Health Business Blog

A nice contrast of articles in the Boston Globe this morning:

First, the good news. Saliva is replacing blood for an increasing number of diagnostic tests. Technology for detecting small quantities of genetic material is improving at a rapid rate, which means that many tests that used to require a blood draw can now be done with saliva. It’s cheaper and less painful to spit than to drain a vein, which will make it feasible to do more frequent tests for physiological changes and will encourage the needle shy to get the tests they now avoid. See Saliva may replace blood as test for disease.

Next, the bad news. It turns out many people are sharing their prescription drugs with others. Why is this occurring? The elderly and the poor do so to reduce costs, teenagers do it for fun, and people in general are overconfident of their ability to self-medicate. It can be a dangerous practice: efficacy is reduced for those sharing their pills and drugs may be given to people who should avoid them (e.g., Accutane to a girl who make get pregnant).

From Many who share drugs don’t know the dangers:

When it comes to prescription medications, many people embrace the adage to share and share alike. Armed with good intentions and largely unaware of the dangers, they gladly hand over leftover antibiotics, asthma inhalers, antidepressants, insulin and pain pills. After all, if the drugs worked for them, then perhaps they’ll help similarly suffering family members, friends or colleagues. And, considering the drugs’ expense, throwing away excess, out-of-date or ineffective pills can seem like a waste.

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Grand Rounds XXXVI is up at Dr. Sanity’s. It includes some of the best medical blogger posts of the week, organized under a Leonardo da Vinci theme. My post, “Giving away $50 million isn’t as easy as it seems” is included.

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My local electrical utility, NStar found a way to use health care as a weapon against its striking workers. From today’s Boston Globe (Contract restores health benefits immediately):

NStar had also restored, retroactive to the May 16 start of the strike, its 85 percent contribution to strikers’ Blue Cross Blue Shield health insurance. In a move that union leaders denounced as heartless, NStar slashed its healthcare contribution within hours of the start of the strike.

Workers could still get health coverage if they paid the full bill, and NStar said it was obvious that workers choosing to strike would forfeit pay and benefits. But union leaders and many elected officials blasted NStar’s move as excessively harsh to workers facing cancer treatments, childbirth, and expensive medical procedures.

That last sentence is a bit of a red herring, considering NStar is paying the same insurance contribution regardless of an employee’s health status.

Key issues in the contract negotiation between NStar and Local 369 of the Utility Workers of America included work rules and –you guessed it– health care benefits.

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Yesterday’s Wall Street Journal asks, Do Food Claims Help Consumers or Baffle Them? The FDA has allowed food and dietary-supplement companies to make health claims about their products since 2003, but the companies must disclose their level of proof. Since most claims are not very well established, the wording can be a turnoff. For example:

Scientific evidence suggests but does not prove that eating 1.5 ounces per day of nuts… as part of a diet low in saturated fat and cholesterol and not resulting in increased caloric intake may reduce the risk of coronary heart disease.

The article doesn’t mention it, but food companies are already working on mini versions of the clinical trials done by pharmaceutical companies. Beyond dietary benefits, some foods may be useful for improving medical conditions such as mental state (think anti-depressants), behavior (think ADHD drugs), and memory.

At MedPharma Partners, we are helping clients bring some of the tools from the pharmaceutical R&D world into the food industry.

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…as reported yesterday, does it also give you hairy palms, stunt your growth, make you go insane, or give you acne?

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Three scary things from my trip to New York City yesterday and today. The first two are from yesterday’s New York Times.

Face-Lift Played Major Part in Woman’s Death, City Finds
A woman came from Ireland to NYC for cosmetic surgery and kept it secret from her family. She died of cardiac arrest after the surgery. She had read about the surgeon, Dr. Michael Sachs in the Irish Sunday Independent. The story told about what a great job he’d done on another Irish patient, without mentioning that he’d settled 33 malpractice lawsuits recently and had been restricted by the State Department of Health from performing certain procedures without supervision. Way to go, Independent!

Fake Doctor is Back in U.S. And Facing Murder Charge
This one may be even worse. Dean Faiello started in construction, then got a job at a spa, and then he began practicing medicine without a license. He put a patient under sedation to remove a black fungus from her tongue. She went into convulsions and eventually died. Returning to his construction roots, he buried the body in a concrete slab in his house, which he then sold. He fled to Costa Rica and has just now been extradited to the US. Maybe they should have left him in Costa Rica (or sent him to work at the Irish Independent).

And finally, while I was having a breakfast meeting in a restaurant this morning, NY State Attorney General Eliot Spitzer walked in to do some business of his own. Luckily his attention was focused on someone else!

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Earlier this month, Cardinal Health announced it would stop trading in the secondary market for drugs. Its trading activities had been criticized because of the potential to let counterfeit drugs into the supply chain. (See Cardinal takes another step away from the trading business.)

Now, according to the Boston Globe, CVS has announced it will stop buying drugs from wholesalers who use secondary distributors. It’s really not that impressive that CVS is taking this step now. After all, with the major wholesalers stepping away from the trading business, CVS now doesn’t have to worry anymore that it will be at a disadvantage to competitors.

Three years ago a 16 year old liver transplant patient died after taking fake Epogen bought at CVS. Why didn’t CVS step up then and make the announcement? It could have forced the big wholesalers to act.

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Last Friday in (Do statins prevent cancer? We may never know) I cited a Wall Street Journal article describing why we shouldn’t expect to see drug companies sponsor trials on the efficacy of statins in preventing cancer.

To my delight, today’s New England Journal of Medicine published the results of a study that showed that taking statins reduced the incidence of colon cancer by almost half. The study was funded by the NIH, and the Ravitz and Weinstein foundations. Study participants were in northern Israel.

The Wall Street Journal has a story about the article.

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I hosted a dinner event for about 60 people last night at Harvard Business School. The keynote speaker was Micky Tripathi, CEO of the Massachusetts eHealth Collaborative. Micky’s job is to create 3 community ehealth pilots over the next 2-3 years. The communities have been selected and the rollout is underway. Blue Cross Blue Shield of MA has committed $50M to the effort.

Micky made a few interesting points:

• “Giving away $50M isn’t as easy as it looks.” Before docs will accept the free EMRs, there are technical concerns to address (e.g., will this disrupt my office?), privacy and security issues (e.g., what to do if there is a breach of the network), and liability questions (e.g., am I liable if data I enter into the system is used improperly or ignored by another MD?)
• The goal is to move from efficacy to effectiveness. To go beyond a demonstration that a system works to actually having an impact in the messy real world
• Even more important than the $50M is the commitment by all stakeholders (payers, providers, government, liability carriers, patient groups, etc.) to participate. This differs from other initiatives –such as Micky’s previous situation in Indianapolis– where one or more key constituencies is not at the table

Micky’s got a tough job, but looks increasingly likely to be able to pull it off.

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Welcome Grand Rounds visitors! While you are here, consider touring the rest of the Health business blog.

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Pfizer, GSK, and Schering-Plough currently have a new class of anti-HIV drugs in phase 2 of development. These CCR5 antagonists represent a novel approach –they target a host cellular receptor rather than a viral enzyme. Clinicians and patients are excited about the potential to add a new type of weapon to the anti-HIV arsenal.

Yesterday I attended a meeting on CCR5 antagonists hosted by the Forum for Collaborative HIV Research in Washington, DC. Attendees included representatives of US and European regulatory authorities, academic researchers from around the world, government research institutes, diagnostic companies, patient advocates, foundations, and pharmaceutical companies.

Using a collaborative, problem-solving approach, the group identified and discussed some of the details of common regulatory issues, diagnostic challenges, and resistance issues. The regulators were able to share their views and concerns and get substantive feedback from the other parties. Pharmaceutical companies were able to learn more about what’s expected of them and why. It was a good use of time for all involved and will help improve phase 3 trial design.

To my knowledge, this type of broad and deep collaboration only exists in the HIV world. I’ve written recently about how the Forum has tackled other issues such as pediatric formulations. It would be worthwhile to consider how to bring the various parties together on specific topics at regular intervals in other fields.

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