When Prescription Information Looks Like A Rubiks Cube...

A lot of what I've talked about on this blog so far centers around small improvements that can be made to the U.S. healthcare system. Small improvements like checklists for surgeons and less administrative costs could lower spending more than you could imagine. I want to bring up another small improvement: focusing on health literacy and making sure patients understand the medications they are putting into their body.

Each year, millions are spent treating patients in the ER who misunderstand their medication. Who is to blame? The Wall Street Journal Health Blog posted recently about the FDA stepping in on this issue. They propose making the information that comes with medication more efficient. Instead of medication coming with multiple pages of information and additional promotional material from drug companies, it would come with a simple one- sided sheet with only the most important information. The bottom of the sheet would direct patients to a website for more information.

Some have harshly criticized this idea. Saying that 1 page is not enough to cover all important medical instructions. Others have said 1 page is enough to cover a bullet-ed list of essential medication instructions.

My opinion is two part:

1) The amount of information that comes with medications now is out of control. I recently picked up a prescription and had no idea where to start. Pages of information, promotional material, stickers. 1 page is definitely enough. Show me the dosing information, how to take the medication, and a number I can call if I don't understand something.

2) It doesn't end with simplifying the information. If you want to reduce medication misunderstandings, communication between patients, doctors and pharmacists MUST be stressed more. Patients should feel comfortable enough to ask when they don't understand. Doctors and Pharmacists should be willing and able to communicate with their patients.

Doing so will save a ton of time and money. I'm curious if anyone else has had a similar experience? Are you often confused by a medication you receive? If so, how can this be improved? Can essential information fit on one page?

Fixing Medicare

When ideas of healthcare reform began the question being asked was: Should we fix Medicare? With debates about the federal deficit swirling, the question has now become: How should we fix Medicare? The shift in positions and increase in urgency has come from the acknowledgement that Medicare is broken, and its costing the U.S. a ton of money.

It's easy to say we should fix Medicare; Actually figuring out how is a tad more difficult. As outlined in this New York Times article, President Obama's deficit reduction committee has considered a number of options. These options include (but are not limited to) :

1) Increasing the eligibility age for Medicare from 65 to 67
2) Requiring beneficiaries to pay higher premiums
3) Charging Co-payments for home health services
4) Paying doctors in "lump" amounts for entire treatments as opposed to paying for each step (tests, procedures) individually

The list goes on. For the complete range of options, check out the article. It's hard to say which option is best because all have pros and cons. For example, raising the eligibility age would save the government money for those two years, but those 65 and 66 year old patients might now be eligible for Medicaid. This just displaces the cost from Medicare to Medicaid.

Whichever solution is chosen, it will have to be supplemented with one thing: more efficient care. Changing the structure of Medicare will do nothing if health care is still administered in an inefficient way. This means, reducing medical errors, hospital infections, and administrative costs. More efficient care means cheaper care in the long run.

Fixing Medicare will probably require a pretty creative solution. What do you think is the best way to tackle this problem? Do you agree that any change needs to be supplemented with better health care? Will raising premiums do anything?

Optimism in Medicine

Although this blog generally centers around health economics and policy, an article I read in the New York Times made me want to switch it up today. Let's talk about ethics and optimism. Specifically the ethics of early stage clinical trials and patient optimism.

The article I linked to above, starts with a touching story about a mother in her 30's with cancer. If you have a few minutes, the article is a must read. Aside from being a story about selflessness and courage, it also raises a tough ethical debate about optimism and patient consent.

The woman in the story had been through numerous, experimental clinical trials. The purpose of these early stage clinical trials is often to test the safety of a new drug and not to actually treat the patient. In the story, doctors told the woman exactly that: she shouldn't expect this to benefit her, it was just for the purpose of advancing science. Although the woman confirmed that she knew this...I can't help but wonder if she had at least some hope and optimism about the experimental drug.

I truly believe that optimism is a gift. However, some are debating if unrealistic optimism is an ethical issue in this case. Studies in the article show that patients can be filled with optimism in clinical trials even when only 5 percent of patients see "some" benefit from these trials. Some argue patients are going into these trials without knowing the true purpose them and unrealistically expecting to be cured. When this is not explained clearly enough to patients, it presents an ethical dilemma.

Is there such thing as unrealistic optimism? Do you think having unrealistic expectations is harmful to patients?

Personally, I believe that any kind of optimism can only help in this situation. However, I do believe that every single patient is owed a clear explanation before they enter an early stage clinical trial. Patients need to know that the purpose of the studies they are participating in. They have the right to know early stage clinical trials are strictly about efficacy. If after knowing all of this, a patient still wants to be optimistic, that is an admirable decision that should solely be reached by them.
Your opinion may differ though. Some believe that by realistically explaining this to a patient you are ruining hope and harming the patient. Looking forward to seeing all sides and opinions.

Drug Shortages Becoming a Crisis

According to The Wall Street Journal, U.S. hospitals are facing a drug shortage crisis. This shortage could be causing breaches in medicinal safety and an increase in hospital costs of over 200 million dollars annually. The alarming part of this problem is that it applies to important chemotherapy and emergency treatment drugs. The shortage is requiring doctors and pharmacists to seek treatments that ultimately do not match the effects of the original treatment or cost more.

For example a brand name drug called Fusilev is being used to fill the shortages of a generic version called leucovorin. While the generic that is in short supply costs $7.41 a dose while the branded drug costs $177 per dose.




The problem has become so dire, that in some cases the FDA is allowing non-FDA approved drugs from overseas to act as replacements.


Who ultimately has responsibility for this? Do you believe generic drug makers have the responsibility of investing capital to build resources that can handle the volume of drug demand? What incentives could be provided to increase production of these drugs? Should the FDA be allowing use of unapproved drugs from overseas? What will be the solution to this issue ultimately?

Waivers and Weakness

An earlier post detailed the recent step backwards President Obama took by allowing states to apply for waivers to the Affordable Care Act. These waivers would allow states to drop the mandate for individual  health insurance as long as an effective, affordable alternative was reached.

Since the last post, there have been a number of reactions to President Obama's decision. A recent NY Times Article shows that along with Maine, five other states have applied for these waivers including Florida, Georgia, Kentucky, Nevada and New Hampshire.

Instead of praising President Obama for his decision, many Republicans are labeling it as a sign of weakness in the law. They argue that if the law was a good law, it would need no waivers. Many see the law as pointless if there will be so many waivers allowed.

Is providing waivers an admission that health care reform is weak? Is this proof that the Affordable Care Act is not perfect?

The Future of Patient Care....Not Just Yet

Ideas about health care are continuously evolving. One vision shared by many, is a medical future characterized by team-based patient care. As explained by this piece in the NY Times, this vision would involve converting traditional medical centers to "patient centered medical homes," where patients are seen by a team of doctors rather than just one individual. This team of doctors would also focus on cost cutting measures like preventative care. The overall goal of this vision is to create efficient, high quality care at an affordable price.

Sounds nice right? Unfortunately this dream is not yet a reality. 36 small practices tried to make this conversion and have run into a number of issues. The primary issue being the time and difficulty of converting traditional medical centers into patient centered medical homes. Eventually, I believe this will become a reality for the U.S. health care system. It just needs more time.

After reading the article and my post, what issues do you see arising with team  based care? It sounds nice on paper... but will it work in a real setting?

Is the Age of the Blockbuster Over?

For pharmaceutical companies, the 90's and early 2000's were the age of the blockbuster drug. Pharmaceutical companies developed drugs that could be used by huge patient populations and could rake in revenue from their respective drug patents. According to the New York Times, it is no secret that these patents are beginning to expire; but what is alarming for the industry is that there isn't much in the pipeline to replace them.

As patents begin to expire, major pharmaceutical companies will see significant erosion to their revenues from competition of generic brands. Add to this problem the lack of new drug discoveries, pressure from the government to lower drug prices and a series of heavy fines against pharmaceutical companies. This perfect storm of factors spells trouble for the pharmaceutical industry.

Why do you think drug innovation has slowed? Should the government still be  putting pressure on industry giants to lower their prices? Does pressure on price discourage innovation?

What strategy would work best moving forward? : focusing on branded generics, acquiring companies with near market ready drugs or concentrating only on health areas of need?

Obviously this article has a number of business, health and policy implications. It would be great to explore all of the different angles so feel free to comment.