Schwitzer health news blog

U.S. pushing drugs on other countries

Yesterday we wrote again about the U.K. cost-effectiveness review agency named NICE. BMJ editor Fiona Godlee writes about NICE in her editor’s note, "Fear not the heat."

She writes: “The United Kingdom's main rationing body, the National Institute for Health and Clinical Excellence (NICE), is in the hot seat, and things look set to get hotter. NICE is facing its first ever legal challenge from the drug industry—about the decision making process behind its recommendation to restrict drug treatments for Alzheimer's disease. And it is under attack from US drug companies, apparently with White House backing, for stifling innovation in an overt attempt to gain unrestricted access to the National Health Service as part of a free market. (Editor's note: See story in The Guardian.)

What this shows is not that NICE is in trouble but that it is doing its job. It was set up to ensure that treatments available on the NHS provide value for money. Decisions to restrict drug treatments are hugely emotive to patients and clinicians. Controversy is inevitable. But the fact that there is insufficient evidence that the drugs are cost effective in the early stages of dementia is not NICE's fault and does not mean that the process is itself flawed, as Pfizer and others contend. Independent review of NICE's processes by the World Health Organization concluded that they are optimal for health technology assessment. Even if a judicial review recommended changes to the process in this case, the need for a body like NICE to make decisions on cost effectiveness will not go away.

Nor is the UK alone in this. Germany's Institute for Quality and Economic Efficiency in Health Care, which emulates NICE, is under attack from the drug industry for being insufficiently transparent. And … tensions with the industry have increased since the German government proposed extending the institute's role to include cost effectiveness of drugs as well as their clinical effectiveness. Australia's groundbreaking initiative to establish such a "fourth hurdle" crumbled under pressure from the US drug industry. An unholy deal was struck that allowed Australia access to US markets in exchange for unrestricted access to Australia's pharmaceutical market. Germany must hold its ground, and so too must the UK."

Brits say Herceptin will force rationining

As discussed earlier on this blog, the United Kingdom has an agency that does health care cost-effectiveness analysis – at a level and in a way unlike anything done by the U.S. government. That UK agency is called NICE – the National Institute for Health and Clinical Excellence. The BMJ recently published a commentary about NICE’s recommendation of the use of the new breast cancer drug Herceptin. The commentary, “How much will Herceptin really cost?”, points out some of the limited evidence of effectiveness for Herceptin. “Although the three published trials showed a statistically significant improvement in rates of recurrence, as yet, only one has shown a benefit in survival.” And the authors say the real cost of Herceptin will be borne by other patients whose treatment has to be dropped to balance the books. The authors write, “Nobody has suggested what treatments we cut in favor of Herceptin – not the media, medical advocates of the drug, the courts who upheld patient appeals, or NICE. … Political pressure, patient advocacy and media hyperbole should not determine who is treated and what they are treated with.” They predict that Herceptin may not be the last controversial case of “rationing by media.”

I marvel at the contrast between nations. In the U.S. we don't tend to have these kinds of discussions. Everything seems to get approved. Everything is advertised on TV drug ads. Politicians always wave in the direction of discussing health care reform at election time. But we never seem to have the public and social policy discussion about limited resources. Yet we have 47-million uninsured and a clearly tiered health care delivery system. Benign neglect.

Conflicts of interest in American Diabetes Association?

The New York Times raises old and new concerns about non-profit health organizations selling out to corporate interests. The Times reports:

"Many public health charities, from the American Heart Association to the Lupus Foundation of America, raise money from businesses. But for the American Diabets Association, and some other charities, the effort has increasingly become an exercise in balancing the need to raise money with core matters of conscience.

Others remain concerned about the A.D.A.’s relationships with pharmaceutical companies. Their presence is evident throughout the charity, from its annual convention, which is largely underwritten by drug makers, to its board meetings, where pharmaceutical executives have served on the volunteer committees that set policy."

Egregious spinning of lung cancer screening news

In the latest edition of The Cancer Letter (Nov. 22, 2006, Vol. 32 No. 42), Editor & Publisher Kirsten Boyd Goldberg and Editor Paul Goldberg, publish an extremely important and troubling followup to the lung cancer CT scanning study published in the New England Journal of Medicine several weeks ago. They obtained documents distributed by the the International Early Lung Cancer Action Program – or I-ELCAP - the organization that conducted the study published in the NEJM. The documents give “talking points” to be used in media interviews about the study. Physicians who put patients on the study were urged to repeatedly use the word “compelling” to describe the results being published, refrain from mentioning ongoing randomized trials, and urge people to get screened. The “talking points” also urged interviewees to avoid using the terms “observational or noncomparative” to describe the design of the trial – even though those are accurate terms for the study design, seen as a limitation by some critics.

In the article, ethicist Heidi Malm says “Why instruct other researchers not to state factual claims? This limits informed consent by suggesting that this kind of study has the same merit as other studies. [Claudia Henschke, I-ELCAP principal investigator and lead author of the study] is blocking the terms that would make it clear that it isn’t the same kind of study, so people might just assume that it has the same evidentiary quality as a randomized clinical trial. This limits informed consent from the public. They are assuming this has been shown to be effective in terms of saving lives and not just in terms of finding new cancers. It feeds into the misassumption by the public that finding more cancers is the same as saving more lives and that’s what we need the randomized trial to show.”

I am also quoted in the article: “I consider myself well-informed on the latest methods of ‘managing the media’ by different sources in the dissemination of health, medical and science information. I consider myself quite skeptical. Yet I am shocked by what is written in these I-ELCAP ‘soundbites.’ The admonition to ‘stay on the high ground’ begs the question of ‘what is the low ground?’ To me, the low ground is the deception that is recommended in these talking points. The advice is to avoid discussing the trial design. Here are scientists urging each other to mislead journalists into doing an inferior job. The observational nature of the trial is critical to consumer understanding. But the I-ELCAP PR machine advises spokespersons to run from the truth.”

A copy of the "talking points" spin document is included in The Cancer Letter article. While the Letter is a subscription-only publication, Editor & Publisher Kirsten Boyd Goldberg says she will send a free copy to anyone who writes to her at: kirsten@cancerletter.com.

FDA Warns Against Guidelines Backed by National Kidney Foundation

From the Integrity in Science project at the Center for Science in the Public Interest:

"The New England Journal of Medicine last week published a Johnson & Johnson-funded clinical trial showing that patients with failing kidneys who were given high doses of Amgen's anti-anemia drug Epogen suffered 34 percent more heart attacks and strokes than patients given lower doses nearer to the FDA-approved standard. A comment that appeared in the Lancet online pointed out that the higher dose achieved in the study was within guidelines recently issued by the National Kidney Foundation, which received 57 percent of its $19.7 million budget in 2005 from corporate and organizational partners, including $4.1 million from Amgen and $3.6 million from J&J. Amgen and J&J compete with variants of Epogen sold as Aranesp and Procrit, respectively, in the oncology market. The Food and Drug Administration late last week warned physicians not to exceed agency-approved prescribing levels for Epogen, Aranesp and Procrit. "

USA Today Weekend special "breakthrough" edition

The HealthBehaviorBlog takes a poke at the most recent USA Today Weekend edition, which offers "13 scientific breakthroughs that could change everything" in medical care.

The blog post reads:

"Although the newspaper offers a blithe caveat that "there's no guarantee, of course," nine of the 13 magic bullets in the article were basically ads for drug or device manufacturers. Two of the remaining four were about advances in genetic engineering and only two were about improving health through behavior: the value of breastfeeding to prevent obesity in children as they grow, and surviving breast cancer through exercise.

The others deal with new drugs or machinery that may or may not do more good than harm, that are not yet fully proven and that are designed to help people recover from or repair ailments they might have prevented in the first place if more money were spent -- or made -- on researching human behavior. The design of these "breakthroughs" is quite simple: $."

The Best Advice is Free – From Conflicts of Interest

The Center for Science in the Public Interest wrote the headline above for a statement CSPI issued last week.

The statement was written by CSPI Integrity in Science Director Merrill Goozner concerning U.S. Senate Bill 3807. He wrote:

"There are three crucial FDA advisory committee meetings coming up in December. One will discuss drug-eluting stents on December 7-8; one will discuss antidepressant use and adult suicidality on December 13; and one will discuss the antibiotic Ketek on December 14-15.

The scientists who advise the FDA should be free of all financial ties to firms whose products are under review. The public’s faith in the integrity of the process will be undermined by any reform legislation that allows physicians and scientists with conflicts of interest to continue serving on these committees."

Most defective medical device ever OK'd by FDA?

Dr. Sidney Wolfe, Director of Public Citizen’s Health Research Group, criticizes the FDA's approval of silicone gel breast implants, calling them "the most defective medical device ever approved by the FDA."

Wolfe, in a statement on the Public Citizen website, writes: "The approval makes a mockery of the legal standard that requires 'reasonable assurance of safety.'

This approval of such a defective medical device raises again the larger issue of the poor leadership and dangerously poor performance of the FDA’s Center for Devices and Radiological Health (CDRH). Recent examples of this include the large number of defibrillator and pacemaker recalls, primarily the fault of manufacturers such as Guidant but abetted by the lack of FDA promptness, and the approval of the vagus nerve stimulator for depression despite the opposition of dozens of FDA staffers because it lacked evidence of effectiveness."

NBC reporter involvement/editorializing on lung scans

NBC news correspondent Mike Taibbi says he quit smoking after ABC's Peter Jennings died of lung cancer. Now Taibbi is telling his story on the air. Included in that story is Taibbi having a CT scan.

His main source is Dr. Claudia Henschke, who recently promoted the benefits of lung CT scanning with a new study. In the story last night, Henschke told Taibbi after his scan:

"Your lungs really look quite good. You're completely fine."

That misleads viewers about the certainty of these tests. For balance, Taibbi did include the comment of Dr. Peter Bach of Memorial Sloan-Kettering Cancer Center who said it was "outrageous" that Dr. Henschke estimated that 80 percent of lung cancer deaths could be prevented, and who suggested Taibbi was reading too much into his own clean scan.

Dr. Bach says it was simply too soon to rely too much on the scans as a basis for treatment. The story continued:

"If they're being told it will help them, they're being misled," he says.

That was my reason for getting tested, and it's why I feel good about the results. It's also why I know I won't smoke again, and why I'm committed to future scans as my best chance to know what next steps, if any, might be needed.

So despite the split opinions, and despite the argument against the evidence, Taibbi tugged on heart strings and editorialized and put himself into the story. He and NBC are wrong for failing to conduct an evidence-based discussion. That's not reporting. That's crusading.

Why evidence-based medicine is important

The New York Times published an important story, "When Blind Faith In A Medical Fix Is Broken." Excerpt:

"A major study, presented Tuesday at a medical conference in Chicago, challenged the widespread use of tiny balloons and metal stents in people who had suffered heart attacks days or weeks before.

The new report is the latest example of a rigorous experiment turning medical practice on its head by proving that a widely accepted treatment is not the great boon it was thought to be (except maybe to the bank accounts of doctors, drug companies and makers of medical devices). "

Read the rest of the story for other examples.

Administration refuses to negotiate Medicare drug prices

We've written about Democrats' intention to address the Medicare drug benefit legislation prohibiting the feds from seeking better drug deals.

But the New York Times published a piece this week quoting administration officials saying they would not budge on the issue.

Health & Human Services secretary Michael Leavitt told the Times he did not want the power to negotiate drug prices. “I don’t believe I can do a better job than an efficient market,” he said.

“We are seeing large-scale negotiations with drug manufacturers, but they are conducted by private drug plans, not by the government,” Mr. Leavitt said. “A robust marketplace with a lot of competitors has driven down prices. It’s the magic of the market. To assume that the government, in our genius, could improve on this belies the reality of a complex task.”

To continue on the current course belies the reality that the U.S. is one of the few "super powers" that does not have its government negotiate drug prices. And there are many American consumers who are not entranced by the "magic of the market" that Leavitt levitates about.

Election impacts media & health issues

TV Week has an interesting article on how the midterm elections may impact media-and-health issues, such as the $4.7 billion a year spent on broadcast drug ads. Excerpt:

"Sen. Ted Kennedy, D-Mass., has repeatedly questioned whether direct-to-consumer prescription drug ad costs are driving up health costs and co-sponsored legislation that could impose a two-year moratorium on spots for any new drugs, which ad groups have contended is unconstitutional.

His bill also limits deductions for tobacco ad spending, raising ad groups' fears of a precedent to limiting deductions of other industries, especially alcohol ads. Sen. Harkin has also questioned any ads being directed to younger kids."

Post-election health policy agenda suggestions

From former U.S. Senator David Durenberger (R- Minn), in his newsletter from the National Institute of Health Policy:

"Everything in the Medicare Modernization Act of 2003 and subsequent Deficit Reduction Act of 2006 - the biggest changes in national policy passed without bipartisan support since 1965 - deserves a 64 -slice MRI exam. It’s a great way to educate Republicans in this Congress who were health policy sheep when it passed three years ago. My hearing agenda starting in January would be:

· The structure and financing of the Medicare Prescription Drug benefit (Part D).
· The decision to move all Medicare and Medicaid beneficiaries into private managed care plans and the willingness to spend, on average, $1.20 on insurance companies for every $1.00 spent on doctors and hospitals in Traditional Medicare.
· The fairness and equity issues involved in tax subsidies for Health Savings Accounts (HSAs) and solo indemnity insurance which provide $2.50 to wealthy for every $1.00 spent on low-middle income.
· The dis-integration of health care and care systems into silos, focus factories, and other commodities.
· Physician payment reform. Aligning financial incentives in Medicare with the health results we desire. Whom shall we hold accountable and how?
· All health care is local. Quality and practice disparity can be traced. A good geography lesson may teach us the value of measuring and paying for transparent performance.
· The growing disparities in income between primary/cognitive care professionals and proceduralists, especially those benefiting not from the gene pool but from medical technology.
· The growing disparities in income between the owners, managers and directors of for-profit health care companies and those of not-for-profit organizations, which are drying up the talent pool available to the latter, to say nothing of the ethical standards of health professions.
· Why should the richest nation on earth, which already spends twice as much on healthcare per person than any other country, require the 50 states of this nation to insure access for all citizens to basic health care benefits?"

eHealthcare Leadership Award to HealthNewsReview.org

Last week in Atlanta, at The Tenth Annual Healthcare Internet Conference,
HealthNewsReview.org won an eHealthcare Leadership Award for "best community benefit."

PR firm pays journalists to attend drug hearing

The Center for Media and Democracy reports on a tidbit from across the pond:

“The U.K. drug industry's self regulatory body, the Prescription Medicines Code of Practice Authority (PMCPA), has censured Janssen-Cilag after an employee from its PR firm, Burson-Marsteller (B-M), offered journalists cash if they attended a hearing of the government drug regulator. The offer related to a public hearing on Jannsen-Cilag's appeal against a decision against approving the drug Eprex before the National Institute for Clinical Excellence. "As it is possible that the hearing will take up most of the day, and we understand that your time is valuable, we are able to offer £200 (€293) if you wish to attend," the B-M employee wrote. The PMCPA found that Janssen-Cilag, a subsidiary of Johnson & Johnson, was responsible for B-M's actions. In June B-M told PR Week the offer was a "human error" but has declined to comment on whether the employee still works for the firm.”

If you care to read the entire PMCPA case report, go to the PMCPA website, search for "Janssen-Cilag," and then click on the “Media/Director v Janssen-Cilag Alleged payment to journalist” link. It takes you to a pdf file of the full, seven-page case report.

In this country, we don’t have a cost-effectiveness review agency such as the UK’s National Institute for Clinical Excellence (NICE – although drug companies probably view it as anything but nice.) But we still see many ethically-challenged efforts to promote more drugs to broader markets.

Trust in medicine; docs can't be pharma lapdogs

A Georgetown professor warns in this week's BMJ that doctors can not be lapdogs to drug companies.

Her warning comes after she addressed a conference about the influence of the drug industry on continuing medical education. And after several companies withdrew or threatened to withdraw their support for future conferences because of what she said.

Professor Adriane Fugh-Berman’s talk covered the costs of drugs, the costs of promoting drugs to doctors, the salaries of drug representatives, and the funding of continuing medical education. She also covered psychological profiling and monitoring of physicians, including prescription tracking.

She writes, “Drug representatives are paid to be nice to us, as long as we cooperate, sustaining market share of targeted drugs, and limiting our continuing medical education lectures to messages that increase drug sales. ...If we remain dependent on pharmaceutical companies for sponsoring continuing medical education, then these courses will remain under the control of the drug industry. This control is not contractual, but it is enforced through psychological manipulation. ... As a last resort, we physicians could actually pay for our continuing education, as do lawyers, accountants, business people and aerobics teachers, to mention a few." ...Medicine must shed its docility and the corporate leash. Let us not be a lapdog to the pharmaceutical industry. Rather than sitting contentedly in our master’s lap, let us turn around and bite something tender. Freedom calls.”

In the same issue of BMJ, editor Fiona Godlee writes, "Trust is at stake in every decision doctors make, and unchecked clinical enthusiasm can threaten professional integrity. Above all, beware of optimism bias... Two papers in the BMJ suggest that this "unwarranted belief in the value of interventions" has been at work with statins."

Optimism bias is fed by pharma influence. Thanks, BMJ, for publishing these important observations.

Dems win drops drug stocks

The Medicare prescription drug benefit legislation passed up a huge opportunity for the government to try to control drug costs. The legislation prohibits the feds from negotiating with drug companies for the best deal on all those drugs the government is now helping sell to seniors.

But the Washington Post reports: "Rep. John D. Dingell (D-Mich.), the presumptive chairman of the House Energy and Commerce Committee, said Democrats would try to close a gap in which Medicare beneficiaries must cover their drug expenses and push the government to negotiate with drugmakers for lower prices. He also vowed to remedy what he called the "large overpayment of insurance companies."

Dingell also said he would look into whether generic drugs were being kept off the market by deals among manufacturers and how drug companies were "creating new uses of questionable value" for old drugs nearing the end of patent protection. And he said Congress needed to scrutinize the Food and Drug Administration's licensing process. He took special aim at the dietary-supplement industry. "People are being killed" because of lax oversight, he said."

In response to this news, shares of big drug companies such as Pfizer fell the past two days. Drug benefits manager Medco Health Solutions Inc. has seen two days of Wall Street losses, as has Humana Inc., the second-largest provider of Medicare drug coverage.

Cholesterol TV ads clog reality

How can you argue with ads for a drug attacking America's leading killer?

Easy - when you base the argument on facts and evidence rather than emotion and fear-mongering.

Canadian drug policy analyst Alan Cassels writes about disease-mongering in ads for cholesterol-lowering drugs such as Pfizer's Lipitor, the #1 selling prescription drug. He writes: "What most people won’t learn from such ads is that when scientists have done meta-analyses (a study of a collection of studies) of the largest statin drug trials, they inevitably find that the drugs show no difference in mortality, when compared against placebo. There may be some changes in heart attack rates, but no changes in overall deaths, which is what the ads are all implying. We don’ t call this disease avoidance, we call it disease substitution. The drug may prevent a heart attack death but in the process will cause other kinds of deaths, a sort of zero sum gain that is the equivalent of taking an expensive placebo."

Cassels writes about one Pfizer Lipitor ad that shows the tagged toe of a corpse. “What would you rather have, a cholesterol test or a final exam?” asks the headline. Cassels says "The key message is that getting a cholesterol check and then, probably taking drugs to alter your cholesterol, will prevent a premature death. Even, if you are otherwise healthy."

Big Canadian media company fights to overturn drug ad ban

The U.S. midterm elections are over and health care reform didn't get the amount of attention it deserved. So let's take a peak over the border of our neighbor to the north and see what's going on up there.

As we often write about, the U.S. is one of only two countries that allows direct-to-consumer prescription drug advertising. The other, New Zealand, is considering a ban. But in Canada, the big CanWest MediaWorks media company wants to overturn the country's ban on drug ads.

Now a Canadian newswire reports that "A coalition of unions, women's and health groups have been granted intervenor status" in the case. "The groups argue that if CanWest is successful it would push up healthcare costs and undermine the sustainability of the Canadian healthcare system. CanWest is arguing that the ban on DTCA is a violation of their right to freedom of expression. In an analysis of the case, Colleen Flood and Michelle Zimmerman from the University of Toronto Faculty of Law, warn against assuming that the court won't decide in the media giant's favour. "In order for the current legislation to be upheld, courts will need to be persuaded that nothing short of the existing limits on DTCA would allow the federal government to achieve its other pressing societal concerns, such as protecting patient safety. This will be a difficult task," they wrote.

If only health care reform issues mattered

As Americans go to the polls today, I'm going to reflect on several items recently in the news.

Headline: "Americans Upset With Rising Health Costs". Excerpt: "Due to rising costs, Americans are falling behind in savings and struggling to handle even basic expenses, which over time has had a significant impact on their confidence in the health care system."

Headline: "Consumer Unease With U.S. Health Care Grows". Excerpt: "The U.S. health care system — touted as providing the best medical care in the world — is becoming more precarious to most Americans, who are rattled by rising costs, questions about quality and fears about the future. 'If you can afford it, it's the best health care system in the world, but, increasingly, people aren't able to afford it.' "

(Note: on the first day I visited the USA today website to read this story, it appeared alongside ads for a sleeping pill drug, a toenail fungus drug, and a new diet "as seen on 60 MInutes." Does anyone see a link between the two stories listed above, and the fact that the U.S. is one of only two countries in the world that allows direct-to-consumer prescription drug advertising?)

Headline: "U.S. Lags in Several Areas of Health Care, Study Finds". Excerpt: "The United States trails other countries in adopting electronic medical records and computerized systems to remind patients about follow-up care, prompt physicians to give patients test results and warn of potentially harmful drug interactions. It found that primary care doctors in America were less likely to have financial incentives to improve the quality of the care they provide. 'Although the U.S. pays more for health care than any other country, we are under-investing in our primary care system.' "

It's a shame that in these midterm elections, politicians didn't spend more time on the meat of these issues, instead of dragging us through more Mark Foley, more John Kerry gaffes, and an unprecedented assault on our psyche with attack ads. There is so much that could be done and needs to be done.

GOP claims Dems using flu shots as voter lure

The Associated Press reports that the city of Houston "has stopped offering free flu shots at early voting sites after Republicans alleged it was a ploy by the mayor to lure more Democrats to the polls.

Foundation officials say the program is a convenient way for older people, who are especially vulnerable to the flu, to get vaccinated for a disease that kills 32,000 people over 65 every year. Polls provide access to many people who need the vaccine."

Scan-happy medicine may be hazardous

The Wall Street Journal (subscription required) yesterday published a story, "Worries Mount Over Excessive CAT Scans." The story described a “growing number of medical professionals, managed-care companies and scanner manufacturers that are trying to rein in CT scanning out of concerns over excessive radiation, which is known to increase the risk of cancer."

It continued: "There's been an explosion in CT scanning in recent years. Scans increased by nearly 50% between 2000 and 2003, when they hit 57 million. The rise comes from rapidly advancing CT technology that gives doctors better, more-detailed information to work with, making the scan widely viewed as one of the most valuable diagnostic tools in the field. What's more, the test is noninvasive and typically doesn't cost anything for insured patients. The test has also become popular as a means for patients to get full-body scans as a check-up.

There haven't been any studies that directly examined whether people who had multiple CT scans went on to develop cancer. But as the number of CT scans has climbed, some doctors have started to take notice of individual patients who have received multiple scans that place their total radiation doses at levels near or beyond those of some survivors of the nuclear attacks on Japan in World War II.”

Questions about the health insurance biz

I always look forward to the weekly newsletter from former U.S. Senator David Durenberger (R - Minn.) at the National Institute of Health Policy. Excerpts from the latest:

"Again last week we read of record-setting profits at casualty insurance companies. The editors of the Wall Street Journal remind us that these very same companies demanded Congress subsidize the risks they undertook as a result of 9/11, which Congress finally did in November 2002. The subsidies are still there today, paying for those record profits, because premiums far exceed actual risk.

Reminds me of the same subsidy which the same industry demands as a price of doing Medicare business. Most know that the current GOP health policy includes moving the Medicare and Medicaid programs from the government to America’s health insurance plans - a move Democrats are scrutinizing for both accuracy of information and true value to beneficiaries.

Watching UnitedHealth Group’s corporate conscience on public display is not fair to the plans. But a simple test of the health insurance plan market is fairly predictive of what will drive the future performance of the for-profit plans. Money - pure and simple. Behavior change, care quality and value, electronic information exchange are all possible products. But profits – not healthcare cost containment - drive the train.

Vanessa Fuhrmans’ story of Aetna’s latest quarterly report in the Wall Street Journal is illustrative. Insurance company profits are up 28% because premiums are up. Investors dropped Aetna three months ago because profits were down. They thought Aetna was making a mistake trying to reduce consumer product prices in order to gain market share. So what we end up with is less health insurance price competition. Today, that hit Humana when the company reported tripling profits, setting record highs but “not meeting other targets.”

Nationally, the number of health insurance buyers is going down. The only new business is HSA-like plans, and new Medicare Advantage and prescription drug plans. Congress wants us to buy Medicare from private plans, and is willing to spend trust fund dollars to subsidize them – up to an average of 111% of what it pays for Traditional Medicare. Add this to the 21% we pay through premiums for doing business with private insurers (on top of the real price of medical services), and I have to wonder what it is that we are all getting for our money. We know what they are getting for the money they make for their investors, but what about us?"

Drug company astroturfing with patient advocacy groups

The New Scientist has an important article about the concerns “that some patient groups are perilously close to becoming extensions of pharmaceutical companies' marketing departments.”

The term “astroturfing” is used for fake grassroots campaigns created by PR professionals for special interests, spawning supposedly spontaneous upheaval of public opinion. In the case of drugs promoted by patient advocacy groups, there’s a lot of money and misinformation at stake.

The New Scientist says it “conducted the largest survey to date of industry donations to patient groups based in the US - the biggest single market for drugs and medical devices. … We selected 20 US patient groups operating on a national level with annual revenues of more than $100,000, plus five with revenues exceeding $10 million, pulling them at random from the GuideStar database, which provides information on US non-profit organisations.

Just two groups identified in New Scientist's survey - the National Women's Health Network (NWHN) and Breast Cancer Action - refuse to accept donations from pharmaceutical or medical device companies. "We want women to know that when they come to us, they are getting independent information," says Amy Allina, the network's programme director. "We think of ourselves as virtuous, but poor."

One researcher, a breast cancer survivor, concludes: "There is a tendency not to want to criticise the motives of the patient groups, because a lot of them are made up of people who are pretty seriously sick.” She and others say that patient advocacy groups must be more transparent so that patients can make informed judgements about whom they can really trust.