Healthcare MBA Director Larry van Horn on Healthcare and the 2008 Presidential Election

As it embraces the new media revolution, the Owen School has been pushing out some great business-centric content. Part of that content is a podcast series with Owen Faculty discussing current events in their respective fields.

You can now listen to Healthcare MBA Director Larry van Horn discuss healthcare, politics, and everything in between.

You can tune in by clicking on the picture to the right or the link below.

[via The Owen Schools Featured Faculty Research]

Preventative care saves money in the long run, right? Not necessarily.

While catching up the feeds this morning, I ran across an interesting story in the Boston Globe.  The story reports a study from the Dutch National institute for Public Health and the Environment which says, basically, that long term healthcare costs are much lower for the obese - anywhere from $50K to $100K over the course of a lifetime.

The difference?  Unhealthy people die sooner.

"This throws a bucket of cold water onto the idea that obesity is going to cost trillions of dollars," said Patrick Basham, a professor of health politics at Johns Hopkins University who was unconnected to the study ... "If we're going to worry about the future of obesity, we should stop worrying about its financial impact," he said.

Add to that the fact that fat people are good for the economy.  Junk food, fast food, soda, and chain restaurants - all industries that popped up in an effort to help us manage the food portion of our hectic lifestyles.  And let's not forget the health clubs, exercise equipment, and diet aids that help us manage the weight loss portion of our hectic lifestyles.

There are any number of ethical undercurrents that we'll acknowledge while in the very same breath declare that we want no part of discussing.  But, as the saying goes, the data are what the data are. 

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Vanderbilt to drug reps: We'll buy our own pens, thanks!!

Earlier this week the Vanderbilt University Medical Center announced plans to outlaw gift from drug reps.  Included on the list are all forms of branded swag (pens, paper, clothes, and other personal items) as well as food.  Drug company representatives would also be precluded from attending or sponsoring continuing medical education events on the Vanderbilt campus.

According to VUMC Dean Steven Gabbe, the rule, which comes in the form of a conflict of interest guideline, is aimed at "... [giving] the public great assurance to know that our decisions are based on what's best for them." (quote from the VUMC Reporter, January 25, 2007).

Also of interest in the VUMC Reporter piece:

VUMC leaders estimate the new rules will save about $2 million in drug costs each year. “A portion of our budget goes to buy drugs, devices or materials that are not cost effective or that could be purchased at a lower price, such as generics,” said Gordon Bernard, M.D, assistant vice chancellor for Research.

The new guideline is set to take effect in July of this year.  You can read more about it, as well as reactions to it, in the Nashville Tennessean as well as the Wall Street Journal.  Or, for a laugh, you can check out the Drug Rep Toys blog.

Technorati Tags: Business School, Health Care, Healthcare, Little Blue Pill, MBA, Nashville, Owen, Owen Graduate School of Management, owenbloggers.com, pharmaceuticals, Vanderbilt, VUMC

Can Big Pharma produce generics? Wyeth thinks so.

You might have heard that pharmaceutical giant Wyeth Pharmaceuticals has been locked in a battle with generic drug manufacturer Tea Pharmaceuticals.  The disagreement revolves around the heartburn medication Protonix.  In short, Teva thinks Wyeth's patent (which runs through summer 2010) is bogus so it started selling a generic version.  Time in the New Jersey federal court system failed to resolve the issue to Wyeth's liking.

Yesterday Wyeth announced that it is producing and selling a generic version of Protonix, its own drug that still has some 18 months of patent protection left.

Particularly interesting in the press release is a thinly veiled threat that this will adversely affect the development and production of new medicines.

"Compound patents, like that infringed by Teva, represent the foundation of pharmaceutical innovation, a critical underpinning in bringing important new medicines to patients,” says Bernard Poussot, President and Chief Executive Officer for Wyeth.

UPDATED 2/1/08:
This morning Teva announced that it is not relaunching generic Protonix.  There's an interesting piece at the Wall Street Journal that opines on the possible motivations behind the move.  Whatever the reason, its an interesting twist to an already confusing situation.

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Blue Cross thinks it has the answer to universal healthcare

Not content to wait out the current political cycle, Blue Cross and Blue Shield has announced a "plan" to cover many of the 47M currently uninsured Americans.  Already responsible for coverage of about 100M people, the new plan would extend coverage to an additional 30M to 35M.

The plan is financed by a proposed tax credit, although the specific amounts are still undetermined.  Furthermore, the company would help states enroll qualifying, uninsured people in current public health programs. The goal is to help low wage workers, small businesses, and any individual burdened by exorbitant healthcare costs to secure coverage.

While a true and virtuous goal, the plan lacks a certain ... completeness.  A perusal of the full report (PDF) and the accompanying web pages reveals very few actionable items in the oft-heard mantra of "Increase quality, increase access, reduce costly errors, make coverage affordable."  The initial announcement piqued our interest, but digging just a little deeper led us to ask the inevitable question: 

Do we really need another glossy brochure enumerating all the things we already know are wrong with the system?

 

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First it was $4 generics. Now Wal-Mart gets into the PBM business.

Back in September we wrote about Wal-Mart's burgeoning generic drug business.  At the time Wal-Mart was expanding its own employee prescription drug program to cover, at a cost of $4 per refill, over 2,400 of the most common medications on the market.

Today we're hearing indications that Wal-Mart wants to take this a step further by managing pharmacy benefits for other companies.  Pharmacy Benefits Managers (PBM's) sit between the payer and the prescription fillers by administering and processing claims. 

One of the more interesting tidbits from the WSJ article is:

A spokesman told the WSJ that one possibility would be to have a company contract with Wal-Mart to fill all or at least a majority of employee prescriptions.

In addition to handling the paperwork, one of the other traditional roles of a PBM is to negotiate prescription drug prices on behalf of their clients.  What happens, then, when a company with a reputation for incredibly fierce price negotiations throws its hat into the pharmaceutical ring?  And what happens when they position themselves as a one-stop-shop that will not only negotiate "Everyday Low Prices" on your behalf but also will handle the claims administration and actually filling the prescription?  Add to that the recent news that insurance companies are encouraging doctors to move to generics.

If I were a betting man I'd say that someone somewhere is getting just the slightest bit scared ...

* Check out our sister blog Big Red Horseshoe for Glenn's take on the business strategy implications of Wal-Mart's move into the PBM space.

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Google Health one step closer to going live

Google's long-anticipated Health site, which aims to integrate patients' health information (both personally entered and downloaded from healthcare providers), search and information gathering, and provider information, is one step closer to going live.  Google Blogscoped is reporting that the login page for GHealth is up, although as yet non-functional.

GHealth, a direct competitor to Microsoft's Health Vault, was finally confirmed late last year.  Google has projected an "early 2008" opening for the site, although specific dates are hard to come by.

It will be interesting to watch the ensuing battle of standards between MSFT and GOOG, both of which tout the ability for providers to upload information directly from their own information systems into the online portals.  Will doctors, hospitals, and pharmacies really want to deal with two different web portals, each presumably with its own interface and upload protocols (and when have we really ever known MSFT to play nice with others)?  Or will they leave it to the patient?  It seems like the true value - and power - in these systems is in providing a central storage location for all your medical data as well as the ability to tailor search results based on those data.

* A tip of the hat to Glenn from The Big Red Horseshoe for the heads-up.

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The Drugs Don't Work, Try Eating Better

Let the resolutions begin. It's a new year and every magazine I've seen this month is offering a new fitness routine or challenging me to lose the weight and make this the best year yet. Well, I've started the new year off with higher hopes than last and will keep at it until the work consumes me and I fall out of the routine.

Others feel differently than I do. A professor of mine seems to think that there is no motivation to exercise or eat healthy since he can eat french fries with mayo and then take a drug to maintain his health. Last week, information about an ongoing clinical trial suggests that the drugs do not work as well as it was once thought. It seems that the wonder drugs Zetia and Vytorin may not be as effective at lowering cholesterol as previously hoped. There is even the suggestion that these drugs contribute to the buildup of plaque which may lead to heart disease. So maybe it’s not okay to eat junk food and hope that the pharmaceutical companies have something in the pipeline that’s going to save us. Maybe it’s time to have some tofu and head to the gym.

UPDATE: a correction to the original article states that the concern is much broader than whether or not the drugs are effective; it’s now being questioned as to whether lowering cholesterol is even beneficial to our health. For existing drugs, approval from the FDA was granted when it was demonstrated that a drug actually lowered cholesterol. Going forward, it seems that evidence will have to support the notion the lowering cholesterol actually improves our health in order to gain approval from the FDA (tough news for Merck as it waits for approval of the drug Cordaptive).

Once thing remains clear, there are still no definite answers. It is uncertain whether Zetia and Vytorin are effective in reducing cholesterol and more importantly, it isn’t clear whether lowering cholesterol even has an effect on our health. My advice, don’t eat the french fries with mayo in the first place.

The Little Blue Reader - Sunday January 20, 2008

CoverTN broadens reach to larger companies [Nashville Business Journal]

Tennessee's CoverTN is expanding its coverage to small businesses.  Companies with fewer than 50 employees (up from 25), half of which must make less than $43K/yr (up from $41K/yr) are now eligible for the program.  The move is presumably to lighten the burden of providing healthcare on small businesses in the state.

Do Cholesterol Drugs Do Any Good? [Businessweek]

Merck and Schering-Plough published results of a study in which two cholesterol lowering drugs were combined (Zetia plus a statin).  In the end, cholesterol levels were lower in the combined group than with the stain alone, but there were no discernible long term health benefits.

Beth Israel Deaconess aims to end preventable mistakes [Boston Globe]

Now that CMS and other payers are ratcheting down payments over preventable mistakes, hospitals around the country are undertaking efforts to not only identify the root causes of those mistakes but also put in place mechanisms to help avoid them in the first place.  Harvard's Beth Isreal now undertakes a similar project.

Most back mandatory health coverage [Scientific American]

A survey by the Commonwealth Fund reports that 68% of Americans believe everyone should be required to obtain medical insurance.  With healthcare taking center stage in this year's Presidential race, one of the major topics - and sticking points - is a viable plan to cover the approximately 47M people in this country who have no coverage whatsoever.

Waits Grow in Emergency Rooms [WSJ.com]

The Wall Street Journal reports a study by Health Affairs that shows ER waits in the 8 years between 1997 and 2004 grew an average of 36%.  In 1997, the median wait time in an ER/ED for a heart attack patient was 8 minutes.  In 2004, it was 20 minutes.  What's more, in 1997 75% of those same heart attack patients were seen by a doctor within 20 minutes; in 2004 it was more like 50%.  With so many people receiving all their healthcare from ER/ED, its becoming more clear what the secondary effects of this phenomenon are.

F.D.A. Says Cloned Animals Safe to Eat [NYTimes.com]

Some four years ago the FDA tentatively suggested that food from clones animals was safe for general consumption.  This week they have confirmed their earlier suggestion.  This is good news for companies such as ViaGen, which specialize in the sale of cloned farm animals (cows, steers, and hogs, mainly).

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Google's online scientific data repository

Wired reports that Google has taken yet another step closer to to being the one-stop repository for all data everywhere.  The company has announced that their Palimpsest Project, which aims to house vast quantities of open-source scientific data (which includes nearly all of the data published in peer reviewed scientific journals).

The project, which was supposed to go live in August of last year, has been pushed back and will debut "soon."

Predictably, Google has also announced a set of

tools that help scientists search, organize, and make sense of any of the data housed in the project.

If you're interested in learning more, Attila Csordas' blog Pimm has more details, including slides from a Google presentation about the Palimpsest Project.

Image: Figer.com

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