Medications

September 22, 2019

It’s a season to get ripe view of money-grasping Big Pharma and plutocrats

For those who get a rise out of following the plight of plundering plutocrats, forget about pop culture shows like Succession, Dynasty, or Empire. Instead, it may be worth peeking in on the true-life Sackler family saga. It also underscores the truth of this idea: Never get between Big Pharma and a buck.

The Sackler story, turning on the fate of the family’s Purdue pharmaceutical firm and a fortune estimated at $13 billion, has been ripe with recent developments, including a potential settlement of thousands of claims by states, counties, cities, Indian tribes, and others — all claiming billions of dollars in damages due to the maker’s aggressive and less than accurate sales and marketing of its prescription painkiller OxyContin.

With a federal judge in Ohio consolidating and pushing a “global resolution” of a giant number of opioid-related lawsuits, Purdue and the Sacklers announced a tentative settlement of many of the governments-filed claims. Roughly half the plaintiffs were eager to get what money they could — to not only help constituents staggered by damages due to opioids, overdoses, and addictions, but also to refill government coffers depleted by the huge costs of dealing with nightmares caused by the painkillers.

September 3, 2019

Transplant patient’s nightmares illustrate why patients fear and loathe medical bills

by Patrick A. Malone

It may be bad for the blood pressure. But to understand a key reason why Americans seethe when talking about medical bills and medical costs, just start perusing a timely new magazine report on hospitals and debt collection.

The Atlantic article — “What Happens When You Don’t Pay a Hospital Bill” — details the horrors and frustrations experienced by Joclyn Krevat, an occupational therapist in New York. She sought medical care for what she thought was a nasty case of flu. She, instead, suffered from a severe heart inflammation — and ended up undergoing a costly and physically draining heart transplant.

Weak, sick, and on the brink, Krevat still was hounded by out-of-control debt collectors — cruel men and women who not only lack hearts of their own but who engage in relentless, often ridiculous tactics (like trying to connect on social media, just to harp on patients there about their bills) to wring pennies out of those with illness and injury, reported writer Olga Khazan.

September 1, 2019

Big Pharma flinches in opioids suits: a J&J loss in Okla. and a Sackler bid

by Patrick A. Malone

Big Pharma has hit at least two pain points of potential significance as government officials and trial lawyers work to hold drug makers accountable for at least some of the carnage caused by prescription painkillers.

There’s still a far way to go before companies see a full legal reckoning in the civil justice system for opioid overdose deaths that have killed an estimated 400,000 Americans since 2007, as well the drugs causing tens of thousands of cases of suffering and addiction.

But Oklahoma officials have struck hard at pharmaceutical interests by winning a $572-million nuisance ruling from a state judge against Johnson and Johnson, a legendary and once-respected health care brand.

August 26, 2019

Americans spend billions on illicit and recreational drugs. Their toll is rising.

by Patrick A. Malone

All drugs carry costs, risks, and harms as well as benefits. Illegal ones too. Americans can’t escape the toll of harm as they use and abuse recreational and illicit substances, recent news reports show.

With the long Labor Day weekend upcoming — the traditional summer’s end, with gatherings of friends and families for outdoor barbecues, relaxing, fun, and potentially drinking and use of marijuana or more — it may be worth taking note of some indicators of the serious problems associated with substance abuse:

The nonprofit, independent RAND Corp. reported that its studies suggest that American drug users spent an estimated $150 billion on cocaine, heroin, marijuana, and methamphetamine in 2016 alone. The marijuana market is now roughly the size of the cocaine and methamphetamine markets combined, and the size of the retail heroin market is now closer to the size of the marijuana market than it is to the other drugs. Further, after plunging from 2006 to 2010, cocaine consumption’s decline slowed by 2015. Results suggest there were 2.4 million individuals who used cocaine on four or more days in the past month in 2015 and 2016. Results also suggest that consumption grew in 2016 among a stable number of users as price per pure gram declined. And heroin consumption increased 10% per year between 2010 and 2016. The introduction of fentanyl into heroin markets has increased the risk of using heroin. From 2010 to 2016, the number of individuals who used marijuana in the past month increased nearly 30%, from 25 million to 32 million. RAND experts estimate a 24% increase in marijuana spending over the same period, from $42 billion to $52 billion.

August 22, 2019

Do health care’s perverse incentives lure MDs into deliberate misdiagnosis for profit?

by Patrick A. Malone

When doctors become medical outliers, shouldn’t hospitals, colleagues, insurers, and the rest of us ask how and why an individual practitioner diverges so much from the way others provide care?

Olga Khazan details for the Atlantic magazine the disturbing charges involving Yasser Awaad, a pediatric neurologist at a hospital in Dearborn, Mich. As she describes him, for a decade he racked up hundreds of cases in which he is accused by patients of “intentionally misreading their EEGs and misdiagnosing them with epilepsy in childhood, all to increase his pay.” Khazan says his case “shines a light on the grim world of health-care fraud—specifically, the growing number of doctors who are accused of performing unnecessary procedures, sometimes for their own personal gain.”

In the malpractice cases that are unfolding against him, Awaad’s pay has become a central issue, with evidence showing his hospital contract rewarded him for boosting the number of screenings he ordered and diagnoses he made. Jurors have been told that Awaad, whose salary increased from 1997 to 2007 from $185,000 annually to $300,000, “turned that EEG machine into an ATM.” He earned bonuses exceeding $200,000, if he hit billing targets.

August 21, 2019

Glimmers of hope in new therapies to battle killer Ebola and lethal TB strain

by Patrick A. Malone

Rare good news on destructive infections is emerging from Africa: Medical scientists, Good Samaritans, and public health officials are hailing the successes of powerful new therapies in treating a deadly and extremely drug-resistant strain of tuberculosis and Ebola, a killer viral hemorrhagic fever that spreads like wildfire.

Americans may skip over dispatches about these “foreign” news developments. They would be wise not to do so, because they have heightened importance these days, domestically, including in providing key lessons to be learned about how to safeguard the public health.

The TB care that is winning great attention overseas requires patients to take three drugs in a regimen in which they take five pills a day for six months. That already is a boon compared with other, now common therapies in which they might need 40 pills a day for as long as two years, or daily antibiotics shots with bad side effects like deafness, kidney failure, and psychosis.

August 14, 2019

For patients’ sake, U.S. must slap down Big Pharma chiseling on tests, trials

by Patrick A. Malone

Big Pharma is testing crucial boundaries in the way that the nation determines the safety and effectiveness of prescription medications. And regulators, for patients’ sake, need to shove back — hard.

The concerning incidents involve “pay to play” clinical trials and “manipulated” data submitted to the federal Food and Drug Administration by maker Novartis as part of the approval process for a gene therapy drug with a sky-high price.

Neither instance, officials insist, had immediate effects in endangering patients. But both show extreme practices and conduct that regulators should slam to a halt.

August 13, 2019

Would workers really be sad if health insurers didn’t grab a third of their pay?

by Patrick A. Malone

With the 2020 presidential campaign obsessing early about health insurance rather than costly health care overall, voters may wish to reframe their thinking about coverage and candidates’ views on making it affordable. Their chief query may need to be this: Just how much of the vig should the bagman take?

That may be a blunt a way to put it, but is the vernacular of the criminal “protection” racket all that out of place here? Michael Hiltzik, a financial columnist for the Los Angeles Times, makes pretty much the same argument, that the bagman’s share ought to be zero. Why not get rid of health insurers, he asks in a bit of evidence-based hyperbole? He finds the companies don’t fulfill much of a public mission, save, as a former insurance executive describes it, to make themselves money and to persuade all of us that they are essential. Indeed, as Hiltzik sees it, insurers are not just a rip-off but a failure in their own terms:

“Let’s start by examining what the insurers say are their positive contributions to healthcare. They claim to promote ‘consumer choice,’ simplify ‘the health care experience for individuals and families,’ address ‘the burden of chronic disease,’ and harness ‘data and technology to drive quality, efficiency, and consumer satisfaction.’ (These claims all come from the website of the industry’s lobbying organization, America’s Health Insurance Plans (AHIP). They’ve achieved none of these goals. The increasingly prevalent mode of health coverage in the group and individual markets is the narrow network, which shrinks the roster of doctors and hospitals available to enrollees without heavy surcharges. The hoops that customers and providers often must jump through to get claims paid impose costly complexity on the system, not simplicity. Programs to manage chronic diseases remain rare, and the real threat to patients with those conditions was lack of access to insurance (until the Affordable Care Act made such exclusion illegal). Private insurers don’t do nearly as well as Medicare in holding down costs, in part because the more they pay hospitals and doctors, the more they can charge in premiums and the more money flows to their bottom lines. They haven’t shown notable skill in managing chronic diseases or bringing pro-consumer innovations to the table.”

August 7, 2019

Loneliness, debilitation, and depression blamed for seniors’ rising suicides

by Patrick A. Malone

The nation’s rising suicide crisis torments seniors, too, with just under one out of five such deaths in 2017 occurring with individuals 65 and older. Men 65-plus, experts say, face the highest suicide risk, while seniors 85 and older, men and women, rank No. 2 in groups most likely to die by taking their own lives.

As the nation grays — 10,000 baby boomers a day turn 65, in a trend that will persist until 2029 — the already high concern about suicide, especially among seniors, is rising, National Public Radio reported.

NPR, noting that suicide already is the 10^th leading cause of death among all Americans, said that experts see loneliness, bereavement, grief, and depression as key factors in cases in which older individuals kill themselves. They find themselves isolated, overwhelmed, and with unending sadness when spouses and friends die. Their children, grandchildren, and other family members often live far away. They also struggle with their lives due to age’s increasing debilitation. As NPR reported:

July 23, 2019

As overdose deaths dip, new outrages disclosed on Big Pharma and opioids

by Patrick A. Malone

The nation may be hitting an inflection point in the opioid crisis. But Big Pharma, regulators, and politicians have much to answer for prescription painkillers’ terrible toll and their sluggish efforts to reduce the tens of thousands of casualties.

The spare good news about U.S. drug abuse — the first drop in overdose deaths since 1990 — came from the federal Centers for Disease Control and Prevention. The agency also warned its findings were freighted with many “yes, but …” elements, including:

The reported 5% decline occurred in deaths from prescription opioids;