In the Spotlight
Christopher Reeve: Action Hero
Robert Goldberg, Ph.D., 10-18-04
Senator Kerry has occasionally invoked Christopher Reeve, the late, paralyzed actor, in calling for federal funding of embryonic stem cell research. It is true the late action hero was a passionate advocate of such research, but he was much more than a one-trick-pony. Reeve's balanced, comprehensive approach to improving treatment of paralysis, one that involved rather than demonized private drug companies, was a model that those who seek to walk in his shoes ought to emulate.
Continue reading . . .
Beating Back Cancer . . . Again: Ten Years Without Leukemia Meant Everything Was Supposed to Be OK; It Wasn't
Wall Street Journal, 10-11-04
This personal essay about a Journal
writer's battle with leukemia is useful to remind us how far medical progress has come, and how far it can go if permitted. Some facts from the piece:
- Close to two-thirds of people diagnosed with cancer now live at least five years, up from a five-year survival rate of 50% in the mid-1970s;
- Chronic myelogenous leukemia (CML) was a death sentence until researchers from the 1970s through the 1990s pioneered a series of treatments, including Gleevec, a drug that blocks the molecular cause of CML.
U.S. Will Miss Half of Its Supply of Flu Vaccine
The New York Times, 10-6-04
Fixing Vaccine Supply System; Task Will Not Be Easy, Say Health and Drug Industry Officials
Washington Post, 10-9-04
Flu Shortage Shows System Flaws; Fewer Companies Making Vaccines
The Boston Globe, 10-10-04
Sometimes it takes a crisis to focus policymakers' attention on a problem, and this year's flu vaccine shortage might finally be enough to force Washington to fix our nation's vaccine production system. This article lays out the problem nicely: only one company now makes MMR vaccine, and only three make flu vaccine, with two of them controlling over 95% of the market.
The cure for the crisis is thus not too hard to discover: enact policies which encourage more investment in new vaccines, and improve the incentives to produce existing ones. Many existing policies serve to discourage vaccine investment and production, including payments through the Vaccines for Children program that are too low, pre-approval study requirements that are as much as ten times as stringent as would be required for approval of a normal drug, and uncertainty among manufacturers about their potential legal liability. Widespread vaccination was among the earliest public health successes in the 19th and early 20th Centuries; it would be a policy failure of epidemic proportions to permit such a success to undo itself.
Selling Prescription Drugs to the Consumer
The New York Times, 10-12-04
Advertising has been a bogeyman for critics for most of the last century. Dorothy Sayers poked fun at it in her classic Lord Peter Wimsey novel Murder Must Advertise; Cary Grant took his stab at it in Mr. Blandings Builds His Dream House ("If you ain't eatin' Wham, you ain't eatin' ham!") and John Kenneth Galbraith and a host of liberal academics in the 1960s blamed advertising for a host of ills besetting capitalism. Basically the criticism goes as follows: we are sheep, the advertisers are clever, and if they put a product in front of us enough we'll go out and buy it whether we need it or not.
Today the song remains the same, but the words are slightly different. People really don't need all these wonder drugs being thrust upon them on television, and by the way they really aren't so wonderful after all. This article takes specific aim at Nexium, which the article alleges is really no better than the generic drug Prilosec, but the anti-direct-to-consumer-advertising movement is increasingly having its voice heard. In the current environment, it behooves one to take a step back and remember the decades-long critique of advertising and place the current blasts into context. After all, if advertising were really so powerful, wouldn’t we all be driving Edsels?
More seriously, the real problem with DTC advertising is that consumers do not have to spend their own money to indulge their fancies. If you see a great ad for a Mercedes, your limited pocketbook helps curb your appetite for luxurious speed. But if you see an ad for the blue or purple pill, you just head out the door, find a doctor who will write the prescription, and someone else picks up 80% of the tab. Before we move to ban advertising of legitimate and helpful products, perhaps we should think about reforming such a cockamamie financing system.
Health and Money Issues Arise Over Who Pays for Weight Loss
The New York Times, 9-30-04
Obesity is a calling card for our age, and increasingly health care professionals are calling for something to be done to reduce it. In one sense, it's hard to complain with these calls. People who are overweight are at more risk for a host of chronic diseases and conditions like diabetes and heart failure that are harmful to the person and costly to treat. In a world where health care costs are rising dramatically, it makes sense at one level for insurers - including the government - to begin to pay for weight loss treatments if doing so will help them avert larger costs down the road.
But in another sense, this is putting the cart before the horse. Insurance works best when people pay a sum of money to protect themselves against a rare hazard the onset of which they have little control over. In health care, and in obesity in particular, people have a great deal of influence over their conditions. Economists have long argued that when people do not bear the costs for their actions, they are likelier to engage in risky behavior. The technical term for this is moral hazard, but think of it this way - if you knew nothing serious would happen to you if you drove too fast, would you still obey the speed limit?
In our third party payment, group coverage world, people are not charged different health insurance premiums for their risky behavior. A 300-pound person pays the same as a 150-pound person, even though the heavier person is likelier to create higher costs down the road. Rather than initiate payment for weight loss treatments, many of which don't work in the long term anyway, perhaps policymakers should let basic economics work in everyone's favor by permitting rate discrimination even in group policies on the basis of clear behavior-related health risks like smoking and obesity. When people have to pay the piper, they often stop signing the tune.
Kerrycare: This Plan Is Bad for Our Health
The Philadelphia Inquirer, 10-17-04
CMP Director Bob Goldberg takes aim at Senator John Kerry’s health care proposals, arguing they will increase government control and spending too much while retarding medical progress. President Bush's plan, he argues, is more market friendly, and will help reduce the number of uninsured without expanding government control of health care.
HSA Man v. Healthzilla
Wall Street Journal, 10-12-04
CMP Senior Fellow Dr. David Gratzer took the occasion of the final Presidential debate to note that ten years after Hillary Clinton's failed health care proposals, statism is alive and well in the American health care policy debates. He notes that burgeoning health care costs were not restrained during the 1990s by expansion of government programs and adoption of government-like cost controls via HMOs, so why should we expect that more of the same would cure our ills? Dr. Gratzer argues that instead we should start to shift payment for health care to the people who consume it, that this will result in lower cost and more insurance coverage. He also notes that President Bush is friendlier to this approach than is Senator Kerry.
New York Post, 10-12-04
Bob Goldberg examines Senator Kerry's and President Bush's healthcare proposals again, this time noting that the Senator's plan is likelier to help large insurance companies sell traditional policies than is the President's, which encourages competition in the health insurance market through encouraging Health Savings Accounts which employ high deductible catastrophic care policies.
A Hit Job on the Drug Companies
The Standard Reader, 10-11-04
Bob Goldberg reviews Marcia Angell's new book, The Truth About the Drug Companies, and finds the title more than a little misleading.
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