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Feds Seek to Change Drugmakers' Practices With Pfizer Settlement

Greg Webb — Sun, 13 Sep 2009 14:41:06 GMT

A record $2.3 billion settlement with Pfizer has reinforced the Obama administration’s stance on health-care fraud. Recently, “Pfizer unit Pharmacia & Upjohn pleaded guilty to a single felony charge that accused the company of marketing its anti-inflammatory drug Bextra for broader uses and higher dosages than those approved by the Food and Drug Administration.”

The investigation of Pfizer began four years ago when corporate insiders began to question the marketing practices that were being employed by the company in order to turn a profit. The methods used by Pfizer meant that employees were expected to “increase profits at all costs, even when sales meant endangering lives,” said John Kopchinksi, a Pfizer salesman from Florida. It was a group of employees, including Kopchinski, who called attention to the company’s illegal activity, which included bribing doctors into prescribing Bextra for conditions that it was not designed for, “[creating] sham requests for medical information as an excuse to send unsolicited advertising materials to physicians,” as well as writing articles to promote their product without disclosing the fact that they had a hand in preparing the promotional materials.

Pharmacia and Upjohn will pay $1.3 billion in fines and forfeiture and an additional $1 billion to state and federal authorities to “resolve civil allegations of improper marketing over Bextra and three more drugs,” with the former payment being the largest criminal penalty ever imposed in the U.S., according to prosecutors. The other drugs in question were: “Geodon, an antipsychotic medicine; Zyvox, an antibiotic; and Lyrica, an epilepsy medicine.”

The Pfizer settlement is one step in a long-term goal, with federal agencies more focused than ever on targeting and taking action against wrongdoing drugmakers in the health-care industry. In addition to the Pfizer settlement, the “task force” deployed by the Justice and Health and Human Services departments have been issuing indictments on smaller companies over the past several months for “[bilking] Medicare and Medicaid out of hundreds of millions of dollars through schemes involving wheelchairs, medical equipment and costly HIV/AIDS treatments.” With the Pfizer settlement, “the Justice Department’s civil division…has pledged to devote more attention to whistleblowers at drug companies and insurance firms who flag improper payments and marketing schemes.”

According to the acting U.S. attorney in Massachusetts, Mike Loucks, Pfizer, the world’s largest drugmaker, “has entered into four settlements with the Justice Department over the last decade.” With Bextra being voluntarily removed from the market in 2005 over its role in “strokes, heart attacks and blood clots in the lungs,” Health and Human services Secretary Kathleen Sebelius said scrutiny on the company will be heightened.

Despite the settlement, concerns grow that it will not be enough to sway drug companies from their “bad behavior.” With the pharmaceutical industry being one of the most profitable in the country (raking in close to $50 billion last year), Sidney Wolfe, director of Public Citizen’s Health Research Group notes: “The ever-escalating fines are unlikely to stop drug companies from continuing to bribe doctors because they represent just a fraction of drug company profits and no one has gone to jail.”

Originally posted at InjuryBoard by Greg Webb

Family Medicine Doctor Numbers Declining

Greg Webb — Tue, 01 Sep 2009 17:40:44 GMT

In recent years, there has been a decline in the number of medical students who want to pursue family medicine, though many say it is the frontline for wellness and preventive-care programs that can help reduce healthcare costs. According to the American Academy of Family Physicians (AAFP), the number of U.S. medical students going into primary care, which includes family physicians, general internists and general pediatricians, has dropped 51.8% since 1997. Medical specialists have cited the decline to such factors as longer days, lower wages, less prestige and less administrative headaches. Some experts believe the biggest problem is the payment model because the more procedures a doctor performs, the more money he or she makes. This encourages medical students to pursue a procedure-based specialty as opposed to a primary-care track.

Because it takes about ten to eleven years to educate doctors, health-care experts are worried that the decline will cause a shortage of 40,000 family physicians in 2020 when the demand is expected to spike. Eleven of the top conventional medical schools in the U.S., including Johns Hopkins and Harvard, do not even have a separate family-medicine department. Finding a doctor will become increasingly difficult; there will be longer waits in the waiting rooms and more people will turn to the emergency rooms to get help because the waves of patients will be enormous. When patients visit the doctor’s office, they may also see a nurse practitioner or physician’s assistant instead of the doctor due to the increasing demand. This practice of involving nurse practitioners and physician’s assistants in care is already in place to alleviate physicians from time-consuming tasks in order to focus on the continuity of quality care.

While the U.S. healthcare system has about 100,000 family physicians, it will need 139,531 in ten years; the current environment is only attracting half the number needed to meet the demand. At the heart of the rising demand for primary-care physicians is not only the current group of underserved patients, but the baby boomer generation also, born from 1946 to 1964. This generation will be turning sixty-five in 2011 and will need increasing medical care. If Congress passes healthcare legislation that extends coverage to a significant part of the forty-seven million that do not have insurance, the number of people requiring care will continue to escalate.

In March 2009, U.S. medical school graduates only filled forty-two percent (1,083) of the 2,555 resident positions for family medicine. More than two hundred positions were left unfilled nationwide. More than half of the other spots were filled by non-U.S. students educated internationally, U.S. citizens educated internationally and graduates of colleges of osteopathic medical schools, though graduates of international medical schools and osteopathic medical schools seem to be losing interest in primary care also. This presents the problem of some foreign students with poor English skills not being able to communicate well with their patients.

Members of Congress have taken notice of the potential “crisis” associated with the lack of primary care physicians and have begun looking into bills that could help doctors who choose primary care with loan forgiveness or other debt relief and payment increases for their services.

Originally posted at InjuryBoard by Greg Webb

Former Insurance Executive Outs Insurance Companies in Healthcare Debate

Greg Webb — Wed, 19 Aug 2009 21:34:28 GMT

Wendell Potter, the former head of communications for health insurance giant Cigna, understands why many people across the country are showing up to town hall meetings extremely upset when members of Congress try to explain why the government needs to expand its role in the health care system. He admits to having many conservative friends who are worried about a government takeover of healthcare. Both the people in the town hall meetings and Potter’s conservative friends have the same ideology: the less government control in our lives, the better. Potter further illustrates his point by providing the example of a man standing in line to get free healthcare at Remote Area Medical’s recent health care endeavor at the fairgrounds in Wise County, Virginia. Although the man knew firsthand the desperation many Americans feel every day for affordable health care, he told reporters he was dead set against President Obama’s health care reform proposal because he was worried about the increase in taxes; he would rather wait in a long line to see volunteer doctors in animal stalls than pay more taxes. Potter does, however, feel that there needs to be reform in order to ensure the safety and prosperity of the American people and wants the American public to realize that a lot of the information against Obama’s healthcare reforms was started by the healthcare industry itself.

In a recent press conference, which was later reported about on the radio, Potter claimed insurance companies funded many of the protestors against President Obama’s healthcare plan. What the radio report failed to include, however, was how health insurance companies and their public relations team influence everyone’s opinions without us even knowing it; after all, before Potter quit his job last year he was one of the leaders of this PR army. It was Potter’s job to “promote and defend” the company’s reputation by trying to persuade journalists to write positive stories about the industry’s reform ideas. During the last few years of his career, however, Potter became concerned about the American people. He was scared the high deductible plans insurers were now pushing would force more and more people into bankruptcy; he also saw how the insurance companies would drop people after they became sick in order to increase profits and reward Wall Street investors. In response, Potter decided he could not be an industry mouthpiece and kill much needed reform, so he quit.

Potter further explains how the healthcare industry funnels millions of its policyholder premiums to PR firms. In return, the firms will use their close connections with the conservative media in order to scare people away from industry reform. He wants to inform Americans that the healthcare horror stories, such as Canadians waiting in lines for hours to see doctors, is part of a script written by the insurance industry; the industry has been using these scare-tactics since they campaigned to kill President Clinton’s reform plan. Potter says the “death panel” rumor is a prime example of the health care industry sponsored rumors. Potter concludes his commentary by saying that whenever you hear someone warning against a “government takeover” of healthcare, or that the healthcare reform is down a “slippery slope to toward socialism,” know that one of his former colleagues wrote those terms.

Originally posted at InjuryBoard by Greg Webb

Many College Athletes Have Insufficient Health Insurance

Greg Webb — Sun, 26 Jul 2009 19:58:05 GMT

In 2005, the National College Athletic Association (NCAA) began requiring universities guarantee their athletes have adequate health insurance due to many years of concerns that college athletes had insufficient health coverage. The association did not, however, establish clear standards for this coverage, which allowed colleges to decide for themselves what was adequate. Although some colleges assume almost all medical expenses, many others accept almost none. In order to turn this problem around, the National College Player’s Association is lobbying for legislation to protect college athletes; the Association believes the NCAA is too focused on doing “right” by the schools themselves, not the players.

Many people claim medical insurance should be required as a cost of having an athletic program. Middlebury College, for instance, ensures all of their varsity athletes and students in club sports have accident insurance paid for by the college. Spalding College pays for secondary coverage for their athletes, pointing out the fact that student athletes represent the school and insurance is ethically the right thing to do. Large universities such as Michigan State and the University of Iowa also give their athletes comprehensive medical insurance.

Many athletes are unfortunately not this lucky. While the colleges that do not insure their athletes claim they go out of their way to inform athletes about their limits of insurance, many students and their parents still find themselves in horrible situations, having to shoulder large and expensive medical bills. An athlete from Colgate University, for example, piled up about $80,000 in medical expenses after injuring her back and legs while in training with the crew team; insurance only covered about a third of the expenses because of the way her condition was diagnosed, a sickness as opposed to an injury. Also, because many students are insured by their parents, the plan they are under excludes varsity sport injuries, limits out-of-state treatment or does not cover the entire bill. Some colleges buy secondary plans to fill in these gaps, however, these plans have holes as well. Additionally, only players that are hurt enough to require extensive care can turn to the NCAA for coverage; its catastrophic insurance deductible is currently $75,000, but will change to $90,000 next year.

Another problem with health insurance for athletes is how difficult it is to attribute every symptom to a sports injury that the plan will cover and a virus that the plan will not cover; there is an ambiguity in paying for care and treating an athlete who has more than one health concern. Sustaining an injury while sick would be a bad situation, and in the case of an athlete having a disease intermingled with an injury, it is unclear where one stops and the other begins. Within a single state university system, such as the University of Wisconsin, health coverage can vary widely. While at the university’s main campus at Madison, all varsity athletes fall under secondary sports coverage, at the university’s Division III campuses, only treatment for minor sports injuries that can be fixed in the training room is covered. Because it would be too expensive for universities to insure all athletes in the current economic times, it is unlikely the NCAA will require they provide more insurance anytime soon. Many believe health-care reform is the only answer.

Originally posted at InjuryBoard by Greg Webb

Report Says Children’s Products Contain Dangerous Chemicals

Greg Webb — Mon, 08 Jun 2009 08:00:00 GMT

A March publication from the Campaign for Safe Cosmetics reported finding formaldehyde and 1,4-dioxane, a trace contaminant of chemicals used in cosmetic products, in 55 children’s personal-care products. The Environmental Protection Agency lists these chemicals as probable human carcinogens. Seventeen of the products contained both chemicals, including Johnson & Johnson’s Baby Shampoo.

The same month, New York Senator Kirsten Gillibrand announced the “Safe Baby Products Act,” which asks the FDA to investigate chemicals used in children’s toiletries. She expressed concerns as a mother because many of the products listed in the report were products that she kept in her bathroom.

The editor of Stats.org, Trevor Butterworth, conveyed reservations about the implications of the report. Butterworth said that people are exposed to similarly low levels of these chemicals every day in food, air, and shower water, and that studies linking them to cancer are based on ingesting or inhaling large quantities of the chemicals in industrial or lab settings.

A statement from Johnson & Johnson said that all of their products meet or exceed requirements in every country in which they are sold.

Originally posted at InjuryBoard by Greg Webb

MRSA Infections Typically Caught In Hospitals, Killing 18,000 People Each Year

Greg Webb — Tue, 09 Dec 2008 08:00:00 GMT

MRSA infections kill more than 18,000 people a year, and six out of seven people infected with the antibiotic-resistant germ contract it at a health care facility. The germ, methicillin-resistant Staphylococcus aureus, spreads by touch or contact, and can enter breaks in the skin as small as a mosquito bite. It can cause painful and treatable skin lesions or slip into the blood; one percent of infections are fatal, and many others result in crippling injuries.

MRSA is typically carried on the skin. Researchers have previously estimated that 1 to 2 percent of the population carries the germ, but Washington hospitals that instituted selective screening found that up to 11 percent of people carried the germ on their skin.

Last fall, the Centers for Disease Control and Prevention announced the astonishing number of deaths caused by MRSA each year. In the past ten years in Washington, hospital patients infected with MRSA jumped from 141 per year to 4,723. However, the hospitals don’t track the germ or infected patients, nor do they have to reveal infection rates. The Seattle Times analyzed documents, including hospital records and death certificates, and found 672 previously unreported deaths caused by MRSA.

Screening for MRSA is quick and painless, only costing about $20, but no community hospital in Washington screens every patient for the germ. Federal veterans’ hospitals screen all patients, and have reduced their cases to almost zero. But the Washington hospitals claim that testing is unnecessary, and that washing hands and wearing protective garments is enough to prevent MRSA from spreading. However, the hospitals claiming these infection control measures are enough are failing to use them, even when state and federal inspectors are around. State records show that seven staff members at one hospital were cited for violating basic infection-control standards during a four-day inspection in 2007, even after advanced notice of the inspection. In fact, most of the state’s 25 largest hospitals have been cited for unsanitary conditions or failure to adhere to fundamental safety standards, according to state and federal regulatory reports dating back to 2005.

In Washington, there are no state or federal mandates for screening patients for MRSA. While cardiac patients, critically ill patients, and patients with weakened immune systems are among the most vulnerable to infections, there is no set screening policy among hospitals. One hospital may test intensive-care unit patients but not those having elective surgery, while another tests patients having elective surgery but not patients in its ICU. The Seattle Times found that in Washington’s 25 largest hospitals, most patients don’t get tested. Those who oppose testing all patients argue that hospitals lack the staff, resources, and space for testing or isolation of patients with MRSA. In addition, they say screening could result in lawsuits where patients picked up MRSA in the hospital after a negative screening upon admission.

The number of deaths caused by MRSA is unknown because of missing information in public health records. When filling out death certificate forms in Washington, physicians are asked to state not only the primary cause of death, but also the chain of events contributing to death. The Seattle Times found multiple instances where an autopsy or medical record showed MRSA, but the death certificate omitted it completely. In addition, an old database of death certificates released by the Washington Department of Health excluded information regarding doctors’ notes, and used an international standardized coding system with more than 13,000 diagnosis codes, none of which are for MRSA. The Seattle Times requested a complete database this year, and found 672 deaths linked to MRSA from 2003 to 2006; the old database did not link any deaths to MRSA.

Nationally, exact numbers of deaths attributed to MRSA are also unavailable, leading to the question Chuck Velte, whose mother died from MRSA, asked: “How many people die of MRSA and nobody ever knows?”

Originally posted at InjuryBoard by Greg Webb

Employees Seeing Fewer Employer-Sponsored Health Care Plan Options

Greg Webb — Tue, 02 Dec 2008 08:00:00 GMT

Many employers are doing away with health benefits, and even those that still offer them are cutting back the options. If an employer does offer benefits, the options are likely limited to plans with high annual deductibles of at least $1,100 for individuals and much higher for families. Conventional plans typically have annual deductibles one-third as high.

To ease some of the strain of the high-deductible plan, employers may offset the deductible with a lower monthly premium than conventional insurance. They may also offer an opportunity for employees to put money in a tax-sheltered health savings account, and some will make contributions to those accounts.

These high-deductible plans were introduced in 2002, and this year more than 100 large companies and hundreds of smaller ones offered these plans as their only option to employees. Among those large companies are Nissan and Delta Airlines. One Nissan plan offers a deductible of $2,500 per person, with a maximum of $7,500 per family, and monthly premiums of $35 for a single worker and $100 for a family. Nissan also offers up to $1,600 for a worker’s health savings account, and annual physical checkups, well-child care and immunizations, and flu shots and cancer screenings are covered 100 percent.

Employees who have a choice between a high-deductible plan and a conventional plan should take into consideration their expected use of health care. High-deductible plans are more attractive to healthy single workers who do not expect many medical costs, or to families who know their medical costs will be much higher than the annual deductible. However, the monthly premiums, even at the lower amount, may not compensate for the deductible.

Companies offering only the high-deductible health care plans believe the plans encourage workers to participate in and manage their own health care with more concern; employees will focus on their health, get healthier, and think before spending money on expensive visits and tests. President Bush calls these plans “consumer-directed” and “consumer-driven” plans. However, while employers have seen savings from implementing these plans, there is still a concern about whether workers are wiser and healthier, or if they are not going to the doctor because of the out-of-pocket costs, says Jeffrey D. Munn, a benefits design expert at Hewitt Associates consulting firm.

President-elect Barack Obama may not advocate the plans like President Bush has; one anonymous advisor said the plans were not consistent with Obama’s position on health care. However, there may be more changes coming after the financial crisis late this year, forcing employees to pay even more out-of-pocket expenses.

Of the 12 million families with high-deductible plans, which equals 7.5 percent of people with employer-sponsored coverage, only about one-fourth of them have health savings accounts. Though most employers make contributions to their employees’ accounts, employees typically use most or all of that money each year. And one quarter of companies with high-deductible plans make no contribution at all.

Employees should get as much information as possible when deciding between health care plans, urges Peter V. Lee, executive director for health policy at the Pacific Business Group on Health.

Originally posted at InjuryBoard by Greg Webb

AARP Faces Senate Inquiry Due To Misleading Marketing

Greg Webb — Tue, 25 Nov 2008 09:59:12 GMT

The AARP, the lobby for older Americans, has hired an outside investigator to look into the sale of some of its more popular health insurance products after a Senate inquiry found evidence of deceptive marketing. The AARP and the UnitedHealth Group, one of the country’s largest insurers, have voluntarily suspended certain policies sold by the UnitedHealth Group that carry the AARP seal. Millions of Americans have purchased these policies, which have names like Essential Plus, AARP Medical Advantage and Hospital Indemnity Plan. These policies pay fixed cash benefits, often much less than consumers expected, for certain services. Charles E. Grassley, the Senior Republican on the Senate Finance Committee, claimed the marketing on the policies were often misleading since it suggested the policies offered complete coverage. For example, one of the AARP’s Medical Advantage plans pays only a maximum of $5,000 for surgeries that may cost two or three times that. The marketing material on this plan, however, misleads consumers by highlighting full coverage for relatively low-cost procedures.

The Senate inquiry is potentially embarrassing for the AARP since it has always taken pride in its position of a champion for its members and consumers in general. It accused the Bush administration of overstating the value of private healthcare plans offered to Medicare recipients along with criticizing the hard-sell tactics of private insurers. Grassley is asking the AARP to disclose the earnings it accumulated from selling the limited-benefit insurance products. The investigation does not include the marketing of specific prescription drugs or Medicare Advantage plans offered by UnitedHealth and endorsed by the AARP.

Originally posted at InjuryBoard by Greg Webb