Health Business Blog

Excuse me while I second guess you, Doc

From the Wall Street Journal (Insurers Want Patients to Press Doctors About Drugs and Costs)

Lumenos Inc., a unit of health insurer WellPoint Inc., intends to start offering a service that lets its patients enter the names of drugs into their cellphone Web browsers, which in turn will shoot back a list of comparable drugs, ranked by how much they cost under Lumenos’s plans. That way, patients can ask their doctors about cheaper alternatives while they’re still at their appointment, the company says.

The scenario above sounds rude, and reminds me of an earlier post (Cell phone etiquette in the doctor’s office.) When health insurers think of consumer empowerment they tend to think of enlisting consumers in taking an adversarial role with physicians –just like the insurers themselves do. A better idea would be to help patients and physicians engage jointly in finding the most efficacious, cost-effective, and easy-to-tolerate regimen.

Some of the other approaches described in the article make more sense, including providing health statements with suggested questions for patients to ask their physicians.

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Grand Rounds is up at Barbados Butterfly

Grand Rounds, the best of the week’s medical blogging, is up at Barbados Butterfly.

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Exuberant for Exubera

From the New York Times

An inhaled form of insulin won federal approval…, offering the first alternative to injections for millions of people with diabetes since the drug was introduced in the 1920′s.

David Kliff, who takes insulin for his Type 2 diabetes and publishes the Diabetic Investor newsletter about diabetes-related companies, said the inhalation device might be too big and cumbersome to attract users.

“When you extend it, it looks like a bong,” Mr. Kliff said. “I can’t see somebody whipping this out in public and using it. People with diabetes are sensitive enough as it is.”

But Paul Matelis of Miami, who has used the device in clinical trials for seven years, disagreed. “I’ve used it at the Orange Bowl,” he said.

Mr. Matelis, who is 54 and has Type 1 diabetes, said the inhaler is much more convenient than syringes. “It much easier to take a puff than to load up a syringe and inject yourself in a moving vehicle,” he said.

They will also still have to prick their fingers to measure their blood sugar levels.

Once continuous transcutaneous measurement is common the true potential of insulin puffs will be realized because diabetics will be able to control themselves at much lower levels of glucose. It seems like one should also be able to have an implanted device that would broadcast glucose levels to the outside.

Analysts predict that Exubera will rapidly become a blockbuster drug, a term used in the industry to describe a treatment with more than $1 billion in annual sales. Ian Sanderson, an industry analyst at SG Cowen, predicted that Exubera, which was also approved in Europe this week, will have $1.8 billion in annual sales worldwide by 2010, including $1.1 billion in the United States.

That estimate is conservative because it assumes that only 12 percent of patients now taking insulin for Type 2 diabetes will switch to Exubera, Mr. Sanderson said. But many patients appear to strongly prefer Exubera, he said.

“I’ve been astounded at the patient response to Exubera,” Mr. Sanderson said.

Mr. Sanderson predicted that Exubera would cost between $120 and $150 a month, roughly comparable to the price of pills taken by some people with Type 2 diabetes but about three times the price of injectable insulin.

How refreshing. An advance that doesn’t cost more.

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Over-diagnosed but under-treated

A story in today’s Boston Globe (Peanut allergy epidemic may be overstated) devotes its first 19 paragraphs to arguing that reports of the prevalence and growth of peanut butter allergy are overblown. It’s just a bunch of anecdotal evidence and fussy parents, according to the author.

Then we get to the very last paragraph of the story:

[D]espite their best attempts to avoid peanuts and carefully read labels, the average person with true peanut allergy still gets a reaction every three to five years. Yet only one in three parents of allergic children has a potentially life-saving dose of EpiPen nearby and knows how to use it. [Emphasis mine.] Affected children should never be without an EpiPen and someone who knows how to use it.

Isn’t that the part of the story that’s newsworthy?

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A new use for Net Nanny

As school officials try to clamp down on prescription drug abuse, some are calling for random drug testing. But that’s expensive and physically intrusive. It won’t be long before parents, administrators and police departments start calling on Google to help figure out which students are looking up illegal drugs and considering buying and selling them.

Ladies and gentlemen, start your anonymizers.

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More on prescription drug abuse

As I’ve posted before in DTC blowback, the younger generation is more apt than earlier ones to abuse prescription drugs. At the high school level it’s now easier to get a dose of the benzodiazepine Klonopin than to buy alcohol, and that’s causing trouble. See A new choice in drug abuse. (A spokesman for the maker of Klonopin conveniently claims not to be aware of its use by teenagers.)

When I was in high school, the kids I knew who abused prescription drugs had parents with a wide array of drugs in their homes for their own use. That appears to be the pattern today,

”A lot of families in the suburbs have good medical care and will oftentimes have these drugs in their medicine cabinets,” [a coordinator of New Bedford's antidrug student assistance program] said. ”With kids, availability and ease of use are two key factors when kids are using drugs. Klonopin doesn’t smell, but you can still be high on it. And if there is a network of people selling these things, it’s easy access.”

By the way, don’t you love the definition of “good medical care?”

Another thing that hasn’t changed is for teenagers to blame their problems on the suburban lifestyle:

A senior at Arlington High, who spoke on condition of anonymity, said prescription drug abuse seems to be on the rise at his school and others… He believes the reason prescription drug abuse is popular is because there is little for teenagers to do in Arlington. Kids get sick of going to the movies or out to dinner, he said.

How profound.

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New blog alert: Dr. Flea

Dr. Flea has started blogging from the perspective of a solo practice pediatrician. Like other blogging docs I’ll bet she uses email, too.

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The medium is the message

A doctor wrote a letter to the Boston Globe complaining about an article that gave tips on how to select a doctor, and had suggested finding a doctor who uses email:

Emphasizing the role of e-mail access in selecting a physician is questionable. E-mail is a tool for communication and not a criteria [sic] for a good physician. How the physician communicates with the patient is far more important.

Of course communication style matters, but email –or better yet, structured messaging using a tool such as RelayHealth– is convenient and provides much better access to the physician. I wrote a 2-line message to my doctor at 6 am on Monday about symptoms that were bothering me and asking for a referral. By 8 am he had responded with the name and # of the specialist and let me know he’d informed his staff of the referral. By 9:15 am I’d made an appointment with the specialist.

In the “traditional” world I would have had to wait until the doctor’s office opened, then left a message with the receptionist. Eventually the doctor would have called back and probably would have had to leave a message –he probably wouldn’t have made the referral without speaking with me.

I wouldn’t pick a physician who didn’t use electronic messaging. “How the physician communicates” is affected by whether or not they use email.

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Managed care redux

The Massachusetts Group Insurance Commission (GIC), which has been pushing a quality and efficiency agenda for the state employees it represents, is back in the news with a proposal to introduce variable co-pays based on physicians’ quality and efficiency ratings. (See Plan would tie copayments to doctors’ ratings in the Boston Globe.)

Members would pay a $15 copay for a top-rated provider and $25 for others. Its being touted as a bold new idea, but in its initial design it’s just a wimpy version of an open access network. The relatively weak incentives reflect the fact that the tools and data for measuring quality and efficiency –especially for specialists– are immature. There’s a reasonable chance that if the GIC pushes too hard at this point there will be a major, well deserved backlash.

The move is still significant in two ways:

• It’s really a trend away from consumer directed care. Rather than consumers reacting to quality ratings of physicians, it’s the health plan that’s doing so
• It shows that measures that are being collected for pay for performance programs –which can make a few percentage point difference in reimbursement– can also be used to drive market share changes. That has serious implications for physicians and hospitals

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Is Google a threat to e-health?

Something like 90 percent of Internet users search for health care information online. As with other searches, Google is the most popular tool. Considering how concerned people are about the privacy of their online health information, they probably wouldn’t use Google so freely if they realized Google was archiving every search they ever did and might someday turn the information over to the government, a health insurer, or a business or personal rival.

Sound paranoid? I would have agreed until recently when the company with the “do no evil” motto started collaborating with the Chinese government in censoring searches. If someone got hold of your Google health care searches they would see not only the sites you went to but all the context of what you did while there, what you wrote and received in email (if use you Gmail) and all of your other search habits.

If you are worried about the privacy of your health care information you should think hard about what you’re doing on Google.

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