I’ll Have a Burger With a Side of Lipitor, Please

Want to eat all of the McDonald’s cheeseburgers, fries and shakes you want without increasing your risk of heart attack? Why not pick up a statin capsule when you stop by the condiment bar to put ketchup on that burger?

This may sound like a spoof commercial for Lipitor or a skit on Saturday Night Live, but it’s actually the recommendation made by the authors of a recent study published in The American Journal of Cardiology. The authors, who are from the Imperial College in London and funded by the British Heart Association, write; “Fast food outlets already offer free condiments to supplement meals. A free statin-containing accompaniment would offer cardiovascular benefits, opposite to the effects of equally available salt, sugar, and high-fat condiments.”

Roll Back Reform? Easy to Say; Hard to Do.

Summary: House Republican leaders unveiled a "Pledge to America" yesterday to repeal the health care overhaul law, along with other promises like canceling the unspent stimulus money. The New York Times asked me to write a short Op-ed for “Room for Debate.” The question at hand: “Can the Republicans gain traction on a promise to roll back benefits that are now in place? Conventional political wisdom says you can't sell a negative. But in what situations has such an approach won voter support?” You’ll find my piece, along with opinions from three other contributors, here.  

Below, the original version of my piece, restoring some information I cut to fit the Room for Debate format. You can Enter the Discussion on the Times site, and/or comment here.

As Reform Begins, the National Physicians Alliance Answers the Question: “Are Physicians Knights, Knaves or Pawns”?

Summary: The National Physicians Alliance (NPA) http://npalliance.org/membership. is the American Medical Association (AMA) of the future. The AMA began as a guild, designed to protect the interests of its members. The NPA, by contrast, looks outward, and understands that it can save the profession only by focusing on the legitimate needs of patients.  Founded in 2005 by former leaders of the American Medical Student Association, the NPA represents a broad spectrum of some 20,000 forward-looking doctors committed to “service, integrity and advocacy.”  Its members take no money from the pharmaceutical industry.

Below, excerpts from a letter written Dr. Valerie Arkoosh, president of the NPA, to her membership, on the six-month Anniversary of the Patient Protection and Affordable Care Act. (ACA)

In Challenge to Health Reform, State Attorney Generals Betray Their Promise to Protect Public Health

State attorney generals have historically functioned as advocates for their citizens, especially when it comes to health issues. In 1994, Mississippi’s Attorney General Michael Moore filed the first lawsuit demanding that tobacco companies compensate the state for Medicaid costs associated with tobacco-related illness. More than 40 other state attorneys eventually filed similar lawsuits, leading to the Master Settlement Agreement in 1998 that required the major tobacco companies to pay a total of $206 billion to the states and also led to restrictions in how cigarettes are marketed.

Lainie Rutkow, assistant professor at Johns Hopkins’ Bloomberg School of Public Health, along with coauthor Stephen Teret (also at Hopkins), write in the new issue of JAMA  that state attorneys general are “powerful but underrecognized participants in establishing and refining health policy.” Rutkow mentions other health advocacy efforts undertaken by state attorneys general including preventing pharmaceutical companies from promoting off-label uses of their drugs and investigating improper health claims by food manufacturers. Just last year, New York’s Attorney General Andrew Cuomo investigated the charge that Igenix, a subsidiary of United HealthCare, was instructing insurers to underpay “usual and customary” charges for medical procedures by some 10-28%; resulting in consumers shelling out excessive out-of-pocket medical expenses. Also in 2009, Connecticut’s attorney general Richard Blumenthal began an investigation into “erratic and excessive” pricing of Tamiflu, a drug that can shorten the duration of flu symptoms, just as the recent H1N1 epidemic reached its peak.

With this history of advocacy, it now seems so incongruous that state attorneys general (along with a handful of governors) from 21 states have filed lawsuits charging that the Patient’s Care and Affordable Health Care Act is unconstitutional and are demanding its repeal. The Act, which would cover some 30 million Americans who are currently uninsured and offers relief from medical bankruptcy to millions more, would seem to be squarely in the public’s interest.

Health Reform Begins to Kick in Today

Consumer Reports Health offers an excellent concise Guide to New Benefits—including the fine print. You’ll find it here.

The Hospital Room of the Future, Brought to You by GE

You may have read that last year, Jack Welch fell victim to a medical error that could have killed him. While in the hospital, the retired General Electric Chairman and CEO contracted what was presumably a preventable spinal infection. It was so serious that some newspapers began polishing Welch’s obituary. 

The 73-year-old did recover—but only after spending 91 days in New York’s Columbia Presbyterian hospital battling “discitis.” Welch believes that the infection was caused by “a dirty needle from a cortisone shot he took to help him play golf.” The infection “not only spread through his spine, but also to his artificial right shoulder, which had to be surgically cleaned out.”

Enter GE Healthcare, a $16 billion unit of General Electric. Alarmed by Welch’s close call, GE researchers decided to take a close look at patient safety—and perhaps consider whether the company could develop a new line of business in the process.

Victor Fuchs: Longevity vs. the Quality of Life, and “Why What Can’t Happen, Will Happen”

Summary: In the newest issue of The New England Journal of Medicine, famed health care economist Victor Fuchs argues that: “Current demographic, social, and economic forces will create new priorities for future biomedical innovations: more emphasis on improving quality of life and less on extending life, and more attention to value-enhancing innovations instead of pursuit of any medical advance regardless of its cost relative to its benefit.”

Sunday, Matthew Holt published a superb interview with Fuchs, (now the Henry J. Kaiser Professor Emeritus at Stanford University) on The Health Care Blog (THCB).  Below, excerpts from that interview. At the end, I offer extended commentary on this exceptional interview.  As always, Fuchs offers some eye-opening insights. You’ll find the complete September 19 THCB interview here.

The Next Priority for Health Care: Federalize Medicaid

Summary:   Below, excerpts from a policy brief written by Greg Anrig Century Foundation vice-president for policy and programs, for the New America Foundation's Next Social Contract Initiative and the Century Foundation.  In this paper, Anrig proposes turning Medicaid into a federal program. While this might sound radical, this is in fact not a new idea. As he notes, “In 1969, 1977, and again in 1981, the U.S. Advisory Commission on Intergovernmental Relations, which comprised officials in all levels of government, had recommended that the federal government assume full financial responsibility for all public assistance programs, including Medicaid. The Commission argued that its ideas would greatly improve an intergovernmental system that had grown more pervasive, more intrusive, more unmanageable, more ineffective, more costly and above all, more unaccountable.”

And, in 1982, Ronald Reagan, of all people, “proposed a grand bargain: the federal government would become entirely responsible for financing Medicaid in exchange for giving states responsibility for more than 40 other federal programs, including Aid to Families with Dependent Children – the primary welfare program that President Clinton and Congress would radically reform 14 years later.”  The idea never gained traction at the time.

Malpractice Reform Is No Panacea For Rising Health Costs

New findings indicate that putting limits on malpractice awards and enacting similar tort reforms are unlikely to do much to curb the nation’s surging health care costs. In fact a new study, published last week in Health Affairs suggests that costs associated with medical malpractice are far less than the $650 billion figure (26% of all money spent on health care) cited by some Republicans who have made tort reform a cornerstone of their vision for “bending the cost curve” in health care. The newly calculated figure, $55.6 billion, represents just 2.4% of health costs.

According to NPR, “Longtime malpractice and patient safety researcher Michelle Mello of the Harvard School of Public Health [one of Health Affairs authors]” said that “some of the figures used during the recent health overhaul debate were ‘quite imaginative.’”

No, Obesity is Not Driving Health Care Inflation –Part 1

Summary: A report from the Congressional Budget Office (CBO) that came out last week spurred a flurry of headlines suggesting that fat people are responsible for the high cost of health care in America. “CBO-- Obesity Will Decimate Future Health Costs and Care,” blared one headline. The story began: “While our nation’s obesity problem has trashed health care and insurance rates, the worst is yet to come.” In other words: forget about reform. Folks who eat too much will wipe out any savings.

It is true that obesity has become epidemic. As the CBO study points out, “From 1987 to 2007 the share of adult Americans who are obese has more than doubled –from 13 percent to 28 percent.” Over the same span, the amount that we spend on health problems associated with obesity has soared: “health care spending per adult grew substantially in all weight categories between 1987 and 2007,” the researchers write, but “the rate of growth was much more rapid among the obese. Spending per capita for obese adults exceeded spending for adults of normal weight by about 8 percent in 1987 and by about 38% in 2007.”

It is easy to assume this means that the rise in the percentage of Americans who sport a body-mass index (BMI) equal to or greater than 30, accounts for roughly one-third of the rise in health care spending. But that is not what the report says.