Health Business Blog

If you thought a blog called Trick-cycling for Beginners might do Grand Rounds in a weird way you were right. Haiku it is.

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Stephanie Sulger from Medical Tours International pointed out that our photo has been posted on the Good Gang-An Hospital website. (Look closely and you’ll see my computer bag in the bottom right.) I enjoyed my visit there last month.

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The New York Times has an extensive piece today on the role of free trade zones in enabling the trade in counterfeit drugs (Counterfeit Drugs’ Path Eased by Free Trade Zones). The article describes how the seizure of drugs in a free-trade zone in Dubai led to an unraveling of fraud in Canada:

… an examination of the case reveals its link to a complex supply chain of fake drugs that ran from China through Hong Kong, the United Arab Emirates, Britain and the Bahamas, ultimately leading to an Internet pharmacy whose American customers believed they were buying medicine from Canada, according to interviews with regulators and drug company investigators in six countries.

Some pills, a government official said at the time, contained cement powder.

The trail went through the Bahamas:

The site belonged to RxNorth, described by one trade association as the world’s first major online pharmacy.

A founder, Andrew Strempler, had been the subject of numerous profiles, including one in The New York Times in 2005 that described how at the age of 30 he had two Dodge Vipers, a Jaguar and a yellow Lamborghini with a license plate that reads “RX Boss.”

The article reported that Mr. Strempler’s innovation “created a whole new Canadian industry that has plugged a niche in America’s troubled health care system almost overnight, providing about $800 million worth of low-cost drugs a year to two million uninsured and underinsured Americans, many elderly.” Drugs have traditionally been cheaper in Canada…

As Mickey says, “At least with medical tourism you know what country you are in.”

I’d also be willing to bet that Pfizer’s PR people were the impetus for this story.

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MedGadget is initiating the fourth annual Medical Weblog Awards. You can nominate blogs in the following categories:

• Best Medical Weblog
• Best New Medical Weblog (established in 2007)
• Best Literary Medical Weblog
• Best Clinical Sciences Weblog
• Best Health Policies/Ethics Weblog
• Best Medical Technologies/Informatics Weblog
• Best Patient’s Blog

Nominations can be made in the comments section of the MedGadget post.

I hope no one is deterred by the fact that last year’s winner of Best New Medical Weblog crashed and burned a few months after receiving the prize.

Blogosphere etiquette on these things is still evolving. I’ve been on the receiving end of fairly aggressive self-promotion by some nominees, while others stay quiet about it, even on their own blogs.

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The Massachusetts Department of Revenue (our local version of the IRS) has posted new health insurance-related tax forms, which income tax filers in Massachusetts will have to complete. Those who have health insurance have to fill in only one page of Schedule HC: Health Care Information , which is very straightforward. Those with private insurance simply list their insurance company and its tax ID number. The tax ID number will be contained on a separate MA 1099-HC, which insurance carriers will provide to their subscribers. The 1099 will also include insurance information for each dependent, including subscriber number and dates of coverage. Filers with government subsidized health insurance just need to fill in an oval next to the appropriate program, e.g., Medicare, VA and write in the name of their insurance carrier or program.

Those without insurance have to jump through some more hoops. Claiming a religious exemption is straightforward. Filers must affirm that they are “claiming an exemption from the requirement to purchase health insurance based on [their] sincerely held religious beliefs.” However, if they received medical care in 2007 they are denied the exemption.
Those claiming financial hardship (remember the law says you’re only required to buy insurance if it’s affordable) must provide their Certificate of Exemption number, issued by the Commonwealth Connector. Applications for a Certificate of Exemption must  be filed with the Connector by December 31, 2007. Anyone without a certificate can still claim an exemption based on affordability by completing a worksheet in the instruction booklet and –even if the affordability provisions don’t get them off the hook– can appeal on hardship grounds.  Hardships include homelessness, fires and floods, and similar issues. Interestingly, having high medical bills is also grounds for appeal.

All of this is a little complex, and that may just be the nature of income tax filings. There is also a potential Catch-22 in all of this: Anyone who can successfully navigate the affordability worksheet and fill out all these forms correctly probably has the ability to get a job that pays enough to disqualify them from the exemption.

The Department of Revenue has a Health Care Information website, which contains all the forms, FAQs and an overview of the filing requirements.

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The facts of this case (Woman Misdiagnosed With HIV Gets Millions) are unclear. It may be Munchausen’s syndrome, with the woman claiming falsely to have AIDS, or a sloppy doctor who didn’t bother to check the old records, or both.  In any event, it is a good argument for thorough, portable, personal health records.

A jury awarded $2.5 million in damages Wednesday to a woman who received  HIV treatments for almost nine years before discovering she never actually had  the virus that causes AIDS.

In her lawsuit against a doctor who treated her, Audrey Serrano said the  powerful combination of drugs she took triggered a string of ailments,  including depression, chronic fatigue, loss of weight and appetite and  inflammation of the intestine.

[Dr.] Lai testified last week that Serrano told her she had worked as a  prostitute, her partner had AIDS, and that she had suffered three bouts of a  type of pneumonia typically associated with those infected by the virus.

Serrano has denied she had ever been a prostitute. She confirmed that  her former boyfriend tested positive for HIV/AIDS, but disputed the claim that  she told the doctor that she had suffered bouts of Pneumocystis pneumonia.

Lai testified that she had no reason to question Serrano’s original  diagnosis at another clinic because Serrano convinced her she had HIV when she  took her personal history, and her blood had abnormal amounts of cells used to  fight infections.

Thanks to Mickey.

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Check out the latest edition of the Health Wonk Review, hosted this time by David Harlow at HealthBlawg. Good stuff!

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Michael Segal, MD, PhD, CEO of decision support software company SimulConsult, suggests that computerized decision support tools should be used to support the troops in Afghanistan. He pointed out today’s front-page New York Times article (On Taliban Turf, Long Lines of Ailing Children)

Each patrol was a foray into villages regarded as Taliban sanctuaries. Each began with tension and the possibility of violence. But the Taliban did not confront the heavily armed paratroopers, and within minutes the mood of the patrols shifted.Once the villagers realized that the platoons were accompanied by medics, they pushed forward sick children and pleaded for help.A catalog of pediatric suffering quickly formed into queues: children with grotesque burns and skin infections, distended scrapes and scorpion and spider bites, bleeding ears, dimmed eyes or heavy, rolling coughs. Some were bandaged in dirty rags. Others were in wheelbarrows because they lacked the strength to walk.Almost invariably, a similar scene unfolded.

Once the meetings ended, the people brought forward sick children. The American medics, who conducted examinations in front of mosques, were the only modern health care many of the villagers had seen in years.

Sometimes the medics were able to help, quickly cleaning wounds and dispensing simple medicines. Much of what they saw was beyond their reach.

During his recent patrols, the medic for Second Platoon, B Company, Pfc. Corey R. Ball, was asked to treat not only infected cuts and persistent colds, but also retardation, blindness, autism, deafness and epilepsy. “We are medics,” he said. “They want us to be miracle workers.”

Captain DeMure said the health-care situation in the district allowed the government to try to draw a contrast between its actions and those of the Taliban. The government is trying to provide services, the message goes, while the Taliban try to take services away.

According to Dr. Segal:

Since there is some mismatch between the adult medicine training of medics and the predominately pediatric concerns of the population, the medics should be equipped to pull out computers and tap into knowledge put together by their colleagues back in the US. They wouldn’t pull off a miracle in each case, but the process would be as impressive to the populace as Star Trek medicine was to us in the 1970s. For the retardation, autism and epilepsy cases the medics could tap into our free neurological syndromes diagnostic software; we’ve pulled off some miracles with the software back in the US; the medics deserve their chance at a few miracles as well.

This is a good way to project soft power in a way that is very impressive technologically.

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At the International Medical Tourism Conference in Washington, DC last week I spoke with Dr. Robert Crone, who was until recently President and CEO of Harvard Medical International, or HMI. Over the past several years, HMI has been involved in the development of world-class health care facilities outside of the US, including Wockhardt Hospitals in India and Dubai Healthcare City.

We spoke about accreditation, the impact of the globalization of health care on the US, and the Medical Tourism Association.

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David Williams interviews Dr. Robert Crone, Harvard Medical International Play Now | Play in Popup | Download

Could medical tourism be cutting into the income of US plastic surgeons? I think the answer may be yes. On Saturday the Wall Street Journal had a front page article about the possibility of a recession in the US (Evidence Grows That Consumers Are Pulling Back. Latest Industry to Feel Pinch: Plastic Surgery; Debating a Recession).

The latest sign that growth in consumer spending, the mainstay of the U.S. economy, is slowing? A nip and tuck in spending on cosmetic surgery.

The slowdown was a hot topic at the meeting of the American Society of Plastic Surgeons in Baltimore this fall. One breast-implant maker sees hints of a slowdown in demand. The number of vision-correction surgeries appears to be falling as well. “This whole mortgage credit crisis is making people think twice,” said J. Peter Rubin, a Pittsburgh plastic surgeon. “It’s something I’ve noticed and some colleagues have noticed as well.”

The Journal cites the tightened spending as evidence of a possible recession, and it could be. However, another explanation could be that more patients are substituting surgery overseas for surgery in the US. If so, the problem for the plastic surgeons is a lot more serious than a temporary slowdown, and the Journal will have to find another folksy recession indicator. How about haircuts?

If it turns out that medical tourism is a significant contributor to the slowdown in the US plastic surgery market, it will be interesting to see how the surgeons respond. Will they cast aspersions on foreign providers or argue for legislation to restrict the flow of patients? Will they cut prices or work to improve customer service? Plastic surgeons may pave the way for how US providers respond to medical tourism. Dentists are likely to be only a few steps behind. Orthopedic and cardiac surgeons may also take notice at some point.

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