Thanks, Brie...

Sex and Drugs: The Era of Fashionable Pharmaceuticals

Brands are an image. You see them everywhere: designer jeans, luxury cars - even coffee is trendy. Indeed, we live in a material world. And often times, we make purchases not based on judgment, logic or experience, but rather, on brand alone.

Marketing has revolutionized the way our society functions. Huge corporations have been founded on the lone principle that we are an impressionable people (thank you for hosting this blog, Google). Today we absorb more information than ever before, consciously or not, and capitalism is rightly taking advantage of it. And it certainly is not uncommon for this information to appeal to our desires and emotions, for this is the tried and true method of establishing brand loyalty. This is how fashion is created.

But since when have prescription drugs become commodities of haut monde?

In the past decade, pharmaceutical companies have nearly tripled their spending on promoting their products. What is troubling, however, is that the majority of this marketing explosion can be attributed to the growth of direct-to-consumer (DTC) advertising. These DTC advertisements are marketing campaigns directed at the general public, and are the reason so many prescription drug brands have become household names. And these advertisements have gradually taken on the form of traditional, consumer product marketing. They appeal to us through feelings of hope, happiness and fear. They even tempt our sexual desires.

DTC advertising has effectively positioned brands like Zoloft, Lunesta and YAZ among the ranks of Budweiser, Calvin Klein and Lexus.

Questions must be asked. Does this type of marketing affect physicians' prescribing habits? Do "consumers" have the ability to look beyond emotional innuendo, and can they adequately comprehend all risk associated with using a certain drug? Should the public even know drugs by name?

After all, aren't physicians specifically trained to be solely responsible for their patients' health? Patients know what ails them, and doctors treat - that's how health care works. But DTC advertising has effected a reversal of roles. Patients now visit their physicians pre-armed with an advertisement-inspired treatment plan. When patients request prescription drugs by name, they effectively pressure their doctors into making decisions that may not be in their best interest.

And even more disagreeable is that DTC advertising is often misleading. FDA reprimands against pharmaceutical companies for violating DTC regulations have grown as markedly as the advertising campaigns themselves. DTC advertisements frequently exaggerate effectiveness and/or minimize side effects. And yet, the FDA has done little to curtail these deceptions. And as the FDA grows shorter on funding and more susceptible to pressure from the drug industry, we can only expect this situation to escalate.

Meanwhile, physicians and patients alike need to maintain vigilance. Our society needs to understand that DTC advertising is not an educational tool - it is simply a tactic used by the pharmaceutical industry to boost sales. Accordingly, we must learn to simply ignore it. The best way to end DTC advertisements is to end their persuasive power.

Mike Sharley, Esquire

Well, it's late (or early, depending...) and I'm up browsing health care blogs. I came across a YouTube video for the CNN debate and thought it was pretty clever. And now that I'm becoming more accustomed with the "blogosphere," I have "embedded" it below:

Karen Ignagni: President, CEO, Spin Doctor, Heartless Devil

She's in charge of the largest lobbying organization representing the health insurance industry. She's the reason there are 50 million people without insurance in this country. She's why insurance companies can get away with unethical practices. She's got the ear and pocket of just about every legislator in D.C.

And you most likely pay her $1.2 million paycheck.

Firstly, let me exonerate myself of any bias. I do not advocate for government-run, single-payer, or any radically interpretable style of universal health care. Nor am I a proponent of a market-based system. I prefer to take the safe, albeit somewhat cowardly, stance of supporting universal access to and quality of health care by whatever means necessary.

But Karen Ignagni does not share this ideal. Her motivation is money. She has not only sold her soul to the Devil, she is now playing his personal collection agent. And that's what makes her so good at what she does.

Karen Ignagni is the President and CEO of America's Health Insurance Plans (AHIP). This organization represents companies providing health insurance coverage for more than 200 million Americans. AHIP advocates for issues like increasing Medicare Advantage (MA) spending and reducing intra-industry competition by supporting huge corporate mergers. To do this, Ms. Ignagni maintains quite a boisterous presence on the Hill, and an even louder voice.

Ms. Ignagni has the unparalleled skill to twist any issue to her and her organization's members' benefit. Of course this is the tried-and-true method of politics, but she is the Barry Bonds of the political arena. She can sit in a room full of skeptics and critics and transform them into believers within an hour. While not much good can potentially arise from the issues she fights for, Karen Ignagni still manages to gain support.

For instance, in Dayton alone, 89% of the market is shared by WellPoint and United Healthcare. This restricts coverage options available to patients and practice options for doctors (physicians are not legally able to unionize). This oligopoly is representative of nearly every geographic market in the United States. And yet, few legislative and judicial means have been utilized to limit insurance companies' stronghold on the market share.

As for MA, I witnessed Ms. Ignagni explain to a roomful of health reform advocates that MA cuts would be disastrous to senior care. Keeping previous posts on the issue in mind, as well as the American Association for Retired Persons' (AARP) stance that such cuts would benefit seniors, MA plans are merely money-making programs for the insurance industry and do not provide beneficial care options. And yet, Karen Ignagni managed to walk out of the conference as a champion for senior's health.

If you are ever faced with Karen Ignagni's rhetoric, I have some simple advice: Distrust her words, distrust her savvy, and distrust her motives.

Watch Karen Ignagni in action as she responds to Michael Moore's SiCKO:

Medicare Shareholder Advantage

Curious as to exactly how my representative, House Minority Leader John Boehner (R), feels about the SCHIP issue, I took a gander over to his official website. A line of his statement caught my eye:

"14,267 seniors currently benefit from Medicare Advantage and 73 percent of them will lose their benefits if the Medicare cuts in the House bill become law."

Mr. Boehner, I think you need to revisit your logic.

The fact of the matter is that while enrollment in employee-based health insurance programs is at all-time lows for the major health insurance companies, and cost of care is at an all-time high, insurance firms are still seeing record-breaking profits. A few examples:

• Humana's profit more than doubled to 19% last quarter despite an 11% loss of enrollees in employer programs. Why? "About 59 percent of Humana revenue in the second quarter of 2007 came from Medicare programs."
  
• Wellpoint lost 108,000 employment-based beneficiaries last quarter but still managed a 11% rise in revenue. The reason: "Expanded enrollment in government-funded programs and tighter control of costs."
• UnitedHealth Group profits rose 22% while losing 10,000 customers in employer programs. The cause: "The boon UnitedHealth has seen from increasing the profitability of its Medicare programs for the elderly."

It is clear that the 12% overpayment to private insurance companies by the Medicare program is directly subsidizing huge profits. But Mr. Boehner's argument still stands: will cutting the subsidization reduce benefits for seniors?

It is true that private fee-for-service programs offer seemingly admirable benefits such as dental and vision coverage, specialty services, and even gym memberships. But these attractive benefits mask the lack of coverage for more serious issues.

Testimony given by Dr. Patricia Neuman for the Kaiser Family Foundation reveals that these private fee-for-service plans lack certain essential benefits covered by traditional Medicare. The KFF discovered that enrollees in these private FFS plans would in fact pay extensively more for procedures, hospital stays, prescriptions and skilled nursing facility usage than under traditional Medicare.

Additionally, AMA Trustee Dr. Robert Wah's testimony unearths an even more alarming aspect of this issue. Aggressive and unfair marketing techniques utilized by the plans intentionally mislead Medicare patients to enroll in private FFS plans without adequately disclosing the unfavorable terms. 37 of 43 states received complaints that inappropriate marketing techniques were used to enroll beneficiaries without their full understanding of the consequences of their decision. These plans take advantage of the population they cover by specifically targeting and misleading vulnerable seniors - in fact, beneficiaries with cognitive impairments make up 25% of the enrollees in private FFS plans.

So the question remains. Would seniors be disadvantaged from cuts to private FFS plans? If the cuts forced them to return to traditional Medicare, they would probably be better off.

CHAMP: Access to Care vs. Specialty Interests

A recent correspondence with a fellow classmate has prompted me to address the darker, undiscussed aspects of the House's SCHIP bill, Children's Health and Medicare Protection Act of 2007 (CHAMP).

The countering issues contained within H.3162 adequately demonstrate the complexity of the issue, and certainly make it clear why the AMA can't be "the voice" for all physicians simultaneously. From my short time on the Hill, I certainly learned that just about every piece of legislation contains its caveats, and that makes it difficult for physicians to unite behind a single bill.

In contrast to the benefits of this bill outlined in my previous posts, this bill additionally imposes restrictions on physician-owned hospitals. It would prohibit any patient referral by a physician to a hospital of which the physician has partial ownership. This practice seems to be gaining momentum after the repeal of a similar ban in 2006 in an attempt to provide patients with specialty medicine options, avoid scheduling conflicts, and allow continuity of care.

Medicare Payment Advisory Commission (MedPAC) itself admitted that physician-referred Medicare patients receive quality, cost-effective care at such institutions, and such referrals pose little ethical dilemma in terms of conflict-of-interest. The AMA worked hard to get the similar restrictions lifted in 2006, and it would be a shame to see it happen all over again. The problem lies in the public's distrust of physicians' motives - at first glance the issue appears to present an opportunity for personal financial gain for hospital-owning physicians. However, the practice of medicine is bound by ethical and moral guidelines which I would like to believe (perhaps naively) all physicians adhere to. Perhaps Congress' distrust of an ethical obligation lies within an internal reflection of their own professional practices.

Other provisions of the bill that do not sit well with physicians are the imaging reimbursement cuts and the division and allocation of medical specialties into six separate but interdependent Sustainable Growth Rate (SGR) categories. Dividing the SGR into six distinct entities would limit the growth rate of some specialty fields while providing more funding for others. However, the growth of certain specialties is not physician-dependent - it's regulated by patient demand. Therefore, limiting growth of expanding specialties would have a direct, negative effect on patient access to adequate care.

Even the Medicare Advantage (MA) cuts used to fund the SGR update tend to be disagreeable among some physicians. Although most of the overpayments to private fee-for-service programs are directly absorbed by insurance companies, many physicians, especially in areas like Oregon where MA overpayment rates tend to be the highest, fear that cuts in payments to their payers will be passed on to them.

This issue exercises a balance between drawbacks and merits. While on one hand, subgroups of physicians may be negatively affected by reimbursement cuts and restrictions on referrals, the other depicts a different, larger picture. This bill will significantly increase access of care to millions of children while simultaneously preventing major reimbursement cuts to most doctors. Of course this is not justification for the drawbacks of the bill, nor is it support for them, but it must be given weight when determining the most acceptable outcome.

Also visit http://www.acr.org/HomePageCategories/News/ACRNewsCenter/HousePassesSCHIP.aspx for more information on the imaging cuts and SGR division.

SCHIP Update

Well I came into the office today because I just can't get enough of this place and I needed to write up a report to get paid/credit (but mostly for the free lunch that was offered by my fellow worker-friends). I found out that the House's SCHIP bill passed the House last night with a vote of 225-204 (with 5 R's voting "yay" and 10 D's voting "no") - great news but the numbers are not high enough to counter a Presidential veto.

The bill passed virtually untouched. It includes the $0.45 cigarette tax, the Medicare Advantage cuts, and the SGR fix. Of course the Republicans were all opposed because they tend to think this will lead to a single-payer system, and the Democrats are happy because children won over big tobacco.

Just to bring it home a little, John Boehner, one of Dayton's 3 representatives and House Republican leader stated:

“This is a very partisan bill, done in a very partisan way. It expands government-run health care beyond anything any of us could have imagined in the last 10 years.”

Republican Pete Sessions agreed with Boehner, saying:

“The bill uses children as pawns in a cynical attempt to make millions of Americans completely reliant on government for their health care needs.”

Mr. Sessions, you'll have to forgive me, but isn't it better to make millions of children completely reliant on government for their health care than have none at all?

So, it's a good day for doctors and my fellow doctor wannabes, and an even better one for our kiddy patients. But, of course, we still have to wait and see how this one turns out down the road.

*** One last morsel for your ruminitive mind***

"People have access to health care in America. After all, you just go to an emergency room."

- President Bush's rationale for threatening an SCHIP veto.