Direct to Consumer Advertising: Drugs, Hospitals, Research….

October 23, 2008 / Michael D. Miller MD / Access to Healthcare, FDA, Information & Communications, Politics / 4 Comments

A very contentious health policy issue is that of advertising. Usually the specific topic is the advertising of medicines directly to patients – known as “Direct to Consumer Advertising.” There have been proposals to limit or ban this activity, and some states have, (or have proposed), limiting or requiring disclosure of other marketing activities by pharmaceutical companies – such as marketing directly to doctors and hospitals.

However, I’ve found it intriguing that many other components of the healthcare industry advertise directly to patients. For example, the Boston area free daily paper, Metro, contains lots of ads recruiting people to participate in medical research trials. …

More on Employer-Based Health Benefits

September 25, 2008 / Michael D. Miller MD / Access to Healthcare, Politics, Private-Employer Based Health Insurance / No Comments

A couple of weeks ago in writing about ERISA, I included some data on the stability of health benefits provided by large companies. The Kaiser Family Foundation just released their 2008 Employer Health Benefits Survey. Below is the updated chart from my earlier post.

Large Companies (>199 employees) Offering Health Benefits:
Eligibility, Take-Up and Coverage Rates

The Kaiser Family Foundation’s Report also included an interesting table that provides some insight into what I wrote earlier this week about the differences in employer health benefits between high and low turn-over industries. The relevant information from the Kaiser report’s Exhibit 2.3 is below:

Value of Employer Provided Health Benefits

September 18, 2008 / Michael D. Miller MD / Access to Healthcare, Economics & Financing, Health System Reform, Politics, Private-Employer Based Health Insurance, Public Health / 4 Comments

I recently heard Michael Critelli, Executive Chairman of Pitney Bowes Inc., talk about what the company has learned about the value of providing quality health benefits and services to their employees.

Because they have a workforce that is divided between their offices and customers facilities, Pitney Bowes has been able to conduct a natural experiment and see how providing access to different health and wellness services can effect their employees and the company’s costs. What they found was that providing a good quality health benefits package in conjunction with healthy food and exercise options, etc., has reduced health care costs for their employees that work in their own offices compared to employees who work off-site.…

Stem Cells, Cancer, and Politics

September 15, 2008 / Michael D. Miller MD / Access to Healthcare, FDA, Information & Communications, Innovation, Politics / No Comments

The cover of this week’s Economist magazine caught my eye because this weekend I was talking with people about stem cell issues in the context of the Presidential election.

Part of our discussion was how the selection of Sarah Palin as John McCain’s Vice Presidential nominee will effect the Republican ticket’s position on stem cell research.

Doing a quick search on the internet, it appears that John McCain is refining in his position to support research on adult stem cells, while maintaining a foundation that doesn’t alienate the conservative base of his party. Specifically, the only reference to stem cell research that I could find on the campaign’s web-site is:

Addressing the Moral Concerns of Advanced Technology

Stem cell research offers tremendous hope for those suffering from a variety of deadly diseases – hope for both cures and life-extending treatments.

…

Incentives for Everything But Primary Care

September 10, 2008 / Michael D. Miller MD / Access to Healthcare, Delivery of Healthcare, Economics & Financing, Innovation, Medicare, Politics, Public Health / No Comments

Two interesting and related items recently dropped into my inbox concerning the future availability of primary care clinicians. As most people are aware, primary care services are becoming increasingly scarce – and has been seen here in Massachusetts expanding insurance coverage may only increase this strain. In addition, there is some good evidence that a major reason for our higher health care spending is having too many specialists and not enough primary care clinicians. So increasing the number of primary care clinicians might be part of the solution to controlling health care spending.

Incentives to Become a Specialist
The first article in my inbox was a Washington Post story stating that only 2% of graduating medical students were contemplating going into primary care. …

ERISA: The Unbridged Chasm of Health Reform – Challenges for Massachusetts and Federal Action

September 9, 2008 / Michael D. Miller MD / ERISA, Federal Healthcare Reform, Health System Reform, Politics, State-Level Healthcare Reform / 2 Comments

A recent Boston Globe article about a possible legal challenge to Masschusetts’ health reform initiative indirectly raised one of the most stubborn challenges in health reform: The Federal ERISA law. (See below for more about ERISA.)

The contentious issue in Massachusetts is a proposal to require employers to both pay at least 33% of full time employees’ health insurance premiums and ensure that at least 25% of their employees are covered by their health plan. (The current requirement is that they do one or the other.) So why should this difference be the basis for a law suit? Actually, there isn’t really any legal difference. …

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. …

Republicans Give Up on Health Care

August 11, 2008 / Michael D. Miller MD / Medicare, Politics / 1 Comment

A political insiders poll conducted by the National Journal (and published in their August 2nd issue) shows that Republicans are not counting on health care to help their party in the November elections.

Among the 7 choices to the question, “Which two issues will most help your party in November’s election?” none of the 42 Republican insiders picked health care. Compared to that 0%, Energy was chosen by 90%, and National security by 31%

The poll results were also interesting for what the Democrats chose. It appears that they are giving up on Immigration and National security as the issues that will help them in the November election – those two issues were picked by none of the Democrats. …

National Health Spending – Lots of Confusion

August 4, 2008 / Michael D. Miller MD / Economics & Financing, Politics, Public Health / 3 Comments

I was at a party over the weekend with a number of clinical Fellows from a major academic medical center. They were all very nice, but I had a very strange conversation with a couple of the Fellows.

The conversation became strange when one of them asked me about what I thought was the biggest healthcare spending problem. Rather than let me fully explain what I thought, they somehow quickly pronounced that pharmaceuticals were the largest cost in the US healthcare system, implying that this was the biggest spending problem. The strange part of this conversation was that one of them had just taken a health policy class at the public health school affiliated with their Fellowship program.…

New Health Posting in Iraq

July 22, 2008 / Michael D. Miller MD / Delivery of Healthcare, Miscellaneous, Politics, Public Health / No Comments

I couldn’t resist witting something about this when I saw today’s press release from HHS which announced that Terry Cline, Ph.D., the administrator of HHS’ Substance Abuse and Mental Health Services Administration is leaving that post, and starting August 31st he will be the HHS Health Attaché and representative at the U.S. Embassy in Baghdad, Iraq.

On the serious side, I’m sure he will do good things to help improve the healthcare system in Iraq. But on the less serious side, someone (maybe Jon Stewart?), needs to ask how did this happen? How bad did he step on someone’s toes to get moved from Rockville, MD to Bagdad?…

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. …

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.…

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