2centsworth.info

Like a lot of other baby-boomers I have been helping my parents figure out the complexities of the Medicare Plan D drug program. So far it seems to be accomplishing its primary purpose… Channeling billions in tax dollars and subscriber premiums to the major pharmaceutical companies.

It would have been nice, however, if they had made at least some effort to serve the interests of the retired folks that are the supposed beneficiaries of this program.

• My Mother doesn’t currently need any prescription drugs but they have bullied her into signing up anyway with their policy of escalating the premiums for anyone who does not sign up right away. So now she pays a monthly premium to the program and gets nothing in return.
• Some months after they signed up, my parents received a coupon booklet and envelopes for sending in their monthly Plan D subscription fees. But last week they received a letter from the Social Security Administration saying that the Plan D fees were being deducted from their Social Security benefits. The letter said that they (my parents) had requested this. Since they had most definitely NOT requested this and since this meant that they were paying twice for their Plan D program, my Mother called up the Social Security Administration to ask what was going on… The bureaucrats at the local Social Security office said the letter had nothing to do with them (even though it said Social Security on the letterhead).Apparently any of the insurance companies administering a Medicare Plan D program (in this case AARP) can simply garnish a subscriber’s Social Security payments by simply typing something into a computer. My parents contacted AARP who admitted it was a mistake and promised to discontinue deducting the Plan D premiums from my Father’s Social Security paymets. That was in July, as of September, Social Security is still deducting the premiums and AARP is still cashing my parents premium checks (they continued to send them in the naive assumption that AARP was going to discontinue garnishing the SS payments). When contacted, an AARP supervisor agreed that the SS deductions were in error, and again promised to stop them in future. She indicated that AARP would not directly refund the overpayments. The best she could offer is a credit against future monthly premiums.

I see a very unfortunate trend in the US these days. Thanks to the huge influence of lobbyists on both the Federal and State legislatures, private companies are now able to directly interfere with, and benefit from, taxpayer financed programs and services. With Medicare Plan D we have over 40 private corporations that can directly access every citizen/taxpayer’s Social Security account. The Republicans talk about smaller government and privatization but what really seems to be happening is the wholesale diversion of tax dollars to politically well-connected corporations. The Medicare Plan D program is the domestic equivalent of Halliburton’s military support contracts in Iraq.

Remember the old TV ad’ with guy from the day-time soap saying “I’m not really a Doctor, I just play one on TV.”

Those were more innocent times, I cannot imagine the various actors playing doctors in today’s drug adverts bothering to warn us. In response, of course, we have grown more cynical about advertising in general and prescription drug advertising in particular.

But what if the guy really is a Doctor… Can you believe him then? I guess not… Or, at the very least, you better find out who is slipping money into his pocket.

The New York Times had a piece today entitled Generic Smear Campaign (May 9th 2006 by DANIEL CARLAT) which describes how doctors are no longer simply being paid to tout the benefits of various drugs… They are actually being paid to discredit or smear competitors’ drugs. Specifically, they are being paid to trash lower-cost, safer, generic drugs.

The article describes how three pharmaceutical companies (Sepracor, Sanofi-Aventis, and Takeda) have been paying university-affiliated psychiatrists to publish articles trashing a generic drug called trazodone. According to the New York Times piece, trazadone has been around for 25 years, has a good safety record, and costs as little as 10 cents a pill. In contrast the products from Sepracor, Sanofi-Aventis, and Takeda cost as much as $3 a pill. But every time a doctor prescribes the 10 cent trazadone pill it is a lost $3 sale for one of these pharmaceutical giants. Hence the disinformation campaign. And they are apparently having no problems finding psychiatrists willing to pocket their ethics along with some cash.

This all comes at the same time as Wyeth, another large pharmaceutical company, is pressuring the FDA to clamp down on the prescribing of bio-identical hormone replacement therapies (HRT) claiming they pose significant health risks to the women taking them. Of course, Wyeth’s touching concern with women’s heath has absolutely nothing to do with the fact that the women are turning to the bio-identical HRT after a major 2002 health study found that Wyeth’s synthetic HRT increased a woman’s risk of heart attack, breast cancer, and stroke.

As a WashingtonPost.com article (Firm Seeks Crackdown on Custom Made Drugs by By ANDREW BRIDGES, The Associated Press April 21, 2006) put it:

Those findings hit Wyeth hard. Sales of the company’s Prempro and Premphase, which combine estrogen and progestin, and its Premarin, an estrogen-only pill, fell to $880 million in 2004 from $2.07 billion in 2001, the year before the Women’s Health Initiative released its hormone-replacement results. Compounding pharmacists and their backers allege that Wyeth seeks to stifle competition by calling in the FDA.

And, of course, with GW’s guys running the FDA, they may well succeed.

Another interesting New York Times article, entitled Doctors Object to Gathering of Drug Data by Stephanie Saul in the Thursday May 4th 2006 edition.

It is an interesting example of what I call the “soft corruption” that is evident all across US society, business, and government.

A group of data-mining companies (the article mentions IMS Health, Verispan, Dendrite International, and Wolters Kluwer) pay various retail drugstore chains (e.g. Walgreens and CVS) to provide them with electronic data on each prescription they handle. This data would include the prescribing doctor’s name and the details of the drug prescribed.

The data-mining companies then match up this data with dossiers on each doctor provided to them by the American Medical Association. The data provided in what the AMA calls the Masterfile includes the doctor’s specialty, board certification, and disciplinary records. The AMA did not disclose to the NYT reporters how much they get paid for this information but did state that the AMA’s total revenue from the sale of information was $40 million per year.

The AMA is opposing any attempts to restrict access to this data in spite of the fact that, according the NYT article:

A Gallup Poll commissioned by the A.M.A. in 2004 found that two-thirds of doctors surveyed were opposed to the release of such data to pharmaceutical representatives, and that 77 percent felt that an opt-out program would alleviate concerns about the release of data. Nearly a quarter of the doctors were not even aware that the pharmaceutical industry had access to such information.

The data-mining companies (IMS Health, Verispan, Dendrite International, and Wolters Kluwer) match up the prescription records with doctors’ dossier’s provided by the AMA and then sell that information to the pharmaceutical companies for use by the industry’s 90,000 salesmen.

And what do the salesmen do with this information? They can use it to reward doctors who frequently prescribe their drugs with various “perks” including gifts, and meals. It also allows them to target what the industry calls “cowboys”, doctors who are willing to prescribe a drug as soon as it comes on the market.

The “soft corruption” in this case is exhibited by the AMA which is behaving against the wishes of two thirds of its own members because it does not want to lose millions of dollars in revenue. (And, it would appear, selling information about its own members without their knowledge or approval.)

You also have an entire industry (the article states that IMS Health’s annual revenue last year was $1.75 billion, presumably their competitors’ revenues are on a similar scale) based on facilitating the ability of the pharmaceutical industry to corruptly influence doctors to prescribe drugs against their patients’ interests.

And I am not sure we should let the retail drugstore chains off the hook, either. They are selling information about what each doctor prescribes without getting permission from the doctors.

The issue of medical malpractice and the high medical malpractice insurance premiums paid by MD’s is one the many problems facing a US healthcare system that is in a state of crisis.

As with many of the other facets of the healthcare crisis, the solution proposed for the medical malpractice situation (capping settlements) seems flawed and ill-considered.

The real problem is that a civil court is not the best place, nor are a bunch of jurors (or even a judge) , the people best suited to establish whether malpractice has occured. Nor, for that matter, is simply increasing the insurance premiums for a physician actually guilty of malpractice a satisfactory outcome.

Doctors accused of malpractice should be judged by panels of other doctors and, if found guilty of malpractice, should have their license to practice suspended or revoked. Doctors, after all, are the people who know what can be reasonably expected of a physician and are the most competent to understand the circumstances of a case involving medical procedure.

This seems like plain commonsense. So why isn’t this how malpractice cases are judged?

It is because no one at this point trusts the medical profession to police itself. Law enforcement’s “blue wall of silence” is flimsy compared to that of the medical profession. Several generations of physicians have refused to challenge even the most egregious examples of malpractice by their colleagues because they feared (with justification) that they would be ostracised within the medical community. Complaining about another doctor’s incompetence or negligence was, and is, viewed as professional suicide.

Ideally, a doctor charged with malpractice should be judged by a credible medical panel. If he is found guilty he should have his license suspended or revoked. And he (and his insurance company) should pay the actual damages to the patient (i.e. no punitive damages).

Unfortunately, this is unlikely to happen given the culture of the medical community and the cynicism of the public.