There seems to be a never-ending outbreak of a certain kind of pathology in the United States. Big Pharma has it and spreads it around, a lot. So, too, do public health figures. Let’s call this scourge what it is — unmitigated gall.
The problem with this nasty condition is that it afflicts the rest of us. Just consider how stomach-churning these shenanigans can be:
Penalties for bogus prescribing of ‘little red pills’ on elderly dementia patients
Drug maker Avanir has fessed up and will pay more than $100 million for bogus conduct in pushing nursing homes and doctors to give dementia patients its prescription medication Nudexta. The drug won federal approvals — and wide public attention in an ad campaign — as a treatment for pseudobulbar affect, or PBA. That’s a rare condition in which patients can’t control their outbursts of laughing and crying. Here’s what should make taxpayers weep: The firm settled whistleblower claims and criminal investigations that it misrepresented its “little red pills,” a potent antipsychotic, for off-label physician prescribing to drug up (“better control”) seniors with dementia. Besides slipping big money to doctors in the form of speaker fees, the drug maker’s sales people were accused of coaching MDs on how to fill out prescriptions to ensure approval, forging physician signatures on paperwork for insurers, and asking nursing home staff for names of patients to create lists of people physicians should target with Nuedexta. Regulators and prosecutors heard claims that the firm paid for one doctor’s firearms training and another’s holiday party to boost their writing of Nudexta prescriptions. One salesman for the firm was accused of dressing in scrubs, going behind a counter to review patient files, and scribbling in them a PBA diagnosis that would then require Nudexta treatment. While its fine may seem hefty and the firm also signed a document that spells out its compliance with integrity guidelines, skeptics may take note that taxpayers, through Medicare, “spent roughly $225 million on Nuedexta in 2017 [alone] — up more than 700% from five years earlier.” Sales of the drug surged in 2016 to $300 million. Legitimate practitioners have denounced off-label prescribing of Nudexta for dementia, saying it is wrong and unhelpful. Whistleblowers, under a federal law, will get a big chunk of the fines. Some doctors face criminal prosecutions. Cheers to CNN for its digging on Avanir’s wrongdoing.
Hanging up on $2 billion ‘genetic testing’ fraud
Prosecutors have done more than slammed the phone down on what they have described as a multilevel, $2 billion ploy that targeted seniors, an aggressive con to get them to take costly genetic tests. Those were promoted to excess as potentially showing patients’ cancer risk or treatability with prescription drugs. Nah, the federal Operation Double Helix asserts, instead, that this was an elaborate scheme, involving labs paying kickbacks and bribes to doctors and others who worked with telemarketing fraudsters. The aim was to fleece seniors, though scare and other tactics, to assent to the tests, for which Medicare was billed anywhere from $10,000 to $18,000 per. Seniors were hustled over the phone, at public events, and even in nursing homes by pushy salespeople. They not only swabbed the cheeks of their elderly marks, supposedly for the gene tests, they also collected private, personal data — information that criminals covet for identity thievery. Once the crooks had patients’ information, they worked to either convince their doctors to order the genetic test (your patient demands it), or they got their own dubious medical personnel to do so, of course, at collaborating and profiting labs. The tests not only aren’t useful and unneeded in the preponderance of the cases, prosecutors found, their ordering may have a big harm for elderly victims: Some may need the diagnostic at some point later. But they may not be able to get it because Medicare already has paid for the complex testing already. Thirty-five folks face federal charges in this case, which by the way, was announced at the same time as another involving 380 people and the accusation of wrongful prescribing of illicit drugs, including opioids.
What are these folks smoking, um, vaping?
Public health officials say the terrible toll of damaged lungs and deaths due to vaping keeps rising. It now has hit a dozen fatalities and more than 800 illnesses in almost all the U.S. states. Based on information from Wisconsin and Illinois — states affected early by cases of vaping-related illnesses — investigators have warned the public about street, bootleg, and illicit vaping products containing tetrahydrocannabinol or THC. It’s the substance that gives marijuana its high. Nervy peddlers on the street sell sketchy vaping liquids not knowing how much THC they contain, much less what other substances may be in their goods (pretty bad stuff, including maybe hydrogen cyanide, and a Vitamin E compound said to be like inhaling grease into the lungs).
So, doctors and public health officials and medical scientists are screaming their heads off with the warning: Please stop vaping, especially until its harms get sorted out.
The alarm bells are blaring too, now, about illicit products with the grown-up and alluring names like Dank, TKO, Off White, and Moon Rocks. This is an evolving mess, with demonstrable danger, and, golly, oops, the federal Food and Drug Administration has said. Guess we should have acted sooner, the agency’s new chief concedes. Yeah, guess so, says the guy who headed the agency when it pulled its punches. Well, he says on social media, a hard-fought plan to crack down on e-cigarettes and vaping needed to wait because the FDA was undertaking years of study on nicotine. As vaping deaths and damages mount, what-about-ism also is proliferating, with some smart and prominent people — what? — calling the federal and state actions “disproportionate” to the actual harm. That’s an interesting take. Wonder if it would be out there with a slightly different scenario: What if folks had a new fad involving a soda-like drink that they ingested because it made them woozy and they belched a lot for fun. Now suppose officials found the drink was filled with toxins of various types. Say it suddenly killed kids and adults and sent hundreds for treatment of serious and sustained injury. How quickly would the public roar if the FDA didn’t crack down?
How do you say ‘sooie’ with a Georgia twang?
He was forced out of one of the top posts in U.S. health care, the job of heading the giant federal Health and Human Services department. That’s because he treated taxpayer money like his pocket change, feeding at the public trough, traveling to swanky resorts in Colorado, Maine, and Georgia on the priciest public dime possible—private charter jet flights that cost thousands of dollars a pop. He also acted as if military aircraft were his personal overseas chauffeur service. A federal watchdog excoriated him and said he should repay Uncle Sam hundreds of thousands of dollars for acting like a pig at the public trough. So, what is up these days with Georgia doctor Tom Price? The Atlanta Journal-Constitution and Politico say he yearns to be back in the nation’s capital. He formally has asked his state’s governor to appoint him to fill a congressional seat that is being vacated by an ailing incumbent. The appointee would serve until next fall before needing to compete for the seat in an election. Price served multiple terms in the House and is well-connected politically in Georgia. But, really?
In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of treatments and prescription medications, too many of which turn out to be dangerous drugs.
Americans spend $3.5 trillion annually on health care, which takes up 18% of the nation’s gross domestic product. But our health outcomes lag folks in other industrialized nations. Critics of a certain stripe love to howl about waste, fraud, and abuse in the health care system. With so much that is right in medicine, and with so many of the people in it hard working, compassionate, and dedicated, we have lots of work to do to deal with the too prevalent presence of knuckleheads and criminals.