On the Retired Doc's Thoughts blog, Dr James Gaulte tied the dwindling of primary care to how Medicare controls physicians' reimbursement. Furthermore, he ties the continuing imbalance between the generally poor reimbursement for primary care and other cognitive services and the much better reimbursement for procedures to the influence of the shadowy RUC (RBRVS Update Committee), a topic which I have also ranted about (here and here). Kudos to Dr Gaulte for trying to keep a flame under this pot.

A little late for Halloween is this post on the WSJ Health Blog describing a vivid anecdote of an unsuccesful attempt by a medical education and communication company (MECC) to generate a ghost-written abstract for a medical scientific meeting. (Our most recent post on ghost-writing and related pheonomena was here, summarizing an article by Moffatt and Elliott that characterized ghost-writing as harmful to people and undermining science.)

The story about artificial joint manufacturers' payments to orthopedic surgeons and others just keeps bubbling along. We have previously posted (here, here, here, here, and here) about the payments, often huge, that five manufacturers of prosthetic joints (Biomet, DePuy Orthopaedics (a unit of Johnson & Johnson), Stryker Orthopedics,a unit of Stryker Inc, Zimmer Holdings, and Smith & Nephew) just revealed they made to orthopedic surgeons and various academic and other organizations. The lists are here: Biomet, DePuy, Smith & Nephew, Stryker, and Zimmer.

A few intrepid reporters have pursued this story by looking for local surgeons on the lists. First, Bill Toland in the Pittsburgh Post-Gazette found some recipients of the companies' largesse, and what he learned from one was typical,

In Pittsburgh, Dr. James D'Antonio, of Greater Pittsburgh Orthopaedic Associates, has received $850,000 to $875,000 through the first 10 months of 2007 from Stryker. On his extensive resume is the development of a new alignment system for artificial knee joints, femoral research, and two decades of experience in knee and hip replacements, performing them at several regional hospitals.

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In Nature, a news article by Jim Giles focused on potential biases of pharmaceutical company funded continuing medical education (CME). We had previously posted about an illustrative case, in which GlaxoSmithKline funded speakers seemed to favor clinical policies which would promote increased use of its drug valacyclovir (Valtrex) for genital herpes infections. Giles also used that case for illustrative purposes in a sidebar entitled "Smokescreens."

Giles then described two relevant, but unpublished studies. The first was by Jatinder Takhar

Takhar and her colleagues went on to develop a standardized checklist of potential problems to be used for measuring bias in CME, which they published in June (J. Takhar et al . J. Cont. Educ. Health Prof. 27, 118-123; 2007). The team then applied its checklist to 17 company-sponsored CME events. Nine of these were found to be biased and should not have been approved, Takhar says. Some focused only on the sponsors' product and ignored rival treatments. In others, information on side effects associated with the sponsors' drugs was reduced to small print.

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"Twice I have with my own ears heard the sound which resembled the distant baying of a hound." [The Hound of the Baskervilles: Another Adventure of Sherlock Holmes By Arthur Conan Doyle]

We just posted about a report by the US Senate Finance Committee charging that top executives of GlaxoSmithKline had tried to silence an critic of rosiglitazone (Avandia, by GlaxoSmithKline). (For our earlier discussion of the Avandia controversy, see this post and older links.) The Wall Street Journal just published a news article on Finance Committee report which provided a few more details.

Over a period of several years, drug maker GlaxoSmithKline PLC was so concerned about a prominent physician's negative views of its diabetes drug that it engaged in a concerted effort to intimidate him and stifle his opinion, a report by the U.S. Senate Finance Committee found.

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A little while ago we posted about accusations that Health Net Inc, a for-profit managed care organization, cancelled individual health insurance policies after the policy-holders became ill and filed claims. Now the company is also accused of trying to conceal related information from state regulators.

The San Francisco Chronicle reported that

State health regulators fined Health Net Inc. $1 million Thursday for lying to investigators about paying employees bonuses based on the number of contracts they canceled after those policyholders got sick.

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On the Clinical Psychology and Psychiatry blog, this post discusses an amazing case of a psychiatrist who had his license suspended for giving genital herpes to two patients. Why is that amazing, or relevant to Health Care Renewal?

The psychiatrist also is known for enrolling patients in clinical trials sponsored by no less than 11 well-known pharmaceutical companies (AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Janssen, Johnson & Johnson, Novartis, McNeil, Pfizer, and Shire) and working with no less than six well-known contract research organizations (I 3 Research, INC Research, Parexel, PPD Development, Quintiles, Rho Inc).

Apparently an FDA investigation of the (not so) good doctor also found he had "imprisoned" one patient, enrolled at least two patients in trials without informed consent, hospitalized patients in unlicensed facilities, and failed to record drug dosages in trials.

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As I posted last month, I had the good fortune to be able to attend the Aspen Health Forum last month, and got to hear some presentations that were remarkably frank about some of the issues facing health care today.

Just before I had to run to try to catch a plane, I attended the session entitled "Health, Humanity and Politics: Prospects for Reform." Again, I found that the speakers were remarkably frank in addressing some of the issues that we discuss on Health Care Renewal. However, many of the comments went by too fast for me to take accurate notes. The Aspen Institute just released video and audio from most of the Forum sessions. So I was able to transcribe some of the relevant thoughts.

Mark Ganz, President and CEO of the Regence Group, a Blue Cross- Blue Shield affiliated health insurance company based in Oregon, describing a typical anecdote representative of the fundamental dysfunctionality of the current system:

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Both Ed Silverman on the PharmLot blog and the Wall Street Journal Health blog covered the report by US Senator Charles Grassley (R - Iowa) about the attempt by GlaxoSmithKline executives to intimidate an early critic of the cardiovascular effects of Avandia (rosiglitazone). As we just noted, apparently chiefly responsible for this whistle-blower intimidation was then GSK executive "Tadataka Yamada, who now heads the global health program at the Bill & Melinda Gates Foundation and today was announced as a board member of the FDA's new Reagan-Udall Foundation, which is designed to foster drug research," per Ed Silverman (see also our post here.)

Also the WSJ blog noted that Grassley "invited researchers who feel they have been bullied by the industry to contact him. And, he added, 'they can also anonymously provide information and documents by mail or by fax.' Grassley ... even helpfully announced the fax number - 202-228-2131 - on the floor."

Since support for health care whistle-blowers has been sorely lacking, at least the fax number is a welcome development. Read the rest of this entry »

On PharmaLot, Ed Silverman noted questions raised about the leadership of the new Reagan-Udall Foundation, which is supposed to help the US Food and Drug Administration (FDA) streamline drug and device development. The foundation's financing through the pharmaceutical industry had already raised one obvious set of questions.

New questions were raised by the just announced membership of the Foundation's board. Silverman focused on the presence of Dr Tadataka Yamada, billed as President, Global Health Program, Bill & Melinda Gates Foundation. Dr Yamada, however, was previously a GlaxoSmithKline executive, and had been accused of trying to intimidate one of the early critics of Avandia (rosiglitazone). (See our post here.)

I should also point out that another member of the board is Dr William Brody, billed as President of Johns Hopkins University. But Brody also is a director of Medtronic Inc, a large manufacturer of medical devices, and as such has a fiduciary responsibility for that company's finances and operations. Thus, he seems to represent device manufacturers, but I suspect was not appointed as such. Brody was also recently involved in the creation of a speech-code at his university which threatens punishment of any student who is "rude" or "disrespectful." (See our post here.)

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