Category: Health/Fitness
Uwe Reinhardt on the health of the economy and the economics of health
My friend professor Uwe E. Reinhardt of Princeton University presented ECONOMIC TRENDS IN U.S HEALTH CARE: Implications for Investors, at J.P. Morgan’s annual healthcare conference on Tuesday, January 13 2009. The first half of the presentation (46 slides!) deals with macroeconomic and financial issues in Uwe’s inimitable style – equal portions of wit and insight. The second half deals with the embarrassing mess known as health care in the US.
Doctor Side Pay from Drug Companies
Barry Fox is in big demand. The UW infectious disease specialist had lucrative side jobs working for seven different drug companies in just one year, including one that paid an undisclosed sum of $20,000 or more, records show.
Fox is one of dozens of University of Wisconsin-Madison physicians who also work for drug companies. Some sit on advisory boards; others do promotional or educational work. Fox, for example, did promotional work involving an antibiotic for one company in 2007, working five days for what appears to be at least $2,000 a day, his disclosure form says.
Doctors’ moonlighting for drug companies – though legal – is coming under increased scrutiny, both at UW and across the country. This month, the trade group Pharmaceutical Research and Manufacturers of America enacted a voluntary ban on company gifts of branded pens, sticky notes and other items and dinners for doctors. Also of special concern are university physicians who are sought by drug companies because of the influence and respect they wield with colleagues practicing in communities.
Most patients have no knowledge of the side work. Even the university is not aware of exactly how much its doctors earn from drug and medical device companies; they are required to disclose only ranges of income received, and no range beyond $20,000.
More than 30 UW physicians exceeded the $20,000 threshold in 2006 and 2007, records show. At least one of those doctors made at least 20 times that amount in previous years – more than $400,000, paid by a maker of orthopedic implants. But that became known in 2006 only because of records filed in a lawsuit.
Last week, for the first time, signs went up in a handful of UW Health clinics alerting patients about doctors’ drug company ties. In addition, the dean of the medical school said the university’s policies need to be shored up. Among other things, the medical school might begin requiring doctors to specify how much they are paid, said Robert Golden, head of the UW School of Medicine and Public Health.
Further, U.S. Sens. Herb Kohl (D-Wis.) and Chuck Grassley (R-Iowa) have introduced a bill that would require drug and medical device companies to disclose payments made to physicians. Kohl said it would be best to ban the practice, noting that the medical industry spends $20 billion a year in payments and gifts to doctors.
“The relationship between the doctor and patient is frayed,” Kohl said.
The Marshfield Clinic’s Electronic Medical Records System in the News
Joseph Calderaro, 67, is one of health care’s quiet success stories. Over the last four years, he has carefully managed his diabetes by lowering his blood sugar, blood pressure and cholesterol with diet, exercise and medication.
To keep on track, Mr. Calderaro visits his doctor, attends meetings for diabetes patients and gets frequent calls from a health counselor. It is a team effort, orchestrated by the Marshfield Clinic here. And it is animated by technology, starting with Mr. Calderaro’s computerized patient record — a continuously updated document that includes his health history, medications, lab tests, treatment guidelines and doctors’ and nurses’ notes.
To visit the Marshfield Clinic, a longtime innovator in health information technology, is to glimpse medicine’s digital future. Across the national spectrum of health care politics there is broad agreement that moving patient records into the computer age, the way Marshfield and some other health systems have already done, is essential to improving care and curbing costs.
There has been some loose talk about the Obama administration providing “incentives” for health care automation. These investments should be made on their merits, rather than funded by yet another taxpayer give-away.
Marshfield apparently built their own system, a competitor to Verona based Epic Systems.
Might this article be part of their initial marketing efforts to other health care organizations?
The Checklist
he damage that the human body can survive these days is as awesome as it is horrible: crushing, burning, bombing, a burst blood vessel in the brain, a ruptured colon, a massive heart attack, rampaging infection. These conditions had once been uniformly fatal. Now survival is commonplace, and a large part of the credit goes to the irreplaceable component of medicine known as intensive care.
It’s an opaque term. Specialists in the field prefer to call what they do “critical care,” but that doesn’t exactly clarify matters. The non-medical term “life support” gets us closer. Intensive-care units take artificial control of failing bodies.Typically, this involves a panoply of technology—a mechanical ventilator and perhaps a tracheostomy tube if the lungs have failed, an aortic balloon pump if the heart has given out, a dialysis machine if the kidneys don’t work. When you are unconscious and can’t eat, silicone tubing can be surgically inserted into the stomach or intestines for formula feeding. If the intestines are too damaged, solutions of amino acids, fatty acids, and glucose can be infused directly into the bloodstream.
The difficulties of life support are considerable. Reviving a drowning victim, for example, is rarely as easy as it looks on television, where a few chest compressions and some mouth-to-mouth resuscitation always seem to bring someone with waterlogged lungs and a stilled heart coughing and sputtering back to life. Consider a case report in The Annals of Thoracic Surgery of a three-year-old girl who fell into an icy fishpond in a small Austrian town in the Alps. She was lost beneath the surface for thirty minutes before her parents found her on the pond bottom and pulled her up. Following instructions from an emergency physician on the phone, they began cardiopulmonary resuscitation. A rescue team arrived eight minutes later. The girl had a body temperature of sixty-six degrees, and no pulse. Her pupils were dilated and did not react to light, indicating that her brain was no longer working.
Personality Variation by USA Region
US personalities vary by region, say researchers. It’s pretty thin on the details, but luckily the original paper can be found online in full, A Theory of the Emergence, Persistence, and Expression of Geographic Variation in Psychological Characteristics. I haven’t read the whole thing, nor do I know much about personality, so I have put the maps which illustrate regional variation in traits below the fold. But I do want to note the correlations between Openness and the following metrics on the state level:
The Coming Boom in Medical Travel
HEALTH care has long seemed one of the most local of all industries. Yet beneath the bandages, globalisation is thriving. The outsourcing of record keeping and the reading of X-rays is already a multi-billion-dollar business. The recruitment of doctors and nurses from the developing world by rich countries is also common, if controversial. The next growth area for the industry is the flow of patients in the other direction–known as “medical tourism”–which is on the threshold of a dramatic boom.
Tens of millions of middle-class Americans are uninsured or underinsured and soaring health costs are pushing them and cost-conscious employers and insurers to look abroad for savings (see article). At the same time the best hospitals in Asia and Latin America now rival or surpass many hospitals in the rich world for safety and quality. On one estimate, Americans can save 85% by shopping around and the number who will travel for care is due to rocket from under 1m last year to 10m by 2012–by which time it will deprive American hospitals of some $160 billion of annual business.
The Rise of Medical Tourism
What used to be rare is now commonplace: traveling abroad to receive medical treatment, and to a developing country at that.
So-called medical tourism is on the rise for everything from cardiac care to plastic surgery to hip and knee replacements. As a recent Harvard Business School case study describes, the globalization of health care also provides a fascinating angle on globalization generally and is of great interest to corporate strategists.
“Apollo Hospitals—First-World Health Care at Emerging-Market Prices” explores how Dr. Prathap C. Reddy, a cardiologist, opened India’s first for-profit hospital in the southern city of Chennai in 1983. Today the Apollo Hospitals Group manages more than 30 hospitals and treats patients from many different countries, according to the case. Tarun Khanna, a Harvard Business School professor specializing in global strategy, coauthored the case with professor Felix Oberholzer-Gee and Carin-Isabel Knoop, executive director of the HBS Global Research Group.
The medical services industry hasn’t been global historically but is becoming so now, says Khanna. There are several reasons that globalization can manifest itself in this industry:
Everyone’s Poop
“Down the drain, off the brain” is how most people think about it, but human waste—or effluent, as the professionals call it—has a lot to tell us about how we live, what we eat, and who we are.
They say that shit runs downhill. This is commonly understood to mean that the world is an unfair place, except among those few people who actually work with the substance, for whom it is considered something of an article of faith. This is because municipal sewerage systems are powered almost entirely by gravity, which means that when working properly, they move millions of gallons of sewage a day across considerable distances with only a minimum expenditure of energy, a feat of efficiency virtually unparalleled in the annals of engineering. When sewage stops running downhill, as it inevitably does from time to time, very bad things indeed can happen, as they did on Pecan Springs Road, in the Austin neighborhood known as Windsor Park, one morning last September.
I was spending the day with an Austin Water Utility emergency-response crew when dispatch got a call from a woman reporting that two rooms of her house were flooded with sewage. Our crew consisted of a TV truck, piloted by a twenty-year line-maintenance veteran named David Eller, and a flusher truck, driven by another longtime utility employee, named Dale Crocker. At the house, Eller, who wears wraparound sunglasses and looks a little like the country singer Dwight Yoakam, unspooled a thick red cable from the back of his truck. On the end of the cable was a camera about the size of a roll of quarters, which Crocker shoved down into a PVC clean-out pipe near the curb in the front yard. The woman leaned on a walker in her driveway, looking worried.
Excellent Article.
A profession is born to help people navigate the health care maze
Margalit Mathan and Peter August found themselves caught in a maze of medical appointments and conflicting professional opinions when their 7-year-old daughter developed serious eye problems related to her juvenile rheumatoid arthritis.
The Berkeley family decided to consult yet another professional. They turned to a health care advocate, an adviser who specializes in helping patients and their families cut through the health care bureaucracy to find the help they need.
“It’s been this huge roller coaster with the medical system and negotiating her different needs and the different information we’re getting from different doctors,” said Mathan, a high school psychologist. Her daughter, Siona, was diagnosed two years ago with arthritis, a condition that can cause eye inflammation and, in Siona’s case, led to glaucoma.
Private health care advocacy is a new and growing field emerging at a time when an increasing number of Americans find themselves dealing with a chronic disease, aging family members or the bureaucracy of health insurance.
A professional advocate might have some background in health care, such as nursing or medical social work. But the business of health advocacy is unregulated, and people who call themselves a health advocate might have no training other than helping a family member through a difficult illness.