Category Archives: Ethics

Fiat-Chrysler Games the System

Rather than build fuel efficient cars FiatChrysler decides to cheat.

“Environmental regulations can create strange bedfellows, it seems. The Financial Times has learned that Fiat Chrysler Automobiles will pay Tesla hundreds of millions of euros (specific numbers aren’t available) to pool the EV brand’s cars with its own fleet and avoid fines for violating stricter EU emissions rules in 2020. The move should help FCA meet the EU’s CO2 emissions target of 95g per kilometer by lowering its average from a higher-than-usual 123g. Fiat Chrysler has been relatively slow to adopt electric and hybrid cars — this buys it time to catch up without having to take many (if any) radical steps.”

Medicynical note: Gaming the system. Sad but apparently true, manipulating regulation is one key to success in capitalism. Ask Boeing, or big Pharma (here and here and here).

Meh. So a few people here and there die. As long as revenue grows what’s the big deal.

It is the Corporations

Backed by health insurance corporations, Trump and the GOP have spent years trying to repeal, negate, or undermine the law that’s provided health care to between 20 and 30 million Americans. (They failed in Congress, but they’re still trying in court.)”

“Backed by billionaires, they passed an almost incomprehensibly large tax cut for the rich that’s sent the deficit soaring to record heights — and immediately proposed huge cuts to Medicare, Medicaid, and Social Security to cover the difference.”

“Egged on by military contractors, they’ve put forth military budgets that award more money to a single corporation — Lockheed Martin — than the federal government spends on K-12 education. (And much of it is for a single plane that doesn’t work.)”

Medicynical note: And they want your civil rights, gay rights, contraception, right to choose, your unions and yes your Social Security too.

United Healthcare…..in it for the money

Not a big surprise

For those who thought insurance companies are in it to provide excellent healthcare……you were wrong.

“US Chief Magistrate Judge Joseph Spero issued his decision Tuesday against United Behavioral Health, a unit of UnitedHealthcare, saying the insurer created internal policies that effectively discriminated against those seeking mental health and substance abuse treatment.”

“”It is well-established that effective treatment of mental health and substance use disorders includes treatment aimed at preventing relapse or deterioration of the patient’s condition and maintaining the patient’s level of functioning. UBH Guidelines deviate from that standard,” Spero said”

Medicynical notes: Given a choice between enhanced profits or funding excellent care, the private insurer’s policy was programmed to choose the former. After all it’s their their fiduciary responsibility.

Pizza and Prescriptions.

We’ve talked about doctors receiving honoraria and other payments from drug companies to influence their choice of treatments.  Always quite righteously physician groups have responded to such allegations with drivel about their professionalism and their over riding concern for their patients.  That works up to a point but in our culture money talks.

This puts such arguments to rest:

As little as one free meal from a drug company can influence which medicines doctors prescribe for Medicare patients, according to a study using Medicare records and recently released data from the health care law’s Open Payments program.

More here.

Medicynical Note:  For the almost 50 years that I’ve been a physician drug companies have vied for face time with physicians.  Some of it is fairly legitimate education on new better drugs but most is simply  a sales pitch to get the doc to change his/her prescribing habits, almost always with limited benefit and  increased cost.  Various incentives are provided to get this access–cash payments, meals, faux jobs, deals on medications given directly to patients.  It all works and it all costs the system integrity and cash. 

But hey that’s the way America works. Check out the gun lobby and the recent assault weapons votes.  Money buys access and influence.  Doctors are not immune. 

Your Money or Your Life: America’s Health Care Disaster

It used to be financial planning was a field which provided assistance for the golden years (retirement),  In the U.S. financial planning is necessary for patients to get their health care.  Our amazingly inefficiency expensive (most in the world) health care non-system is now providing such planning to patients to “help” finance their care.  Something is terribly wrong here.

His doctor had prescribed the cancer drug Gleevec, but Steiner’s insurance refused to cover its $3,500 monthly cost. Steiner, a warehouse manager for a publisher of Bible-themed literature, and his wife, Brenda, a part-time nurse, made just $30,000 a year. No way could they afford the drug on their own.

“We still had six kids at home — how were we going to come up with that kind of money?” Steiner said. “We couldn’t re-mortgage the house, because it had already been re-mortgaged. I wouldn’t have been able to take the medication. We would have had to just trust in the Lord.”

It was a scary brush with “financial toxicity,” as researchers call the mix of economic stress, anxiety and depression cancer patients often endure. But then Steiner was assigned to Dan Sherman, an oncology social worker at Mercy Health Lacks Cancer Center who within days got a free supply of Gleevec from the manufacturer. He also made sure it was delivered promptly. The package arrived at Steiner’s home on Christmas Eve, his 46th birthday.

In the eight years since, Steiner has faced a series of medical and financial reversals, and each time Sherman has done as much as any doctor to keep Steiner going — scrambling to get the treatment he needed without sending his family into bankruptcy. “He keeps throwing me life rafts before I sink,” Steiner said.

Read the entire article.

Medicynical Note:  Health care in the U.S. is a special type of hell if you are not independently wealthy.  Something like 60% of bankruptcies in our country are related to medical expenses and it appears from the above article that the first goal of our non-system is to spend all the patient’s savings and then offer assistance.

Our insurance companies’ main goal is to assure profits to share holders, hospitals have a multilevel billing system which ironically bills most those without insurance coverage and least able to pay;  our drug companies think nothing of gouging patients to pad their bottom line, because they can (pretty sadistic); and our medical practitioners often are on their receiving end of payments from technology providers to get them to use the company’s product.  Care of patient is not the primary concern of many in our health care industry.

There are bright spots.  People working to help patient’s figure out the non-system; primary care types working very hard for relatively (compared to some medical specialties) low salaries; our nursing and medical support colleagues who work face to face with patients helping with their care and problems, medical and otherwise.  

The Affordable Care Act is a good first step but more needs to be done.  

Medical Alchemy: Valeant again, Seconal

America’s uniqueness lies in part in the fiction that free markets work and that the “music of the marketplace” will unerringly do the “right thing.”

As medicine became monetized (def: is the process of converting or establishing something into legal tender) in the U.S. it’s fiscal processes have become more grotesque.  We have medications on the market that big Pharma sells at many multiples of the median and/or average income of our citizens.  Most of these drugs have minimal to moderate effect on the ultimate course of diseases.  And even if completely effective can we afford medications at such multiples of our incomes? 

In recent years the fad in monetization has been buying old drugs and rapidly increasing their prices.  The old cover of we need to charge a lot to pay for research falls by the way side as these companies simply charge whatever they can because they own the drug.  No research is necessary it’s simply a monetary play, as in “The Big Short.”  Patients well being is simply not their concern.  In health care today, it the money stupid.

The issue arose last year, when Valeant Pharmaceuticals International of Quebec acquired the rights to Seconal, the trade name of secobarbital sodium, the most commonly prescribed drug for aid-in-dying patients. The firm quickly doubled the cost, from $1,500 to more than $3,000 — and up to $5,000. That’s on top of previous retail price increases for the nearly 90-year-old sedative that once sold for $150 for a lethal 10-gram dose.

Medicynial Note:  Yes the article describes the fix for the price increase, as new concoction which while effective is likely not as ideal as the secobarbitol (seconal).  But consider this, a drug that was patented in 1934 and at one time cost pennies a dose (for sleep) and as recently as 30 years ago cost in the range of $50-$100 is now priced at  $3000.  Alchemy?   An American success story? Or part of the continuing demise of our health care non-system? 

Poster Boy: In Defense of Martin Shkreli, the useful tool

Understand that Martin is the poster boy for the corruptish practices in what was once a self proclaimed “ethical” industry.  In fact the pharmaceutical industry, Big Pharma in the United States, has always run close to ethical boundaries.  Going back to my graduation from medical school, who was there to take the senior class to an expense paid weekend in New York? Why none other than that “ethical” company Ely Lilly.  Some might have called this a conflict of interest for both the new docs and the “ethical” company but when you are a poor struggling senior medical student you are easily bribed.  To this day doctors are targets of drug companies often receiving various forms of payments for either their continued use of products or for listening to the spiels of drug salesmen.  In this relationship there is a very narrow line between legitimate product education and payment for services.

Throughout the next 48 years of my professional life  this so-called “ethical” industry did everything to protect and improve its position.  They have one of the strongest lobbys in D.C., having most of the congress on their payroll—facilitated by our Supreme Court.   In that time we have seen medicine change from an ostensibly doing good industry into a doing well industry.  Patients no longer are viewed as sick people but rather customers for various product lines.  Drugs are no longer developed to help patients but rather to improve company’s bottom lines and yes the sicker the patient the more we can charge, regardless of the cost of drug development.

Getting back to our stooge Shkreli, he has been the focus of our ire for his raising the prices of medications that his company has bought the rights to.  He  gleefully accepted the criticism and cynically shows no contrition.  But consider that his behavior  is standard for the drug industry; that Big Pharma has been gouging U.S. consumers for years; that his companies governing boards have approved of his actions (only removing him because of his alleged earlier criminal behavior).

Some examples of drug company gouging and misbehavior can be found by simply reviewing Medicynic’s archives but to make it easy with a quick googling I came up with these examples.

http://www.businessinsider.com/john-oliver-takes-down-prescription-drug-industry-2015-2

https://projects.propublica.org/docdollars/

http://health.usnews.com/health-news/patient-advice/articles/2015/07/15/how-doctors-make-money-from-drug-companies

http://www.huffingtonpost.com/entry/americans-pay-more-for-drugs-than-anyone-in-the-world_561bda8fe4b0e66ad4c89449

http://money.cnn.com/2015/10/09/investing/drug-ceo-daraprim-price/

http://www.wsj.com/articles/pharmaceutical-companies-buy-rivals-drugs-then-jack-up-the-prices-1430096431

http://www.bloomberg.com/news/articles/2015-09-23/how-marketing-turned-the-epipen-into-a-billion-dollar-business

http://www.wallstreetotc.com/serious-price-increase-for-generic-drugs/212724/

http://www.wallstreetotc.com/serious-price-increase-for-generic-drugs/212724/

Medicynical Note:  And it’s not just generics increasing in price.  New patented cancer drugs start their pricing now at $10,000/month and increase at rates often over 10% a year.  For example, Gleevac (imitinab), a drug for chronic myelogenous leukemia,  was released in 2000 at a price of around $40,000/year it’s now three times that price.  Drug  prices are based on whether there is an alternative and how sick the patient is, not the cost of development.  The fewer the options and the sicker the patient the higher the price.  And yes in the U.S., being the perfect fools, we pay much much more for drugs than anyplace else in the world.  Why?  Because Big Pharma has abused the system and induced  congress to ignore their abuses.

Instead of damning the clown Shkreli, we should be thanking him for bringing the price gouging of Pharma to our attention.  Will anything be done?  For good reason I’m a medicynic, so I don’t think our congress is capable of intervening.  They don’t bite the hands that feed them.  Sad, but that’s American Exceptionalism.