Digesting Medical Progress

September 1, 2008 / Michael D. Miller MD / Health System Reform, Information & Communications, Innovation, Miscellaneous, Nutrition, Public Health, Therapeutic Substitution & Interchange / No Comments

One of the challenges for improving the healthcare system is creating a vision for what is achievable in a timeframe of months or years. The first step for creating such a realistic vision is to understand how progress has been made in the past.

A microcosm of such progress was described in a recent article in The Economist. This article describes advances in our understanding of stomach ailments – one of my favorite areas of biomedical progress because in the last several decades dramatic changes have occurred in our basic knowledge about this area, and so many people can relate to stomach problems.…

Changing Life Sciences Communications Environment for 2009

August 25, 2008 / Michael D. Miller MD / Comparative Effectiveness, Economics & Financing, Information & Communications, Innovation, Therapeutic Substitution & Interchange / No Comments

Cost containment is becoming an increasingly powerful force in shaping the environment for life sciences companies – as well as other parts of the healthcare system. In addition, more sophisticated tools for analyzing and demonstrating the clinical and economic value of medical treatments are making it more challenging for life sciences companies to communicate the value of their new products to all types of audiences, including clinicians, payers, patients and regulators.

These new tools and the changing environment are requiring life sciences companies to think about developing more sophisticated messages to reach these audiences. I recently recorded a short 6 minute discussion about these topics with Jeff Sandman, CEO of Hyde Park Communications – where I am also a Senior Counselor. …

Importing and Exporting Health Care

August 18, 2008 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Patents & IP, Politics / 1 Comment

The August 16th Economist had an interesting article (and commentary) about patients traveling to other countries for medical treatments, a.k.a. “medical tourism.” The article focused on the US healthcare system, and mentioned other parts of healthcare that are being exported, (such as transcription of medical records, reading of imaging studies), and imported, (such as physicians and nurses). But there are two aspects of this issue that the article didn’t touch upon – chronic care and pharmaceuticals:

Medical Tourism Doesn’t Work for Chronic Care
Patients are traveling from the US to other countries for expensive procedures like heart surgery and joint replacements. …

Questions and Answers About Pay-For-Performance (P4P)

August 14, 2008 / Michael D. Miller MD / Clinician-Patient Relationships, Comparative Effectiveness, Delivery of Healthcare, Economics & Financing, Health System Reform, Information & Communications, Therapeutic Substitution & Interchange / 1 Comment

An article in the July/August Health Affairs about Massachusetts health plans implementing Pay-for-Performance (P4P) incentives for physicians raised more questions than it answered.

The study found that P4P programs from 5 private sector payers “wasn’t associated with greater improvement in quality” compared to the overall upward trend in the factors measured. But the study didn’t address some overarching questions and basic realities about P4P, such as:

How the payers P4P incentives to the physician groups was actually translated into incentives for the individual physicians – or smaller groups of physicians inside the larger groups?
How the P4P incentives compared to the other financial incentives the physicians are facing?

…

Colon Cancer Insights – Vitamin D and Cannabis – “Good and Good for You”

August 7, 2008 / Michael D. Miller MD / Delivery of Healthcare, Innovation, Nutrition, Public Health / No Comments

A couple of recent reports provide new insights into preventing and treating colon cancer. These studies remind me of the scene in Woody Allen’s movie Sleeper, where he wakes up in the future to find out that all the things he thought were bad for you are really healthy.

The first study was in the Journal of Clinical Oncology which found that people who had higher levels of circulating Vitamin D and later developed colon cancer had a better survival rate than people with lower Vitamin D levels. An accompanying editorial points out that this could be because people who exercise more are outside for longer periods of time – which gives them more sun exposure leading to higher Vitamin D levels – and that more exercise itself might provide a better survival rate. …

Literacy, Communications and Star Trek – Cores for Reforming Healthcare

July 30, 2008 / Michael D. Miller MD / Clinician-Patient Relationships, Delivery of Healthcare, Health System Reform, Information & Communications, Quality of Care & Safety / 1 Comment

In talking to people about the problems with the US healthcare system, two fundamental truths have become apparent.

First, people really want the type of healthcare that is envisioned in science fiction such as Star Trek, where almost any ailment is treated with a single injection or pill, or a few waves of a healing wand. Unfortunately, medical science hasn’t accomplished that, except in a few instances – antibiotics for a bacterial infection, or perhaps relocating a dislocated finger or shoulder (and those still require weeks to heal and therapy to regain strength and mobility).

And second, the ongoing problem of healthcare literacy and communications may be getting worse as the complexity of medical treatments increases.…

Financial Returns from E-Prescribing – Saving Medicare $2.1 billion

July 23, 2008 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Information & Communications, Innovation, Medicare, Quality of Care & Safety / 5 Comments

The leadership of HHS had a tele-conference on Monday to highlight the new Medicare incentives for physicians to adopt e-prescribing systems. What the Washington Post and Kaiser Family Foundation reported about this press briefing that wasn’t in the HHS press release was that the Acting Administrator of CMS said that the per physician cost of e-prescribing systems is about $3,000 up front, and then $80-400/month for operation and maintenance.

These numbers caught my eye, because with the incentives in the Medicare bill, the break-even point for physicians is as follows:

First, let’s assume that the per month cost is $240 (the mid-point between $80 and $400), or $2,800 per year.…

Vacations – Poker – Diagnostic and Research Skills

July 21, 2008 / Michael D. Miller MD / Clinician-Patient Relationships, Innovation, Miscellaneous / No Comments

What’s the point of vacations? As a consultant that’s something I often ask myself since with the internet, cell phones, etc., it seems almost impossible to really “get away” and not be connected to work.

So what’s the value of vacations? I think I’ve found the answer at the poker table. As Ricky Ricardo used to tell Lucy, “Lemme splain!”

The point of vacations is to recharge by being in a different environment that presents a new context for viewing our normal “reality.” A great practitioner of this principle was Teddy Roosevelt. He would travel to the wildest and most dangerous parts of the world, and hunt the largest of animals.…

Scientific Study of Resveratrol: Challenges for Reporters to Unravel the Spin

July 15, 2008 / Michael D. Miller MD / Information & Communications, Innovation, Politics, Public Health / No Comments

One of my interests in health communications is how the findings from scientific research are presented to various stakeholder audiences. Because of this, I was interested to see how the titles of several reports about one study of an investigational compound highlighted different perspectives.

The compound being investigated in this research was resveratrol, which has been shown to replicate the life-span extending effects of dietary restriction in lower animals. (Resveratrol is also the component of red wine that is believed to provide various health benefits.) The new study looked at the effects of resveratrol in mice. The titles of the journal article of the study’s findings, the NIH’s press release and the company’s press release were:

“Resveratrol Delays Age-Related Deterioration and Mimics Transcriptional Aspects of Dietary Restriction without Extending Life Span” (From Cell Metabolism’s web-site)
“Resveratrol Found to Improve Health, But Not Longevity in Aging Mice on Standard Diet” (From National Institute of Aging’s web-site)
“Long-Term Study of Middle-Aged Mice Shows Resveratrol Improves Health and Mimics Some Benefits of Dietary Restriction” (From Sitris’ web-site)

Looking at these titles it is interesting to note that the scientific journal only includes a general statement about life-span. …

E-Prescribing – Good? E-Dispensing Bad!!

July 10, 2008 / Michael D. Miller MD / Access to Healthcare, Clinician-Patient Relationships, Delivery of Healthcare, FDA, Information & Communications, Miscellaneous, Public Health, Quality of Care & Safety / 1 Comment

With two notable government actions in the last couple of weeks there has been significant movement towards increasing the use of e-prescribing.

DEA Proposed Rule
The Drug Enforcement Agency (DEA), proposed regulations on June 27th that would make it possible for controlled substances to be prescribed electronically. Interestingly, this was released right after a National Journal article on this topic.

The DEA’s proposed rule is very important, because while it is appropriate to place stronger safeguards on medicines that are likely to be abused (which is the criteria for being a DEA scheduled medicine), having controlled medicines prescribed by pen and paper while all other medicines are e-prescribed would be a logistical problem and obviate many of the potential benefits of e-prescribing. …

Pharma Industry’s US R&D Spending Breaks Milestone

July 7, 2008 / Michael D. Miller MD / Innovation, Miscellaneous, Politics / No Comments

According to my calculations, sometime this month research and development spending in the United States by pharmaceutical companies will pass the $100 million per day mark.

The $100 million/day figure assumes R&D spending seven days a week, and it doesn’t include R&D spending outside the US, or spending by smaller biotech, medical device, diagnostic, or health IT firms. By comparison, the National Institutes of Health spends about $79 million a day.

With all the reports about the slowdown in the industry’s output, higher barriers for FDA approval of new medicines, and the criticism of the industry and the FDA, I hope that the industry’s ongoing R&D investments do produce new medicines that are valuable to individual patients and society overall.…

Updates on Vitamin D

June 27, 2008 / Michael D. Miller MD / Clinician-Patient Relationships, Innovation, Nutrition, Public Health / No Comments

Since I wrote about the importance of Vitaim D a few weeks ago, some new information has come out.

A report was released this week from researchers in Australia about Vitamin D reducing the risk of all causes of death. The study was in the Archives of Internal Medicine, about their evaluation of 3,258 men and women scheduled to have a angiogram of their heart arteries. They found that the people who had below average Vitamin D levels had about twice the risks of dying than those with levels in the highest 25% of the group.

While looking for the report of the Austrlian study, I found another study from a group of reserachers in Boston, that looked at 18,225 men who had no diagnosed heart disease. …

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