Published CommPro.biz 2014.02.10

Legally But Not Medically Necessary

Depending on whose numbers you look at, somewhere between 5% and 40% of the cost of healthcare in America is spent on “Defensive Medicine.”  In 1994 the Congressional Office of Technology Assessment defined it: “Defensive medicine occurs when doctors order tests, procedures, or visits, or avoid high-risk patients or procedures, primarily (but not necessarily or solely) to reduce their exposure to malpractice liability.”

The body formally known as the Trial Lawyers Association, the barracuda bar that strikes fear into the hearts of all in the medical world, says that defensive medicine does not exist. They see it as a big scam that the medical types use as an excuse to ratchet up their income. And while we don’t buy that, there is a certain amount of truth in what they say. Testing facilities owned by doctors, hospitals and others in the game certainly benefit. As do those who consult to affirm the decisions made by their colleagues.

The leading solution is Tort Reform, restrictions on the legal profession. And/or limitations on the amount those harmed by the medical system can collect. Some of those reforms have been set up by state governments, however, and they don’t seem to help. That either means the lawyers are right, that unnecessary medical stuff reflects greed among medical providers, or that the practice is so ingrained that fear makes it near impossible for them to stop.

A totally different approach is now under consideration in Florida and Georgia, a concept that eliminates the possibility that any medical player could be sued. The Patients’ Compensation system would take medical errors out of our legal system entirely. Panels of experts would be tasked with evaluating claims and awarding the injured party funds to cover their losses. It would be quick and fair.

We spend more per-capita than other countries on healthcare but our outcomes rank below third world nations. We fail to make it into the top twenty-five in most cases. On the other hand our VA Health Care system provides excellent care at 40% less per patient than the national average. That’s an impressive number made even more impressive when you look at their patients. Mostly a bunch of beat up old folks, with some really beat up younger folks from our recent wars. Compare that to the national patient base; it includes all those folks under forty who are in relatively good health.

Oh yes, the VA enjoys a few other advantages. Their people don’t have to worry about lawsuits. And they don’t have to spend a lot of time filling out paperwork for insurers. They were among the first to go digital; any Vet can go into any VA facility in the world and they can pull up their records in seconds. All this allows them to focus on prevention. And the VA can negotiate to hold down drug costs, unlike Medicare that is prohibited by Big Pharma who has our Congress bought and paid for.

"Am I wrong?"--"Am I Nuts?"-

-"What do you think?"--"Do you agree?"

Published CommPro.biz 2014.02.04

The Bad Apples

Every year Harris Interactive surveys Americans on our level of trust in a group of nineteen industries. Over the last ten years a dismal outlook has gotten worse. Harris asks, "Which of these industries do you think are generally honest and trustworthy – so that you normally believe a statement by a company in that industry?" Not a single industry met that standard in the minds of even half of Americans, not one in the last decade. Most businesses are trustworthy, it’s the few bad apples that drag everyone down

Supermarkets did best at 30%. That means 70% of us do not trust supermarkets. The list gets worse quickly. All but one of the remaining 18 industries scores in the teens or a single digit. Oil and tobacco companies are at the bottom of the list. Oil comes in at 4%, putting their distrust level at 96%, tobacco scores 3% putting their distrust level at 97%. Fitting for a couple of industries that have fed the grim reaper millions of people around the world? Tobacco is at the bottom. We can’t imagine how anyone could have a positive outlook when it comes to tobacco. It’s more like a criminal enterprise that has killed more people than all the dictators of the 20^th century combined. Imagine, more than the big three –Mao Zedong, Jozef Stalin and Adolf Hitler– plus all the minor tyrants of the last century. 

Hospitals came in second at 28%, dropping from 36% in 2012, a result of the wide range of healthCARE entities that have become healthGreed entities. Banks come in at number four with a trust level of 18%. That means eight out of ten Americans have no trust in anything our bankers say. In 2004 the banks had a 40% trust level. That collapsed with the recession and recognition by the public that the monster banks are out of control. We would guess the 18% who trust banks are referring to their local community bank. In the same poll the number of Americans who say banks should face stronger regulation jumped 50% in the last decade. No surprise given what’s happened since the banksters lobbied away the regulations that protected us for almost a century. 

Industries sharing a low trust level and support for more regulation are topped by two that are literally killing us, tobacco and oil. The health care industries follow close behind. Driving costs out of control are Big Pharma, insurers and hospitals focused on money in this industry group that is immune to competition. Any fix is being blocked by those we elect to protect our interests. Our legislative bodies, in the states and at the national level are controlled by the lobbyists who pour money into their pockets. That leaves all of us out in the cold, spending more by far than on healthcare any nation on earth and getting third world outcomes.  

"Am I wrong?"--"Am I Nuts?"--

"What do you think?"--"Do you agree?"

Published in CommPRO.biz 2013.09.17

Good News “IS” News, Occasionally

We find ourselves largely focused on a minority. The majority, most of us, are trying to do the right thing everyday. By nature we are an honest hard-working people. And most businesses understand that an ethical model is a roadmap to long-term strong profitability. Take care of your customers, employees, vendors, community, and the environment; and the bottom line takes care of itself.

In our weekly pursuit of ethical issues, we find ourselves largely commenting on players who choose to ignore the ethical model. Those not interested in long-term growth. Then there are those who operate in a non-competitive market. A market that is structurally immune to competition such as healthcare. When was the last time someone struck a deal with a surgeon whilst headed for the operating room?

More disturbing are those made immune to failure through their lobbying efforts. Take the monster banks. They have created a world where they are not only too-big-to-fail; they are permitted to take part in unimaginably outrageous practices. They make huge bets –outright gambling– on anything they can label “investing;” even with depositors’ funds insured by the United States taxpayers. Worse, our Department of Justice is afraid to go after these scumbags; a monumental failure.

So between big pharma, predatory healthcare entities, and smarmy bankers, we have lots of unethical issues. We aren’t forgetting that the scumbags make up a tiny minority. Most folks in healthcare are there for the right reasons, executing herculean efforts everyday. Most bankers focus on depositors and businesses in their community. They guard depositors’ savings; make loans to keep businesses growing, homes building, and dreams evolving.

However, good news rarely makes “The” news. That’s what we like when we find a major story about a newsworthy ethical happening. IBM, a pioneer in personal computers, sold that business in 2005 to Lenovo, a Chinese company most of us never heard of. Since then Lenovo has grown their share of the home computer market, recently surpassing Hewlett-Packard. Ninety days ago Lenovo opened an assembly plant in North Carolina. 

All of that is nice, but the icing on the cake came earlier this month (2013.09.02) when Lenovo CEO, Yang Yuanqing, announced that he was splitting $3.25 million –most of his annual bonus– with his workers. For the workers in North Carolina the $300 bucks they received was a nice surprise. For the vast majority in China the $300 is roughly a month’s pay.

Hats off to Yang. He gave away $3 million of his bonus last year. It wasn’t news here until Lenovo built their plant and Yang announced that he would split his time between two headquarters in Beijing and Morrisville, NC. Those who see this as a marketing ploy may have a point, but the impact on Lenovo workers in twenty countries is still there. Unlike other big players, Lenovo produces their computers, phones, laptops and tablets in their own factories. And we’ll bet they don’t have nets stretched around them to prevent the workers from jumping to their death.

Published in CommPRO.biz 2013.07.24

The Teeter-Totter

The Cystic Fibrosis Foundation finds itself running back and forth on a seesaw of its own making. It runs to the one end to care for those stricken by a horror story disease. But then it does a swivel and heads for the other end to collect its share of $307,000.00 some of those dealing with the coughing, wheezing and gasping desperately for breath pay every year to ease their suffering. The Foundation put up $75 million dollars to develop Kalydeco, the $307,000.00 a year drug sold by Vertex Pharmaceuticals. A drug based on NIH (National Institutes of Health) research funded by our taxes.

Vertex is quick to insist they have invested over five billion in R&D since going into business in 1989, with a “significant” amount on cystic fibrosis. It would be hard for them to be any less transparent than that. Given the formula the Pharma companies use to calculate their R&D costs, this doubletalk leads us to believe Vertex invested little or none of their own money directly into Kalydeco. Vertex priced it, “based on how well it worked in patients and the cost of developing it.” What? In other words, whatever the market will bear.

The Cystic Fibrosis Foundation’s share of the booty is secret. Best guess? Under 10% of the $307,000.00 Vertex collects each year from each and every suffering patient that needs this drug. And what are they doing with their share? Is it given to help folks pay for the drug? No, the Foundation is too busy looking for ways to invest in other new drugs. Did it ever occur to them to demand the right to look at Vertex’s books? To limit the cost to patients? Those seem like minimal demands for a $75 million dollar investment.

Oh no, no, that’s a “deal breaker.” What deal? They got no deal. Just hand Vertex most of the bucks they need to bring the drug to market for a paltry share of the revenue? Here’s a deal. Take their $75 million, add it to the NIH break-through and watch dozens of drug companies hungry for a winner jump for it. Anyone could craft a better deal than Vertex gave the Cystic Fibrosis Foundation.

Speaking of deals, America deserves a better deal on drugs. Canada has 10% of our population –less than the State of California– yet they pay a fraction of what we pay for drugs. Why? They negotiate lower prices; an option Congress denies us. Big Pharma pours a few million in the pockets of our representatives in the Congress for a deal allowing then to reap billions. Ethically, morally, there is no excuse for this insanity. No excuse for the Pharma sector to drive up the cost of health insurance, our taxes and out-of-pocket costs for drugs. There’s no excuse for the Congress to license the drug companies to rip off every American.  

Published 2013.01.15 in CommPRO.biz

‘Big Pharma’s’ C-Suite 

All Money, No Ethics?

Groundbreaking investigative reporting by the Milwaukee Journal Sentinel and MedPage Today has exposed disgusting conflicts of interest in the guidelines doctors follow in treating almost every malady known to mankind. The various branches of medicine convene “panels” of their member doctors to examine the scientific evidence and create clinical practice guidelines for their members.

The Institute of Medicine (IOM), part of the National Academy of Sciences, an independent, nonprofit organization –not an arm of the government– has some pretty straightforward rules on how these panels are to be set up. They are very clear especially when it comes to a panel member’s connections to those peddling medications or other treatment tools. Less than half of the panel is to have a financial relationship with a company connected to the condition. The panel Chair is never to have such a relationship; pretty low ethical bars.

The Journal Sentinel/MedPage Today looked at a cross section of 16 panels that were willing to disclose conflicts. Of those only two met the IOM standard and at least ten panels (62.5%) were chaired by doctors with Big Pharma financial ties. The journalists looked at twenty clinical practice guidelines for conditions that may be treated in the US by blockbuster drugs like Lipitor, Cymbalta, OxyContin, and Nexium. Nine of the guidelines were written by panels with more than 80% of the doctors on Big Pharma payrolls. What do you think they recommend?

Overall, of the panels that even check for conflict of interest, 66% of the docs had connections to Big Pharma. “Some guidelines recommend drugs not scientifically proven to safely treat conditions, leading to inappropriate or over-prescribing, specifically guidelines for anemia, chronic pain, and asthma,” the journalists report. Research funded by drug companies was not counted as a conflict in the Journal Sentinel/MedPage Today investigative report, just fees for speaking, consulting and advising.

Big Pharma and other interested parties, including some docs, contend that all the top people have financial deals. They say it would be impossible to put together expert panels if you disqualify those with conflicts. We wonder how that came to be? Is it possible that those peddling drugs and medical gadgetry from artificial body parts to hi-tech imagery would seek out and sign-up as many of the very top doctors as they can when their bottom line might benefit? Of course they would and they have! How about the docs; how could any doctor consider serving on a panel related to companies they have accepted cash or other goodies from?

The companies have been slapped with massive fines to no avail. “What we’re learning is that money doesn’t deter corporate malfeasance,” says Eliot Spitzer, former New York State Attorney General. “The only thing that will work in my view is CEOs being forced to resign and individual culpability being enforced.” We agree. When there are billions in profits to be gained, fines are just another cost of doing business for these companies.