Category Archives: Ethics

Two interesting events this week illuminate why health care costs are increasing (by double digit percentages) each year and why they are bankrupting individuals, insurance companies, Medicare, Medicaid, states and indeed the U.S. government.  And while this is happening congress is taking resolute steps to cut NPR’s funding, question individual’s rights to abortion (even in cases of rape, incest and mother’s life risk).  Their budget cuts amount to about 2% of the current budget deficit.  This budget balancing urgency comes after granting a 400 billion dollar a year tax cut.  Remarkable ineptitude.

How health care is  bankrupting us:

1.  Consider the recent rebranding of a long time generic drug hydroxyprogesterone caproate into  Makena.  Without getting into the question of efficacy, consider that hydroxyprogesterone caproate was available for many years at $10-15/ dose from compounding pharmacies.  The branded version of this same exact drug will sell, according to it’s manufacturer, for $1500/dose and the manufacturer expects individuals and insurers to pay.

Now a national pharmaceutical company has gotten FDA approval to make hydroxyprogesterone caproate and will be charging about $1,500 per shot.
KV Pharmaceutical, headquartered in Bridgeton, Mo., received approval Feb. 4 to make and market the drug for the prevention of pre-term labor that for years had been mixed by compounding pharmacies. (at $15, Medicynical clarification)

Medicynical Note:  It’s better than alchemy to be able to make a $15 drug into a $1500 one.  But that’s American ingenuity and creativeness.

2.  Selling a marginally effective drug (Provenge) for $93,000/course of treatment:

Medicare officials said Wednesday that the program will pay the $93,000 cost of prostate cancer drug Provenge, an innovative therapy that typically gives men suffering from an incurable stage of the disease an extra four months to live.

The Centers for Medicare and Medicaid said the biotech drug made by Dendreon Corp. is a “reasonable and necessary” medicine. The decision ensures that millions of men would be able to afford the drug through the government-backed health care coverage. With government reimbursement, analysts estimate Provenge could rack up $1 billion in sales next year. The decision, which will be finalized by June 30, is important for Dendreon because most prostate cancer patients are 65 or older.

Also:

“It’s impossible to put a dollar figure on a human life, especially when you’re talking about a drug that has such mild side effects,” said Jim Kiefert, a prostate cancer patient and advocate who was part of the Provenge study. “Of all the treatments I’ve had — with surgery, radiation and hormone treatment — Provenge had fewer side effects than any of them.”

But bioethicists who study health care decisions say Medicare’s ruling on Provenge mirrors the bias of the overall U.S. health system, which emphasizes expensive treatments over basic medical care. Health care costs account for nearly one fifth of the U.S. economy, more than any other country.

Medicynical Note:  It’s obvious to any thoughtful person that unless the cost of care comes down, we can’t afford our non-system.  We pay twice as much as other similar countries and still have 50 million and climbing uninsured.

Resolving the conundrum of health care costs is a major question that instantly strikes our politicians deaf, dumb and blind.  Even the most innocuous suggestion, for example, comparing the efficacy of new drugs against older less expensive ones, in studies not sponsored by drug companies, is considered controversial.

I’m sad for my grandchildren.

Addendum:  4/1/2011 Drug company slashes price of drug from $1500 to $690. A bargain?  Still only 50 times the price of the generic.  Amazing!

The price of an expensive (? Medicynical question mark) drug to prevent premature births has been cut by more than half, following bitter controversy over its high cost.KV Pharmaceutical Co. said Friday that it is dropping the price from $1,500 per dose to $690.

The company got government approval in February to exclusively make the drug named Makena (mah-KEE’-nah), and it hit the market last month. For years, specialty pharmacies had been making a version of the weekly injection for $10 to $20 a dose, so the price of Makena was a shock to doctors who prescribe the drug and private and public insurance programs that pay for it.

It’s hard to tell what’s real on April fools day.

Be careful what you wish for.  This cuts both ways.

The incidental economist notes: (Austin Frakt)

If one wants to address the problems in health insurance markets and/or to get providers to accept payment reforms, the mandate–or something like it–is the political price. Yes, it’s about money. What else?

Put it this way, if one wants to retain a private market-based health insurance system (which ours largely is), it takes a mandate. Reject the mandate without replacement with a similar mechanism and the whole thing unravels, not just as a matter of health economics (adverse selection) but as a matter of politics.

Medicynical Note:  We’ve created the most dysfuntional, expensive healthcare non-system in the world.  Yes we’re number one.

Employer sponsored health care is a mess.  Employers don’t have to provide their employees health care–in many instances they can’t afford to provide it; “contractors” are not employees and don’t qualify for employer provided benefits;  if you get sick and can’t work, you lose your insurance.  Remarkable.

Our health care costs are twice that of many other industrialized countries and thousands more per capita/year.  We have 50 million uninsured and have a “system” that encourages “free” use of the most inefficient, most expensive health care provider in the country–emergency rooms.

We all pay.

Bloomberg has an interesting article on the limited medical benefit of spinal fusion to patients–but big financial benefits to doctors, medical practices and suppliers (Medtronic). The article documents at least the appearance of, if not actual, conflicts of interest; high costs $135,000 for the surgery (yes on one patient); $800,000/year incomes for the orthopedists–three times that of pediatricians.

The possibility that many of these and other surgeries are needless has gotten little attention in the debate over U.S. health care costs, which rose 6 percent last year to $2.47 trillion. Unnecessary surgeries cost at least $150 billion a year, according to John Birkmeyer, director of the Center for Healthcare Outcomes & Policy at the University of Michigan.

“It’s amazing how much evidence there is that fusions don’t work, yet surgeons do them anyway,” said Sohail Mirza, a spine surgeon who chairs the Department of Orthopaedics at Dartmouth Medical School in Hanover, New Hampshire. “The only one who isn’t benefitting from the equation is the patient.”

There’s lots to this article including evidence that fusion is no better than physical therapy for disc related pain in several studies–only a 47% success rate for surgery in one U.S. study;  high complication rates for surgery;  direct payments from the medical supplier (Medtronic) in the form of royalties and consulting fees to doctors (as high as $440,000/year to an individual doctor and 1.75 million to a practice in Minneapolis).

Medicynical note: Not a pretty picture of American medicine. Costly, open conflicts of interest, use of aggressive expensive unproven procedures over more conservative approaches–with the same or worse outcomes.  Is it any wonder that our costs are one and half to two times that of other industrialized countries.

The “free market” encourages entrepreneurs to find ways to take advantage of markets, sometimes that leads to better outcomes and more efficiency but in medicine it seems to encourage waste, high cost and over-utilization.

The Washington Times presents a tortured argument against promoting more efficient care in the most expensive health care non-system in the world.

Think of it, a centralized, federal database tracking your every visit to a health care provider – where you went, who you saw, what was diagnosed and what care was provided. Chilling.  Medicynical note: as if private insurers oversight that  controls and limits treatment given is less intrusive, or as if the data will have patient identifiers.

The Times takes issue with the notion of efficiency in health care.  To them, apparently,   spending 50% more per capita on health care than any other nation in the world and 17% of GDP, and increasing yearly, is acceptable:

There is no telling what metrics will be used to define the efficiencies, but it is clear who will bear the brunt of these decisions. Those suffering the infirmities of age, surely, and also the physically and mentally disabled, whose health costs are great and whose ability to work productively in the future are low. And how will premature babies fare under the utilitarian gaze of Washington’s health efficiency experts? Will our severely wounded warriors be forced to forgo treatments and therapies based on their inability to be as productive as they once might have been? And will the love between a parent and child have a column on the health bureaucrats’ spreadsheets?

The Times then goes on to compare cost efficacy measures with the nazis.

Medicynical note: Nothing surprising here. Until we show some will to control  costs our non-system caring for an aging increasingly health care needy population will continue to spend our nation’s wealth.

Our republican friends have been amazingly quiet about their solutions. Their “free market” rhetoric leads one to assume they would put an increasingly large burden of expense on individuals–their form of individual mandate. They would then let the costs of health care assure economic rationing. For those who can’t afford care, I suppose their solution for patients is that of 18th century France and will let them eat cake.