Unhealthy Care

I found some newspaper items this morning that provide a good follow up to the “Demand Supply” post from last week. The first is from an editorial in today’s Atlanta Constitution:

After two decades of steady improvement, the death rate for Georgia babies could soon be on its way up again. While neonatologists in specialized nurseries have achieved remarkable success at saving the lives of medically fragile infants, the rate of babies born too soon to Georgia mothers has been slowly rising since 1994. These babies are at a much higher risk of death in their first 12 months of life.

More ominously, the percentage of Georgia women getting adequate and early prenatal care has actually declined since 1999. Experts believe the lack of prenatal care, as well as chronic conditions such as diabetes and obesity that are more prominent in young mothers today than a generation ago, will result in higher infant mortality rates in the years to come, as has already happened in Mississippi and several other southern states.

If Georgia could achieve the U.S. average in infant mortality, the lives of approximately 220 babies would be saved each year. As it is now, approximately 1,100 Georgia babies don’t make it. Merely approaching the U.S. average will require much more intensive, targeted public health nursing in communities where teenage pregnancy rates and births to unwed mothers remain exceptionally high. That intense approach occurs now in only a handful of Georgia counties.

The price of such early intervention is small compared to the high cost of caring for premature babies, which can reach $4,000 to $5,000 a day in neonatal units and often extends well beyond the nursery in treatment for chronic lung problems, cerebral palsy and other conditions.

This illustrates nicely why our health care “system” is, essentially, screwy. The U.S. health care industry is driven by profit. On the whole we do a bang-up job at creating and marketing innovative health care products that make somebody a lot of money. But we neglect those functions that are not profitable. Thus, many U.S. hospitals have sparkling state-of-the-art intensive care units for newborns with all the equipment, medicines, bells and whistles one might want. Babies born with health problems get excellent care in them. It’s also very expensive care, and somebody makes a nice profit from selling the equipment, medicines, bells and whistles to hospitals.

But there’s no profit to be made from providing basic prenatal care to poor, uninsured women, so on the whole we’re not doing that well at all. When compared to babies born in other industrialized nations, U.S. babies come into the world with a higher rate of health complications, which results in infant mortality rates that are higher than they should be, in spite of our superior intensive care gizmos.

I want to add that you absolutely cannot explain this problem to a rightie. The usual excuse for our infant mortality problem is that in U.S. physicians count some hopelessly compromised infants as “live births” that would be considered “stillbirths” in other countries, even though they might live for a very brief time. Stillbirths are not counted in infant mortality rate, which is calculated from the number of babies born in a nation that die before their first birthdays. Thus, righties argue, our high infant mortality rates are just a statistical illusion. This Wikipedia article discusses the issue.

On the other hand, as Ampersand documents here, if you factor in stillbirths — thus wiping out the discrepancies — the U.S. still doesn’t compare well. So much for the statistical illusion.

And if you see the huge differences in infant mortality rates among states and populations within the United States, I can’t see how anyone can claim there isn’t a problem. But righties are wondrous creatures who can not see any problem if it might require a tax increase to fix it.

See also this editorial in today’s New York Times

The explosion in the use of three anti-anemia drugs to treat cancer and kidney patients illustrates much that is wrong in the American pharmaceutical marketplace. Thanks to big payoffs to doctors, and reckless promotional ads permitted by lax regulators, the drugs have reached blockbuster status. Now we learn that the dosage levels routinely injected or given intravenously in doctors’ offices and dialysis centers may be harmful to patients.

As Alex Berenson and Andrew Pollack laid bare in The Times on May 9, wide use of the medicines — Aranesp and Epogen, from Amgen; and Procrit, from Johnson & Johnson — has been propelled by the two companies paying out hundreds of millions of dollars in so-called rebates. Doctors typically buy the drugs from the companies, get reimbursed for much of the cost by Medicare and private insurers, and on top of that get these rebates based on the amount they have purchased.

Although many doctors complain that they barely break even or even lose money on the costly drugs, for high-volume providers the profits can be substantial. One group of six cancer doctors in the Pacific Northwest earned a profit of about $1.8 million last year thanks to rebates from Amgen, while a large chain of dialysis centers gets an estimated 25 percent of its revenue, and a higher percentage of its profits, from the anemia drugs. It seems likely that these financial incentives have led to wider use and the prescribing of higher doses than medically desirable.

You might have seen the television ads in which people declare “I’m ready to start my chemotherapy!” I think those are for Procrit, but I’m not sure. Expensive ad campaigns for prescription drugs have always struck me as weird, but if they didn’t drive up demand for prescription drugs I’m sure the pharmaceutical companies would stop the ads.

Finally, here is an article that refutes the claim that American cancer patients survive at higher rates because they get advanced drugs that are not available elsewhere.

The clinical reality for metastatic colorectal cancer is that the FDA-approved combination regimen of IFL (irinotecan, bolus fluorouracil, and leucovorin) plus Avastin increases median overall survival by 4.7 months. This small increase comes with a host of side effects, which impinge upon quality of life, as well as placing a burden on the patient and the healthcare system.

While this small increase is hailed by the FDA as being impressive, the clinical reality is that there is no cure for metastatic colorectal cancer. The much-vaunted blockbuster drug Avastin is simply an antibody supplement incorporated into an already complex chemotherapeutic drug regimen that may slow down the cancer process depending on the genetic constitution of that individual. The cost of drugs for metastatic colorectal cancer alone would exceed $1.5 billion per year if all the patients in the U.S. received treatment.

The clinical reality for metastatic breast cancer is similar. The latest treatment with Herceptin followed by lapatinib and capecitabine only increased the median time to progression from 4.4 to 8.4 months. Furthermore, 70% of patients do not respond to Herceptin, and resistance develops in virtually all patients.

Of these two big killers, both remain incurable, and this sobering fact contrasts with the glowing reports on Avastin and Herceptin emanating from the financial and tabloid media.

The authors (George L. Gabor Miklos, Ph.D., Phillip J. Baird, M.D., Ph.D.) also say,

It’s easy to tell when an area has run out of ideas. The hype becomes extreme, and technology substitutes for brainpower. The cancer research area has reached this sorry state. The tiniest increase in the survival time of drug-treated cancer patients or median time to progression is touted as a cure, and wildly unrealistic claims about personalized cancer medicine emanate from the highest governmental and academic sources. …

…Is the future of cancer medicine one in which doctors become financial advisors, telling their patients whether they can or cannot afford expensive treatments of dubious survival value?

Although the authors don’t say this explicitly, I infer that cancer research itself is being driven by the desire for new money-making products rather than by science or even the well-being of patients.

6 thoughts on “Unhealthy Care

  1. There is so much that could be said on this subject. I am looking forward to Michael Moore’s “Sicko” (out end of June) to blow the lid on it, in a big way.

    A few datapoints:

    An optometrist told me about a recent treatment for wet-type macular degeneration, which involves injecting a substance – a byproduct of cancer therapy – into a patient’s eye. The treatment is cheap and effective, about $50 a shot, but is not yet FDA approved. He said that a pharmaceutical company found a way to twist the molecules of the subtance in question, in such a way that the resulting compound was still effective and now patentable. It’s also FDA approved, at $1000 a shot. Most doctors won’t touch any treatment that isn’t FDA approved.

    I live down the road from Amgen, a major pharamceutical company. It is one of the most desirable places in the area to work at, and they get thousands of resumes a month. They have something like 50 buildings on their campus, and one hears stories of a no-expenses-spared approach to their research. Buildings are razed to the ground and rebuilt if they were put up wrong or don’t meet specs. There are many Amgen millionaires where I live – even janitors or low level people – who were lucky enough to catch the explosion in pharamceutical stocks early.

    I just read today on DailyKos about how:

    “Medical tourism is now being touted on the corporate web site of the Blue Shield Association and at least one Blue Cross plan (BlueCross BlueShield of South Carolina and BlueChoice® HealthPlan of South Carolina)…”

    “Now this makes good sense, this is smart. You go to say Thailand, India or Singapore for major surgery, then when you return to the United States, the Third World of healthcare, you may need some additional care, so who better to help than the for-profit insurance industry. They see money in medical tourism.”

    You mention that righties will deny everything, unless it involves tax cuts, which isn’t exactly true. They’ll deny everything until they personally are suffering. Until that time, you keep away from their tax monies.

  2. My sister-in- law had lasic surgery done in Colombia. The cost of the surgery, the air fare, and accommodations was less money than having the procedure done here in the United States..She claimed, and I believe, that there was nothing second rate in quality and care.

  3. The weird thing about oncology (cancer treatment) as I understand it is that oncologists, alone among physicians, can make a profit on the drugs they prescribe. And yes, this creates all the unhelpful incentives that you’d expect.

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