Greedy Trial Lawyer
Gaming The System
Drug Companies Interviewing Your Genes For Witnesses Against You
Category: Gaming The System
The light bulb has gone on at Big Pharma. This genetic stuff can save our asses, is the new mantra.
Locating blame for adverse drug reactions
Adverse drug reactions often appear idiosyncratic. Some drugs have powerful effects and everyone experiences the side effects (e.g., cancer chemotherapeutic agents). Others, however, seem to disagree with only a few people, although that disagreement can be major. Obviously drug companies would rather not have to contend with the fallout that occurs when their customers become collateral damage. Much of the controversy over drugs like Vioxx is how much the companies knew about that damage and what they did with that knowledge. Big Pharma would rather the blame the drug failure on the victim than the company. Maybe that's too cynical a view of a new initiative just started by five of the world's biggest drug companies. On the other hand, when it comes to drug companies, can any view be too cynical?The companies started the International Serious Adverse Events Consortium to study genetic causes of bad drug reactions, according to a statement today by the nonprofit group. The first two projects, in partnership with university researchers and the U.S. Food and Drug Administration, will examine why some people suffer liver damage or life-threatening skin reactions to drugs. (Bloomberg)
Meanwhile the major cause of liver failure in the US remains Tylenol ingestion. Maybe that's the fault of some (fairly common) genetic variation. But maybe it's also caused by the combination of Tylenol with other factors in the diet, environment or over the counter or prescription drugs taken simultaneously.
Or maybe it's even because most of the American public thinks Tylenol is a perfectly safe drug. I wonder where they got that idea. Maybe they were genetically predisposed to believe it.
From Effect Measure
I would be interested in a genetic study of the leaders of the drug industry. There must be a common gene among them. It causes them to deny, deflect and deceive at every opportunity. It explains why they are doing so well under the Bush Administration.
Docs & Hospitals Need More Joint Venture Opportunities - Give Me A Break!
Category: Gaming The System
The United States needs more money-making joint ventures between doctors and hospitals. That is the message Dr. Richard L. Reece over at MEDINNOVATIONBLOG is pushing this week.
Medicare To Ban Doctor Referrals to Hospital-M.D. Joint Ventures
The public thinks hospitals and physicians ought to cooperate and collaborate for the common good of patients and the community.Everybody, it seems, except Medicare officials, Office of the Inspector General, and Representative Pete Stark who are bent on preventing hospitals and doctors from innovating and "colluding" for mutual profitability.
At least, that's what a Sept. 12 WSJ piece "Medicare Moves to Cut 'Self-Referral' Practice: Proposed New Rules the Rise of Doctors Sending Patients to Centers They Own." Physicians, McKinsey data indicates, are profiting to the tune of $8 billion/year by sending patients to facilities doctors own, often because of increased efficiencies and excellent outcomes achieved by focusing on specialized procedures.
Not so, says Medicare, profit-mongering doctors are referring to themselves and doing unnecessary procedures because of their ownership stake and "creating incentives for over-utilization and corrupting medical diagnosis." That is the main reason why, Medicare says, the money expended on imaging(CT and MRI) increased from $9.6 billion in 2003 to $13.7 billion in 2006.
In any event, Medicare is taking dead aim to joint ventures between doctors and hospitals and the shared investments and profits that ensue from MRIs, CTs, endoscopies, and outpatient and diagnostic surgery units.
To Medicare officials and their legal advisors, "pursuing the perfect" is preferable to "preserving the good" that could be achieved by realistic collaborative joint ventures.
From MEDINNOVATIONBLOG
I recall being approached some years back about a realistic collaborative joint venture that would have allowed me, a greedy trial lawyer, to partner with some doctor-investors in an MRI facility. The idea was that I and the docs could assure a steady stream of patients for diagnostic testing which would make the facility extremely profitable. I was told that this was being done all over the country. I passed on the opportunity because it had the odor of an illegal or unethical scheme to milk the government or insurance companies.
I don't know how many profit-mongering doctors ignored the odor and joint-ventured MRI facilities. But, I would suspect those who did uncovered a greater need for MRI studies in their practices. Not many investors are willing to sit idly by as their enterprise slowly dips into the red. Especially when all God's children could use an MRI now and then anyway.
Minnesota Doctor Maintains Impartiality Despite 350,000 Reasons To Favor Drug Companies
Category: Gaming The System
When the federal government is spending $28 Billion on drugs each year for Medicaid patients it only makes sense that drug companies would want to have really good friends on the state advisory panels who essentially select the drugs used. Slipping $350,000 here and $350,000 there into the pockets of select panel members for speaking engagements should do the trick, I would think. But, a Minnesota doc says the money don't buy any love. This will be disappointing to Big Pharma.
Minn. Law Sheds Light on Drug Companies
(AP) -- A groundbreaking Minnesota law is shining a rare light into the big money that drug companies spend on members of state advisory panels who help select which drugs are used in Medicaid programs for the poor and disabled.Those panels, most comprised of physicians, hold great sway over the $28 billion spent on drugs each year for Medicaid patients nationwide. But aside from Minnesota, only Vermont and Maine require drug companies to report payments to doctors for lectures, consulting, research and other services.
An Associated Press review of records in Minnesota found that a doctor and a pharmacist on the eight-member state panel simultaneously got big checks - more than $350,000 to one - from pharmaceutical companies for speaking about their products.
The two members said the money did not influence their work on the panel, and the lack of recorded votes in meeting minutes makes it difficult to track any link between the payments and policy.
But ethical experts said the Minnesota data raise questions about the possibility of similar financial ties between the pharmaceutical industry and advisers in other states.
The Hospital Sales Force - Admitting Doctors
Category: Gaming The System
When health care in America is viewed from the perspective of a particular hospital a purely capitalistic goal and driving purpose is revealed. Take a look at this just-released analysis of hospitals:
Physician Perspectives on American HospitalsThe 2007 Hospital Check-Up Report--Physician Perspectives on American Hospitals examines the experiences of more than 21,000 physicians at 224 hospitals across the nation in 2006. The report provides physician perspectives on hospitals across the country. In addition to the key role physicians play in providing care and making treatment decisions, physician admission and referral patterns drive the financial health of the hospital, making physicians critical to business operations as well.
In order to increase the growth of the hospital, administrators must convince low-admitting and low-referring physicians to utilize the hospital more frequently.
Press Ganey Associates, Inc.
What we have here, in the center of the health care delivery system that is already by far the most costly in the civilized world, is one of the most costly engines of that system being told the growth of the hospital is of primary importance. Worse, that doctors need to be conscripted into greater utilization of hospital beds and services.
Memo to hospital administrators: Why not just institute a contest to see which doctors in each specialty can admit the most patients in a month? Or, who can pack the operating room? That should do the trick (if the prize is a free trip to Aspen). Even low-admitting and low-referring physicians have to ski somewhere.
Thieves And Con-Artists Who Call Themselves Insurance Companies
Category: Gaming The System
Property insurers are a pretty despicable lot. That is the only conclusion to be drawn after reading the article at Bloomberg.com excerpted below. If you read the entire article the carriers just get even more despicable.
Home Insurers' Secret Tactics Cheat Fire Victims, Hike Profits
When there's a disaster, the companies homeowners count on to protect them from financial ruin routinely pay less than what policies promise.Insurers often pay 30-60 percent of the cost of rebuilding a damaged home -- even when carriers assure homeowners they're fully covered, thousands of complaints with state insurance departments and civil court cases show.
Paying out less to victims of catastrophes has helped produce record profits. In the past 12 years, insurance company net income has soared -- even in the wake of Hurricane Katrina, the worst natural disaster in U.S. history.
Property-casualty insurers, which cover damage to homes and cars, reported their highest-ever profit of $73 billion last year, up 49 percent from $49 billion in 2005, according to Highline Data LLC, a Cambridge, Massachusetts-based firm that compiles insurance industry data.
The 60 million U.S. homeowners who pay more than $50 billion a year in insurance premiums are often disappointed when they discover insurers won't pay the full cost of rebuilding their damaged or destroyed homes.
Property insurers systematically deny and reduce their policyholders' claims, according to court records in California, Florida, Illinois, Mississippi, New Hampshire and Tennessee.
The insurance companies routinely refuse to pay market prices for homes and replacement contents, they use computer programs to cut payouts, they change policy coverage with no clear explanation, they ignore or alter engineering reports, and they sometimes ask their adjusters to lie to customers, court records and interviews with former employees and state regulators show.
The industry's drive for profit has overwhelmed its obligation to policyholders, says California Lieutenant Governor John Garamendi, a Democrat. As California's insurance commissioner from 2002 to 2006, Garamendi imposed $18.4 million in fines against carriers for mistreating customers.
"There's a fundamental economic conflict between the customer and the company," he says. "That is, the company doesn't want to pay. The first commandment of insurance is, 'Thou shalt pay as little and as late as possible.'"
Insurance is intended to provide prompt and full compensation at the time of a covered loss. When insurance carriers decide it is in their best interests to cheat and delay, they cease to be insurance carriers and become, instead, thieves and con-artists.
Some Authors Are Tone Deaf On Conflicts Of Interest
Category: Gaming The System
You be the judge. Did these authors of a medical study have an undisclosed conflict of interest?
Experts' silence revs conflict of interest debate
CHICAGO - A new study showing that padded hip protectors didn't prevent fractures in the elderly has renewed questions about hidden drug industry ties to medical research.Three of the authors of the study on bone breaks didn't tell editors of an influential medical journal, which is publishing their research Wednesday, that they had consulted for or received research money from the makers of bone-strengthening drugs. That potential conflict was discovered by The Associated Press.
Editors of the Journal of the American Medical Association -- which has tough rules on financial disclosure -- had asked the authors about any conflicts and were told there were none. The researchers said later they didn't believe their industry connections were relevant because the study of hip fractures didn't involve bone drugs and didn't recommend them.
The non-disclosers might as well have taken out an ad in the New York Times declaring: (1) No matter what medical device you use to protect hips from fractures it ain't gonna work and (2) You better take bone-strengthening drugs.
It's Business At Usual At U.S. Supreme Court
Category: Gaming The System
Three cheers for the Roberts Court!!!
Small Business at the Court: A Review of the 2006-2007 Supreme Court Term
While the Rehnquist Court was generally receptive to business interests, the Roberts Court has been even better, if only because of its willingness to review a greater number of business-related cases. Experts estimate that at least half of the 2006-2007 docket included cases with a substantial business interest. The Court's pro-business approach will benefit businesses of all sizes, since the impact of many decisions...will be felt by small firms as well as corporate clients.From NFIB, The Voice of Small Business
It is reassuring to know that we have a Supreme Court with a pro-business approach. I mean it nicely balances the pro-business approach of President Bush and the entire executive branch. Thank God, we can look forward to the Roberts Court for many years. I wouldn't want businesses to suffer from neglect.
Drugs Oncologists Don't Administer Don't Get Prescribed
Category: Gaming The System
Some doctors hate competition and love money so much they don't even mention the possible use of the two most promising drugs in the treatment of Non-Hodgkin's lymphoma.
Market Forces Cited in Lymphoma Drugs' Disuse
Non-Hodgkin's lymphoma is the fifth most common cancer in the United States, with 60,000 new cases and almost 20,000 deaths a year. But fewer than 2,000 patients received Bexxar or Zevalin last year, only about 10 percent of those who are suitable candidates for the drugs."Both Zevalin and Bexxar are very good products," said Dr. Oliver W. Press, a professor at the University of Washington and chairman of the scientific advisory board of the Lymphoma Research Foundation. "It is astounding and disappointing" that they are used so little. The reasons that more patients don't get these drugs reflect the market-driven forces that can distort medical decisions, Dr. Press and other experts on lymphoma treatment say. A result can be high costs but not necessarily the best care.
The drugs have not been clinically proven to prolong survival, compared with other therapies. But patients are more likely to respond to them than standard treatments, and trials to test whether the drugs do have a survival benefit are nearly complete.
Other, more thoroughly tested lymphoma drugs are preferred as first-line treatments. But doctors often repeatedly prescribe such drugs even after they have lost their effectiveness -- and when Bexxar and Zevalin might work better.
One reason is that cancer doctors, or oncologists, have financial incentives to use drugs other than Bexxar and Zevalin, which they are not paid to administer. ["Because the drugs are radioactive, they must be administered in a hospital, not a doctor's office. Therefore, oncologists do not get paid for prescribing them, as they are when they give chemotherapy." From the Cancer Blog]
In addition, using either drug usually requires oncologists to coordinate treatment with academic hospitals, whom the doctors may view as competitors.
As a result, many doctors prescribe Bexxar and Zevalin only as a last resort, when they are unlikely to succeed because the cancer has advanced. "Oncologists use everything in their cupboard before they refer," Dr. Press said. "At least half the patients who get referred to me have had at least 10 courses of treatment." [I can only imagine the dollar bills vacuumed by the oncologist who can put a patient through 10 courses of chemotherapy.]
From the New York Times
Does the word unethical come to mind?
Binding Arbitration, The Video
Category: Gaming The System
Wearing my movie/video critic hat I have to give five stars to the six minute sales pitch for arbitration in medical malpractice claims provided to patients of a Florida medical clinic. The on-screen spokeswoman very calmly explains why binding arbitration is an all-around good deal. (It saves time and money.....) I mean, this woman could sell ice to Eskimos.
Watch video, sign away your rights..
Medical malpractice insurers have come up with a devious new way of preventing injured patients from suing their doctors, by forcing people to sign binding arbitration agreements as a condition of receiving treatment from doctors they cover. The latest in this wave comes from a clinic in Florida that has helpfully made this video that patients can watch at home before they sign an agreement promising not to sue for future or past malpractice.From the Tortellini
It may have been a tad more balanced if it had mentioned death could occur as a result of medical malpractice, and the surviving spouse was also restricted to binding arbitration. Or, if it had provided some statistics reflecting the average verdict range compared to the average arbitration award. Or, if it mentioned the arbitrators (at least one of them) would know the insurance coverage of the clinic was only $250,000 whereas a jury would not be informed of that prejudicial fact.
A Little Jury Music, Please
Category: Gaming The System
"Jury No. 3, are you tapping your feet?"
Murder juror 'listened to music under hijab'
A juror could face an unlimited jail sentence after she was arrested for allegedly listening to an MP3 player under her headscarf during a murder trial.The judge at London's Blackfriars Crown Court thought he heard "tinny music" during the testimony of a man who brutally beat his disabled wife to death.
The Muslim woman in her early twenties, who cannot be identified for legal reasons, had repeatedly tried to avoid jury service.
She was finally ordered to serve on the jury in the trial of pensioner Alan Wicks who was subsequently convicted of bludgeoning his wife to death after 50 years of marriage.
Problems started the next day with the first of a number of late arrivals at court, prompting Judge Roger Chapple to repeatedly ask her to change her ways.
The woman not only continued to be late, but left lawyers wondering whether she was "in a world of her own".
a member of the defence team thought she caught a glimpse of a wire under the woman's traditional Muslim hijab.
Finally, another woman juror sent the judge a note, which apparently confirmed his suspicions that the juror had been secretly listening to music instead of following the trial.
After further legal submissions, the Muslim juror was called into court on her own and informed of the allegation.
The judge warned that her behaviour, if proved, would not just give "cause for concern" but would amount to "contempt of court".
He also told her she would be arrested. A police officer then stepped forward and escorted her from court. Outside, she was searched and the MP3 player found and confiscated.
In the old days we only found booze and pornographic novels.
Secrecy Has Its Rewards, But Can We Afford Them?
Category: Gaming The System
We all know the pen is mightier than the sword. But, who knew the Top Secret stamp is mightier than the entire U.S. legal system?
Court supports Bush in wiretap suit
Because plaintiffs can't prove they were targets of the secret program, they can't sue, according to the federal appellate ruling.A federal appeals court on Friday handed the Bush administration a major victory, ruling that plaintiffs who had challenged its domestic spying program did not have legal standing to do so.
Judges Alice M. Batchelder and Julia Smith Gibbons of the 6th Circuit, both Republican appointees, said no single plaintiff could prove that he or she had been wiretapped and had therefore suffered harm -- the legal standing necessary to go to court.
Batchelder wrote: "The plaintiffs do not -- and because of the state secrets doctrine cannot -- produce any evidence that any of their communications have ever been intercepted by the NSA, under the TSP, without warrants." Rather, she said, the plaintiffs had asserted "a mere belief" that their overseas contacts were the types of people being targeted by the NSA.
The ruling presents "a Catch-22," said Larry Diamond, a senior fellow at the Hoover Institution at Stanford University and one of the plaintiffs.
"If the court insists that a plaintiff must have certain knowledge that some of their messages were intercepted in order to have legal standing ... then no one can ever have standing because we can never know, since the program is secret," Diamond said.
From the LA Times
If the domestic spying program is as successful, comprehensive and extensive as the government claims, shouldn't we simply assume that these plaintiff's have standing. After all, some of these plaintiffs need to communicate with likely targets -
ACLU lawyer Ann Beeson had asserted that her clients suffered "concrete harm" by having to forgo conversations with individuals who they reasonably believed might be the targets of government surveillance.
Or, is the real secret the program's failure to generate any productive (actionable?) intelligence?
The Meat Lobby Chops Off Your Right To Know
Category: Gaming The System
You have an excellent chance of knowing where the fish you are about to eat spent its last night in the sea. But, where your hamburger or lettuce comes from - that is another story. According to the New York Times the federal food labeling law, passed in 2002, is not being followed.
Labels Lack Food's Origin Despite Law
In every American supermarket, labels tell shoppers where their seafood came from. But there are no such labels for meat, produce or nuts.Behind the contradiction is a lesson in political power in Washington, where lobbyists and members of Congress have managed to hold off the enforcement of a five-year-old law that required country-of-origin labeling on meat and produce as well as fish.
Now, with Democrats in control of Congress and mounting questions about the safety of food imported from China, proponents of the labeling law say they believe that they finally have momentum on their side.
After all, they say, at a time when consumers are ever more concerned about where their food is coming from, why not just tell them on the package?
"No. 1, there's a basic consumer right to know," said Michael Hansen, senior scientist at Consumers Union, an advocacy group that publishes Consumer Reports magazine and supports the labeling law. "People are more and more concerned about the food they eat."
Should it take 5 years to type out the labels? Has Brownie been transferred from FEMA to the USDA?
...the labeling law has formidable foes, including the meat lobby, which so far has outmaneuvered its opponents on Capitol Hill. In the years since the labeling law was enacted as part of the 2002 Farm Bill, its opponents have successfully blocked all but seafood labeling from taking effect.
We need the meat lobby to take on Congressional earmarks. These guys know how to swing a cleaver.
Why Drug Reps Never Need An Appointment At Your Doctor's Office
Category: Gaming The System
We now know why Americans pay the highest drug prices in the world. Drug companies have to funnel $19 Billion a year back to our doctors to keep the prescriptions flowing.
Senate Special Committee on Aging Chairman Herb Kohl (D-WI) held a hearing to examine the pharmaceutical industry's costly practice of providing payments and gifts to doctors, and to consider what kind of influence this wields over some of our nation's physicians. It is estimated that drug companies spend 19 billion dollars annually on doctors in the form of lecture honoraria and conference registration fees, research grants, trips, meals, drug samples, and other freebies. A study published in the New England Journal of Medicine earlier this year reported that 94 percent of physicians have received such gifts and payments from drug companies."The financial ties between doctors and drug companies are only deepening," said Chairman Kohl. "These gifts and payments can compromise physicians' medical judgment by putting their financial interest ahead of the welfare of their patients."
The pharmaceutical industry remains one of the most profitable industries in the world, returning more than 15 percent on investments. At the same time, Americans pay the highest drug prices in the world, forcing some employers to drop health coverage for employees, squeezing the budgets of state and federal government, and ultimately harming senior citizens by putting drug costs out of their reach.
The solution to our national healthcare crisis might be as simple as allowing the drug companies to employ all the doctors. That would save the bribe money.
Is Your Doctor A Factory Owner?
Category: Gaming The System
Doctor to Patient: "We need to schedule you for an operation on Friday at my little specialty hospital down the road."
Patient to Doctor: "Could I just pay you the $$$$ and avoid the surgery entirely?"
Healthcare Economist has the aptly named article:
The popularity of specialty medical facilities (SMF) has increased over the years. The number of Medicare-certified ambulatory surgery centers (ASCs) has doubled to 3,371 during the past decade. A question remains: are these "Focused Factories" good for society?According to the Community Tracking Study, most specialty hospitals are either "heart hospitals" or hospitals specializing in orthopedic surgery. They are generally joint ventures between physicians and national specialty firms or local hospitals, but a few are wholly owned by either physicians or by local hospitals.
Another issue is whether SMFs create incentives for excess medical care. This is related to the problem of integrating the diagnostician of a problem and the treater of a problem (see 10 April 2007 post). If physicians own the SMFs, there may be an even larger incentive for them to recommend that their patients have invasive medical procedures since the physicians themselves often will profit not only from the labor compensation they will receive from performing the procedure, but will receive additional income as return on capital from their investment in the SMF. Even physicians who do not treat patients and only diagnose them will have an incentive to recommend surgeries if they own a share of the SMF where the surgery would be preformed.
Think of speciality hospitals as factories whose owners control the demand for the product. Memo to physician-owners: We need four more operations on Friday to fill the available suites. See what you can drum up.
Are They Shooting Heart Attack Patients At Seven U.S. Hospitals?
Category: Gaming The System
I remember the bell-shaped curves that were used to grade just about every test I ever took in my undergraduate work. According to some dictionaries a bell curve is supposed to be a symmetrical curve representing the normal distribution. All I can say is that I know one when I see it.
An editorial in today's New York Times describes a very special bell-shaped curve manufactured by Medicare to keep the public in the dark concerning hospital mortality rates for cardiac patients. Something is suspicious about a rating system that declares 98% of approximately 4,500 hospitals are average. This is not your average bell-shaped curve.
(Sort of) Rating Hospitals
The federal government deserves a modest pat on the back for identifying hospitals that have the very best -- and very worst -- mortality rates for cardiac patients. One can only hope that the information will goad underachieving hospitals into improving their performance. Unfortunately, the ratings are too broad to help most patients decide which institution they can entrust with their lives.The new ratings -- based on how many Medicare patients die within 30 days of being admitted for a heart attack or heart failure -- were published by federal Medicare officials last week as part of a growing movement to provide more information to medical consumers and to hold hospitals accountable for the quality of care they deliver.
While the hospitals were told how they scored and were given data allowing them to compare their performance with other institutions, the public is being kept mostly in the dark. No mortality numbers for any institution were published. The hospitals instead were lumped into three broad categories -- "better than the national rate," "worse than the national rate" and "no different than the national rate" -- with more than 98 percent placed into the vast middle category.
Of nearly 4,500 hospitals evaluated for heart attack outcomes, 17 were rated better than the national rate, 7 were rated worse and 4,453 were placed in the middle category. Of some 4,800 hospitals evaluated for heart failure outcomes, 38 were better than the national average, 35 were worse and 4,734 were rated no different than the national average.
Think about the absurdity (and the dishonesty) in saying only 7 hospitals out of approximately 4,500 are below average. They must shoot the heart attack patients at these institutions.
Is "Incomplete" The Same As "False" Or "Dishonest"?
Category: Gaming The System
"Senators, before I begin my testimony today I would like to seek permission to revise and extend my remarks because I believe my testimony, in keeping with the Bush Administration's procedure, will be incomplete."
Deputy AG Says His Testimony Was 'Incomplete'
All Things Considered, June 21, 2007 · Deputy Attorney General Paul McNulty told the House Judiciary Committee on Thursday that he never intended to mislead Congress about the firings of several federal prosecutors last year. But he acknowledged that his earlier testimony to Congress was "incomplete."The committee is investigating charges that, under the leadership of Attorney General Alberto Gonzales, the Justice Department increasingly has been used to serve political ends.
The Locality Rule In Medical Malpractice Cases - Never Intended To Produce Justice
Category: Gaming The System
A commentary in the Journal of the American Medical Association discusses the absurdity of the Locality Rule in determining the standard of care in medical malpractice cases. This is an absurdity which persists purely for the benefit of the medical profession and to the disadvantage of a victim of malpractice.
Standard of Care Remains a Moving Target in Medical Malpractice Cases
Courts in 21 states adhere to a local or community standard of care in medical malpractice cases, slowing implementation of evidence-based, resource-based, nationwide standards.So said Michelle Huckaby Lewis, M.D., J.D., of Johns Hopkins and Georgetown University, and colleagues in a commentary in the June 20 issue of the Journal of the American Medical Association.
The locality rule was a 19th century concept intended to protect rural physicians from being held to the same standards as physicians working in urban areas or at academic institutions, the authors said.
But, they note, modern communication has removed barriers to standardization -- no place is more than a phone call or a mouse click away from the latest evidence-based findings.
As a result, a rule originally intended as a protection now "imposes additional duties and legal risk on physicians. Not only must they remain aware of advances in their own specialty, physicians must also be aware of the standard of care in their locality, whether or not that standard is considered substandard at the national level," the authors wrote.
Dr. Lewis and colleagues contend that the locality rule is also ethically suspect. In the communities that use it, "basic principles of justice may not be met for patients who have been harmed as the result of suboptimal local care standards," they wrote.
That's because patients may be unable to find expert witnesses who'll establish what the standard of care is in that locality -- either because there are too few physicians in the area in that specialty, or the local physicians will be unwilling to testify against one of their own. [BINGO!]
Friends In High Places (a.k.a. Supreme Court Justices) Should Serve Scooter Well
Category: Gaming The System
Maybe the Scooter Libby case should have been tried before the Supreme Court in the first place. Based on the Bush v. Gore decision I think Scooter would have received a Medal of Honor.
Libby in Court to Try to Stall Sentence
WASHINGTON (AP) -- Former White House aide I. Lewis "Scooter" Libby is headed back to court to try to forestall his 2 1/2-year prison term in the CIA leak case.Libby, the former chief of staff to Vice President Dick Cheney, planned to ask a federal judge Thursday to put the sentence on hold while he appeals his perjury and obstruction conviction.
If they lose Thursday, Libby's lawyers have said they will ask an appeals court for an emergency order delaying the sentence. Because one of the issues in the appeal is whether Special Prosecutor Patrick Fitzgerald had the authority to charge Libby, defense lawyers also could ask the Supreme Court to step in.
Eli Lilly Survey Says Drug Product Litigation Is Bad For Patients
Category: Gaming The System
Drug manufacturer Eli Lilly has funded a survey of psychiatrists. Surprise! The survey shows that personal injury lawyers, via their advertisements and drug product litigation, may be putting patients at risk for relapse.
Survey results released today shed light on a new barrier to treatment affecting people with severe mental illness. The findings show fears raised by product liability litigation involving antipsychotic drugs may be putting patients with schizophrenia and bipolar disorder at risk for relapse.The survey, which was conducted among 402 psychiatrists who treat patients with schizophrenia and bipolar disorder, showed that, even when patients were responding well to their prescribed antipsychotic treatment, many requested a medication change because these drugs are featured in law firm advertisements. Other patients stopped taking their medication, often without telling their psychiatrist, for the same reason.
Dr. Ralph Aquila, assistant clinical professor of psychiatry, Columbia College of Physicians and Surgeons; director, residential community services, St Luke's-Roosevelt Hospital Center, New York, NY: "This irresponsible advertising is hindering the progress of therapy for many of these patients and disrupting the important relationship between them and their healthcare providers. Plaintiffs attorneys need to consider the consequences that these advertisements may have on patients."
The findings from this survey, which was commissioned by the National Council for Community Behavioral Healthcare and Eli Lilly and Company, are consistent with a Harris Interactive(R) poll of 250 physicians commissioned by the U.S. Chamber of Commerce in 2003(i) that examined how pharmaceutical litigation impacts prescribing decisions across disease states.
More than half (55%) of surveyed psychiatrists indicated that they had changed their prescribing practices over the last five years due to product liability cases involving antipsychotic medications [have the remaining 45% of psychiatrists decided ignorance is bliss?]- and reported frustration and concern that this type of litigation sometimes interferes with patient treatment. Furthermore, many psychiatrists (62%) reported that they know of colleagues who have made similar changes in their prescribing practices.
This survey was conducted by independent market research company Ipsos- Insight and commissioned by the National Council for Community Behavioral Healthcare and Lilly. The survey was funded by Lilly.
My self-funded survey of victims of defective drugs finds they believe the drugs hindered the progress of therapy (to borrow a phrase from Dr. Ralph Aquila above). Of course, my researchers were unable to speak with those who died as a result of taking defective drugs.
"No Drug Left Behind" Is The Policy Of Physician CME
Category: Gaming The System
The chore of teaching doctors how to practice medicine has been handed to the pharmaceutical industry. As a result, dangerous side effects are rarely on the curriculum.
With these words from the Op-Ed page of the New York Times we better understand why No Drug Left Behind is the prevailing policy of the medical profession. Even stinko drugs that kill and injure thousands are praised and touted by docs to docs.
Here is how it works:
Diagnosis: Conflict of Interest
Most states require that doctors obtain a minimum number of credit hours of continuing medical education each year to maintain their medical licenses. Not so long ago, most of these courses were produced and paid for by universities and medical associations. But this has changed drastically over the past decade.According to the most recent data available from the national organization in charge of accrediting the courses, drug-industry financing of continuing medical education has nearly quadrupled since 1998, from $302 million to $1.12 billion. Half of all continuing medical education courses in the United States are now paid for by drug companies, up from a third a decade ago. Because pharmaceutical companies now set much of the agenda for what doctors learn about drugs, crucial information about potential drug dangers is played down, to the detriment of patient care.
Education that doubles as advertising for drug companies occurs in all branches of medicine.
Drug companies don't directly pay doctors to teach courses. Instead, they pay someone else to cut the checks. Similarly, the drug companies don't explicitly tell doctors to say good things about their products. Instead, they hire a company to write good things about their products and to pay doctors to deliver the messages.
These shenanigans were recently spotlighted by Senator Max Baucus, Democrat of Montana, and Senator Charles Grassley, Republican of Iowa, of the Senate Finance Committee. In April, their committee released a report, two years in the making, concluding that drug companies have used educational grants unethically as a way of marketing their products.
Oncologists Keep Their Eye On Profits
Category: Gaming The System
Are oncologists uniquely focused on maximizing profits within the medical profession? Are they the only specialty which is willing to provide meaningless and expensive care to dying patients?
Chemotherapy: profits vs. questionable benefits to patients
A