Category Archives: General Cynicism

The headline reads “Alzheimer’s Drug Misses Goal, but Offers Hint of Potential”.  It’s clear the drug didn’t work, but Lilly is spinning the results like mad—it’s stock actually rose.

An Alzheimer’s drug being tested by Eli Lilly failed in its main goal of halting progress of the disease, the company said Friday, but there were some signs it could slow cognitive decline in patients with mild cases.

The study found:

The two clinical trials involved a total of more than 2,000 patients with mild or moderate Alzheimer’s disease who received either solanezumab or a placebo for 18 months. In both trials, those treated with the drug were not better off at the end of the trial than those who received the placebo, either in terms of cognition or daily functioning.

Sounds conclusive to me, but through manipulation of data Lilly found that

there was a statistically significant slowing of the decline in cognition. When the data was further broken down, it was found that this beneficial effect was found in the patients with mild disease but not those with moderate disease.

Medicynical Note:  It would be nice if we could suspend reality and say that this drug had benefit but it’s hard to ignore the first part of the findings.  The discussion notes that “It is also not clear whether a slowing of cognitive decline, without an improvement of the ability of a patient to perform daily activities, would be sufficient for approval.”

Kind of pathetic.   It seems clear that the drug didn’t work and that Lilly is grasping at the straw of a subgroup without revealing the extent of the “benefit,” or the number of patients out of 2000 who “benefitted.”  

The press report and presumably Lilly’s press release reeks of a (Medi)cynical statistical manipulation designed to boost Lilly’s stock, not to improve the care and outcomes of these patients

To fully understand what’s happening in the health debate you  need to keep in mind that the repubs opposed Medicare (as well as Medicaid and Social Security) from it’s inception and have done everything in their power to cripple it (them).  They’ve prevented Medicare from assessing efficacy of treatments and interventions, prevented Medicare from negotiating prices with the drug companies, and have worked to “privatize” it.

Now they try to sell privatization as an improved program when it would appear to be a rather cynical effort to undermine affordable coverage to both the elderly and younger populations.  How else to interpret this:

He wanted to reassure the seniors in the crowd about the Republican presidential ticket’s plans for Medicare, the government health insurance program serving 39 million seniors.

“Our solution to preserve, protect and save Medicare does not affect your benefits,” Ryan, Romney’s vice presidential pick, said during an Aug. 18, 2012, stop at The Villages.  “Let me repeat that — our plan does not affect the benefits for people who are in or near retirement

Medicynical Note:  Guess who gets to pay for the continued benefits of the elderly under Romney/Ryan?  Our children and grandchildren! Guess who will get lower benefits and higher costs now and when they retire?  Our children and grandchildren!  This is a greed is good deal. 

In plainer terms “Romney/Ryan is a Faustian bargain with the payoff being the wealth, health and well-being of our children and grandchildren.    The Romney promises are empty as he has a track record of flip-flopping on health care and many other issues, depending solely on his political ambition. 

Romney has no apparent heart felt core issues, except to protect the interests of the wealthy.   Accepting his assurances  on health care provides no certainty that he actually will maintain the policy.  Adding to the uncertainty are the beliefs of his radical conservative tea party backers who want to completely gut Medicare, Medicaid as well as Social Security. 

Supporting Romney/Ryan is Faustian, there will come a time when we/you will be called upon to pay!

Simon Johnson observes regarding the LIBOR scandal:

In the aftermath of the Barclays rate-fixing scandal, the most surprising reaction has been from people in the financial sector who fully understand the awfulness of what has happened. Rather than seeing this as an issue of law and order, some well-informed people have been drawn toward arguments that excuse or justify the behavior of the Barclays employees.

The justifications offered include that this kind of cheating has long been done; that everyone does it; that “no one” get’s hurt; that the regulator’s should have caught them; and that it was only a very few basis points—a very small percent of a huge amount of money.

Medicynical Note:  This sounds vaguely similar to some of the arguments put forth for continuing and “freeing from regulation”  our non-system of health care.  It is posited that “free markets” without government regulation will magically contain costs and result in better outcomes.  Something that has not occurred anywhere in the world. 

It should be noted that we’ve seen how well deregulation worked in the 80’s with Reagan’s S&L disaster; in the 90’s with Enron’s manipulation of energy markets; in this past decade with the Bush/Greenspan collapse of the financial system and now with the LIBOR scandal. 

From these experiences, the long term effect of deregulation on complex markets would appear to be collusion and corruption.  The goal of which is to maximize short term profit (and incomes) of those involved.  Perhaps, that’s why the U.S.’s quasi free market of health care costs 1.5-2 times that of any other place in the world. 

Improved health is not the driving force of this system.   But rather the motivation is more revenue and profits  for suppliers, whether they are insurers, providers, pharmaceutical companies or developers of technology.  As with the LIBOR scandal, integrity and honesty (and improved quality, affordability, and access) is not their concern.

And as Simon Johnson noted:

Power corrupts, and financial market power has completely corrupted financial markets. Barclays and the other global mega-banks involved in fixing Libor have brought their own industry very low – completely destroying the legitimacy on which sensible financial intermediation needs to be based.

Interesting article in JAMA (Journal of the American Medical Association) reviewing the effects of incentives (mostly financial) in medical decision making.  They affect both patient and physician decision making and may be useful in getting additional value out of our non-system of health care.

There is ample evidence that physicians, who typically fulfill the criteria for being economically rational, are exquisitely sensitive to the incentives they face. Physicians tend to recommend tests and treatments that will provide them with financial benefit. For example, oncologists who are reimbursed based on the chemotherapy drugs they provide administer more of these drugs and concurrently, the more expensive drugs.¹ On average, compared to physicians paid on a capitated basis, physicians paid for specific procedures tend to recommend more of those procedures. 

And

Patients tend to face idiosyncratic health issues, get relatively little useful feedback about the quality of medical decisions, and often make decisions when sick and, as a result, in a heightened emotional state. Perhaps not surprisingly, therefore, the behavior of patients can be less than perfectly rational.

Medicynical Note:  There is an opportunity here but I’m doubtful that there is enough support for the  social engineering necessary to improve.  For example, doctors are all for change until it affects their bottom line.  Patients want limitless access to everything regardless of efficacy or cost.  Both approaches lead to excessive costly medical interventions without quality improvement.

I guess we’ll see!?