a much smaller company called SafeMed. Rich Nossfinger & Ahmed Ghouri hasve built a very very sophisticated rules and processing engine which can interpret drug data and embed that decision support into patient specific indications. Very intriguing stuff and you can learn more by listening to this interview (although they weren't allowed to let me tell the world in advance that they are one of the first partners in the Google ecosystem. Here's the SafeMed interview.

View the original article here

Should the FDA relax in the search for new cures?

By Matthew Holt

Over at DiabetesMine #1 health blogger Amy Tenderich has very important post. She and several fellow travelers are appealing to the FDA to strike a balance between safety and progress in allowing new diabetes treatments.

The FDA of course has been beaten to a pulp these last few years because it’s played footsie with the drug industry and ignored several potentially damning studies, with the result that the number of drugs withdrawn from the market has been much higher than in previous years.(Vioxx, Phen-Fen, Baycol, et al).

I’ve always felt that the FDA’s role should not to be a black/white (dangerous/safe) stamp of approval, but instead it should be the honest broker of getting all the data out there. As Amy and her crew point out, some diabetics may be prepared to take a risk of higher long-term cardiac complications in return for a medium term gain from a new medication. Something similar is certainly true in terms of hormone replacement therapy.

Obviously it’s one thing to say that all the information should be released and then doctors and patients should make an informed choice on what they want to use. It’s another to actually get pharma companies to release negative results and for that matter for the FDA to release all its data. John Abramson’s Overdosed America shows the very nasty world of that cooperation, including his need to get a FOIA for the FDA to release information it had about Celebrex among other drugs.

And on the flip side we know that big Pharma is quite prepared to push drugs it knows have serious risks and just not disclose them. (Dodgeballl anyone?)

So the FDA has to live in a very imperfect world.

But with the rise of very informed patients, perhaps the new FDA Commissioner can aim to create a transparent environment in which everyone in the system (pharma, regulators, doctors and patients) gets to release and consider all the information about a product and are then expected to act like responsible grown-ups. It’s an ideal, I know, but one that someone should stake out. We don’t want to repeat the last 10 years.

January 9, 2009 in e-patients, FDA, Health 2.0, Patient Safety, Pharma, pharmaceuticals | Permalink

More transparency would be of real help and FDA should take stringent measures in this direction.

Posted by: Govindan | Jan 9, 2009 1:58:30 AM

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PHARMA: Stunt doubles in pharma DTC?

I’m sure (well I’m not sure but I’ll cheerfully and casually postulate) to keep you all amused on a Friday) that there are many possible overlooked problems with Lipitor and the statins. I’ve heard of severe muscle pain, even amnesia. But then again most cardiologists and the medical establishment recommend statins very widely and the general medical opinion is that they’re under-used.

I’m reading an interesting book The Last Well Person by Nortin Hadler whom I had the pleasure of meeting at the FIDMD meeting a few weeks back. Nortin is not exactly modest(!) but he’s very amusing and has firm firm opinions. In the book he systematically goes through the randomized clinical trial evidence of the value of much heart treatment including angioplasty, heart bypass, and statins. And his analysis from the West of Scotland trial (which admittedly was using Pravachol not Lipitor) is that statin use made only marginal absolute improvements in heart attacks and essentially no difference in overall mortality.

But is Congress investigating whether the medical establishment has been lead astray or is leading us astray? No.

Apparently the most important question is whether Robert Jarvik actually rowed his own boat in a Lipitor commercial….

February 8, 2008 in Pharma | Permalink

Congress really has its priorities straight. Did Jarvik row his own boat? Did Belechik steal signals from the Jets? COME ON, GUYS! Let's get to the really tough questions: Does Shaq use Nair to keep his dome shiny? Does J. Lo get collagen injections in her butt? Is Lou Dobbs really a genetically modified woodchuck? (Tape at 11.)

Rome burns . . .

Posted by: tcoyote | Feb 9, 2008 4:20:02 AM

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PHARMA: The statin backlash (or WSJ later than THCB by 5 years!)

Yesterday the THCB hit meter went off the charts. not sadly because of some new genius posting on THCB, but because the WSJ has this article about Lipitor causing memory loss and Google searches are bring up an article from 5 years ago on THCB that I wrote—after reading a piece in Smart Money about the same topic. Here was the key paragraph form that article

Unfortunately the Smart Money article doesn't give any denominators, so there's no real evidence other than these anecdotal stories about whether significant numbers of people have had these reactions to Lipitor.  So despite the heart-rending stories, you can't draw any conclusions. Also don't forget that in the grander scheme of things (if you believe the conventional wisdom that lower cholesterol reduces heart disease), Lipitor is saving thousands of lives for each one it hurts--if it does hurt.

The problem is that increasingly it’s become evident that the statin story is similar to other heart intervention stories—the endpoint which it helps (lower cholesterol in the case of statins, less heart blockage in the case of CABG and stents) doesn’t necessarily reduce overall mortality all that much on an absolute risk basis—and may have other damaging side-effects. Of course the most under-reported side effect from CABGs is also neurological deficiency. In fact there are serious clinicians who believe that use of statins or revascularization prior to a heart attack is clinically wrong.

So it appears that we know far too little about what’s going on before we really should be putting statins “in the water” as the cardiologists use to joke.

Then of course there’s the business interests involved. Pfizer has been roundly criticized for its Lipitor off-label marketing (even if going after Robert Jarvik for his lack of rowing skills is a little silly). But the pressures around a $12 billion franchise are likely to create this kind of behavior.

And worse. Peter Rost (not exactly Pfizer’s best buddy) has been pillorying Schering Plough for the stock trading behavior of its senior execs before recent belated release of data on the failed Zetia trial. And now Congress is joining in there too.

All of which gives me  pause to think about whether the whole statin era may be on its way out. It’s looked so obvious for so many years that more people should be on them, but maybe the pendulum of the perception of the evidence is starting to swing the other way.

And when you read a message board like this one at DailyStrength, it certainly gives this 44 year old with borderline high cholesterol pause before wanting to go down the statin path. Still I guess Feb 14 is an appropriate day to be confused about affairs of the heart!

February 14, 2008 in Pharma | Permalink

I've always found it humorous that statins became multi-billion dollar drugs even though no one knew how they worked. Oops..it isn't the cholesterol-lowering effects of statins that make them miracle drugs, it's the totally unforseen anti-inflammatory effect.
I was the TV medical reporter for CBS in Chicago for many years. (Now I run a large physician marketing company)I interview many cardiologists laughing about "putting statins in the drinking water."
I was skeptical of the financial incentives then...and I'm even more skeptical now.

Posted by: Michael Breen M.D. | Feb 14, 2008 10:02:38 AM

This statin conundrum reminds me of the old days when AIDS was first identified as a clinical syndrome but its cause was unknown. At the time, the American Red Cross stated positively that there was no evidence it could be transmitted by blood transfusion and therefore "directed donor" transfusions were to be discouraged. (I was a community hospital pathologist trying to deal with panicked patients; that's why I remember this.) Their viewpoint was shared by most medical authorities, but there was a "radical" group at San Francisco hospitals which dissented - in retrospect, probably due to their higher caseload and therefore greater clinical experience.
Well, guess who was eventually proven right??
I think this just illustrates that sometimes only the tincture of time and additional research tell us what helps and what harms. In the meantime, we all struggle - patients and doctors alike.

Posted by: bev M.D. | Feb 14, 2008 11:37:07 AM

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Life insurance can fill the pension plan uncertainty

Well, all we tend to hear these days is the jeopardy of the pension system.

So, do not be surprised if Ontario Finance Minister Dwight Duncan ignores last year’s proposal from former law dean Harry Arthurs to increase the maximum pension guarantee from $1,000 a month – where it has stood since the early 1980s – to $2,500 a month.

Guarantees are harder to find.....life insurance may be the answer

The government of Canada  and it’s provinces has thrown their hands in the air and pleaded an inability to guarantee Canadians their supposed right to receive their company pensions.

History has shown that when companies fail, or reach a point of restructuring or going out of business, they look to tap into what should be the “untappable”.

Laws tend to not protect the hard workers that have contributed to, and are relying on their company plans.

Now, let’s take this a step further.

The husband and wife living off one pension, and realizing the uncertainty are looking for ways to ensure the survivor and their children are left with a half decent standard of living need to look at what can be guaranteed.

In the old days, countless sales ideas were bantered around to suggest that life insurance can be an estate creation tool, and an estate preservation tool.

It is also a tremendous way of creating a pension, and it is this aspect that should be explored.

When young, and furthest from retirement, the amount of life insurance a couple needs is the greatest.

Often however, the agent looking to sell a policy looks to sell the one with the highest commission, and therefore leans toward the permanent versions at the outset.

This can cause a variety of issues, the greatest being a high premium outlay, and a low insurance amount.

If you are lucky enough to survive to retirement age, and are looking to use your insurance as a pension plan backup for your family, have you got enough coverage to be turned into an income stream?

If you are no longer insurable, you have now created a situation that you cannot change the amount of insurance (money) you will be able to leave your spouse and family. Wouldn’t it have been better to guarantee the higher amount with term insurance?

And, there is another problem you have when working – disability.

If you bought expensive life insurance and did not look at disability issues, then you will be taking additional chances.

You work to provide income, but also only by working do you contribute to your pension.

If the disability plan at work does not include a contribution to the pension when disabled, your pension will be smaller than it should be.

And, what if your income level is literally cut in half? Would your mortgage payment be covered?

Would you become a bank mortgage statistic? Another foreclosure because of poor planning or an insurance agent that did not include disability as part of your insurance planning?

It happens, and it happens more than you might think.

To prove it, ask yourself when your insurance agent last looked at your situation should you become disabled, and did he/she review your long-term disability coverage in your employee booklet?

You can ask us to help you – 1.866.856.6799.

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Big pharma has big problems

Big pharma has big problems. The root cause is a lack of research and development productivity, which means a dearth of new products to make up for looming patent expirations. Something near half of big pharma’s revenues will be threatened by generic competition within the next three to four years, and that will radically change the face of the industry.

The R&D productivity problem isn’t exactly new. When I was at the Boston Consulting Group (BCG) in the mid-90s we were already talking about the “NCE gap,” which referred to the number of new chemical entities that needed to be developed to justify pharma companies’ valuations at the time. Back then, there was still a possibility that new discovery tools would boost productivity and prevent a collapse of the industry.

Over the next decade or so, pharma largely managed to maintain its revenue growth and valuations, but things weren’t as healthy as they looked. The revenue growth was due to price increases, new indications for existing products, changes to guidelines (e.g., blood pressure, cholesterol) that increased the number of people who were recommended for drug therapy, combination products, new formulations, growth outside the U.S., and the arrival of the Medicare Part D prescription drug coverage. Almost all of these growth levers are now tapped out.

According to the Washington Times (Drugmaker ads to target Obama idea) the pharmaceutical industry is now planning a large advertising effort to undermine President-Elect Barack Obama’s plan to have the government negotiate drug prices on behalf of Medicare, rather than leaving it up to the PBMs that do the job now.

My old BCG buddies are at it with a new report, which the Times cites.

Giving Medicare the authority to negotiate drug prices - a provision that they currently don’t have - would cause the pharmaceutical industry to lose $10 billion to $30 billion in annual revenues, according to a report released last month by the Boston Consulting Group.

“If you start to take a pretty big price decrease out of that large market, it has an enormous impact on drug companies and really their ability to generate their type of shareholder return that they have had in the past,” said Peter Lawyer, a senior partner with Boston Consulting.

According to the Times, the ads will “tout the importance of free-market health care” and may try to have the same impact as the famous Harry and Louise ads of 1993 that undermined the planned Hillary Clinton-led reform bill. (By the way the brains behind the Hillary effort was ex-BCGer Ira Magaziner.)

If that’s really the aim, someone is misjudging the mood of the public. People aren’t looking for “free-market” anything at the moment, especially when what the pharmaceutical industry really means by “free market” is pricing freedom for themselves. And remember, drugs are protected by patents, which are granted by the government, not the free market.

Here’s some friendly advice to the pharmaceutical industry: don’t make the mistake of attacking the policies of our new President. Such a move is likely to backfire.

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma,  biotech, and medical devices. Formerly with BCG and LEK.

When I see patients in my (nonsurgical specialty) practice, elderly patients (and often younger ones with high medical usage) with long lists of medications, I feel that we are really diverting a lot of wealth for little in return. For most costly drugs, there are reasonable generic substitutes (of course not for all drugs and for every patient, I am aware of allergies, side effects, interactions). And when I see elderly people who get a lot paid by medicare part D and still have substantial copays, I do think that for these folks, there basically is a second tax, and a very high one.

Posted by: rbar | Nov 19, 2008 9:04:19 AM

Pharma is just tyring to fend off challenges to their revenues and their profits but the hand-writing is on the wall. Economist had a brief piece on it but the future of pharma companies profits is going to be in the BRIC countries and non-G20 countries outside of North America and the EU zone.

http://www.economist.com/business/displaystory.cfm?story_id=12601852

Posted by: MG | Nov 19, 2008 9:53:04 AM

When the new, expanded Medicare for All is implemented upon the passage of H.R. 676, the pharmaceutical companies will then have to begin negotiating their prices with the government as they currently do with the VA. This will bring drug costs in the USA more in line with those much lower costs that are found in most every other country around the world.

If you believe that affordable health care in America should be a right and not a privilege, then join HR676.org today and your voice will be heard.

Larry Pius, Dir
www.HR676.org

Posted by: Larry Pius | Nov 19, 2008 10:37:08 PM

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Insurance for Dummies 101: Are your insurance plans draining or ensuring cash flow?

It was hard to put this topic out there. What would you think of me?

If someone wrote a book called “Insurance for Dummies”, you’d laugh, and if you wanted to really find out how to look at insurance, you might even buy the book.

Part of my website includes an ability to see what keywords folks use to find the insurance issue they are looking for.

Nobody is a dummy! But, if I were looking for something in your field of study then you might know right off the bat that I didn’t have a good grip on the issues, or what I really should be looking for. Right?

Same for insurance. And, the industry is ripe for agents and companies to separate you from your money with piecemeal products that don’t have a rhyme nor reason to really exist.

These products have really high relative premium to what they might, if ever, actually return.

Shame on the insurance industry!

Are your insurance plans separating you from your money or guaranteeing it? Which is it in your case?

Look at the credit card companies asking you to take out the disability insurance.

You might tell me you have disability coverage, and we look at it, and yep, if you are disabled, the credit card company pays the minimum monthlypayment on your card. Whoopee!! What’s that worth $50 or less? Wow, thanks guys!

And they feed you the “if you don’t have a balance you don’t pay”. Thanks again! Imagine how happy that should make you.

And have you ever oversighted some insurance plan like this and tried to appeal to have the premium returned? Not so easy is it?

Right. The card company will blame the insurer and say they cannot control the insurers policies. Well, who was it that sold me that turkey in the first place?

Live and learn, or do we?

The problem is it is an insignificant issue. The premium though can be significant.

It is not uncommon for families to have a whole bunch of insurance charges for insignificant coverages, and have no basic idea of the important issues like how much will I get in income replacement if I am disabled? How long will it pay? How will it refuse to pay? Will it be enough to keep us in our home?

You know, the big questions.

But, we rarely get that call at 6 PM as we prepare to eat our dinner do we?

No, we get the “Hello, it’s so and so company….thank you for your loyalty…and because you are a good customer, you have an opportunity to take blah, blah, blah for only $8 per month? Would you like some of that?”

Ouch!!!

Would you want your healthcare to be handled that way?

“Hello, this is a medical clinic calling. We would like to offer to remove your appendix because it may need to be one day, so why wait?”

Doesn’t work does it?

Go to the doctor and monitor your health, and if there are issues creeping up work on a plan with your doctor, right?

Well, with insurance, income replacement in the event of death or disability is the goal.  And not $13 minimum card balance payments either – really important income replacement or debt payments like the mortgage and property taxes.

We can do that for you. But we won’t do anything until we look at what it is you might have, and what you need to supplement what’s already in place.

And by the way, you’d be no dummy to want that!

There is ‘No book required! ‘

Do me a favor though…. don’t answer your phone at dinner time again! They probably just want to make a meaningless sale.

We are here it help at 1.866.856.6799, in Ontario and Alberta, Canada.

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What does the upcoming EI inclusion for the self-employed mean?

The unemployment insurance opportunity will be extended to allow short-term disability to be addressed for the self-employed. Weighing the need and importance to the client should be compared with the cost, as with all insurance opportunities.

In 2010, the Government foresees the inclusion of the self-employed to the employment insurance system in a limited way.

How limited?

Well, actually limited to what makes sense.

As a self-employed person you will not be able to claim for job loss (because you are your own boss), but you will be able to claim for disability, maternity leave, and other medical reasons.

In short, this means that the issue of short-term disability can be addressed, and the analysis should form part of your overall insurance planning.

The system will be voluntary, so an insurance broker should weigh in the importance you as a client would put on short-term disability.

Premiums can range up to $60 per month approximately, depending on income.

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Benefit plans ABC, 123 – Sesame Street style (Ontario & Alberta, Canada 1.866.856.6799)

Why does insurance advice have to be technical and complicated?

Confused yet over your benefit plan choices? Well if you are not, then chances are you haven’t looked long enough. Keep going, and you will be really confused in a short time.

Why do I call this article Benefit Plans Sesame Street Style?

Because we need to get back to basics the more confusing an issue gets. Cut down a few trees to see what we have in front of us. The basic ABC’s and 123’s please!

Okay, here goes the logic behind my approach…..

You call for a benefit plan to ensure you are okay in the event of an illness. Because, after all, who will cover those expensive medical drugs right?

Question: How did you get to a point that you need expensive drugs?

Did you get cancer or have a heart attack or stroke that led to those drug costs?

Yes?

Okay, so were you working before? Are you working now? What if you cannot work?

If you cannot work, would you produce an income to pay the bills? The bills, including any premium for the drug plan you called for! Any bill for that matter?

So, priority number one is covering off the income problem, because without income, forget the drug problem, it pales in comparison.

And, this explains why if you are working for a large company they offer life and disability, medical, and dental, right?

The bottom line is that if you are looking for a benefit plan, you should first be looking to cover off the income need – that is, you need to ensure income or it’s game over. Then, the gravy is how you will look at the drugs and dental expenses.

And, if you are in Ontario, should drugs become a huge issue, there is also the Trillium Drug plan to help.

The United States is looking to move to a system (jury out) that is similar to Canada. Their problems are far greater than ours, as a simple pregnancy can be costly.

Which would be worse: the doc telling you you need a prescription or that you cannot work and earn your paycheque?

We have the luxury of having basic medical care in Ontario, Alberta, and Canada that is far superior to the issues facing Americans, and I hate to say it, we have income problems more than medical plan problems.

It really becomes a question of ensuring your lifestyle is not affected with illness or injury, or other medical issue. After that, it is a need to cover off inevitable expenses as cost-effectively as possible.

And that’s the ABC and 123 of that!

We are here to help – 1.866.856.6799

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Researchers question publishing ethics of leading economics journal

By Sarah Arnquist

Update: The Harvard Health Policy Review site is back up with an apology and disclaimer for not seeking a response from the JHE editors.

A Harvard Health Policy Review article that details two researchers' account of unethical editing at the Journal of Health Economics (JHE) mysteriously has gone missing from the Internet (but not entirely--here's the PDF). Actually, the journal's entire site has been taken down.

The article is full of drama that rivals a John Grisham thriller. It involves the Ivy League, corporate greed, a suggestion of tainted science, and legal threats -- which I'm guessing may not be over.

In the "missing" article, University of Pennsylvania sociologist Donald Light and health economist Rebecca N. Warburton, of Canada's University of Victoria, recount their two-year ordeal to publish a critique of a 2003 study published in JHE, in which Tufts researchers -- using confidential data supplied by drug companies -- estimated research and development costs for a new drug at $802 million.

Light and Warburton had several criticisms of this article, namely the undisclosed conflicts of interest of the Tufts authors. But they say the JHE editors thwarted their efforts to publish a fair critique.

The "missing" article details the back and forth between the JHE editors (three of whom are Harvard professors) and the original authors. Light and Warburton called it "ultimatum editing," and said the editors "violated almost every ethical standard set for editors."

At one point in the process, Light and Warburton even threatened to sue. Alan Millstein agreed to make a legal case on behalf of the authors and drafted a complaint. “He did not expect much in monetary damages, but expected to win before a jury, revealing to the world how leading economists handled an independent critique of a key article concerning the high costs of drug development form an industry-sponsored research center.”

Merrill Goozner wrote about the conflict in his post, "Where's Harvard's Missing Health Policy Journal?" PharmaGossip also writes about the missing journal here.

October 21, 2008 in Pharma, Policy | Permalink

Wow. I guess I shouldn't be surprised. Money taints every industry even academia, but the blazen disregard for ethical behavior by "professors" - one of the most highly respected professions - is still a big disappointment. Shame on you JHE editors!

Posted by: S. W. | Oct 20, 2008 6:32:58 PM

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