Health Care

How a drug went from $50 to $28,000 a vial

By John Wiens DC|December 30, 2012|Health Care|

The doctor was dumbfounded: a drug that used to cost $50 was now selling for $28,000 for a 5-milliliter vial.

The physician, Dr. Ladislas Lazaro IV, remembered occasionally prescribing this anti-inflammatory, named H.P. Acthar Gel, for gout back in the early 1990s. Then the drug seemed to fade from view. Dr. Lazaro had all but forgotten about it, until a sales representative from a company called Questcor Pharmaceuticals appeared at his office and suggested that he try it for various rheumatologic conditions.

“I’ve never seen anything like this,” Dr. Lazaro, a rheumatologist in Lafayette, La., says of the price increase.

How the price of this drug rose so far, so fast is a story for these troubled times in American health care — a tale of aggressive marketing, questionable medicine and, not least, out-of-control costs. At the center of it is Questcor, which turned the once-obscure Acthar into a hugely profitable wonder drug and itself into one of Wall Street’s highest fliers. (more…)

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The Supreme Court’s health care decision: What it does—and does not—mean

By John Wiens DC|June 28, 2012|Health Care|

Source Harvard Health Blog

Anthony Komaroff, M.D., Editor in Chief, Harvard Health Publications

The passage of the Patient Protection and Affordable Care Act (which I’ll just call the Law) in 2010 was regarded as a landmark event in U.S. history. Today’s ruling by the Supreme Court, which largely upholds the Law, should also be viewed as a landmark event—whether one agrees with it or not.

Why? Three reasons: Everyone wants health care when they need it. Everyone wants to be spared financial devastation from the cost of that care. And health care accounts for 17% of the total U.S. economy, and is growing at a faster rate than the rest of the economy—putting the rest of the economy under enormous strain.

Before the Law was passed, I saw two huge challenges facing U.S. health care. The first was the fact that so many people did not have health insurance. The second was the high cost of health care.

For decades, the percentage of Americans with health insurance has been lower than in other developed nations. Passage of the Law did not immediately change things. At the time of a survey by the National Center for Health Statistics in 2011, 46 million Americans—15% of the population—had no health insurance. These people lived an automobile accident, a heart attack, or a stroke away from becoming destitute.

Who are they? Relatively few are unemployed adults. People who are chronically unemployed have often been able to get health insurance through Medicaid. In fact, most of the uninsured are working adults whose employers did not provide health insurance. Many are children—often, the children of employed but uninsured adults. A smaller fraction are adults under the age of 65 who are out of the labor force.

Another group of people without health insurance are healthy young adults who have simply decided not to pay for health insurance—and to take their chances. They know that if they become seriously injured or ill, they will receive health care somewhere—effectively paid for by the insurance payments that other people are making. They are “free riders.” In passing the Law, the President and Congress basically said to them, “That’s not fair.” (more…)

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Newer antimicrobial therapies proposed may lead to resistance of human innate immune response.

By stevev|February 23, 2012|Ethics, Fever Management, General Health, Health Care, Immune Function, Immune System, Medicine, Public Health, Research, Safety|

One current trend into fighting antibiotic resistant bacteria is developing a new class refered to as antimicrobial peptides (AMP’s). However a newly published study published¹ a proof of concept that bacteria will develop not only resistance to these new drugs but to our own innate immune response peptides as well.

A very nice summary of the findings was published in the latest issue of The Scientist online magazine.²

1. G. J. L. Habets, Michelle, and Michael Brockhurst. “Therapeutic
antimicrobial peptides may compromise natural immunity .” Biology Letters. N.p., n.d. Web. 23 Feb. 2012. <http://rsbl.royalsocietypublishing.org/content/early/2012/01/20/rsbl.2011.1203

2. Richards, Sabrina. “Antimicrobial Cross-Resistance Risk | The Scientist.” The Scientist. N.p., 24 Jan. 2012. Web. 23 Feb. 2012. <http://the-scientist.com/2012/01/24/antimicrobial-cross-resistance-risk/

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Doctors Going Broke

By John Wiens DC|January 6, 2012|Health Care|

Source CNN

NEW YORK (CNNMoney) — Doctors in America are harboring an embarrassing secret: Many of them are going broke.

This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.

Industry watchers say the trend is worrisome. Half of all doctors in the nation operate a private practice. So if a cash crunch forces the death of an independent practice, it robs a community of a vital health care resource.

“A lot of independent practices are starting to see serious financial issues,” said Marc Lion, CEO of Lion & Company CPAs, LLC, which advises independent doctor practices about their finances.

Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors’ lack of business acumen is also to blame.

Loans to make payroll: Dr. William Pentz, 47, a cardiologist with a Philadelphia private practice, and his partners had to tap into their personal assets to make payroll for employees last year. “And we still barely made payroll last paycheck,” he said. “Many of us are also skimping on our own pay.”

Pentz said recent steep 35% to 40% cuts in Medicare reimbursements for key cardiovascular services, such as stress tests and echocardiograms, have taken a substantial toll on revenue. “Our total revenue was down about 9% last year compared to 2010,” he said. (more…)

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To Fix Health, Help the Poor

By John Wiens DC|December 9, 2011|Health Care|

To Fix Health, Help the Poor

The Chiro.Org Blog

SOURCE: The New York Times

By Elizabeth Bradley and Lauren Taylor

Studies show that to improve health care, invest more money in social services.

IT’S common knowledge that the United States spends more than any other country on health care but still ranks in the bottom half of industrialized countries in outcomes like life expectancy and infant mortality. Why are these other countries beating us if we spend so much more? The truth is that we may not be spending more — it all depends on what you count.

In our comparative study of 30 industrialized countries, published earlier this year in the journal BMJ Quality and Safety, we broadened the scope of traditional health care industry analyses to include spending on social services, like rent subsidies, employment-training programs, unemployment benefits, old-age pensions, family support and other services that can extend and improve life.

We studied 10 years’ worth of data and found that if you counted the combined investment in health care and social services, the United States no longer spent the most money — far from it. In 2005, for example, the United States devoted only 29 percent of gross domestic product to health and social services combined, while countries like Sweden, France, the Netherlands, Belgium and Denmark dedicated 33 percent to 38 percent of their G.D.P. to the combination. We came in 10th. (more…)

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New International Health Survey of Sicker Adults Finds Those With a Medical Home Fare Better

By John Wiens DC|November 10, 2011|Health Care|

Chronically and Seriously Ill U.S. Adults Stand Out for Skipping Needed Care Due to Costs and Struggling with Medical Debt

Source Commonwealth Fund

New York, NY, November 9, 2011—Chronically and seriously ill adults who received care from a medical home—an accessible primary care practice that helps coordinate care—were less likely to report medical errors, test duplication, and other care coordination failures, according to a new Commonwealth Fund international survey of patients’ experiences in the U.S. and 10 other high-income countries. Published as a Health Affairs “Web First” article, the study also found that patients connected with medical homes had better relationships with their doctors and rated their care more highly.

The 2011 survey of more than 18,000 sicker adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States included people who reported they were in fair or poor health, had surgery or had been hospitalized in the past two years, or had received care for a serious or chronic illness, injury, or disability in the past year. The study identified patients as having a medical home if they reported having a regular source of care that knows their medical history, is accessible, and helps coordinate care received from other providers.

Sicker adults in the U.K. and Switzerland were most likely to have a medical home, with nearly three-quarters connected to practices that have characteristics of a medical home, compared to about 33 percent to 65 percent in the other nine countries. U.K. and Swiss patients also reported more positive health care experiences than sicker adults in the other countries: they were more likely to be able to get a same- or next-day appointment when sick and to have easy access to after-hours care, and they were less likely to experience poorly coordinated care.

Sicker adults in the U.S. stood out for having the highest rates of problems paying medical bills and going without needed care because of the cost. Forty-two percent reported not visiting a doctor, not filling a prescription or skipping medication doses, or not getting recommended care—a significantly higher proportion than in all the other countries, and more than double the rates in Canada, France, the Netherlands, Norway, Sweden, Switzerland, and the U.K. Moreover, U.S. patients had among the highest rates of self-reported medication, lab, or medical errors, as well as gaps in coordination of care. (more…)

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