Medical Miracles, Maladies, and Morality

Ed Raymond

Union Doctor: “To Work In A Hospital Today Is To Be Constantly Occupied With Money”
   This quote came from an Oregon hospitalist, a doctor who supervises patients’ care in hospitals, when he and his fellow 35 hospitalists decided to form a union when they were offered bonus plans if they supervised more patients in two hospitals that had 450 beds. Their reason as expressed by one doctor: “We’re doctors, we’re professionals. Giving me a bonus for seeing two more patients---I’m not sure I should be doing that. It’s not safe.” They formed a union when the hospital decided to outsource them to a management company that would become their employer. Outsourced doctors make as much or more money than doctors directly employed by hospitals—around $200,000 a year. But outside management companies usually tie compensation to the number of patients seen in a day. One doctor objected to seeing a patient every few minutes: “Sometimes real life is all about the narrative. It’s sitting down and talking bowel movements with a 79-year-old woman for 45 minutes. It’s not that interesting, but that’s where it happens.”
    There has been both positive and negative stories coming out of the business of health care in the last few days. A gynecological clinic, Institute Marques, has researched the idea that fetuses in the womb can respond to music and sounds from speakers placed around the stomach. The research indicates that unborn babies can only hear sounds through the vagina, not from abdominal walls because they muffle all sounds. So a Spanish company has developed a speaker costing between $150-$200 which can be inserted in the vagina. It has a top sound level of 54 decibels and can be used from the 16th week of pregnancy for between 10-20 minutes at a time. According to the company’s website:”Babies learn to speak in response to sound stimuli, especially melodic sound. Babypod is a device that stimulates before birth through music. With Babypod, babies learn to vocalize from the womb.” I guess the proof will be when a baby comes out singing “Dixie,” “The Battle Hymn of the Republic,” or Sinatra’s “It Was a Very Good Year.”
    Doctors at Oxford, England’s John Radcliffe Hospital have developed a bionic eye which may bring back some sight for victims of a disorder called retinitis pigmentosa, which destroys light sensitive cells in the retina. They have implanted the bionic eye in six patients who have had no or little sight for many years. So far the trials are quite promising.
    About one in 5,000 women are born without parts of the vagina, uterus, and cervix. The condition is usually discovered at puberty. The first successful uterus transplant was performed by Swedish doctors last year. The Cleveland Clinic is going to research such transplants by transplanting uteri into ten women aged 21 to 39. When, and if, one or two babies are born with the transplant, it will be removed because of health consequences involving immunity drugs and other factors. This type of transplant is a very complex procedure because it involves the freezing of eggs, the actual transplant, and the transplant must be given 12 months to heal before the implantation of eggs. The Swedes have performed nine uterus transplants resulting in five pregnancies and four live births. These three developments are very positive.

Hospitals,  Drug Companies, Doctors, and Suppliers Practice “Casino” Or “Disaster” Capitalism

    On the negative side, some of the most egregious pricing obscenities are conducted by the health care industry, forcing patients into bankruptcy and early deaths. Florida Governor Rick Scott, who gained notoriety as the CEO of a hospital chain which paid the largest Medicare fine in history at $1.7 billion, wrote a column recently about why Donald Trump was leading in the polls. He wrote that Obama has spent seven years in a government takeover of the economy by excessive regulations and taxation. I am often criticized by business people for not telling the good stories about business. I’m not in the good-story mode when I am surrounded by “Casino” and “Disaster” capitalism. Capitalism by its very nature requires thoughtful regulation because greed is the most difficult “emotion” to control. Scott’s company under his direction committed considerable fraud by billing both Medicare and Medicaid for many tests not ordered by doctors. A $1.7 billion fine represents a lot of excessive tests. All Scott had to do was follow regulations…..
    Turing Pharmaceuticals recently bought the 62-year-old drug Daraprim from Impax Laboratories and immediately raised the price of each pill from $13.50 to $750. The drug treats toxoplasmosis with about a hundred pills, raising the price of treatment from $1,350 to $75,000. Why did the new owner do it? Turing was run by a hedge fund manager who is probably on the way to jail for insider trading—but the price of the drug remains at $750 a pill. The United States is about the only country in the world without price controls on drugs. Drug companies can charge--whatever. In Britain the price of Daraprim is controlled at 66 cents a pill. It is even priced less in India. So in the U.S. the total treatment would cost $75,000, in England $66. Gilead Sciences, Inc. has come up with a new drug to treat hepatitis C called Sovaldi. Sovaldi is a 12-week treatment that replaces drugs that used to take up to a year to control the disease. The World Health Organization estimates there are 130-150 million in the world with chronic hepatitis C --with three million cases in the U.S.  Gilead priced Solvaldi at up to $94,000 for the entire 12-week treatment. India recently developed a drug which is as effective as Solvaldi and sells for $4 a pill, making the total treatment for hepatitis C cost $336 in India compared to about $90,000 in the U.S. How long will Americans take this crap?  What will “The Best Congress Money Can Buy” do about it? Nothing. But why should have to use lottery money to purchase drugs?

When Will We Tighten The Screws On Health Care Costs?

   Pfizer Inc., planning a $160-billion merger with an Ireland-based company to cut its U.S. tax bill to almost nothing, is raising U.S. prices on more than 100 drugs as much as 20%. Pfizer is stiffening its profits on the erectile dysfunction drug Viagra by increasing the price 12.9%. Its take on Viagra swelled to $1.1 billion last year. Pfizer is raising Ibrance, a new breast cancer drug currently priced at $118,200 a year, another 5%. Users of the pain pill Lyrica will see a 9.4% increase. Patients will see 20% increases in the anticonvulsant drug Dilantin, the hormone therapy drug Menest, the angina drug Nitrostat, the irregular heartbeat drug Tykosyn, and the antibiotic Tygacil. These increases are on top of the fact that drug prices in 2014 went up 10.9% with all brand-name drugs going up 15%.
   Three drugs have been developed to treat age-related macular degeneration, a disease which causes blood vessels under the macula to leak or bleed, which destroys sight. These three drugs have been proven to treat this disease equally, but the prices are different. Lucentis costs$2,000 a dose, Eylea runs $1,850, and Avantis $50. Guess which one is used more often by doctors. Good guess. It’s not Avastin. Isn’t that strange?
   Big Pharma, all of the pharmaceutical companies, have been fighting the legalization of marijuana for almost 100 years, afraid that patients might discover that pot may be a better treatment than manufactured drugs. At least there is no recorded death by a marijuana overdose. Opioid painkillers (Vicodin, Oxycontin, Percocet, Kadian-and others) and heroin are now the leading cause of death by unnatural causes in the U.S. A survey of cannabis users found that 87% of users have substituted marijuana for prescription drugs with good results. Adults under 40 responded they were likely to give up alcohol, prescription medications, or other drugs and use medical cannabis. Alcohol is now killing Americans at a rate not seen in 35 years. Isn’t it time to do research on the medical use of a drug that doesn’t kill?

Why Great Britain Insures Everybody And Ranks First Among Eleven Industrialized Nations

    The British National Health Service (NHS), started by Winston Churchill following World War II, has become so trusted in 70 years that most English liken it to “a religion.” Currently going through a strike by young doctors who don’t like to work weekends, the NHS costs $3,405 per capita to cover everybody, according to the Commonwealth Fund. We are ranked at the bottom of the 11 countries studied by the Fund because we fail to cover 29 million people and have a per capita cost of $8,508—and provide both great and lousy health care.  Research indicates we spend 33% of our total health care budget on administration that has nothing to do with the actual delivery of health care! Our government program Medicare costs only 2% to administer. An example of excessive costs is the widespread surgical use of angioplasty at $27,000, an operation that widens narrowing arteries to prevent heart attacks. At one time we performed 600,000 a year, one of the top most expensive procedures according to Blue Cross, costing about $10 billion a year. The problem is, according to an analysis of eight clinical trials of 7,000 patients, angioplasty “offers no benefit compared to less invasive treatment of health disease.” But there’s not much money in doctors preaching about diet, the use of drugs, and lifestyle changes. Heart disease, with all the carving, drugs, and other intricate procedures, is a great cash cow for doctors and hospitals, making millionaires out of most cardiologists and administrators--and billionaires out of health insurance CEOs.
   Let’s take a look at the cost 0f echocardiograms in the world at 2014 prices, ultrasound pictures of the heart often used in diagnosing disease. Five hospitals within a 15-mile radius of Princeton, New Jersey charge an average of $5,200. Seven teaching hospitals around Boston charge an average $1,300. Philadelphia hospitals charge from $700 to $12,000!  In countries where prices are regulated by government and include profit, Belgium allows $80, Germany $115, and Japan’s range is $50 to $88, depending upon the age of the machine. Tokyo’s finest private heart clinic, the Sakakibara Heart Institute, performs an average of 60 echocardiograms per day. The Japanese consider it to be old technology. Japan’s doctors love technology, but the Japanese per capita cost for health care is only about $4,000—and they insure every one. England does not charge at all and has 250 echocardiogram centers in the country. Because the machine is such a moneymaker, the state of New Jersey has far more machines than Great Britain! Echocardiogram use started in the late 1970’s and between 1999 and 2008 the number of examinations rose 90%. One of the most fascinating studies in medicine indicated that patients who had gall bladder surgery recovered and healed faster if they could see trees from their hospital room rather than other brick walls.
   Questions about prices abound in medicine because who thinks of shopping for heart surgery when you’ve had a heart attack? One of my relatives recently had a $70,000 emergency ride in a hospital helicopter. He didn’t take the time to ask for transportation bids. Why does rotator cuff surgery cost $15,000 in New York and $4,723 in Houston? Why does knee arthroscopy run $10,000 in New York and $3,100 in Miami?  Most cardiologists in this country average $1,345 per hour based on a 2,080-hour work year. Does this fit in to the modern Hippocratic  Oath for doctors that says: I will remember that I remain a member of society, with special obligations to all my fellow human beings, those of sound mind and body as well as the infirm.” What should we charge Bill Gates for medical care? What should we charge Mrs. Joe Sixpack?