Health Care.

It came up as a throwaway line in a not widely reported on conference call.  Sen. Kent Conrad, a centrist Democrat who chairs the Senate Budget Committee, remarked that the money raised by cap-and-trade legislation for greenhouse gases could be used to fund health care, echoing an earlier suggestion by Sen. Harry Reid.  It’s certainly an out-of-the-box idea.  The only problem is it’s also a feeble idea.

To review, the president’s budget creates a $634 billion health care reserve fund over ten years.  This fund is intended to get us halfway to universal coverage using a plan similar to what he proposed during the campaign.  The reserve fund comes from equal parts savings in the current Medicare and Medicaid programs and new revenue, with a variety of tax proposals.  By only going halfway with the cost of the program, the White House is making clear they will work with Congress to find the other half, using the legislative process to forge a plan that a majority can not only support but ultimately vote for.

But Sen. Conrad, out of sense of obligation to keep spending down, out of a desire to avoid fights over new taxes, or just because he can is inclined to zero out the health care reserve fund, proposing that Congress find the money all at once when they do health care reform.  This musing about using the money collected through cap-and-trade to fund health care is along similar lines – alternative funding that won’t be as contentious as either raising taxes or getting costs under control through reform of the public coverage programs we have now (and more sophisticated reform than what we’ve seen the past 8 years, where “reforming” Medicare and Medicaid basically translated to attempting to cut reimbursement rates.)  It’s an idea that Majority Leader Reid has also toyed with.

But honestly, the whole point of health care reform is that it can be done revenue neutral, but it can’t be done in the context of the status quo.  As Robert Laszewski writes, “The only way we can achieve sustainable health care reform is to pay for most of the cost of any reform plan out of the savings we achieve fixing the system and its perverse incentives to spend more without regard to what we receive.”  Sooner or later, we need to make the hard choices and show some leadership to repair a health care payment and delivery system whose problems go well beyond the question of who has insurance and who does not.  It will actually be more productive and more self-sustaining to start making those hard choices now rather than doing what we always do – kick the can down the road.

There’s also an element of robbing Peter to pay Paul.  Instituting a cap-and-trade system will make energy more expensive for large companies who will do what they always do – pass the costs on to consumers.  Already too many working poor families and senior citizens have trouble paying their utilities, particularly in the dead of winter.  Even after the stimulus bill money runs out, some will need help weatherizing buildings and installing energy efficient light bulbs or appliances.  Some cap-and-trade money should, out of a sense of humanity, if nothing else, go toward deferring trickle-down economic pain.  As for the rest, I’ll let Global Warming blogger Emily tell us what advances we could make in alternative energy with sufficient investment.

Finally, paying health care with energy revenue means both pieces of legislation would need to be combined in one bill.  Hey, Kent and Harry, you realize doing each of these ambitious and game-changing programs one at a time is already going to be hard enough, right?

So we’re thinking about changing the funding for health care reform to avoid hard decisions and needed structural reform, tie it to equally difficult energy legislation, and depriving a comprehensive energy strategy of some of its funds?  Sounds like a plan only the Senate could love…

(Photo credit:  kartografia on Flickr.)

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I often marvel at how different the current climate for reform is compared to the Clinton push of 1993 to 1994. We have a president who refuses to let health care reform take a back seat to the economy, an Executive Branch that recognizes how important it is for Congress to draft and thereby own the legislation, leaders in the Senate pledging unwavering support, and even former sworn enemies like the small business lobby vouching for the urgency and necessity of reform. But I think we overlook something – if we had the Internet operating in 1994 as it does today, it would likely have been a totally different ballgame.

Let’s be honest, health care reform has already shown signs of becoming a drag-out fight in the mud. On the anti-reform side, the Betsy McCaugheys, Conservatives for Patient Rights and Roy Blunts of the world will increasingly describe life under health care reform as an oppressive, dystopian America, despite this being at odds with the experiences and data from every country with universal health care (and despite their description of a dysfunctional health care system that interferes with the relationship between doctors and patients being the factual statement of where we are now). Overzealous reformers will likely also cross the line, though more often through exaggeration than fiction. The one I hear the most often is that every other industrialized country has single-payer health care, which would come as quite the surprise to Japan, Switzerland, Germany, the Netherlands and the partially-privatized Australia and New Zealand.

But I would argue the noise machine doesn’t matter as much as it once did, especially with the interactive tools of blogs, videos and the social networking and search engines that allows content to spread. when latter day “Harry and Louise” ads sprout up, thanks to the Internet Age, the response is immediate and without mercy. Conservatives for Patients Rights released their latest ad which, for reasons that aren’t clear to me, attempts to liken AIG to health care reform. Hours later, it was being forcefully rebutted online by Health Care for America Now and Think Progress, including in this impressive blow-by-blow fact check of the ad.

Lt. Gov. McCaughey is herself a great case in point. In 1994, her attack came from the pages of The New Republic (not exactly a must-subscribe magazine for most of America) but seeped into the media narrative slowly all the same.  Because I seldom watch Fox News (I was losing my savings replacing TVs that I’d thrown something through), I actually only learn about her 2009 appearances from blogs and news items debunking her claims. Sure, that also means it’s easier for misinformation to spread, particularly into the bloodstream of the mainstream media. But if I can watch a mash-up of John McCain and Britney Spears as running mates, I can’t help but wonder what the YouTube generation would have done to “Harry and Louise” when it first hit the scene.

It’s also almost impossible to overstate how much good information there is out there – with more coming every day. Want to see the Department of HHS’s report, released today, laying out the cost of inaction if we fail to achieve health care reform? How about a transcript and partial summary of the White House Summit on Health Reform? How about a New England Journal of Medicine study on the question of if wait times in Canada actually negatively impact care or patient satisfaction (quick answer: no)? In 1994, getting your hands on any of this information was either impossible or required a trek down to the library. In 2009, access to quality expertise is a Google search away.

I don’t want to sound like I’m fawning, and the fact that I myself am a blogger on a social change Web site makes me feel a little biased, so I’ll just allude how definitely the election of 2008 demonstrated how much the Internet can facilitate grassroots mobilization – another ingredient somewhat lacking in 1994.

Health care reform is tough – if it weren’t, we’d have it already. But when I look at how definitely the Internet has used to rebut the most scurrilous misinformation campaigns we’ve seen already, and how more engaged pro-reformers are online, I can’t help but think that if we somehow finally achieve quality, affordable health care for all, the Web will be the new weapon that makes it possible.

Photo credit: epha on Flickr.

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I often marvel at how different the current climate for reform is compared to the Clinton push of 1993 to 1994. We have a president who refuses to let health care reform take a back seat to the economy, an Executive Branch that recognizes how important it is for Congress to draft and thereby own the legislation, leaders in the Senate pledging unwavering support, and even former sworn enemies like the small business lobby vouching for the urgency and necessity of reform. But I think we overlook something – if we had the Internet operating in 1994 as it does today, it would likely have been a totally different ballgame.

Let’s be honest, health care reform has already shown signs of becoming a drag-out fight in the mud. On the anti-reform side, the Betsy McCaugheys, Conservatives for Patient Rights and Roy Blunts of the world will increasingly describe life under health care reform as an oppressive, dystopian America, despite this being at odds with the experiences and data from every country with universal health care (and despite their description of a dysfunctional health care system that interferes with the relationship between doctors and patients being the factual statement of where we are now). Overzealous reformers will likely also cross the line, though more often through exaggeration than fiction. The one I hear the most often is that every other industrialized country has single-payer health care, which would come as quite the surprise to Japan, Switzerland, Germany, the Netherlands and the partially-privatized Australia and New Zealand.

But I would argue the noise machine doesn’t matter as much as it once did, especially with the interactive tools of blogs, videos and the social networking and search engines that allows content to spread. when latter day “Harry and Louise” ads sprout up, thanks to the Internet Age, the response is immediate and without mercy. Conservatives for Patients Rights released their latest ad which, for reasons that aren’t clear to me, attempts to liken AIG to health care reform. Hours later, it was being forcefully rebutted online by Health Care for America Now and Think Progress, including in this impressive blow-by-blow fact check of the ad.

Lt. Gov. McCaughey is herself a great case in point. In 1994, her attack came from the pages of The New Republic (not exactly a must-subscribe magazine for most of America) but seeped into the media narrative slowly all the same.  Because I seldom watch Fox News (I was losing my savings replacing TVs that I’d thrown something through), I actually only learn about her 2009 appearances from blogs and news items debunking her claims. Sure, that also means it’s easier for misinformation to spread, particularly into the bloodstream of the mainstream media. But if I can watch a mash-up of John McCain and Britney Spears as running mates, I can’t help but wonder what the YouTube generation would have done to “Harry and Louise” when it first hit the scene.

It’s also almost impossible to overstate how much good information there is out there – with more coming every day. Want to see the Department of HHS’s report, released today, laying out the cost of inaction if we fail to achieve health care reform? How about a transcript and partial summary of the White House Summit on Health Reform? How about a New England Journal of Medicine study on the question of if wait times in Canada actually negatively impact care or patient satisfaction (quick answer: no)? In 1994, getting your hands on any of this information was either impossible or required a trek down to the library. In 2009, access to quality expertise is a Google search away.

I don’t want to sound like I’m fawning, and the fact that I myself am a blogger on a social change Web site makes me feel a little biased, so I’ll just allude how definitely the election of 2008 demonstrated how much the Internet can facilitate grassroots mobilization – another ingredient somewhat lacking in 1994.

Health care reform is tough – if it weren’t, we’d have it already. But when I look at how definitely the Internet has used to rebut the most scurrilous misinformation campaigns we’ve seen already, and how more engaged pro-reformers are online, I can’t help but think that if we somehow finally achieve quality, affordable health care for all, the Web will be the new weapon that makes it possible.

Photo credit: epha on Flickr.

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Harold Pollack is a public health policy researcher at the University of Chicago's School of Social Service Administration, where he is faculty chair of the Center for Health Administration Studies. He is a regular contributor to The Treatment.

By any measure, helping smokers quit remains the most powerful and economical measure to prevent avoidable death and illness in the U.S.  As part of the stimulus debate, I and others proposed greater investments in smoking cessation services. House versions included $75,000,000 for these key services.

Sadly, but predictably, Senate critics derided these measures and essentially stripped them from the final package. This oversimplifies a bit. Some such services could be funded within the $1 billion prevention and wellness fund that did reach the President’s desk. Still, it speaks volumes about the interest group politics of American health policy that most of the modest sum proposed for prevention was silently stripped from the stimulus package, even as billions of dollars were (justifiably) added for medical services and for NIH cancer research.

Such outcomes speak equally loud about the selective attention span of ideological combatants across the political spectrum who claim to support prevention and population health, but who often fail to step up when the votes most count or when the boring work needs to be done.

A recent story in the Grand Rapids Press illustrates the real-world consequences of this imbalance. As detailed by reporter Shandra Martinez (and by a complementary Associated Press account) Michigan sporadically fields a Tobacco Quit Line. The hot line offered callers free nicotine patches, gum or lozenges to help people quit. In five days, the hotline received more than 65,000 calls. Martinez reports that many callers were motivated by a pending 61-cent rise in the cigarette tax, as well as by the prospect of free nicotine replacement products, which the state buys wholesale at a marked discount.  (Callers would also participate in five 15-20 minute counseling sessions to help them quit.)

This is how public health policy is supposed to work. Dozens of clinical studies indicate that telephone-based counseling and accompanying pharmacotherapy are effective in helping people to quit. The quit line is also attractive for equity reasons. Let’s face it: Smokers pay large and growing sums in tobacco taxes. As a card-carrying member of the American Public Health Association, I strongly favor these taxes. The economic burden is still real. Smokers–particularly those trying to quit–have a strong claim on at least some of these revenues. People who call the quit line deserve the help and the modest subsidy.

Unfortunately, the Tobacco Quit Line ran out of free products. In tough budgetary times, Michigan has closed the Quit Line for the rest of the fiscal year, which ends September 31. Oh yeah, the Quit Line employed about 400 smoking cessation counselors to field the crush of calls.

No word on how many of these men and women are unemployed. There is equally little word on the number of people–in Michigan and around the country–who will die prematurely from tobacco-related causes when this doesn’t have to be.

–Harold Pollack 

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Harold Pollack is a public health policy researcher at the University of Chicago's School of Social Service Administration, where he is faculty chair of the Center for Health Administration Studies. He is a regular contributor to The Treatment.

By any measure, helping smokers quit remains the most powerful and economical measure to prevent avoidable death and illness in the U.S.  As part of the stimulus debate, I and others proposed greater investments in smoking cessation services. House versions included $75,000,000 for these key services.

Sadly, but predictably, Senate critics derided these measures and essentially stripped them from the final package. This oversimplifies a bit. Some such services could be funded within the $1 billion prevention and wellness fund that did reach the President’s desk. Still, it speaks volumes about the interest group politics of American health policy that most of the modest sum proposed for prevention was silently stripped from the stimulus package, even as billions of dollars were (justifiably) added for medical services and for NIH cancer research.

Such outcomes speak equally loud about the selective attention span of ideological combatants across the political spectrum who claim to support prevention and population health, but who often fail to step up when the votes most count or when the boring work needs to be done.

A recent story in the Grand Rapids Press illustrates the real-world consequences of this imbalance. As detailed by reporter Shandra Martinez (and by a complementary Associated Press account) Michigan sporadically fields a Tobacco Quit Line. The hot line offered callers free nicotine patches, gum or lozenges to help people quit. In five days, the hotline received more than 65,000 calls. Martinez reports that many callers were motivated by a pending 61-cent rise in the cigarette tax, as well as by the prospect of free nicotine replacement products, which the state buys wholesale at a marked discount.  (Callers would also participate in five 15-20 minute counseling sessions to help them quit.)

This is how public health policy is supposed to work. Dozens of clinical studies indicate that telephone-based counseling and accompanying pharmacotherapy are effective in helping people to quit. The quit line is also attractive for equity reasons. Let’s face it: Smokers pay large and growing sums in tobacco taxes. As a card-carrying member of the American Public Health Association, I strongly favor these taxes. The economic burden is still real. Smokers–particularly those trying to quit–have a strong claim on at least some of these revenues. People who call the quit line deserve the help and the modest subsidy.

Unfortunately, the Tobacco Quit Line ran out of free products. In tough budgetary times, Michigan has closed the Quit Line for the rest of the fiscal year, which ends September 31. Oh yeah, the Quit Line employed about 400 smoking cessation counselors to field the crush of calls.

No word on how many of these men and women are unemployed. There is equally little word on the number of people–in Michigan and around the country–who will die prematurely from tobacco-related causes when this doesn’t have to be.

–Harold Pollack 

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If you, like the Disease Management Care Blog, take the time to read Managed Care Magazine, you already know a lot about Clayton Christensen’s view that Retail Clinics are a disruptive innovation in healthcare. Maybe they are, but the DMCB was reminded today of just how similar that business is to ‘usual’ physician-based outpatient primary care.

Today there was a news release on how Walgreen’s Take Care Clinics will be offering free acute care services to persons who can prove they are unemployed and show up between the hours of 11 AM and 3 PM. Remarkable you say? Give them a Gold Star for being socially conscious you say?

Not really. Before the news release described above, the DMCB recently broke bread with some community based primary care physicians and chatted about the bad economy and its impact on their practices. All three physicians described how many patients with ‘good’ insurance were a) losing their jobs, switching into COBRA and using their insurance to ‘catch up’ on all that previously foregone testing while it was still covered, b) going onto the Medicaid rolls or c) becoming uninsured. The DMCB asked if the docs were tempted to ‘drop’ the patients without good insurance from their practices. Their response was not surprising, when you think about it.

The answer was ‘no.’ All three physicians were seasoned businessmen who had been through previous economic downturns. They had seen this before. Today’s patients with no or non-remunerative insurance were not only yesterday’s richly insured but tomorrow’s also. These providers know that when the economy eventually turns around, these patients are going to join the ranks of the employed/insured. By the way, continuing to care for these patients is the right thing to do, but from a business perspective, this is a loss-leader and an investment in the future. In contrast to Walgreens, there are no press releases.

Press releases aside, the same business logic applies to Walgreen’s Take Care. Like the usual primary care providers the DMCB spoke to, Walgreen’s is interested in serving today’s uninsured, because tomorrow they’ll be paying patients who will appreciate what Walgreen’s has done for them. The positive word of mouth will help, there will be good press and lastly, while at Walgreens, these patients are likely to buy prescription and over-the-counter meds and while they’re at it, print out some photos and pick up some diapers (and, by the way, hopefully NOT be tempted to buy any tobacco products). This is shrewd business sense in the field of primary care. It wasn’t discovered by Walgreens.

The DMCB wonders if, with time, the stark differences between Retail Clinics (nurse practitioners using decision support with health information technology to treat common medical conditions) and usual primary care (which will use decision support with HIT to intelligently manage most medical conditions) will fade away. The response of both to the rising numbers of unemployed makes the DMCB wonder if there are more similarities than we’ve suspected.

“Disruptive?” Maybe not.

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For reasons unexplained, the non-sports fan Disease Management Care Blog is doing pretty well in two NCAA Basketball bracket pools. Since this random winning streak makes it fancy itself as some sort of hoops expert, it has developed the DCHR (D.C. Health Reform) Bracket for your betting pleasure.

The source of the DMCB’s inspiration had less to do with Villanova’s clutch shooting or Michigan State’s defence than Congress’ track record to date in simultaneously managing the banking, insurance and automotive industries. Watch out, healthcare…. you’re next!

Pick the DMCB selections at your peril:

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In practice, studies like this can easily be a political sop. They are easier to bury than your kids’ pet goldfish. Had the election turned out differently, that’s what likely would have happened, because the previous government was deeply attached to proprietary models.

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The polypill revolution can mean enormous growth for the pharmacy regimen that has developed in the U.S. over the last 20 years, at a price much of the world can afford. The help it gives branded drug companies in extending patents is nothing compared to what it can do for the world’s health care budget, and my life expectancy.

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By: MARLA

I have no figures to quote or studies to point to, just my innate sense that the un- & under-insured in our country may be using a disproportionate amount of health care dollars by accessing care for lower priority health issues at facilities designed to offer a higher level of care (i.e. accessing emergency rooms for colds).  I’m sure we’ve all heard the “common wisdom” that this is so.  Assuming that it is, it seems to me that it would reduce the cost of healthcare across the board if appropriate care could be provided in the appropriate setting by appropriate practitioners.

Another factor that I haven’t noticed being addressed is the shortage of key medical personnel, such as nurses, general practitioners, family doctors, obstetricians, dentists and others.  While these shortages affect everyone, they can be more significantly detrimental in underserved areas.

Additionally, it seems to me that having under- and un-insured individuals go for long periods of time without health care ultimately results in the care they eventually receive costing more and requiring longer periods of care.  To eliminate this, it would seemingly make sense to work to get them insured sooner rather than later.  In order to accomplish this, underwriting and financial access issues would need to be addressed. 

One last thought:  the development of medications and technologies to combat disease is universally beneficial.  Sharing the responsibility, costs and benefits universally would also seem to make sense and would, hopefully, accelerate the discovery of new treatments and cures.

To that end, I offer the following suggestions and ask for your thoughts in refining and expanding them:

 1.  Offer tax incentives to hospitals, clinics & urgent care centers who work in underserved areas a minimum of 30 hours/week.  The 30 hours to encompass a minimum of 1 hour before 7 AM and 1 hour after 7 PM at least 2 days/week and 3 hours on Saturday and Sunday.

 2.  For facilities opening in underserved areas willing to safely and appropriately renovate and/or remove and rebuild “blight” structures, Federal money should be made available to the local police department for the purpose of providing security.  The amount of money to be applied to be based on factors such as local population and crime rate in facility’s immediate vicinity.

 3.  Salaries paid to health care professionals (doctors, nurses, technicians) and limited to 2 administrators/site in underserved areas to be tax exempt for the first $100K (gross and unadjusted).

 4.  Create a federal insurance program (like the federal flood insurance program) for catastrophic illness (i.e. cancer, ESRD, Alzheimer’s, HIV) and require all health insurance carriers to contribute 1% of every policyholder’s premium to the program’s fund.  In years in which the carriers net profit exceeds 20% above the average net profit for the previous 5 years, they would be required to pay 10% of the net profit above 20% to the fund.  Upon confirmed diagnosis, the federal program would repay to the insurance carrier 75% of all care costs (including medications) paid on behalf of the insured.  Claims with any of the defined diagnosis codes denied would be subject to review by the same board that currently reviews Medicare claim denials.  GAO to do random financial and performance audits, with every carrier with audits performed a minimum of once every 5 years.  Deliberate fraud punishable by repayment to fund of 100% of monies paid for all patients from catastrophic fund for entire period of fraud plus a 10% penalty and posting of a bond equal to 33% of the amount of the fraud.  Said bond to be maintained for 5 years and to be released only upon completion of passing GAO audit.  Subsequent fraud would result in forfeiture of bond and loss of license in all states to sell health care coverage to Federal Employees and Medicare members for a period of 5 years.

 5.  Make health insurance premiums paid by individuals who do not qualify for coverage through an employer-sponsored plan 100% tax deductible up to an adjusted annual income of $200K with the deduction reduced by 10% for each $25K over $200,001.

 6.  Make payroll deducted employee health insurance contributions (including both fully and self funded plans) pre-tax for those whose adjusted income is less than $200K.

 7.  Reduce the threshold for claiming out of pocket medical costs as a tax deduction from 7% of adjusted income to 5% for adjusted incomes less than $200K.

 8.  Offer interest free scholarships in medical fields to highly qualified candidates where there is lower enrollment but a higher public need (i.e.:  nurses, family practitioners, obstetricians, general dentistry).

 9. Offer grants to cover 100% of tuition towards specific medical degrees in return for 2 year commitment to actively practice a minimum of 1300 hours/year in under-served areas (i.e.:  Indian reservations, low-income urban areas)

 10.  Standardize health insurance underwriting for specific chronic conditions on the condition they be certified by a physician to be under control for a minimum of 1 year with either diet/lifestyle change or medication at time of application (i.e.:  Type II diabetes, asthma, cholesterol, high blood pressure).  The rating factor applicable to these conditions when they meet the controlled criteria should be standardized (i.e.:  asthma +1.5%, Cholesterol +3.0%).

 11. Cancer survivors who have been certified to be in remission for a minimum of 5 years and have no other risk factors must be offered coverage with the pre-existing condition rated in the same manner as those conditions referred to in item 10.

 12.  Insured individuals who actively reduce their health risks (i.e. appropriate weight loss or gain, smoking cessation, reduced cholesterol, etc) may, at their discretion, request a review of their physical condition by their family/primary physician 2 months prior to the renewal of their policy to present to the insurer which is to be considered in determining renewal rates.  Significant, maintained health improvement should be “rewarded” with consideration when underwriting renewal rates (i.e.:  if rate increase would have been 8% consideration might allow for a reduction to a 6% or 7% rate increase). 

 13.  A public access website should be created using Medicare accumulated data showing a RANGE OF AVERAGE cost of care for the most common diagnoses and treatments by zip code (i.e. New patient office visit/consultation in zip code 60606:  $180 – $215).  (Although this information is more typically available to members of insurance plans through their secured websites, for uninsured individuals, gathering this information in order to make informed health care decisions is very difficult.)

 14. If medical procedures can be performed safely and more cost effectively overseas, allow 50% of travel exclusively for the performance of these procedures to be tax deductible if not covered by an insurer.  If the patient is insured, insurer must cover the procedure cost at the benefit level specified by the COC, assuming the procedure cost is a minimum of 25% less than if performed in-country:  i.e.:  if their in-country contracted rate for San Diego, CA for a hysterectomy is $1400 with the patient responsibility of 20%, the insurer would pay up to $1050 to the out-of-country provider with the patient paying 20% of the actual cost.  Insurance carrier has the right to ‘vet’ the out-of-country facility to ensure appropriate care and safety.  Insurance carriers would be permitted to negotiate contracts with out-of-country facilities and make a listing of “approved” facilities available upon request to insured’s.  Insurance carriers would NOT be permitted to pressure insured’s to receive care out-of-country.

 15. The US should seek to enter into an agreement with other like-minded countries to create an international fund (contributions to which would be pro-rated based on each country’s population) the purpose of which would be to subsidize pharmaceutical and scientific research into treatments and cures for cancer, HIV, Parkinson’s, Alzheimer’s, etc.  Distribution of funds to be determined by a board of independent, non-political scientists, medical professionals and representatives from organizations such as WHO, NIH, CDC, etc and their international counterparts.

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The push to untangle physicians from industry funding came to medical specialty societies today. Some big-name docs (Steve Nissen, anyone?) published an article in JAMA arguing that the groups should put tight limits on the funding they accept from drug and device makers.

Specialty societies — the American College of Cardiology, say, or the American Psychiatric Association — are important. For practicing docs, the guidelines, conferences and journals the groups put out are a key way to keep up with the latest research.

The JAMA paper has a big list of don’ts, along with a few dos. Ads in journals are OK, as are industry booths at conference exhibit halls. But the authors say groups should cut themselves off from other “general budget support” from industry. Funding for continuing medical education might be ok, but only if contributions go into a general pool, which is then parceled out by docs who themselves have no ties to industry.

And the leaders of the specialty societies should themselves be “conflict-free” during their tenure with “no personal income and no research support derived from industry.” Similar restrictions should apply to the docs who serve on the committees that create the specialty society guidelines.

Opponents of strict limits, including the drug industry’s trade group, argue that industry funding helps bring new information to doctors who might not otherwise be able to keep up with the latest research. And some leaders of specialty societies say they can accept industry money and still present solid, unbiased info that helps their docs practice better medicine.

The paper was funded by the Pew Charitable Trusts.

Photo, from ACC’s 2007 conference, by Bloomberg News

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The push to untangle physicians from industry funding came to medical specialty societies today. Some big-name docs (Steve Nissen, anyone?) published an article in JAMA arguing that the groups should put tight limits on the funding they accept from drug and device makers.

Specialty societies — the American College of Cardiology, say, or the American Psychiatric Association — are important. For practicing docs, the guidelines, conferences and journals the groups put out are a key way to keep up with the latest research.

The JAMA paper has a big list of don’ts, along with a few dos. Ads in journals are OK, as are industry booths at conference exhibit halls. But the authors say groups should cut themselves off from other “general budget support” from industry. Funding for continuing medical education might be ok, but only if contributions go into a general pool, which is then parceled out by docs who themselves have no ties to industry.

And the leaders of the specialty societies should themselves be “conflict-free” during their tenure with “no personal income and no research support derived from industry.” Similar restrictions should apply to the docs who serve on the committees that create the specialty society guidelines.

Opponents of strict limits, including the drug industry’s trade group, argue that industry funding helps bring new information to doctors who might not otherwise be able to keep up with the latest research. And some leaders of specialty societies say they can accept industry money and still present solid, unbiased info that helps their docs practice better medicine.

The paper was funded by the Pew Charitable Trusts.

Photo, from ACC’s 2007 conference, by Bloomberg News

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Among health insurance CEOs, Stephen Hemsley of UnitedHealth is known for shying from the limelight and rarely submits to press interviews, let alone cross-examination at a congressional committee hearing.

So it was something of a star turn when he testified today before the Senate Commerce Committee over whether UnitedHealth and other insurers have systematically underpaid consumers for out-of-network care. Sen. John D. Rockefeller, the committee’s chairman, is delving into the industry’s controversial payment-setting practices more than two months after New York Attorney General Andrew Cuomo began reaching settlements with the industry’s biggest players over the issue.

But the hearing marks the first time top industry executives have been called to publicly defend the practices. The senator from West Virginia has said he wants to determine whether federal legislation is needed to ensure changes to out-of-network payment practices happen in every state, not just New York.

Joining Hemsley at the witness table was Andy Slavitt, head of UnitedHealth’s Ingenix unit, which runs the database that aggregates and supplies the data on “usual and customary” medical charges that insurers use to set out-of-network payments. Like Cuomo (see more on his more recent efforts here), Rockefeller charges that the numbers in the database are skewed, sticking “consumers with billions of dollars that the insurance industry should have been paying.”

However uncomfortable the questioning got — at one point the West Virginia Democrat asked the two executives how they slept at night — Hemsley denied the price data was skewed. He also argued that the database helped set standards for the price of medical care. “The committee knows better than most that physician reimbursement based on nothing but the doctor’s bill is simply not economically tenable for consumers nor our health care system,” he said. UnitedHealth’s agreement with the New York AG’s office to transfer the databases to an independent, non-profit operator isn’t to acknowledge wrongdoing, but to make such medical price information more transparent, he added.

That didn’t appear to satisfy the committee chairman. Calling the UnitedHealth executives’ testimony “profoundly troubling,” Rockefeller said he plans to ask government officials to look into how many federal employees may have been shortchanged for out-of-network care over the years. He’s also sending requests to nearly 20 insurers to explain how they used the Ingenix database.

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Among health insurance CEOs, Stephen Hemsley of UnitedHealth is known for shying from the limelight and rarely submits to press interviews, let alone cross-examination at a congressional committee hearing.

So it was something of a star turn when he testified today before the Senate Commerce Committee over whether UnitedHealth and other insurers have systematically underpaid consumers for out-of-network care. Sen. John D. Rockefeller, the committee’s chairman, is delving into the industry’s controversial payment-setting practices more than two months after New York Attorney General Andrew Cuomo began reaching settlements with the industry’s biggest players over the issue.

But the hearing marks the first time top industry executives have been called to publicly defend the practices. The senator from West Virginia has said he wants to determine whether federal legislation is needed to ensure changes to out-of-network payment practices happen in every state, not just New York.

Joining Hemsley at the witness table was Andy Slavitt, head of UnitedHealth’s Ingenix unit, which runs the database that aggregates and supplies the data on “usual and customary” medical charges that insurers use to set out-of-network payments. Like Cuomo (see more on his more recent efforts here), Rockefeller charges that the numbers in the database are skewed, sticking “consumers with billions of dollars that the insurance industry should have been paying.”

However uncomfortable the questioning got — at one point the West Virginia Democrat asked the two executives how they slept at night — Hemsley denied the price data was skewed. He also argued that the database helped set standards for the price of medical care. “The committee knows better than most that physician reimbursement based on nothing but the doctor’s bill is simply not economically tenable for consumers nor our health care system,” he said. UnitedHealth’s agreement with the New York AG’s office to transfer the databases to an independent, non-profit operator isn’t to acknowledge wrongdoing, but to make such medical price information more transparent, he added.

That didn’t appear to satisfy the committee chairman. Calling the UnitedHealth executives’ testimony “profoundly troubling,” Rockefeller said he plans to ask government officials to look into how many federal employees may have been shortchanged for out-of-network care over the years. He’s also sending requests to nearly 20 insurers to explain how they used the Ingenix database.

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The risk of stroke and other vascular events is reduced in patients with irregular heartbeat who used the anti-clotting drug Plavix along with aspirin compared with aspirin alone, according to data presented today at the American College of Cardiology meeting and published in the New England Journal of Medicine.

The effect was statistically significant but modest, reducing the rate of events like stroke, heart attack and blood clots by 11%, according to Dow Jones. In the Plavix-plus-aspirin group, 7.6%, or 832 patients, suffered such an event, compared with 6.8%, or 924 patients, in the group taking aspirin alone.

But the Plavix group had significantly more bleeding than the aspirin alone group, and there wasn’t a difference in the rate of heart attacks, according to the data.

“For most people, a stroke is much worse than a bleed,” Stuart Connolly, head of cardiology at McMaster University in Hamilton, Ontario, and one of the lead investigators of the trial, told DJ. “We’re reducing far more strokes than major bleeds caused.”

Still, the large, 7,500-patient study, sponsored by Plavix makers Bristol-Myers Squibb and Sanofi-Aventis, could mean a boost in sales for the blockbuster anti-clotting drug that brought in over $8 billion last year. Atrial fibrillation, a common form of irregular heart beat, affects 2.2 million people in the U.S.

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The risk of stroke and other vascular events is reduced in patients with irregular heartbeat who used the anti-clotting drug Plavix along with aspirin compared with aspirin alone, according to data presented today at the American College of Cardiology meeting and published in the New England Journal of Medicine.

The effect was statistically significant but modest, reducing the rate of events like stroke, heart attack and blood clots by 11%, according to Dow Jones. In the Plavix-plus-aspirin group, 7.6%, or 832 patients, suffered such an event, compared with 6.8%, or 924 patients, in the group taking aspirin alone.

But the Plavix group had significantly more bleeding than the aspirin alone group, and there wasn’t a difference in the rate of heart attacks, according to the data.

“For most people, a stroke is much worse than a bleed,” Stuart Connolly, head of cardiology at McMaster University in Hamilton, Ontario, and one of the lead investigators of the trial, told DJ. “We’re reducing far more strokes than major bleeds caused.”

Still, the large, 7,500-patient study, sponsored by Plavix makers Bristol-Myers Squibb and Sanofi-Aventis, could mean a boost in sales for the blockbuster anti-clotting drug that brought in over $8 billion last year. Atrial fibrillation, a common form of irregular heart beat, affects 2.2 million people in the U.S.

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Kathleen Sebelius will be on Capitol Hill this morning, telling a Senate committee why she should run the Department of Health and Human Services, with a bailiwick that includes Medicare, Medicaid, the FDA, the CDC and NIH.

It’s been almost two months since Tom Daschle withdrew from consideration for the job. According to this WSJ graphic, HHS is the last cabinet-level secretary job still vacant.

As we noted earlier this year, Sebelius has pretty good bipartisan chops, and spent several years as the Kansas insurance commissioner before being elected governor of the state. Her nomination been well received, with the notable exception of anti-abortion groups.

Her hearing before the Committee on Health, Education, Labor and Pensions will be on CSPAN3; it looks like it may be also be Webcast on the committee’s site.

Today’s hearing is the first of a two-session series; Sebelius will appear before the Senate Finance Committee on Thursday. We’ll report back later today to let you know what happened at the opening round.

Update: Sebelius’s prepared testimony is online here. Her back-and-forth with senators included questions over whether she’d back a government-run health plan (she would, side-by-side with private insurance plans), and whether she’d be open to putting health reform on a legislative fast-track opposed by Republicans (she won’t take that option off the table). Here’s a full report from the WSJ.

Photo: Associated Press

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Kathleen Sebelius will be on Capitol Hill this morning, telling a Senate committee why she should run the Department of Health and Human Services, with a bailiwick that includes Medicare, Medicaid, the FDA, the CDC and NIH.

It’s been almost two months since Tom Daschle withdrew from consideration for the job. According to this WSJ graphic, HHS is the last cabinet-level secretary job still vacant.

As we noted earlier this year, Sebelius has pretty good bipartisan chops, and spent several years as the Kansas insurance commissioner before being elected governor of the state. Her nomination been well received, with the notable exception of anti-abortion groups.

Her hearing before the Committee on Health, Education, Labor and Pensions will be on CSPAN3; it looks like it may be also be Webcast on the committee’s site.

Today’s hearing is the first of a two-session series; Sebelius will appear before the Senate Finance Committee on Thursday. We’ll report back later today to let you know what happened at the opening round.

Update: Sebelius’s prepared testimony is online here. Her back-and-forth with senators included questions over whether she’d back a government-run health plan (she would, side-by-side with private insurance plans), and whether she’d be open to putting health reform on a legislative fast-track opposed by Republicans (she won’t take that option off the table). Here’s a full report from the WSJ.

Photo: Associated Press

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The blockbuster class of cholesterol-fighters called statins have transformed cardiology and made their money by lowering levels of LDL, or bad cholesterol — an effect that has significantly reduced deaths, heart attacks, strokes and costly bypass and angioplasty procedures.

But many doctors have long been intrigued by indicators that statins work against some of cardiovascular disease’s other culprits as well. They are known as pleotropic effects and evidence of their presence is emerging in several studies being presented at the annual scientific sessions of the American College of Cardiology underway in Orlando, Fla.

Exhibit A is Jupiter, the big trial of AstraZeneca’s cholesterol buster Crestor. In a study presented over the weekend, Crestor sharply reduced the risk of a blood-clotting disorder called venous thromboembolism. Clots in the veins typically aren’t influenced by LDL cholesterol. But logic for the new findings lies in earlier basic research indicating that statins have anti-clotting properties independent of their cholesterol effects.

Another big target of statins is inflammation. A separate Jupiter result showed that participants who achieved aggressively low levels of both LDL and an inflammatory marker called C-reactive protein had a much lower risk of heart attack and other bad outcomes than those who just got their cholesterol down. Paul Ridker, a Harvard and Brigham and Women’s Hospital cardiologist who led the AstraZeneca-sponsored trial, has shown in a string of studies going back a decade that the effects of statins on inflammation are separate from those on cholesterol.

Two European studies reported Monday that giving 80 milligrams of Pfizer’s statin Lipitor shortly before undergoing artery-clearing angioplasty significantly reduced the risk of small heart attacks around the time of the procedure. Statins don’t cause LDL to drop fast enough to play a role in this benefit — but they appear to quickly reduce inflammation.

Even a failed study makes the point. Aurora, another AstraZeneca trial, tested whether Crestor would prevent heart attacks in patients undergoing kidney dialysis. LDL cholesterol fell more than 40%, but heart attacks and other serious events didn’t. Cleveland Clinic cardiologist Steve Nissen pointed out that levels of C-reactive protein didn’t drop in that study — possibly reflecting dialysis’ pro-inflammatory effects on the blood.

What to make of all this? “Hardly any drug that is developed … works the way we think it works,” says Dan Jones, a cardiologist at the University of Mississippi who spoke to the Health Blog on behalf of the American Heart Association. “From a science standpoint, it opens a lot of doors to help us learn more about health disease.”

Broken heart by CarbonNYC via Flickr

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The blockbuster class of cholesterol-fighters called statins have transformed cardiology and made their money by lowering levels of LDL, or bad cholesterol — an effect that has significantly reduced deaths, heart attacks, strokes and costly bypass and angioplasty procedures.

But many doctors have long been intrigued by indicators that statins work against some of cardiovascular disease’s other culprits as well. They are known as pleotropic effects and evidence of their presence is emerging in several studies being presented at the annual scientific sessions of the American College of Cardiology underway in Orlando, Fla.

Exhibit A is Jupiter, the big trial of AstraZeneca’s cholesterol buster Crestor. In a study presented over the weekend, Crestor sharply reduced the risk of a blood-clotting disorder called venous thromboembolism. Clots in the veins typically aren’t influenced by LDL cholesterol. But logic for the new findings lies in earlier basic research indicating that statins have anti-clotting properties independent of their cholesterol effects.

Another big target of statins is inflammation. A separate Jupiter result showed that participants who achieved aggressively low levels of both LDL and an inflammatory marker called C-reactive protein had a much lower risk of heart attack and other bad outcomes than those who just got their cholesterol down. Paul Ridker, a Harvard and Brigham and Women’s Hospital cardiologist who led the AstraZeneca-sponsored trial, has shown in a string of studies going back a decade that the effects of statins on inflammation are separate from those on cholesterol.

Two European studies reported Monday that giving 80 milligrams of Pfizer’s statin Lipitor shortly before undergoing artery-clearing angioplasty significantly reduced the risk of small heart attacks around the time of the procedure. Statins don’t cause LDL to drop fast enough to play a role in this benefit — but they appear to quickly reduce inflammation.

Even a failed study makes the point. Aurora, another AstraZeneca trial, tested whether Crestor would prevent heart attacks in patients undergoing kidney dialysis. LDL cholesterol fell more than 40%, but heart attacks and other serious events didn’t. Cleveland Clinic cardiologist Steve Nissen pointed out that levels of C-reactive protein didn’t drop in that study — possibly reflecting dialysis’ pro-inflammatory effects on the blood.

What to make of all this? “Hardly any drug that is developed … works the way we think it works,” says Dan Jones, a cardiologist at the University of Mississippi who spoke to the Health Blog on behalf of the American Heart Association. “From a science standpoint, it opens a lot of doors to help us learn more about health disease.”

Broken heart by CarbonNYC via Flickr

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