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Paging Dr. Google

Laptop and StethoscopeThe Wall Street Journal reports that Google has begun a project called the Baseline Study to collect individual health information and correlate this with diseases conditions over time. The Google project leader, Andrew Conrad, is best known for his work on quick, cheap HIV screening of blood donations. At Google, Conrad supervises a team of 70-to-100 people, made up of physiologists, biochemists, and experts in optics, imaging and molecular biology. The goal is to amass a behemoth database of hundreds of different sample observations from thousands of individuals, including biology, genetics, blood chemistry, etc. and analyze how it correlates to disease patterns. According to the Journal:

The study may, for instance, reveal a biomarker that helps some people break down fatty foods efficiently, helping them live a long time without high cholesterol and heart disease. Others may lack this trait and succumb to early heart attacks. Once Baseline has identified the biomarker, researchers could check if other people lack it and help them modify their behavior or develop a new treatment to help them break down fatty foods better…

Hits and Misses

woman-with-childIf your parent died young, you may too! Death of a parent during childhood is associated with greater mortality in early adulthood.

Don your pith helmet and Bermuda shorts before heading to the burger joint: Eating meat contributes to climate change.

Empathetic people talk with their hands! (But hopefully not with their fists!)

Social media causes antisocial behavior: Facebook usage “is positively correlated with increasing divorce rates

There are regional variations in happiness: Residents of the Rust Belt cities are among the least happy residents of any U.S. city, but so are residents Gotham.

The Good, the Bad and the Ugly Truth about Specialty Drugs

Recently, my colleague Linda Gorman wrote about Sovaldi, a new treatment for Hepatitis C that actually cures about 90 percent of patients taking it within three months. A regimen of this drug costs $1,000 per pill — or about $84,000 for a course of treatment. Despite its high cost, drug maker Gilead Sciences argues the lifetime costs of treating patients with Sovaldi are lower than older, less effective drugs that merely suppress Hepatitis C, as though it were a chronic condition. The ability to actually cure the disease is a huge bonus, which definitely bolsters Gilead Sciences’ argument. When deciding how to price Sovaldi, Gilead Sciences undoubtedly took the efficacy and cost of competing drug therapies into account. For example, a liver transplant can cost $600,000.

But what if Sovaldi merely held the disease Hepatitis C at bay, and only as long as it was taken regularly? What if Sovaldi had to be taken 6 days a week — year in and year out — at a cost of more than $300,000 per year? That is the type of question Joe Nocera tackles in a recent New York Times article.

Writing in the Times, Nocera actually discusses another wonder drug, Kalydeco, developed by Vertex Pharmaceuticals. Kalydeco targets a specific subset of people with the genetic lung disease cystic fibrosis. For this small subset of patients, the drug works wonders. According to the New York Times:

…it is the first drug that attacks not just the symptoms but the underlying cause of cystic fibrosis, a genetic lung disease that usually kills victims by the time they reach their 40s. It doesn’t work for every sufferer of the disease, but rather for a small subset — probably around 2,000 people — who have a specific genetic mutation that the drug targets. But for those it helps, it is life changing.

Cost to Treat Cancer Drops 34 Percent When Physicians Package Price

An experiment by UnitedHealth Group tested bundled payments for cancer care. Another name for bundled payments that you might recognize is package pricing — where a vendor offers to group all costs together and lower the total price in an attempt to win a consumer’s patronage. Although common in every other industry where consumers buy services, package prices are quite rare in health care (except cosmetic surgery). Ordinarily, oncology doctors are given a fixed percentage markup on the cancer drugs they administer in their offices. For instance, a doctor administering an expensive drug would earn a proportionately larger fee than a doctor using a cheaper generic. UnitedHealth Group wondered if this perverse incentive translated into doctors using higher-priced medications rather than a cheaper drug that might be more effective.

The study found that over a 3-year period doctors who received bundled payments spent about one-third less treating cancer patients than if they had been paid a percentage of every oncology drug they used. Authors noted that while actual drug spending rose, total treatment costs were lower than expected. In other words, doctors weren’t skimping on drugs; they were choosing the most effective drug regardless of their commission.

This result should not be unexpected. What would be considered common sense or conventional wisdom in any other industry is considered novel in health care. The bottom line: incentives matter!

Should Doctors and Dentists Regulate Their Competitors?

An article in Modern Healthcare, “Should state medical boards be allowed to set scope-of-practice? Supreme Court will decide,” poses an important question that would seem like a no-brainer at first glance. Yet, the question deserves a second look. State medical boards are typically composed of members from the industry the board regulates. Thus, it’s common for these boards to take positions in the industry’s self-interest. At issue is an effort by the North Carolina Board of Dental Examiners to prohibit dental hygienists from performing teeth whitening services in mall kiosks, day spas and non-dental offices. Dentists who offer teeth whitening in their offices often supervise dental technicians and hygienists, who perform the actual service. Allowing those same dental technicians and hygienists to perform the work without the supervision of a dentist undercuts dentists’ prices and reduces their profits. According to Modern Healthcare:

The removal of stains from teeth can be a lucrative business for dentists. Starting in 2003, the dental board sent out numerous cease-and-desist orders to competitors who were accused of illegally practicing dentistry. The Federal Trade Commission (FTC) sought to encourage price competition for peroxide treatments by forbidding the state dental board in 2011 from taking action against lower-cost providers that offer teeth-whitening services. A federal appeals court upheld the FTC decision in 2013.

Hits and Misses

Variety of Medicine in Pill BottlesAdherence to drug therapy varies by both the color and shape of the pill!

Don’t clean out the litter box: Cat poop may fight cancer.

You look good on paper! Company will Photoshop your graduation pics to make you look slimmer.

Why is divorce more common among families with girls? (It’s not what you think)

Pincushion therapy: Acupuncture reduces hormonal “hot flashes.”

Health Wonk Review is up: “ObamaCare is creating uncertainty and increased government control of society, which holds down economic growth” says NCPA senior Fellow John R. Graham.

Who’s Your Doctor?

Over at Forbes, Bruce Japsen reports that the Affordable Care Act is boosting demand for primary care providers. As we’ve said before, Obamacare does nothing to boost physician supply. The millions of newly insured will increase their demand for medical care — and someone has to provide it. This has caused a Gold Rush of sorts among medical practices and hospitals scrambling for primary care providers.

Physician staffing firm, MerrittHawkins reports primary care providers — family physicians and internists tops the list. The number of requests for nurse practitioners and physicians’ assistants it’s been ask to recruits is up more than three times (i.e. 320 %). Advance practice nurses and physicians’ assistants didn’t even make the top 20 of most recruited medical practitioners three years ago. Here’s the current list.

In many cases, increased use of nurse practitioners and physician assistants can provide high quality care at reduced costs. I have long advocated increasing these professionals’ scope of practice as an important part of innovation in delivering medical care. On the other hand, this should happen as a consequence of increased consumer-direction of healthcare spending, not as a response to increased government control, as imposed by Obamacare.

Hits and Misses

electronic-medical-recordCall your doctor: CMS says telehealth services should cover annual wellness visits, psychotherapy and psychoanalysis.

A remote control for your birth control.

A simple blood test for Alzheimer’s.

Weight loss: The best medicine for osteoarthritis.

And you thought you were a hoarder: CDC finds smallpox vials from 1950s in FDA storage room.

Poop in a pill: Fecal transplant drug nearing Phase 3 clinical trials.

A problem that self-identifies: Microwave oven that counts calories as it nukes.

Hits and Misses

chopsticks-6What you shouldn’t eat: Instant noodles drive metabolic syndrome (at least in Korean women).

Who would have thought this was the case: Some bee pollen weight loss products are a…scam.

Don’t watch what your workers eat: Non-diet approach to weight management more effective in worksite wellness programs.

However, you can lose weight eating sour milk: Yogurt intake over long term linked to lower risk of becoming overweight.

Less exercise, not more calories, responsible for expanding waistlines.

Should a pharmacist run your corporate fitness program? Sure, it’s yet another job they are infinitely overqualified to perform.

Insurers Propose Adding a Copper Plan to the Health Insurance Marketplace

health-insuranceAHIP, the trade association for insurers and some Members of Congress are proposing to allow consumers another insurance option in the health insurance Marketplaces. The proposed Copper Plans would pay half of medical expenses (actuarial value of 50%), compared to 60% for the Bronze Plans and 70% for the benchmark Silver Plans. My only concern about adding another tiered plan is that still does not provide insurers with enough flexibility. Insurers need the flexibility to experiment with value-based insurance design, Health Savings Accounts, selective-contracting (i.e. narrow networks) and cost-sharing arrangements not currently allowed under the PPACA. But, the busybodies who think they know what’s in consumers’ best interests are critical of the proposal. According to Kaiser Health News:

Insurers and some U.S. senators have proposed offering cheaper, skimpier “copper” plans on the health insurance marketplaces to encourage uninsured stragglers to buy. But consumer advocates and some policy experts say that focusing on reducing costs on the front end exposes consumers to unacceptably high out-of-pocket costs if they get sick. The trade-off, they say, may not be worth it.