Category Archives: Uncategorized

This little gem from the Roanoke Times explains our situation better and more clearly.

Our health care establishment gives higher priority to the quest for profit than the care of patients. Consider this from the Times about one of the leading Roman Catholic hospital systems in our country.

Companies, even non-profits, don’t seem able to resist the urge to maximize revenue. This is a recipe for disaster in health care where patients, not profits should come first. Consider also that Big Pharma charges confiscatory prices for their medications, some amazingly mediocre, and has one of the largest profit margins in American industry. They can’t help themselves, they have a government sanctioned monopoly and it is your money or your life.

What a sad excuse for a health care establishment–it’s not a system.

No other place on earth would consider this.

“The White House says the changes are needed to ensure the “fiscal integrity” of Medicaid and to curb “excessive payments” to health care providers.

These are the same guys whose fiscal policies have led to unprecedented tax cuts for the wealthy; a federal deficit of hundreds of billions of dollars; a war that our children and grandchildren will pay for without a reasonable entrance or exit strategy.

The best they can do is cut support for a health care program for the poorest and neediest. Quite a commentary on our culture, or lack thereof.

The August 10, 2006 New England Journal of Medicine’s lead article, High Dose Atorvastatin after Stroke or Transient Ischemic Attack reports the results of the Stroke Reduction by Aggressive reduction in Cholesterol Levels (SPARCL) trial. The study is sponsored by the drug manufacturer (Pfizer) and all of the authors are Pfizer employees, consultants and grant recipients.

The study found “The atorvastatin group had 218 ischemic strokes and 55 hemorrhagic strokes, whereas the placebo group had 274 ischemic strokes and 33 hemorrhagic strokes. The five-year absolute reduction in the risk of major cardiovascular events was 3.5 percent (hazard ratio, 0.80; 95 percent confidence interval, 0.69 to 0.92; P=0.002). The overall mortality rate was similar, with 216 deaths in the atorvastatin group and 211 deaths in the placebo group (P=0.98), as were the rates of serious adverse events.

Elevated liver enzyme values were more common in patients taking atorvastatin.”

It was also reported ” A total of 136 patients in the placebo group and 154 patients in the atorvastatin group died from causes other than stroke before they could have a nonfatal stroke.” And “On the basis of our data, 46 patients (95 percent confidence interval, 24 to 243) would need to be treated for five years to prevent one stroke, 29 patients (95 percent confidence interval, 18 to 75) to prevent one major cardiovascular event, and 32 patients (95 percent confidence interval, 22 to 59) to avoid one revascularization procedure.”

What is not reported is an estimate of the cost of preventing one stroke using high dose atorvastatin (Lipitor). Medicynic’s estimate is as follows: Additional expenses for the use of the drug in post stroke patients include the drug ($1200/year), additional laboratory costs (liver function tests 2 times a year $150), 1 additional physician visit because of the medication ($75) giving a total of $1425/year/patient for this intervention.

Figuring, as the article suggests, that 46 patients need to be treated for five years to prevent one stroke the cost to prevent one stroke ($1425X46X5) is $327,750 to prevent one stroke. Given the limited benefit of this treatment, no improvement in survival but a small decrease in new strokes, can our system afford such an intervention?

Medicynic realizes this cost estimate is not scientific (i.e. not the actual costs experienced) but rather a seat of the pants estimate based on current costs of care. The estimate is, however, indicative of the price of this intervention. Should the NEJM require all such studies include an accurate cost estimate and include this information in the debate about the intervention’s utility?

According to this article in the Times we must control payments to physicians “because spending on doctor’s services was increasing faster than expected, and faster than the annual goals set by a statutory formula.” The change will result in a saving of 13 Billion dollars over 5 years

Contrast this serious concern about controlling physician costs with the docile acceptance of 10-20% increases in yearly drug expenditures and the utter irresponsibility of a pharmaceutical program (Medicare D) originally estimated to cost 450 billion yearly but actually costing over 550 billion. But of course the poor pharmaceutical companies must not be subject to competition or negotiation because we wouldn’t want to stifle their profits, whoops I mean creativity.

It’s fascinating that we can rationally talk about this. Overseas there is greater variation in quality but with due dilligence, skilled and competent physicians and facilities can be identified. However, people with the greatest problems particularly those needing continuing care have the fewest options…and highest expenses. Outsourcing is not a cure for the sickness in our health care system.

If you do all that they recommend you may not live any longer, but it will seem that way.

The editor of a prominent medical journal duped!

Conflicts of interest are unfortunately the rule not the exception in medical research. Consider the following discussion of medical progress from Medscape.

“Dr. Beer: A couple of presentations pertained to this issue, adding to the growing body of evidence from TAX 327 suggesting that modern chemotherapy can be effective for some patients. One analysis, for example, indicated that pain response is an independent predictor of survival, which is not surprising, but is interesting nonetheless.^“

“Another analysis from TAX 327 evaluated the effect of treatment on quality of life in patients with minimal symptoms. Those researchers found that quality of life improved to a greater extent following treatment with docetaxel plus prednisone compared with mitoxantrone plus prednisone for all patients, as well as for patients with minimal symptoms. We previously learned that survival was better and that prostate-specific antigen (PSA) response rates were greater with docetaxel, but in some patient subsets, toxicity was higher with docetaxel-based chemotherapy. And so it is reassuring to see that docetaxel-based chemotherapy was associated with a higher quality of life than mitoxantrone/prednisone and that the toxicity burden was not so excessive that the benefits were outweighed by side effects.

On the other hand — looking at the numbers critically — more patients experienced a deterioration in quality of life than an improvement, and I think that is a reminder that a lot more work needs to be done.” (italics medicynic’s)

Contrast the time and detail given to extolling the virtues of the treatment (docetaxel) versus the bare minimum of detail disclosing that most patients don’t respond and experience deterioration while on treatment. The fact that the survival benefit is barely two months is not all disclosed. It’s not surprising that the discussant is a paid consultant for the drug company manufacturing docetaxel.

At the bottom of the article in a location that is easy to overlook it states: “Disclosure: Tomasz M. Beer, MD, FACP, has disclosed that he owns stock, stock options, or bonds and is an inventor with rights to intellectual property created for Novacea. Dr. Beer has disclosed that he has received grants for clinical research from sanofi-aventis and Novartis. Dr. Beer has also disclosed that he has received grants for educational activities from sanofi-aventis.”

Can a paid consultant offer unbiased, unspinned information? Is disclosure enough? Medicynic doubts it.