Tag: "drugs"

Asking the Wrong Questions

What’s a year of life worth? Here is Aaron Carroll on the subject:

When asked, most oncologists thought that a drug should cost less than $100,000 per year of life gained to be cost-effective. When confronted with a patient (even a hypothetical one), however, they endorsed giving drugs that cost up to $250,000 per additional year of life.

The authors conclude that we should do a better job of helping doctors understand how cost-effectiveness information should be used. I agree with that, but want to add to it. It’s necessary, but not sufficient.

I think society needs to have this discussion. Almost no one has $250,000, or even $100,000, saved up if they need it to extend their life for one year. So when we say we think that’s the reasonable number, we’re asking others to pay for it, either through government programs or private insurance. Is $100,000 a reasonable amount to pay for an additional year of life? Is it too low? Is $250,000 enough?

What’s wrong with this post? Answer below the fold.

May 04, 2012 | 11 comments | by

FDA Has a Good Idea; Doctors Object

The idea: In a move that could help the government trim its burgeoning health care costs, the Food and Drug Administration may soon permit Americans to obtain some drugs used to treat conditions such as high blood pressure and diabetes without obtaining a prescription.

The Doctors’ Objection: “What the government via the FDA has decided to do is just bypass the expensive doctor and to satisfy some safety concerns of letting people just pick out their medications is make sure they have to get counsel by the pharmacists,” Dr. Mintz [an internist at George Washington University Hospital] said. “I believe there is value to using pharmacists, but not at the expense of primary care.”

The Pharmacists Counter: “We think it’s a great development for everybody — for pharmacists, for patients and the whole health care system,” said Brian Gallagher, a lobbyist for the American Pharmacists Association. “The way we look at it is there are a lot of people out there with chronic conditions that are undertreated and this would enable the pharmacists to redirect these undertreated people back into the health care system.”

More from Paige Winfield Cunningham in the Washington Times.

May 03, 2012 | 5 comments | by

Gouging Seniors

An “observation” patient is technically never admitted and the visit counts as “outpatient care.” In that case:

These observation patients might wind up paying a larger share of their hospital bill than inpatients, since they usually have a co-payment for doctors’ fees and each hospital service. But Medicare doesn’t pay at all for routine drugs that observation patients need for chronic conditions such as diabetes, high blood pressure or high cholesterol…

In Missouri, several Medicare observation patients were billed $18 for one baby aspirin, said Ruth Dockins, a senior advocate at the Southeast Missouri Area Agency on Aging; Pearl Beras, 85, of Boca Raton, Fla., said in an interview that her hospital charged $71 for one blood pressure pill for which her neighborhood pharmacy charges 16 cents; In California, a hospital billed several Medicare observation patients $111 for one pill that reduces nausea; for the same price, they could have bought 95 of the pills at a local pharmacy…

More from Susan Jaffe in the Kaiser Health News.

May 02, 2012 | 4 comments | by

A Better Way to Approve Drugs

In this paper, Avik Roy examined drug development in four major public health areas and discovered that for any given drug on the market, typically 90 percent or more of that drug’s development costs are incurred in Phase III trials. The current Phase III trial system forces pharmaceutical and biotechnology companies to take enormous financial risks and burdens them with needless and unpredictable regulatory delays. It prevents start-up biotech companies from challenging the dominance of large, multinational pharmaceutical concerns. It also, perversely, encourages more innovation in drugs for very rare diseases than it does in drugs for common conditions that afflict hundreds of millions of Americans.

Roy recommends allowing drugs that have been found safe and promising (in Phase I and Phase II clinical trials) to win approval for limited marketing to patients. This would give patients early access to innovative new therapies, while the FDA would retain the ability to collect information confirming the drugs’ safety and effectiveness and to revoke a drug’s marketing authorization later, when appropriate.

May 01, 2012 | 3 comments | by

Dropping Health Insurance, and Other Links

Consultants to employers: drop health insurance.

Does the president have an “enemies list”?

A tribute to Milton Friedman. HT: Greg Mankiw.

More than 70 percent of people who abuse prescription pain relievers obtain the drugs from friends or relatives, usually with permission and for free.

Hospital debt collectors catch deadbeats in the emergency room and in hospital beds.

May 01, 2012 | 5 comments | by

For the bottom 1%: Prison Release or Factories Behind Bars

David Henderson’s post:

In our prisons today are 2,200,000 people… and their wages are typically about 23 cents an hour. They are, essentially, the bottom 1%. Many of them are there for violent crimes, theft, fraud, and other such things. But hundreds of thousands of them are there for buying, selling, or producing illegal drugs. The drug war has put them there. And we taxpayers are paying $30,000 a year and more to keep them there….

We hear the occupy people advocate taxing the top 1% more. I’ve got a better idea: let’s tax the top 1% less – they’re already paying a disproportionately high share of taxes – and let a few hundred thousand of the bottom 1% percent out of prison and out of their grinding poverty in prison.

And my comment:

And for those who are kept in prison, let’s allow factories behind bars, so that they earn more than 23 cents an hour. Here is the principle: just because a person is imprisoned does not mean he should lose his right to work. In fact, prisoners should be able to work for any employer at any task, consistent with the prison’s need for order and security.

Apr 30, 2012 | 7 comments | by

LSD for the Terminal Ill?

A cancer-ridden patient takes a pill and overcomes her fear of death not just for the moment but for weeks and months that follow…One researcher imagines retreat centers where the dying could have psilocybin administered to them by a staff trained for the task.

Full article by Lauren Slater on psychedelic drugs in the NYT worth reading.

Apr 27, 2012 | 8 comments | by

Reforming the FDA

“In many ways, the bill requires the FDA to do things that it is already supposed to do—once more, with feeling,” says Avik Roy. He’s talking about a bill introduced by Sens. Richard Burr (R., N.C.) and Tom Coburn (R., Okla.) Among other things, it would:

  • Retract the dumb 2007 conflict-of-interest rules for FDA advisory committees.
  • Create more accountability for meeting drug-review deadlines.
  • Stop forcing companies to do unnecessary and expensive busywork.
  • Take more advantage of clinical trials in other countries.

More on the “PATIENTS’ FDA Act” in the Forbes.

Apr 26, 2012 | 4 comments | by

Aspirin

The Good:

After just three years of daily aspirin use, the risk of developing cancer was reduced by almost 25 percent when compared with a control group not taking aspirin.

The Bad:

Now some scientists think low doses may work if they’re taken every day; American clinical trials of every-other-day aspirin had no effect on cancer rates at all.

The Ugly:

Public health experts worry about widespread use of aspirin, because the drug increases the risk of gastrointestinal bleeding, ulcers and hemorrhagic strokes that can be fatal. An analysis in Archives of Internal Medicine in January found that for every 162 people who took aspirin, the drug prevented one nonfatal heart attack but caused about two serious bleeding episodes.

More from Roni Caryn Rabin in The New York Times.

Apr 12, 2012 | 4 comments | by

Sparing No Expense for Fido

A long list of cancers, urinary-tract disorders, kidney ailments, joint failures and even canine dementia can now be diagnosed and treated, with the prospect of a cure or greatly improved health, thanks to imaging technology, better drugs, new surgical techniques and holistic approaches like acupuncture…

Dr. Suter, at North Carolina State, has performed bone-marrow transplants on 65 dogs, with 10 more now on the waiting list. Many veterinarians offer hospice care, too, mapping out a treatment plan that lets a pet spend the remainder of its life at home, its pain eased through a program of palliative care.

William Grimes’ article in the New York Times worth reading.

Apr 09, 2012 | 8 comments | by
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