As Obamacare continues to implode, issues with our healthcare system continue to expand. We are fortunate in the United States to have access to the best technologies in the world. We also spend more of our GDP on healthcare than any other industrialized nation in the world. Although the ACA does address insurance costs (by passing on high prices to the young and healthy) as well as access (by providing access to care for all Americans even with pre existing conditions) it does NOT address the escalating cost of drugs and medical devices. I believe that the lack of regulation of the pharmaceutical industry and the prices that they are allowed to set on newly developed drugs is yet another (in the very long list) of major flaws in the legislation.
This week in the New York Times, I was troubled by a story touting the release and FDA approval of a new drug for the treatment of a particular type of aggressive blood cancer known as mantle cell lymphoma. Mantle cell carcinoma has a very poor prognosis and is very difficult to treat. This new drug has been shown to help treat the disease but offers no cure. Most patient who start therapy with the drug see 1.5 years of good results but then no longer respond. For cancer patients time is everything–however the issue with this particular drug is the shiny new price tag–$120K annually. According to analysts the drug could be worth nearly 6 billion in annual sales for Johnson & Johnson and their drug-making partners Pharmacyclics Inc. The drug is expected to also be approved to treat a common cancer in elderly people known as CLL or chronic lymphocytic leukemia which will expand its indications to an even more common and larger group of patients.
Doctors who specialize in the treatment of cancers are concerned about the astronomical prices. Certainly, they are excited to have another treatment option (especially a new one that comes in pill form) but they are surprised at the cost of therapy. The new therapy has been shown to be superior to current therapy in clinical trials–however the new drug does not offer a cure. The company supplying the product argues that the cost of the new therapy “is in line with other new drugs for cancer”. It seems to me that for pharmaceutical makers the cost is based on what the market will bear–given no limits for cost, they are free to charge whatever they like. It is disturbing that those that make potentially life changing (and potentially life extending) therapies profit from the hopelessness and desperation of those suffering with a terminal illness such as rare and advanced cancers. To me, it is reminiscent of the carpetbaggers after the Civil War.
Why is it that physician payments are dictated by bureaucrats–Medicare, Medicaid, CMS and the insurance companies? Why is it that hospital reimbursement is dictated by the same? In the same breath, politicians and others allow pharmaceutical makers to dictate their own terms as to the cost of their product. Are there hands reaching into deep pockets?
At some point as providers of healthcare we must step in and advocate for our patients and loudly exclaim… “ENOUGH”.
As evidenced by a recent change in the law in the state of Maine, medical consumers are beginning to take matters into their own hands. In landmark legislation, Maine recently legalized the import of prescription drugs from pharmacies outside the US. As I discussed on Fox Business recently with Melissa Francis, there are inherent risks with obtaining prescription drugs from pharmacies outside of the FDA’s jurisdiction–there may be impurities and the quantities of the active compound may vary. However, I believe that competition from outside the US is the only thing that will ultimately bring drug prices in the US back within sight. Big pharma will argue that the cost of research and development requires a high price tag–however, I do not believe that the US consumer must foot the entire bill.
We MUST continue to innovate and produce novel, more effective therapies. It is essential that we support our pharmaceutical industry colleagues in the research and development of new technologies through participating in clinical trials and examination of outcomes data. However, we must stop short of providing big pharma with a blank check to charge whatever they like for newly developed drugs. I am opposed to big government and more regulation in general–but something must be done to control drug cost. Maybe the answer lies in the beauty of the great state of Maine. Maybe if we allow a little competition from the outside, prices may fall and ultimately more patients will have access to potentially life saving drug therapy and hope will not cost a life’s savings anymore.
Data is essential in healthcare delivery and it is often what guides us in improving outcomes. Utilizing data obtained from large populations helps us better decide what aspects of disease prevention and treatment need more of our attention. I have shared my concerns about the sanctity and security of these data in a prior blog from July. These data are important and allow us to evaluate at risk populations and target our interventions. In the US, participation in surveys is 100% voluntary. The Centers for Disease Control obtains most of its data from diagnoses reported by healthcare institutions (there are certain disease that are mandated by law to be reported). However, with the advent of the Affordable Care Act (ACA), some corporations and businesses have taken the acquisition of data a step too far. In George Orwell’s novel 1984, the author presents a vision of an dystopian society where “Big Brother” watches every move ordinary citizens make in an attempt to maintain order (and advance his own agenda). We have all seen the recent government abuses within the National Security Administration (NSA) and within the Internal Revenue Service (IRS). As the ACA is implemented, I am concerned that Big Brother may already be here and working in the US healthcare system today as well. In medicine, the doctor-patient relationship is sacred–data disclosed for healthcare should be sacred as well.
Although our country has always been based on basic tenets of freedom of choice, right to privacy and other key freedoms, some institutions see Obamacare as a ticket to interfere with the daily lives of American citizens. For instance as reported in the last several weeks by the New York Times, Pennsylvania State University now is attempting to require all employees, including senior faculty, to undergo physical exams and answer online health questionnaires that contain very personal and very sensitive health information. It is obvious that the pressures of the ACA and the need for cost containment is motivating these types of mandates. From the business standpoint, the university is hoping to reduce risk and liability by modifying at risk behaviors in its insured employees. However, none of these data will help the faculty do a better job for their employers and I am sure that the Penn State University administration clearly see this as a way to save healthcare dollars. The next logical step, however, may be to deny or terminate employment based on health risk and potential cost to the system. Where does the rabbit hole end? Is this the beginning of health status discrimination in the workplace?
Many senior faculty at Penn State are refusing the mandate based on invasion of privacy–even though the university is planning to levy substantial daily fines for non responders. Several prominent professors have stated that if they are forced to participate they will simply answer the questionnaires randomly and provide far fetched ridiculous answers–simply play the conscientious objector. Many other Americans are waiting to see how this pans out–there is concern that this type of activity will begin to spread to other institutions and industries. Labor unions are already beginning to lobby against these mandates–in the case of Penn State, union employees are exempt. At what point are our private lives and medical histories private? What is the separation between workplace and home? Where do we draw the lines and do we allow others (government and employers) to draw the lines for us?
The spirit of risk reduction and working with employees to improve their health status and live better lives makes good sense–however, there are better ways to accomplish this goal. Health fairs, educational seminars and free health screenings for cholesterol and high blood pressure make good sense–but all of these activities should be voluntary. Asking highly personal questions such as sexual preference, prior drug or alcohol use and the state of one’s marriage should not be a part of a wellness program at work. In the case of the Penn State questionnaire there are even questions related to how you get along with others in the workplace–including your boss. These issues are private and should remain that way. In defense of the institution, the development of these wellness programs are not entirely their fault. In fact, the ACA provides a 30% discount for the implementation of a comprehensive wellness program–virtually assuring that every business will “voluntarily” submit to these types of invasion of privacy. Although the university administrators claim that the data is secure and is not available to supervisors and those in the administration, it concerns me greatly that this will not be the case– (just ask those Americans who had unlawful wire taps and those that were bullied by the IRS due to their associations with certain political groups). Big Brother is watching….from your doctors office, from your bedroom and from your back porch. I am afraid that this particular blog may leave you with far more questions than answers….maybe we should ask Big Brother.