Health Business Blog

Here’s one more reason to stay away from the emergency room: there might not find an experienced specialist when you get there:

Specialists such as neurosurgeons and orthopedists more often are saying no to a rising number of calls from emergency rooms and there doesn’t seem to be a simple way to get them to answer again, reports Josh Fischman. With ER visits up sharply over the past decade, the specialists say they are expected to do too much while on call and the risk of being sued has increased. At the same time, free-standing surgical clinics mean specialists can increasingly do without the operating rooms that hospitals have typically offered in exchange for going on call. Three-quarters of ERs reported a shortage of specialists, according to a 2006 survey by the American College of Emergency Physicians.

Contrast the madness of trying to get off-hours care in the US with the common sense approach of the UK’s National Health Service. While on a visit to a business in Milton Keynes in the UK, I picked up a brief brochure in a business’s reception area. It laid out the services provided by the local “Walk-in Centre,” describing the minor ailments (such as coughs, colds, stomach ache, vomiting, rashes) and minor injuries (such as minor head injuries, sprains and strains to limbs, recent eye injury) that are handled there with no appointment.

The brochure also specifies services not provided, which include x-ray’s, Rx renewals, and immunizations.

The facility is open 7 am to 10 pm every day, including weekends and holidays. I’m sure it’s not perfect but it sounds a lot better than a trip to the ER in the US. Its existence must also help the ERs run smoother.

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I recently joined the board of iCardiac Technologies, which is commercializing ECG analysis technology from the University of Rochester’s renowned Heart Research Follow-Up Program (HRFUP). I’m excited to pass along the news that Pfizer and iCardiac have agreed to an alliance. According to the press release:

The aim of the research alliance is the further development of iCardiac’s COMPAS platform and advanced ECG markers for use in the safety testing of in-development and on-market drugs, and includes a cross-licensing arrangement by which iCardiac will receive rights to ECG analysis technologies developed within Pfizer.

Under the terms of the agreement, iCardiac and Pfizer will collaborate on a research program comprised of a series of studies, including retrospective and prospective ECG data analyses. iCardiac will receive an equity investment and technology license payment, plus research and development funding over the term of the alliance. iCardiac will retain commercial rights to the validated technology platform and new biomarkers for future application in cardiac safety clinical trials and technologies.

…As part of the Critical Path Initiative, the FDA has stated that there is a significant opportunity to further improve the cardiac safety testing process and identify better markers of cardiac risk. The long-term goal of the alliance is to improve the precision, increase the speed and reduce the costs of cardiac safety clinical trials.  

Pfizer spokeswoman Kate Robbins said:

“Cardiac safety is one of the most challenging hurdles in developing new medicines. We support the development of new tools that may enhance our ability to predict the safety of potential new medicines in early stages of research and development.”

iCardiac’s tools are exciting in two ways: 1) They may knock out drugs with cardiac safety problems earlier in development –saving lives, money, and time. 2) For certain drugs that are wrongly flagged as potentially dangerous using cruder methods, they may allow development to proceed. That would help more good drugs make it to market.

Congratulations to CEO Mikael Totterman and the entire iCardiac Technologies team.

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Check out Grand Rounds, the best of the week’s medical blogging, at Envisioning 2.0.

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The (London) Independent on Sunday printed a one-sided, gleeful attack on pharma sales reps. This kind of attitude makes for a lively read but ignores the role of other players in the system.

The article goes on to criticize reps for their good looks, sunny attitudes, charisma and expense accounts. It also says that the drug companies are questioning whether the sales efforts even pay off.

But let’s turn this analysis around for a moment. Reps are paid to do a job, and these days they follow a highly regulated protocol for what they can say and do. Their performance is measured objectively by IMS sales audits and they are paid and promoted based on their performance. Is it their fault they are young and inexperienced and cheerful?

Contrast that with physicians, who are much more experienced in life and are better educated than the recent grads. If physicians weren’t interested in hearing pharma pitches they wouldn’t let themselves be “ambushed” and detailing would become a thing of the past. And we know for sure that docs –whether they realize it or not– let reps influence their prescribing and don’t spend as much time as they should forming independent judgments.

Furthermore, physician effectiveness is not measured nor rewarded nearly to the same extent as reps. I wish it were.

The article does mention that medical schools are preparing to teach their students how to evaluate drug company claims, something I have advocated. I didn’t realize these programs were in development, but am pleased that they are.

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While in London over the weekend I saw the play Rock ‘N’ Roll, a Tom Stoppard story about Marxism, Czechoslovakia, England and rock and roll. It was less intellectual and easier to follow than Stoppard plays I saw in the 80s, such as Hapgood and Jumpers, but I found it more moving.

In particular, the early Pink Floyd songs from The Piper at the Gates of Dawn and A Saucerful of Secrets sent a chill down my spine like nothing in many years and reminded me of my long lost high school friend Derek Scott Farmer (find him and I’ll reward you).  The focus on Syd Barrett was especially poignant, considering his recent death.

If Marx were alive today he’d have to substitute “hospital systems” for “means of production” in the post-industrial West. Workers of the world would be less likely to unite.

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Interested in radiology? Check out the latest Radiology Grand Rounds at Sumer’s Radiology Site.

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Change of Shift, the nursing blog carnival, is up at Emergiblog.

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Many news organizations picked up on a story from University of Florida researchers that microwaving a kitchen sponge for 2 minutes could kill bacteria, viruses and parasites. But as people rushed to try the new technique, some didn’t realize the sponge needed to be wet. Several complained to news agencies:

“Just wanted you to know that your article on microwaving sponges and scrubbers aroused my interest. However, when I put my sponge/scrubber into the microwave, it caught fire, smoked up the house, ruined my microwave, and pissed me off,” one correspondent wrote in an e-mail to Reuters.

“First, the sponge is worthless afterwards so you have to throw it out instead of using it. And second your entire house stinks like a burning tire for several hours, even with windows/doors open,” complained another.

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I’m in London for the weekend after spending the week bopping around Europe visiting pharmaceutical manufacturing plants. I went to the gym –for some reason called the “Leisure Room”– at my hotel and picked up a copy of the UK version of Men’s Health while I was there.

I used to subscribe to the US version when it first came out, and I kind of enjoyed it, despite its somewhat lowbrow appeal. It’s a good motivator for healthy living. Once I read it for a year, though I realized that most of the articles started repeating in one form or another.

The UK version uses a similar formula to the US one: a man with “six pack abs” on the cover, and articles about healthy food, weight, fashion, sex, and relationships inside. I did notice a couple of differences: more emphasis on stopping smoking and reducing drinking (more of a problem over here, it seems) along with some female nudity that would be too risque in the States.

There are many references to the latest research along with practical tips on how to take advantage of it. If you tried to eat and drink everything the magazine says is healthy (based on the latest research) your calorie count would double. I did like the recommendation on how to reduce prostate cancer risk:

Scientists at Oregon State University, USA have found a chemical [xanthohumol] in beer that could help ward off prostate cancer…The bad news is to obtain the level of chemical found to make a difference, you would have to drink a liver-bashing 17 bottles of beer. For a solution that won’t require a stomach pump try Xan beer. Microbrewed to contain ten times the amount of naturally occurring xanthohumol, just two bottles will be enough to protect your prostate.

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Health Affairs hosts the latest edition of the Health Wonk Review, featuring the best health care policy and economics posts of the past couple of weeks.

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