What The Media Doesn't Tell Us About U.S. Pandemics

Below, a guest post by Priscilla Wald, the author of the book Contagious (Duke University Press, 2008), a history of how the narratives of epidemics and global pandemics obscure the real cause of such health problems.  This essay originally appeared as an op-ed in the Herald Sun (www.HeraldSun.com.)

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Panic sells newspapers. It keeps our televisions on. It is exhilarating in its way. Even addictive. And it has consequences. People, places and behaviors are stigmatized. Panic affects economies. Travelers cancel trips to Mexico, California and New York. Movies, concerts and sports events are postponed.

In the midst of a threat of pandemic, the media do not remind us of the national health insurance crisis or of the lack of access to health care that is truly a global disaster. Mid-crisis, the problem of global poverty seems too large to address or even comprehend. We have more immediate concerns.

Yet, the threat of a pandemic is precisely the moment for such reminders -- that access to health care should not be a luxury, but a basic human right and a priority, at home and abroad.

Feared Health Rationing Is Already Here

Below, a guest post by Jim Jaffe, health editor at Centered Politics.com

Jaffe points out, quite rightly, that “rationing” is already part of our health care system. No health care system can—or would want to—make every treatment available to everyone who might want it. This is not just because of cost. The government also tries to protect us against treatments that would harm us, quacks and snake oil salesmen. 

Obama’s health care plan, in particular, is focused on figuring out which services and products are effective for particular patients. Insofar as it “rations” care, it strives to limit the amount of ineffective care that patients receive, knowing that, by definition, ineffective care exposes patients to risk without benefit . 

Feared Health Rationing Is Already Here

We’ve barely started to discuss the specifics of health insurance reform and already confront a debate among the deaf.  Consider the concerns of the Washington Times, which opines:

The President’s Budget: An Open Hand, But A Very Firm Handshake

Rahm Emanuel has warned that when gauging President Obama “Republicans and others have made a mistake: He has an open hand, but it's a very firm handshake."

I don’t usually think of Rahm Emanuel as a phrase-maker , but in this case, he has hit upon a superb metaphor for the president’s willingness to reach out to his opponents, and invite them into an honest  bipartisan dialogue-- while making it clear that he is not willing to compromise his bedrock values.

The president displayed his inner steel last Thursday when he told Republicans that he will not let them use a filibuster to veto his health care proposal. The threat of a filibuster had hung over the administration’s health care initiative until last week, when President Obama persuaded Senate Democrats to follow the House and include “reconciliation protection” for health care in the budget bill.  This means that Republicans cannot  block reform by reading the phone book---and Democrats need only a simple majority (50 votes ) to pass health care reform in the Senate.

Tobacco Legislation: Pandering or Progress?

Earlier this month the House passed a landmark bill allowing the Food and Drug Administration to regulate tobacco products, granting the agency broad authority in controlling the manufacture, marketing and sale of cigarettes and other tobacco-based goods. This legislation, called the Family Smoking Prevention and Tobacco Control Act (H.R. 1256) , is now awaiting a vote in the Senate where it is expected to be approved “expeditiously” according to Senator Edward Kennedy, one of the bill’s sponsors.  Senator Harry Reid, the majority leader, recently told Congressional Quarterly that he thought the bill will be taken up before the current session ends at the end of May.

A year ago, with the Bush Administration opposing similar legislation, sponsors of the Senate bill worried that they would not be able to muster the 60 votes needed to override the expected Presidential veto and never voted on the measure. This year, with a strengthened Senate Democratic majority and implicit support from President Obama and Kathleen Sebelius, his Health and Human Services secretary-designate, there appears to be much more optimism that the bill will pass with the two-thirds majority needed to overcome a possible filibuster from Senator Richard M. Burr, Republican of North Carolina, the nation’s leading tobacco producing state, and home to R.J. Reynolds.

Distorting the News

Below, a post from Media Matters

Reporting that "President Obama went golfing and the Department of Health and Human Services is short a secretary, so other U.S. officials took the controls" dealing with the swine flu, FoxNews.com omitted Senate Republicans' role in delaying Kathleen Sebelius' nomination as HHS secretary.

In an April 26 article on the government response to the swine flu, FoxNews.com omitted the fact that Senate Republicans have delayed a vote on the nomination of Kansas Gov. Kathleen Sebelius as secretary of Health and Human Services and misrepresented an exchange during an April 26 White House press briefing to suggest the administration may have held the briefing to distract from President Obama's golfing that day.

Baucus Says Healthcare Reforms Will Be Driven By Medicare: Geisinger’s Example

Tuesday, the Senate Finance Committee hosted the first of three roundtable discussions on health care reform. This session honed in on reimbursement and delivery reform; future roundtables will focus on expanding health coverage  to all Americans  (May 5) and financing health care reform. (May 14).  (Many thanks to reader Brad F. for calling my attention to a report on the roundtable.)

“Medicare is the big driver here,” declared Finance Chair Max Baucus (D-MT), and “How to scale it up” will be one of the key questions, he said, but “Medicare will be a big part of that solution.”

As I have suggested in the past, Medicare is likely to become the place where policymakers can experiment with wringing some of the waste out of our health care system, so that we can provide affordable, sustainable, highly effective care for everyone. In fact, Medicare already has embarked on pilot projects that provide incentives for health care providers to collaborate and become more efficient. The projects that work are likely to be expanded and become part of national health care; those that don’t work can be quickly discarded. During the roundtable discussion, many suggested that Medicare needs more freedom to innovate, additional funds, and a mandate to launch  more pilot projects.  Ultimately, a new, improved Medicare could become a model for a public insurance option. National health care reform does not have to wait on Medicare reform; I suspect that policy-makers will be working on both, simultaneously, over the course of President Obama’s first term.

Mammography Screening: A Double-Edged Sword?

Below, a post by Naomi Freundlich, who has joined The Century Foundation.  Welcome Naomi! -- MM

I still remember the sound of her voice on the phone: scared, frustrated and looking for answers. That summer I was working as a patient representative at a New York City hospital when I got a call from a middle-aged woman who had undergone a routine mammogram two weeks earlier. She still hadn’t received the results. When the woman called the imaging center, she was told that the radiologist had not yet provided his report because he wanted to see films from her last mammogram in order to make a comparison. This simple request created great anxiety for my client:

Why was it taking so long to get results? Had the radiologist seen something suspicious? Was this a sign that something was really wrong? The woman then told me that several years before, a doctor had seen an anomaly on her mammogram and that had led to more invasive testing, including further imaging and a surgical biopsy. The lesion ultimately turned out to be benign, but the experience had been extremely stressful and made her yearly mammograms a dreaded procedure.

Wall Street Investors Try to Dictate Social Policy

When I began writing this blog, back in August of 2007, I published a story about Provenge, a controversial drug that was causing quite a stir both on Wall Street and in the medical community. Now Provenge is back in the news, and the New York Times is taking a beating for supporting the drug before the evidence is in.

First, here’s the background to the story. My original post began:

“Only in America do physicians who evaluate new drugs need bodyguards. You may have read about the brouhaha surrounding Provenge, a vaccine designed to extend the lives of men suffering from late-stage prostate cancer. In March, a Food and Drug Administration (FDA) advisory panel voted 13 to 4 to recommend approval.

The Truth About How Cancer Drugs Are Developed

While responding to a comment on the post about cancer drugs below, I did some research and ran into an eye-opening description of how most cancer drugs are developed. BeIow an excerpt from a piece by Dina Biscotta on the Longview Institute website (http://www.longviewinstitute.org/)

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The pharmaceutical industry promotes the idea that the market is responsible for innovations in medicine.  . . . This statement obscures the enormous role that the federal government plays in the development of new drugs and therapies. The case of Taxol provides a compelling illustration of this pattern. Taxol is used most widely to treat ovarian and breast cancer and Kaposi’s sarcoma.  . . .

Taxol is a complex compound found in the bark of the Pacific yew tree. The bark was first collected in 1962 and its potential for killing cells was demonstrated in 1964 as part of the National Cancer Institute (NCI)-United States Department of Agriculture (USDA) plant screening program.

In 1971, chemists at the Research Triangle Institute in North Carolina, a nonprofit research organization created in 1958 by leaders in academia, business and government, first isolated the compound. The NCI selected Taxol as a development candidate in 1977 and clinical trials began in 1984. The yew bark was supplied by the Natural Products Branch of the NCI, sourced from trees located on National Forest lands. In 1989, the Johns Hopkins University Oncology Group reported that Taxol produced a very high response rate in women with ovarian cancer whose cancer had been unresponsive to other chemotherapeutic agents. 

In December 1989, the NCI chose the pharmaceutical giant Bristol-Myers Squibb as its partner in a Cooperative Research and Development Agreement (CRADA) to work on Taxol. This agreement gave Bristol-Meyers Squibb exclusive rights to develop Taxol for the commercial market and exclusive rights to all clinical data generated by the NCI from trials it had or would undertake to study the drug’s effectiveness. Bristol-Meyers Squibb also got the right of first refusal on all yew products on Federal lands as well as orphan drug status which allows firms up to 7 years exclusive marketing rights over a drug that has not been patented.

Why Medicare Has Not Been Able Rein In the Cost of Cancer Drugs

If you want to understand why U.S. health care is so expensive, take a look at the chart below. It illustrates how the price of cancer drugs has levitated in recent years, revealing how, in our largely unregulated for-profit health care industry, the seller is the price-maker and the patient is the price-taker. In other advanced countries, the government intervenes with an eye to protecting desperate patients from being gouged. In the U.S. the law specifically prohibits Medicare from trying to negotiate for discounts.

In an article titled “Limits on Medicare’s Ability to Control Rising Spending on Cancer Drugs,” published in a recent issue of the New England Journal of Medicine Dr. Peter B. Bach,  a physician and epidemiologist at  Memorial Sloan-Kettering Cancer Center, uses this chart to demonstrate the steep rise in  Medicare spending on cancer drugs in just the past ten years.

 

Figure 1. Monthly and Median Costs of Cancer Drugs at the Time of Approval by the Food and Drug Administration (FDA), from 1965 through 2008.

Note that the chart tracks the monthly cost of cancer drugs (vertical axis) from 1960 to 2009 (horizontal axis). What is extraordinary is how the price of the most expensive bleeding edge  treatments has jumped, since 1990, from $2,000 a month to $5,000, $10,000 and finally $25,000 a month. Meanwhile, the fine red line traces the rise in the median price of cancer drugs—from well under $1,000 a month in the late 1960s to $6,000 to $7,000 a month today.