Accountability seems in short supply in this administration. No one is responsible.

Ethics don't exist. In addition to concerns about the legal profession, shouldn't we have concerns about the physicians monitoring torture?

Posted at April 3, 2008 3:09 PM in response to Yoo: I Thought Torture Was A Bad Idea, Really I Did

Agree. But the war has severely limited our financial flexibility. On top of the housing debacle it threatens to leave us a failed financial system.

The 80's Savings and Loan problems, Enron and the current mortgage disaster are all traceable to the lack of rules, need I say regulation, in our "free market" system. It's discouraging then, to hear McCain on 60 minutes last night continue the Republican mantra of no regulation--sounds Hooveresque.

Posted at March 10, 2008 1:30 PM in response to The Recession: It's the Housing Bubble, Not the War

"Government funding of academic research tends more to support the interests of the big drug companies than novel drug platforms."

I'm not sure what Terry is talking about. Two major advances on "novel platforms" Gleevac and Avastin were extensively financed by government funds before taken private by drug companies.

In the case of Gleevac the drug was one of the rare cases of being an order of magnitude more effective than previous approaches to Chronic Myelogenous Leukemia. It required minimal clinical testing and was almost immediately approved--it sells for $50,000/year.

The antiangiogenesis research by Judah Folkman that led to Avastin was financed by you and me for over 20 years. It was taken private and we now have the privilege of paying up to $100,000/year for this drug alone. Parenthetically it's only maginally effective in most patients extending life a median of a few months in cases of advanced disease.

Drug companies are pricing themselves out of the market. Single drug costs/year exceed that of new autombiles and over a lifetime can exceed the cost of homes. This is irresponsible and requiries some adjustment of patent regulations and or insistance that the drugs originally developed under government funded research be fairly priced (Dole-Bayh). This regulation has never been enforced.

It's pay us or die.

Posted at July 29, 2007 10:04 AM in response to "Me," "We," and the FDA

It's not at all about values, but it is about VALUE.

http://medicynic.com/?p=143

Posted at July 6, 2007 9:20 AM in response to Sicko and the Health Care System: It’s Not About Values

Indeed universal health care will not completely solve this problem, but it will be a start.

Consider that we already pay a health premium simply for being Americans--our per-capita health costs are 50-100% higher than other places in the industrialized world and we don't cover almost 50 million of our citizens. What a refreshing change it would be to provide universal coverage and decrease percapita expenditures on health at the same time. We just need that tax cutting/cost control mentality applied to these costs.

www.medicynic.com

Posted at April 23, 2007 4:59 PM in response to Matthew's Mom and Dad Testify

The articles in the Post were graphic and sadly true. The military’s hospital system provided insensitive, substandard care to our returning injured soldiers. Denial of the seriousness of the problem by the Surgeon General of the army yesterdY indicates his own insensitivity and perhaps incompetence to administer a military health care system.

He said yesterday: “that the problems at Walter Reed were neither widespread nor symptomatic of a system that has “abandoned soldiers and their families.”

The Surgeon General also accused the Post of being one sided. His notion apparently is that health-care ends at the inpatient hospital door, not recognizing as fact that his system keeps recently returned gravely injured soldiers (two interviewed last night on Jim Lehrer’s program) as outpatients and suffocates them with miserable depressing surroundings, stifling bureaucracy and martinets who force the injured to play soldier (having to report each day to morning assembly). Quite bizarre and deserving of a firing in my view. Though this outfit will probably award the Surgeon General a “heck of job” and the medal of freedom.

www.medicynic.com

Posted at February 23, 2007 3:58 PM in response to Walter Reed: Is The Worst Yet to Come?

There are too many flaws in the employer based system to let it continue.
1. When employees get really sick they can't work. Guess what happens to their insurance?
2. It encourages the employer to choose plans on the basis of cost rather than scope of benefits.
3. There is too much duplication of administrative costs when dealing with so many small entities.
4. The current system encourages insurers to segregate risk. They eliminate and regularly cancel high cost policies.
5. It is not unusual in a small employee group for rates to markedly increase if one person has an expensive medical problem.
5. Employers often do not provide insurance

You'll find more on health care at www.medicynic.com

Posted at February 9, 2007 6:17 AM in response to In Defense of Employer-Based Health Care

I recently finished The Prince of the Marshes by Rory Stewart. This book provides the best description of the cultural, political, social, economic, and religious situation in rural Iraq. In doing so, it reveals the insurmountable gap between the vision of a free democratic Iraq and the feudal, theocratic, war lord dominated reality.

We can't "win" this thing so lets find a way out!

Posted at November 29, 2006 4:46 PM in response to Enough Ghosts

The government contribution to drug research is, to a great extent, through direct grants to researchers. For example, Judah Folkman, one of the developers of anti-angiogenesis agents (Avastin) was supported by federal grants for 23 years before taking the drug private. This drug costs $50,000/year.

Another example is imatinib (Gleevec), a drug for chronic myelogenous leukemia. This drug is a wonderful advance, was funded by federal funds during the development stage. It was proven effective after one clinical trial and on the market almost immediately. There were minimal clinical trial costs for the company involved. The cost is in the range of $40,000/year.

The tax payer was a significant contributor to these drug's development. How many times should the taxpayer pay? It’s not as if the pharmaceutical companies are marginal enterprises. Patent law has been carefully crafted to maximize profits of the drug industry. During the patent protected period drug companies can and do charge whatever they wish for a product. The industry has enjoyed record profitability—one example is that in 2002, “the combined profits for the ten drug companies in the Fortune 500 ($35.9 billion) were more than the profits for all the other 490 businesses put together ($33.7 billion).” (From Marcia Angell’s book, The Truth About Drug Companies)

In regard to generics, drug companies still game the system. One only has to look at the July 3 article by Mark Kaufman in the Washington Post which noted "Some at the FDA, as well as leaders in the generic drug industry, complain that "citizen petitions" -- requests for agency action that any individual, group or company can file -- are being misused by brand-name drugmakers to stave off generic competition." Or this article from the Times (http://select.nytimes.com/2006/07/011nocera.html)

In regard to cost estimates of a clinical improvement (QALY). You are right these studies should be limited to stage III studies. Stage II are not comparison studies designed to document and compare efficacy. In my experience stage IV studies are frequently manipulated and of limited utility. The most outstanding example being stage IV studies of breast implants in which the drug company failed to follow-up on half the patients.

A rough estimate of cost benefit can be obtained simply and cheaply by estimating the cost of drug, ancillary expenses and add them up. A benefit that costs hundreds of thousands of dollars (see http://medicynic.com/?p=47 for an example) to achieve and does not prolong life should be a non starter. Requiring such estimates would have a moderating effect on pricing and also call the consumer's attention to the limited benefit of many new agents.

Educating the public about costs is key to controlling expenditures. Charging more than the median and average incomes, more than a new car or for that matter, over the life of a patient, more than his home for one drug is excessive and predatory on the part of the pharmaceutical industry. I do think it is a death tax.

In regard to the location of new drug development, guess what, many new agents are developed and initially marketed overseas.

Posted at August 24, 2006 7:59 AM in response to Health Care Costs and Universal Coverage

Cost and side effects, even for relatively inexpensive medications, would meet my criteria for being open enough--if we have to have DTC advertising.

I certainly agree that a sound/video bite can only confuse and provide incomplete information. My preference, therefore, is to not have such advertising for prescription medications--as is the rule in most industrialized countries.

Posted at August 23, 2006 12:55 PM in response to Health Care Costs and Universal Coverage