Today's News and Commentary

About marketing:

2019 Healthcare Consumer Trends Report: Healthcare providers are increasingly focused on patient perceptions when designing products and services. This thoughtful report has some interesting insights, especially: “51.3% of patients say that convenient, easy access to care is the most important factor in their decision-making. Convenience matters more than brand reputation (39.8%), more than quality of care (34.6%), more than the interpersonal conduct of doctors and nurses (44.2%)—even more than insurance coverage (46.4%). In fact, 80% of patients say that they select providers based on convenience factors alone”. Do patients assume providers are interchangeable with respect to quality?

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About insurance

The $9 Billion Upcharge: How Insurers Kept Extra Cash From Medicare: In this front page Wall Street Journal article, the authors document the systematic overestimation of expenses when companies involved in Medicare Part D (drug benefit) submit their bids to CMS. These bids include administrative expenses as well as profits. If expenses turn out lower than estimates, the companies keep a portion of the overage. They are at risk for some of the losses should they occur. However, so far the industry has reaped $9 billion extra. This article does a great job of investigative journalism and explains the process very well. One further piece of data not in the article: Future Medicare Part D liabilities are more than those for Social Security.

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About the public’s health

Prevalence and Severity of Food Allergies Among US Adults: Ask adults if they have a food allergy and about one in five will answer yes. But only about 11% of the population truly has a true allergy. The article claims this misinformation causes unnecessary lifestyle restrictions and possible adverse nutritional consequences. Authors call for better documentation of these allergies through testing.

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Health advocates say schizophrenia should be reclassified as a brain disease: Other than the specific recommendation in the title, this article highlights the importance of definitions and framing in healthcare. How we define and classify a disease determines (among other things) how research is done, how treatment is funded and who provides the care. For example, epilepsy is caused by “electrical” phenomenon in the brain and is considered a neurological disease treated by neurologists. Schizophrenia is a “chemical” disease in the brain considered to be a psychiatric disease treated by psychiatrists. These differences are the result of tradition…with modern understanding should we change the models?

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About devices

The FDA is still letting doctors implant untested devices into our bodies: This article highlights the problems with medical devices that the FDA approves based on older technology- 510(k) process. The problem is that these devices may be truly new and have unanticipated adverse effects or are based on outmoded treatments. The overarching issue, however, is the FDA’s bringing products to market as soon as possible so they can benefit patients versus assuring their safety. This is a great summary of this problem.

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About pharma

5 Things About the Orphan Drug Act: January 4 was the 36th anniversary of passage of the Orphan Drug Act. The purpose of this legislation was to give pharma companies financial incentives to develop drugs for “rare” diseases. One problem is that drugs can be used for more than one reason. If only one is an orphan indication, the manufacturer receives benefit for all uses. This article summarizes where we are now with the results of the Act.

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Johns Hopkins, Bristol-Myers must face $1 billion syphilis infections suit: In 2010 a professor at Wellesley College discovered that in the 1940s, experiments were conducted in Guatemala on patients with syphilis to test penicillin’s effectiveness. These experiments were echos of the Tuskegee Study, in which African American men were observed for progression of their syphilis long after penicillin was available. The court decision says that the trial may progress to the discovery phase.

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Insurers blame specialty drug costs for rising premiums. This report from California shows why: This study from California reflects a national trend: “Specialty drugs made up about 3% of prescriptions in California in 2017 but accounted for more than half of the prescription drug spending that year.. insurers reported that per member per month [pmpm] drug spending reached about $81 last year, or about 16.5% of premiums in 2017…” Specialty drugs (like biologicals) are driving the pharma cost trend. Without the ability to approve drugs based on cost/benefit criteria, these costs will continue to rapidly rise. To put these costs into another perspective, the pmpm spending in many cases is more than what is paid to primary care physicians in capitated arrangements.

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