Merrill Goozner connects the new GM-UAW contract with Jared Bernstein's term - YOYO economics -meaning You're On Your Own.
On GoozNews.com he writes:
"News coverage of the General Motors-United Auto Workers settlement describes how YOYO economics is taking over health care -- the last bastion of employer-provided social insurance.The Wall Street Journal's trend story describes how large employers are increasingly shifting their retiree benefits from comprehensive Medicare supplemental plans to individual payouts. This mirrors the Republican approach to universal health care for all workers and their families. We make a flat payment to the individual, and YOYO, You're On Your Own to buy policies in the individual market.
But, as the story points out, there are a few problems with that market:
Shifting people to the individual market is problematic . . . at least under the current set-up. It is difficult for people to understand what they're buying, and those with existing illnesses have trouble finding any coverage.
Indeed, the word that most health care economists and wonks use to describe the individual insurance market is "dysfunctional."
Sen. Ron Wyden (D-OR) last year introduced a comprehensive health care reform legislation that repeals the implicit tax break for employer provided health insurance (it's currently not taxed as wages), encourages employers to give the money to their workers, and requires individuals to go out and buy their own insurance plans. But to deal with the dysfunctional individual insurance market, Wyden called for a national regulation scheme for health insurers that would establish community rating for pricing individual policies (it pools risk by mandating that all policies within a geographic area carry the same price for the same level of benefits) and flat-out prohibits insurers from discriminating against potential customers because of previous health conditions, age, or their health status (except for smokers).
The GM-UAW settlement shows that employers are not going to be reliable allies in the push for universal health care. They will opt for any solution that insulates them from rising costs. No one should be surprised. They are not social enterprises in the business of providing benefits. They are in business to make money. That goes for the insurance companies who sell health plans."
The Boston Globe reports:
"Bristol-Myers Squibb and a subsidiary have agreed to pay more than $515 million to settle civil suits over fraudulent drug marketing and pricing schemes, including illegally promoting an anti-psychotic drug to children and the elderly, US Attorney Michael J. Sullivan said yesterday. ...The agreement says Bristol-Myers Squibb gave kickbacks to physicians and healthcare providers from 2000 through mid-2003 to get them to prescribe the company's drugs. The kickbacks came in several forms, including consulting fees and trips to luxury resorts.
"Patients are entitled to unbiased decision-making from their physicians and should not have to worry that financial inducements or lavish entertainment have influenced their physicians' prescribing choices," Sullivan said. ...
Bristol-Myers Squibb participated in pricing schemes, including one involving its anti-depressant drug Serzone, that defrauded the Medicaid program, prosecutors said.
Bristol-Myers Squibb and Apothecon also inflated prices for a wide assortment of cancer-fighting and generic drugs, deceiving federal healthcare programs that established reimbursement rates based on those prices, prosecutors said. ...
Dr. Jerome Kassirer, a professor at Tufts University School of Medicine and outspoken critic of drug companies, is skeptical.
"A lot of these companies, when they get sued for a few million dollars, they just consider it loose change," he said. "I haven't seen any let-up in what they're doing. Most of the time, when they're caught, they'll often say, 'It was a renegade, someone who wasn't following the instructions. Our policy says we shouldn't do that.' "
A story in the September 29 issue of New Scientist magazine reports:
When the US Congress examined the controversy over the diabetes drug Avandia back in June, things got embarrassing for GlaxoSmithKline. A researcher who raised safety concerns in 1999, although he later withdrew them, was questioned about attempts by the company to silence him – a charge GSK denied. Now it has emerged that conversations about how to deal with the critic took place at the highest levels. Internal emails presented to the Senate this month show that several executives, including CEO Jean-Pierre Garnier, knew of plans to put pressure on John Buse, a diabetes researcher at the University of North Carolina at Chapel Hill (UNC). One email, entitled “Avandia Renegade”, was sent in June 1999 by William Claypool, a senior vice president at what was then called SmithKline Beecham, to Tachi Yamada, then chairman of research and development. It accuses Buse of misrepresenting safety data. Claypool suggests warning Buse not to repeat the claims, with the “punishment” being that “we would complain up his academic line” and to the bodies that gave Buse accreditation for teaching. Yamada’s reply, sent the same day, was copied to Garnier. In it, Yamada discusses the possibility of approaching the chairman of Buse’s department and of suing Buse for “knowingly defaming our product”.
The Wall Street Journal, appropriately, is all over the story about the new General Motors deal with the United Auto Workers that "marks the dawn of an uncertain new era for the American auto industry and its unionized work force."
The contract calls for a restructuring of GM's obligation to cover health care for UAW retirees.
Read the story and the accompanying Q&A sidebar to learn about the potential impact of the new GM trust fund approach.
The Wall Street Journal reports:
"The federal government has given the go-ahead for seven health-plan sponsors to resume marketing Medicare private fee-for-service plans to older people after finding the sponsors in compliance with requirements.The organizations had suspended their marketing of the plans in June after the Centers for Medicare and Medicaid Services (CMS) expressed concern about deceptive practices by some insurance agents. ...
Rep. Pete Stark (D., Calif.), chairman of the House Ways and Means Committee's Health Subcommittee, wasn't convinced that sponsors and CMS had done enough.
Rep. Stark, who has targeted Medicare Advantage funding, wrote that he has "seldom seen CMS respond to private fee-for-service plans' marketing abuses as they should, with civil penalties or expulsion from Medicare. ... Talk is cheap, and I look forward to action when private fee-for-service plans are again caught misleading Medicare beneficiaries."
He said that states should be able to oversee all private plans.
"These seven plans certainly weren't readmitted based on an open and transparent process that assured Congress or America's seniors that plans' behavior has changed," Mr. Stark said."
As Ed Silverman reports on Pharmalot.com "intense lobbying by advertising agencies and broadcasters, as well as drugmakers" stifled tougher restrictions in the FDA reform bill.
Get ready for more (name the ads) couples in bathtubs, butterflies in bedrooms, and the famed green recliner. Drug ads, as one advocate gloated, look like they're here to stay.
Australian journalism Melissa Sweet, in a piece entitled, "The ties that bind: how big pharma buys a good press," in the Australian online magazine Crikey (subscription required but free trial available), writes:
"The media is often quick to get on its high horse about the pharmaceutical industry’s wining and dining of doctors, but is much less upfront about the lucre that journalists accept from drug companies and other health organisations.These take the form of journalism prizes -- the booty for the Pfizer Eureka Prize for Health and Medical Research is a hefty $10,000 -- and sponsored trips to attend conferences or other such events.
Organisations as august as the National Press Club take sponsorship for health journalism awards from groups with clear vested interests, such as the pharmaceutical industry lobby group, Medicines Australia, and the drug company, Pfizer Australia.
Indeed, so many vested interests are involved in medical journalism awards that it’s verging on the ridiculous. Roche funds an international award for obesity journalism, and is also one of the companies behind an international osteoporosis journalism award. My personal favourite is the Embrace Award, jointly sponsored by Eli Lilly and Boehringer Ingelheim, for "accurate, responsible and sensitive reporting on urinary incontinence".
Other awards are funded by professional or advocacy groups eager to promote themselves or their issues. The Australasian Society of Clinical Immunology and Allergy has an award "to recognise outstanding medical and health reporting on allergic and immune diseases in Australia and New Zealand". The Royal Australian and New Zealand College of Ophthalmologists gets up to 30 entries each year for its awards - two of $3,000 each - for journalism promoting "understanding of eye care issues specifically related to the work of Australian and/or New Zealand ophthalmologists".
Organisations such as the National Press Club stress the independence of their awards and the judging process, and just about everyone involved in such awards emphasises that their aim is to support and encourage good journalism. That may be the case but of course there are also other agendas, whether generating positive corporate PR, building relationships with key journalists and organisations, or promoting particular issues/products. The Embrace Award at least is upfront about this, saying it aims to "empower women to seek help" - presumably from one of the sponsors’ products."
The Statement of Principles of the Association of Health Care Journalists includes a clause: "...weigh the potential benefits of accepting awards from organizations sponsored by an entity with a vested interest in health care against our need for credibility."
On our HealthNewsReview.org website, we've posted a new Publisher's Note to foster discussion about what's missing in so many of those "health news briefs" or "health watch" digests or "medical minutes."
In the 17 months that we’ve been reviewing stories from about 60 major U.S. news organizations, we have given our top five-star score to only one story of less than 300 words.
We’re coming to the conclusion that such “briefs” may do more harm than good. Almost by default they oversimplify medical research stories. They generally fail to adequately explain how big is the potential benefit of the idea being discussed, or how big is the potential harm. They fail to scrutinize costs, conflicts of interest, or the quality of the evidence.
A case in point is a 191-word story, “Keep an ovary, preserve a brain,” by Katie Hobson, senior editor, health/medicine, for U.S. News & World Report magazine. We rated the story as unsatisfactory on four of our ten criteria.
Katie wrote to us and allowed us to publish her comments:
“Thanks for your site, and for updating reporters on when our articles are reviewed. I have absolutely no quibble with the need for your site and for more stringent reporting standards for health, medicine and science.That said, I do have a quibble with reviewing less-than-200-word items done for our HealthWatch page, which is a quick digest of the week's health news. These items -- including the one by me that you just reviewed -- are almost always condensed versions of far longer stories that appear first on our website, during the week. So first, it seems fair to review the original article rather than the brief summary (in my case, the larger piece might have answered some of your questions, might not have, since it was a Q&A). More broadly, why review briefs at all? There are plenty of long stories in the magazine and on the site which definitely merit review and your criteria should be applied to them to see how they hold up. But given that your list of criteria is literally almost as long as the items themselves, it doesn't seem appropriate to expect a health digest to be comprehensive; there simply isn't room. It's as if you went through the front section of the NYT and criticized the regional briefs for not giving the complete history of a conflict and not consulting outside experts.
Certainly, there's a larger question as to whether a digest section should even exist, since it's impossible to include all the facets of a study in that tiny space. But shouldn't that issue be debated, rather than applying standards that seem more suitable to longer (even over 300-word) articles, rather than quick news hits?
Thanks for reading,
Katie”
Katie and I have exchanged some thoughts in a followup e-mail and she welcomes an open discussion about some of the issues she raises.
Our stance:
Not all USN&WR readers use the USN&WR website; all they see is the magazine. That’s why we think it’s fair and legitimate to review what’s in the magazine.
To the question “Why review briefs at all?” we are clearly countering with the question “Why publish briefs at all?” Katie writes about the limitations of addressing our criteria – “there simply isn’t room…in that tiny space.” But the magazine has decided these stories are only worth a tiny space; they could easily find more space. It’s an editorial decision we’re trying to change.
And that’s the larger question Katie and I (and probably many other journalists) think should be discussed and debated openly. Clearly, you can’t fault the writers and reporters who do their best to cover topics when assigned to write a brief or digest. But editors and publishers should take a hard look at the issues we raise about what’s left out – perhaps to the harm of the reader – for the sake of brevity.
And this is not just a magazine phenomenon. Network TV news health stories – across the board – get weaker reviewers than any other medium in our first 17 months. And self-imposed time limits are usually at the root of the weak review. Yet time is found in many newscasts for Anna Nicole Smith, for Lindsay Lohan, etc.
And newspapers? Last week my local Star Tribune had a full-page (except for a 10” X 13” ad) of eight news briefs on one page – none reported locally, all from wire services. Five were health stories - None more than 225 words. Even a “New York Fashion Week” story on page A2 got more words than that – complete with description of Jennifer Lopez’ design of “denim boy shorts with a sparkling brown hoodie.”
Space is available. It’s a matter of editorial decision-makers choosing how to allocate it.
Yesterday we profiled a Wall Street Journal column about the statistical flaws in some studies. Today we point out a Los Angeles Times column that gives readers a better understanding of the strengths and weaknesses of epidemiologic studies. Excerpts:
"(Critics say that) far too many of these epidemiological studies -- in which the habits and other factors of large populations of people are tracked, sometimes for years -- are wrong and should be ignored.In fact, some of these critics say, more than half of all epidemiological studies are incorrect.
The studies can be influential. Often, in response to them, members of the public will go out and dose themselves with this vitamin or that foodstuff.
And the studies also influence medical practice -- doctors, the critics note, encouraged women to take hormones after menopause long before their effects were tested in randomized clinical trials, the gold standard of medical research.
Some of epidemiology's critics are calling for stricter standards before such studies get reported in medical journals or in the popular press.
(One) of the foremost critics argues that epidemiological studies are so often wrong that they are coming close to being worthless. "We spend a lot of money and we could make claims just as valid as a random number generator," he says.
Epidemiology's defenders say such criticisms are hugely overblown.
They are "quite simplistic and exaggerated," says Dr. Meir Stampfer, a professor of epidemiology and nutrition at the Harvard School of Public Health and a professor of medicine at Harvard Medical School.
...The debate is unlikely to be resolved any time soon. "If you put five epidemiologists and five statisticians in a room and have this debate," (one critic) says, "and try to get each one to convince the other side, at the end of the day it will still be five to five."
The important thing for journalists and for readers to understand is that there is a hierarchy of evidence - and that not all studies hold equal weight or power to point to a conclusion. Both the Wall Street Journal and Los Angeles Times stories are important in reminding us of that.
Robert Lee Hotz wrote in the Wall Street Journal last week about medical scholar John Ioannidis who calculates that most published research findings are wrong.
Hotz writes:
"Dr. Ioannidis ... has documented how, in thousands of peer-reviewed research papers published every year, there may be so much less than meets the eye.These flawed findings, for the most part, stem not from fraud or formal misconduct, but from more mundane misbehavior: miscalculation, poor study design or self-serving data analysis. "There is an increasing concern that in modern research, false findings may be the majority or even the vast majority of published research claims," Dr. Ioannidis said. "A new claim about a research finding is more likely to be false than true."
The hotter the field of research the more likely its published findings should be viewed skeptically, he determined.
If only we could raise the level of skepticism and scrutiny among more journalists - some of whom wait to publish any finding from any journal or any scientific meeting as if it were gospel.
Just watched John Stossel's special, "Whose Body Is It Anyway? Sick in America," on the ABC News 20/20 program.
Wow.
Simplistic. Superficial. Shallow. Superfluous.
Just one example: he used laser eye surgery and cosmetic surgery as two examples of how the competitive marketplace can bring health care costs under control. No discussion of quality. No discussion of evidence. No discussion of overuse.
No discussion about some of health care's true challenges: management of diabetes, chronic heart or lung disease, care for the elderly, care for anyone with multiple chronic conditions.
I wasted an hour.
See Merrill Goozner's blog for a report on White House efforts "to scuttle a key FDA reform."
The Kaiser Family Foundation’s annual study of employer-based health care insurance has a mixed message this year.
While the 6.1% jump in the average family premium is smaller than in recent years, the average annual total premium cost for family coverage is $12,106 – much more than a minimum wage earner bring home in a year. And the average annual worker contribution for that family coverage is now $3,281 – double what it was just seven years ago.
Kaiser president Drew Altman said, “Even if the rate of increase is lower, the pain level is actually higher.”
Nine prominent physicians, including two former editors of the New England Journal of Medicine, wrote to Senators Edward M. Kennedy (D-MA) and Christopher J. Dodd (D-CT) urging them to vote to limit the number of industry-connected scientists who may serve on Food and Drug Administration advisory panels. Kennedy and Dodd are among the congressmen trying to resolve differences in the drug safety bills that have gone through both houses of Congress.
The physicians wrote:
“Allowing conflicted members of an advisory committee to vote can have serious public health consequences. For example, in early 2005 a FDA advisory committee reviewed the safety of COX-2 inhibitors and concluded that all three of these drugs, including Vioxx, were safe enough to keep on the market. Ten of 32 scientists on that panel had financial ties to manufacturers of the drugs. Had their votes been eliminated, two of the three drugs in that class would have ben voted down by the panel. (Vioxx was, of course, voluntarily withdrawn from the market by Merck in September 2004 because of safety concerns).It is possible to find unconflicted experts. The FDA could choose its committee members from among the 123,000 faculty at the 125 medical schools in the United States and public health experts at other federal agencies such as the National Institutes of Health (“NIH”), the Centers for Disease Control, and the Veterans Administration. The NIH’s Office of Medical Applications of Research and the Agency for Healthcare Research and Quality’s U.S. Preventive Services Task Force bar any conflicted scientists from serving on the panels that develop consensus statements on the implications of clinical trial evidence. The Center for Evidence- Based Policy at Oregon Health Sciences University bars any conflicted expert from its analysis of clinical trial evidence to determine what drugs, biologics, and devices provide the best medical outcomes; this evidence is then turned over to states for use in establishing what Medicaid will pay for, among other uses."
Earlier this week, Robert Pear of the New York Times reported:
"Private insurance companies participating in Medicare have been allowed to keep tens of millions of dollars that should have gone to consumers, and the Bush administration did not properly audit the companies or try to recover money paid in error, Congressional investigators say in a new report.The investigators, from the Government Accountability Office, said the money could have been used to reduce premiums or provide additional benefits to older Americans.
Under federal law, Medicare officials are supposed to audit the financial records of at least one-third of the insurance companies each year. But the investigators said the Bush administration had fallen far short of that goal and had never met the “statutory requirement.”
Many have criticized this administration's promotion of Medicare Advantage plans through private insurers.
A Boston Globe story about a study in the September 5 Journal of the American Medical Association reports:
"...a recent study from researchers at the Yale School of Medicine shows that physicians just out of medical school have difficulty interpreting the statistics presented in medical articles, possibly affecting how they understand and apply the new findings to clinical practice. Researchers took several journals, including The New England Journal of Medicine, and presented actual summaries, charts, and tables in the form of multiple choice questions to nearly 300 internal medicine residents from more than 10 different residency programs. The new doctors received scores of 41 percent on average on the test, implying that there were significant deficits in their understanding of the statistics presented in the journal articles. The residents who had been trained in biostatistics or who had a degree in public health performed better than those without that training. "The study shows that most residents lack the necessary background in biostatistics to interpret medical research," said lead author Dr. Donna Windish."
Johns Hopkins University president William Brody, in a speech at the National Press Club on Friday, said journalists are not asking presidential candidates the right questions about health care reform.
“If you’re only reporting cost and coverage issues, you‘re missing a big part of the story,” Brody said.
Brody said that almost no one -- candidates or reporters -- is addressing equally essential elements of the health care puzzle: the quality and consistency of care; the complexity of medical practice today; and the role of chronic disease, the treatment of which threatens to monopolize health care resources. These “three C’s” of health care -- consistency, complexity and chronic disease -- need to be front and center in any reform efforts, Brody said.
“The fact is, cost and coverage solutions alone will not solve our problems,” Brody said. “We can’t provide health insurance for all unless we control the spiraling costs of health care. But we won’t control costs until we deal with these other issues.”
Brody said he will help get the right questions on the table by participating in a planned series of televised conversations with presidential candidates. Brody said that Johns Hopkins is working with the nationally distributed Retirement Living TV network and the National Coalition on Health Care to produce and air Presidential Spotlight on Healthcare ’08: Which Way Forward? during the primary season. In half-hour discussions, Brody will provide the presidential candidates a platform to explain their health care proposals in terms that address all age groups of Americans.
Brody urged reporters and voters to question presidential candidates closely on how they propose to bring rationality and order to what he described as the industrialized world’s most inefficient medical system.
“At The Johns Hopkins Hospital, we have to bill more than 700 different payers/insurers, such as HMOs, PPOs, Medicare and Medicaid,” he said. “Each one has its own set of rules regarding what services are covered, the level of reimbursement, and what kind of documentation and pre-approval is required. Nationally, this kind of inefficiency costs patients billions of dollars every year.”
Ben Goldacre, in this week's BMJ writes:
I was surprised last week by an email circular I received from a science writers' mailing list. It was from the Aspirin Foundation, a group funded by the drug industry, and it was offering—on behalf of Bayer Healthcare—to pay expenses for journalists to attend the European Society of Cardiology's conference in Vienna.Now aspirin is without doubt an excellent and cheap drug. But in my naivety I had no idea such things went on. I pinged off a few emails to friends and colleagues. Most poked fun at my innocence—quite rightly—but some were helpful. Not only is it extremely common for journalists to take money from drug companies, but there have been some astonishing cases in recent history, including one memorable case where a PR company invited journalists to "an exclusive preview" of new laser eye technology, with the offer to "discuss free treatment in return for editorial features."
"I organise the media programmes for a number of medical conferences run by scientific societies," said one person who, without wishing to be melodramatic, has asked to remain anonymous, "and I reckon at least 50% of the journalists present are paid for by drug companies. They get pretty well looked after too—first class travel, five star hotels, posh dinners, etc. Some of them indulge in double dipping, where they are paid by the day by the drug company and then by the publication that takes whatever they have written. Sometimes they don't even use the press room, spend all their time in company hospitality suites, and just go to company sponsored satellite sessions and press conferences."
Perhaps I'm naive, but I don't buy Ben's claim that it's "extremely common for journalists to take money from drug companies." But the points he makes about pharma's pervasive and troublesome influence on some journalists and news organizations is worth noting. He wrote:
"...There are real dangers in being too close to PR people: lovely though they may be, their trade is, by definition, manipulation. Drug companies are businesses, with responsibilities to their shareholders, and they wouldn't pay for journalists to attend their events if they didn't think it would affect media coverage of their product. After all, a journalist's article is far more credible than a paid advertisement, for anybody's money, and more likely to be read by potential consumers. ...It's much easier to get someone to take your calls when they've taken your money. And I, for one, will in future read outraged media reports of academic conflicts of interest with a wry smile indeed."