Thursday, April 28, 2011

The Data Miners' Date With The Supremes

And so it happened: The Supreme Court spent 70 minutes on Tuesday (4-27) hearing arguments about why Vermont’s data mining law should stay on the books, and why it shouldn’t.

This was a big deal – the major media outlets covered this event, all with a different take, which is always welcome and interesting. What we found especially remarkable was that none of them, and we read many stories, interviewed a Vermont physician. It was apparently the doctors themselves who initiated the legislation: When they found out their prescription data were being sold to the likes of IMS, they asked their legislators to write the legislation.

Most of the outlets quoted Justice Antonin Scalia, Chief Justice John Roberts and even Ruth Bader Ginsberg, who questioned the reasoning behind the legislation. They didn’t think it had much to do with protecting the First Amendment rights of the physicians, as Vermont’s legal staff claimed.

“The state is interested in promoting the sale of generic drugs and correspondingly to reduce the sale of brand-name drugs,” Justice Ginsburg said, according to the Washington Post. “And if that’s the purpose, why doesn’t that run up against what this court has said — that you can’t lower the decibel level of one speaker so that another speaker, in this case the generics, can be heard better?”

Critics of the law – which include many large physician groups and the New England Journal of Medicine -- contend that data mining “violates medical privacy” a core precept of the physician-patient relationship. They assert the data are private and that the law “advances state interest by closing gaps in medical privacy and protecting the patient-physician relationship from intrusion by sales people, who tend to promote newer, less-tested and more expensive brand name drugs.”

Which is fine: Except that the law also says that a physician can exclude his data, if he wants it that way.

Does pharma use this data to sell? Of course it does. Can a physician shut his door to a drug rep? Of course he can. Let us not forget that the transparency rules are in place.

We find it curious that industry critics have such little regard for physicians’ intelligence and willpower. 

Monday, April 25, 2011

Healthcare Costs: Let the Sadists Rejoice

As politicians and other policy makers try to curb the costs of healthcare, the people who make their living from saving lives are no doubt trying to figure out how not to lose income without looking like heartless jerks. Odds are they also are trying to figure out how to take money from each other.

The folks in the boxing ring: drug makers, hospital owners and insurance companies.

The heavyweight is the hospital owners, even though their slice of the pie has shrunk 10% between 1980 and 2009, to 32.6% from 42.7%, according to the The Cost of Caring: Drivers of Spending on Hospital Care, from the March 2011 American Hospital Association. That’s 32% of $2,330.1 billion. [I BELIEVE THAT’S A TRILLION?]

And, just to complete the reporting, the drug makers’ and insurance companies’ slices have gotten lots bigger: drug makers’ take has doubled, to 10.7% from 5.1%.

As for the insurance companies, “since 1999 [to 2009] premiums have gone up a total of 131 percent, far more rapidly than workers’ wages [up 38% since 1999] or inflation [up 28% since 1999], according to a Kaiser Family Foundation study. 

It’s difficult to see how any of them will lose money. While insurance companies will likely continuing trying to control patient hospital stays, our population is getting older. You know the rest of the story. According to the AHA article, of the Medicare patients who had heart failure and died between 2000 and 2007, 80% were in the intensive care unit during the last six months of their lives. The per-patient bill hovered around $36,000.

Then there are our lifestyle issues. More people are obese, have diabetes, are hypertensive, have cancer …..

And then there is technology, and more and more of it. It may get people back to work quicker, but it also costs money: “The average spending per heart attack case rose from $12,083 in 1984 to $21,714 in 1998.”

And we’ve all read the stories about hospital staffing shortages.

As costs continue to rise, the country’s 1,000+ private insurance companies, let alone self-insured employers, will surely continue to scrutinize every procedure. But hospital administrators aren’t stupid: the losses they incur from patients who don’t pay, as well as from Medicaid, Medicare and the uninsured will be absorbed somewhere: How many hospitals have closed their maternity wings?

A law of physics applies: Every action has a reaction.

Paul Krugman, in his Times Op-Ed column last Friday, (April 22) wrote in support of the Independent Payment Advisory Board, an expert panel that would set spending limits for Medicare. Mr. Krugman says, “We have to do something about health care costs, which means that we have to find a way to start saying no.”

We? There is no we regarding healthcare. For the economic sadists among us, this is pure joy.

Monday, April 18, 2011

Industry-Physician Education: Walking in Patients' Shoes

Some industry critics have railed that any contact between physician and drug makers is akin to a mortal sin; the very thought sullies the purity of medical practice. We think extremism, in any form, shows poor judgment and lack of logical thought. Transparency is excellent, but contact between industry and physician is still necessary for medical advancement.

So we loved the piece we read in Pharmaceutical and Medical Packaging News about the pharmaceutical consulting firm that set up booths at a rheumatology conference which allowed physicians to experience what their RA patients deal with every day. The point: education for all stakeholders, and that includes the use of biologics. A Web-designed program also stresses the need for exercise and the importance of medication adherence.

The booths were equipped with a working faucet and sink; a laundry detergent container; and working taxi cab door. A pharma sales rep guided each physician through the booth, who was asked to turn on the faucet, and so on. The physician, who was measured on how difficult it was to perform the tasks, generally had no problem doing so.

Then the HCP put on specially made gloves (made by folks at George Tech University) that simulated the challenges the RA patient goes through; the physicians' decline in functionality was significant.

The doctors who went through the booth loved it; 92% said they would go through it again – 98% said the demonstration helped them understand what their patients dealt with every day.

Just think: Maybe the consulting firm that developed this tool, OneWorld, can design similar booths for neurologists, so they can appreciate what migraineurs live with, and for pulmonologists, so they can understand what it’s like to live with emphysema.

Thursday, April 14, 2011

The HCC, Its Priorities, and Financial Disclosure

The headline on the Healthcare Channel article reads: Did Merck conceal funding to a vocal advocate of Gardasil?

If Merck tried to, it did a lousy job. Its financial connection to oncologist Maura Gillison, the woman who linked the human papillomavirus with a new type of tonsil cancer, is readily available on the Web. The earliest connection we found goes back to a Forbes story, written in 2009. If Merck tried to keep the connection out of the story, it failed.

There might be an earlier mention, but there’s no date on this disclosure: Dr. Gillison, who also has a PhD, apparently spoke at a webinar for the Association of Reproductive Health Professionals. She disclosed that she “receives unrestricted educational grants from Merck and Digene.” 

If you haven’t guessed already, this is yet another dust-up over financial disclosure. The Healthcare Channel apparently was all aflutter that Dr. Gillison hadn’t listed Merck as a funding source when she published an article in the New England Journal of Medicine in 2010. It notified NEJM; the journal investigated, and it decided that Dr. Gillison HAD NOT violated any of its disclosure rules because the financial arrangement had fallen into a “gray area.”

We don’t know why NEJM let Dr. Gillison slide; but we think this is an example where we need to be careful about the generalizations associated with industry and healthcare practitioners' relationships.

The Healthcare Channel wrote: “The Healthcare Channel has exclusively learned that Dr. Gillison was in fact receiving payments from Merck, going back to 2008 that benefited at the least her laboratory, while she was at Johns Hopkins.” Maybe if its writers had surfed the Web for 15 minutes, they would have found what we found.

This is what the Merck Web page says regarding the information it discloses:

"On March 29, 2011, Merck updated its report on payments to U.S.-based medical and scientific professionals who speak on behalf of Merck about our products and other health care issues. These reports include legacy Merck products prior to the November 2009 merger between Merck and Schering-Plough. The new report covers payments made to speakers for the full year 2010. The report provides data for 2,088 physicians and other health care professionals who, on average, participated in 5.9 programs each and earned an average of $1,659 per program…"

Dr. Gillison is not listed. The presumption: She didn’t speak for Merck during 2010.

We all know there is no uniformity among the current disclosure laws, or among the industry members who are disclosing on Web sites. We’ll all have to wait for 2013 for that to happen.

This is what the Forbes article said about Dr. Gillison and Merck: “Gillison spent three years trying to draw Merck's attention to HPV tonsil cancer. Finally, she is working with Merck to design a study to see if Gardasil can affect HPV infection in the throat. Merck admits studying the problem is ‘challenging’ but says the potential is big.”

Here is a physician who made the connection between HPV, oral sex and a new form of throat cancer. She did the right thing: She worked with industry to try and find a cure. She never hid her connection with industry.

That old expression about throwing the baby out with the bathwater keeps popping into our brains ....

Monday, April 11, 2011

Saving Capitalism and Sunday Dinner

Whatever happened to taking our time? For those of us old enough to remember, a time once existed when virtually all stores were closed on Sundays. Yes, all shopping happened the rest of the week. Sundays were reserved for family and friends; some of us even ate dinner at an earlier hour, and we didn’t dare be late for it, either. Of course, this was a time when computers were the size of tanks and most of us only got three channels on our television sets. 

Life moved at a slower pace.

Now, life moves in nanoseconds. Is it possible to connect today’s freneticism to Dominic Barton’s argument in the Harvard Business Review that for capitalism to thrive, the business world, among other improvements, must start thinking in the long-term –- and that means not in terms of a few months, but in terms of many years?

Mr. Barton’s concern is that unless business leaders fix those problems that were exposed during the Great Recession, Washington and the public will do it for them. 

“There is growing concern that if the fundamental issues revealed in the crisis remain unaddressed and the system fails again, the social contract between the capitalist system and the citizenry may truly rupture, with unpredictable but severely damaging results,” writes Mr. Barton, the global managing director of McKinsey and Company.
He advocates:
  • Adopting a long-term view for success –- at least five years;
  • Convincing typical stakeholders that also serving atypical stakeholders –- customers, creditors, the environment –- is essential to success, and;
  • Converting disengaged board members into engaged, proactive members.
He makes a lot of sense, but we fear his words are too scary for some.
“Analysts and investors are focused on the short term,” he quotes one executive as saying. “They believe social initiatives don’t create value in the near term.” In other words, Wall Street may not like it.

A couple of statistics from Mr. Barton’s story:
  • In 1995, the average CEO stayed on the job for 10 years; now, that tenure has dropped to six years. 
  • In the 1970s, U.S. equities were held for an average of about seven years; now it’s about seven months. 
  • "Hyper-speed” traders account for 70% of all U.S. equities trading. 
When McKinsey and Company broke down the value expectations buried in share prices, it discovered that 70% to 90% of a company’s value was connected to cash flows that were anticipated in at least another three years. If most companies’ worth relies on results that far out, but its leaders are concerned with what’s reportable in the next quarter, then capitalism -- and by default our American culture -- is in trouble, Mr. Barton says.

We think capitalism, Sunday dinner, and a whole host of other valuable traditions  are in trouble.  Maybe we need to focus on what is important and slow down.  

Thursday, April 7, 2011

$4 Generics and Medication Non-Adherence

Let’s face it – the business of healthcare is enough to make anybody nuts.

Take the recent study, conducted in 2007, showing only a handful of people, relatively speaking, who took advantage of their healthcare insurance provision to buy $4 generic drugs. If all the people who could buy $4 generics did so at that time, society would have saved nearly $6 billion. A lot of money, no question. The study included 31,000 people; fewer than 6% bought $4 drugs.

It’s tough to imagine that 93% of these people hated society, so maybe there’s something else going on here. They didn’t know? Perhaps. They don’t like generics? Unlikely. According to the Kaiser Family Foundation, 72% of all scripts written in 2008 were generics, and sales of generics grew 8% from 2005 to 2006. The percentages wouldn’t have changed that much from 2007.

In that same study, “Over half of physicians say they frequently talk with patients about the out of-pocket costs of medicines they prescribe, 62% say they switch patients to less expensive drugs, and 58% say they give patients office samples.”

It's anybody guess why those patients chose to spend more money. But, none of the above is the good-grief part. The following is.

Back in November, the New England Journal of Medicine ran a piece about the possible damage that these $4 generic sales can do to long-term improvements in healthcare.

Normally, when a patient purchases a prescription with insurance, that purchase generates a claims record. The pharmacy sends the claim to the pharmacy benefit manager. These claims can be used for healthcare management, including medication safety, verifying clinical trial results, and ensuring medication adherence.

But, with the $4 generics, patients often pay in cash. The authors say the pharmacies often do not submit the claim information “since they have no incentive to do so.” The result: patients are classified as non-adherent or non-users. And, because these drugs are often prescribed for chronic diseases, “the consequences of these missing claims are not insignificant.” This is also important to the topic of medication adherence because it already suffers from a lack of awareness. With almost 80% of the prescriptions today being dispensed as generic, medication non-adherence will become more of a silent disease.

The authors, Niteesh K. Choudhry, M.D., Ph.D., and William H. Shrank, M.D., M.S.H.S., aren’t labeling the pharmacies as bad guys – their actions are unintentional, they say. But, as they point out, new systems need to be devised to make sure the claims are filed. 

Monday, April 4, 2011

Pharma Marketers: Smiling Through the Pain

Pharma marketers, it’s little wonder that you aren't happy people these days. The feds have yet again pushed off making decisions about how to regulate social media interaction; your DTC spend has dropped; the Sunshine Act will, indirectly, shift who your customer base is; and your end-users are spending lots of time checking out the goods on the Web before buying. Forgive us for reminding you that patients no longer just blindly take their doctor’s advice on a script.

Your mood is understandable. You need to account for every cent in your marketing budget. We get it.

But may we look at this from another angle? You may not have to recreate your wheel. You can take out a few spokes and replace them.

In other words: Have some fun while you’re miserable.

How? By learning about the game from others in the game. A Medical Marketing and Media article – an oldie but a goodie -- points out that while Pharma companies are learning from other industries’ marketing strategies, they haven’t yet caught on to the value of their own ROI experiences. The article suggests pharma needs “a clear optimization plan…. so that when results come in, everyone can deal with them as opposed to having an academic debate” about what mix works the best.

And then of course, there is keeping track of those Web searches –- not only the searches that patients make, but also those that physicians make. More than 70% of physicians search the Web for drug information, and 30% change the script or treatment course because of information they find on it, according to ThomsonHealthcare.

And more and more, those searches will lead pharma marketing pros to other social media sites like Facebook. For two years in a row, the word Facebook was the top search term on the Web, according to Experian Hitwise.

But waiting for the FDA to make a ruling before industry members are allowed to play the game will lead to many different challenges, not the least of which is disintermediation of their own products. When the FDA finally figures out how it wants industry to conduct itself in the social media world, marketers may not be able to create new spokes for that wheel. We suggest you do some scenario planning to get to those answers.

And hopefully, smile again.