Later On

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Archive for the ‘Medical’ Category

The long con: Big Pharma Quietly Enlists Leading Professors to Justify $1,000-Per-Day Drugs

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Ya gotta spend money to make money, amIrite? The payoffs required are enormous, but once they get in, they make tons of money, and jacking the price of drugs to boot. President Trump promised that he would take care of that and make a deal to roll back drug prices, but then he met with Big Pharma and said, “I don’t really see that there’s a problem here.” I wonder what that cost. Of course, since it opens a chute from the US Treasury via the Affordable Care Act, who cares about a little up-front. I bet Trump cost less than the total of professor payments.

Trump’s in the presidency for profit, so I wouldn’t be surprised if the above fantasy turned out to be somewhat along the lines of reality. And Trump sure reversed his stand on the One-China policy, coming out in favor of One-China once he got his name trademarked in China. The man knows how to make a deal. And no money changed hands: the funds will flow to Trump Inc., and the Chinese government will pay very little.

It’s so out in the open it’s staggering. Am I the only one to notice? If so, I cry, “Wolf! Wolf!”

Annie Waldman reports in ProPublica:

Over the last three years, pharmaceutical companies have mounted a public relations blitz to tout new cures for the hepatitis C virus and persuade insurers, including government programs such as Medicare and Medicaid, to cover the costs. That isn’t an easy sell, because the price of the treatments ranges from $40,000 to $94,000 — or, because the treatments take three months, as much as $1,000 per day.

To persuade payers and the public, the industry has deployed a potent new ally, a company whose marquee figures are leading economists and health care experts at the nation’s top universities. The company, Precision Health Economics, consults for three leading makers of new hepatitis C treatments: Gilead, Bristol-Myers Squibb, and AbbVie. When AbbVie funded a special issue of the American Journal of Managed Care on hepatitis C research, current or former associates of Precision Health Economics wrote half of the issue. A Stanford professor who had previously consulted for the firm served as guest editor-in-chief.

At a congressional briefing last May on hepatitis C, three of the four panelists were current or former Precision Health Economics consultants. One was the firm’s co-founder, Darius Lakdawalla, a University of Southern California professor.

“The returns to society actually exist even at the high prices,” Lakdawalla assured the audience of congressional staffers and health policymakers. “Some people who are just looking at the problem as a pure cost-effectiveness problem said some of these prices in some ways are too low.”

Even as drug prices have come under fierce attack by everyone from consumer advocates to President Donald Trump, insurers and public health programs have kept right on shelling out billions for the new hepatitis C treatments, just as Precision Health Economics’ experts have urged them. With a battle looming between the industry and Trump, who has accused manufacturers of “getting away with murder” and vowed to “bring down” prices, the prestige and credibility of the distinguished academics who moonlight for Precision Health Economics could play a crucial role in the industry’s multipronged push to sway public and congressional opinion.

While collaboration between higher education and industry is hardly unusual, . . .

Continue reading. And ProPublica is another one I donate to. Not a lot: $5/month—so one quad-shot 16-oz latte to go, per month. Seems worth it for reports like these.

Written by LeisureGuy

23 February 2017 at 1:56 pm

When Evidence Says No, But Doctors Say Yes

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David Epstein writes in ProPublica:

Years after research contradicts common practices, patients continue to demand them and doctors continue to deliver. The result is an epidemic of unnecessary and unhelpful treatment.

First, listen to the story with the happy ending: At 61, the executive was in excellent health. His blood pressure was a bit high, but everything else looked good, and he exercised regularly. Then he had a scare. He went for a brisk post-lunch walk on a cool winter day, and his chest began to hurt. Back inside his office, he sat down, and the pain disappeared as quickly as it had come.

That night, he thought more about it: middle-aged man, high blood pressure, stressful job, chest discomfort. The next day, he went to a local emergency department. Doctors determined that the man had not suffered a heart attack and that the electrical activity of his heart was completely normal. All signs suggested that the executive had stable angina — chest pain that occurs when the heart muscle is getting less blood-borne oxygen than it needs, often because an artery is partially blocked.

A cardiologist recommended that the man immediately have a coronary angiogram, in which a catheter is threaded into an artery to the heart and injects a dye that then shows up on special x-rays that look for blockages. If the test found a blockage, the cardiologist advised, the executive should get a stent, a metal tube that slips into the artery and forces it open.

While he was waiting in the emergency department, the executive took out his phone and searched “treatment of coronary artery disease.” He immediately found information from medical journals that said medications, like aspirin and blood-pressure-lowering drugs, should be the first line of treatment. The man was an unusually self-possessed patient, so he asked the cardiologist about what he had found. The cardiologist was dismissive and told the man to “do more research.” Unsatisfied, the man declined to have the angiogram and consulted his primary-care doctor.

The primary-care physician suggested a different kind of angiogram, one that did not require a catheter but instead used multiple x-rays to image arteries. That test revealed an artery that was partially blocked by plaque, and though the man’s heart was pumping blood normally, the test was incapable of determining whether the blockage was dangerous. Still, his primary-care doctor, like the cardiologist at the emergency room, suggested that the executive have an angiogram with a catheter, likely followed by a procedure to implant a stent. The man set up an appointment with the cardiologist he was referred to for the catheterization, but when he tried to contact that doctor directly ahead of time, he was told the doctor wouldn’t be available prior to the procedure. And so the executive sought yet another opinion. That’s when he found Dr. David L. Brown, a professor in the cardiovascular division of the Washington University School of Medicine in St. Louis. The executive told Brown that he’d felt pressured by the previous doctors and wanted more information. He was willing to try all manner of noninvasive treatments — from a strict diet to retiring from his stressful job — before having a stent implanted.

The executive had been very smart to seek more information, and now, by coming to Brown, he was very lucky, too. Brown is part of the RightCare Alliance, a collaboration between health-care professionals and community groups that seeks to counter a trend: increasing medical costs without increasing patient benefits. As Brown put it, RightCare is “bringing medicine back into balance, where everybody gets the treatment they need, and nobody gets the treatment they don’t need.” And the stent procedure was a classic example of the latter. In 2012, Brown had coauthored a paper that examined every randomized clinical trial that compared stent implantation with more conservative forms of treatment, and he found that stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all. In general, Brown says, “nobody that’s not having a heart attack needs a stent.” (Brown added that stents may improve chest pain in some patients, albeit fleetingly.) Nonetheless, hundreds of thousands of stable patients receive stents annually, and one in 50 [2%! – LG] will suffer a serious complication or die as a result of the implantation procedure.

Brown explained to the executive that his blockage was one part of a broader, more diffuse condition that would be unaffected by opening a single pipe. The cardiovascular system, it turns out, is more complicated than a kitchen sink. The executive started medication and improved his diet. Three months later, his cholesterol had improved markedly, he had lost 15 pounds, and the chest pain never returned.

Now, listen to the story with the sad ending: Not long after helping the executive, Brown and his colleagues were asked to consult on the case of a 51-year-old man from a tiny Missouri town. This man had successfully recovered from Hodgkin’s lymphoma, but radiation and six cycles of chemotherapy had left him with progressive scarring creeping over his lungs. He was suffocating inside his own body. The man was transferred to Barnes Jewish Hospital, where Brown works, for a life-saving lung transplant. But when the man arrived in St. Louis, the lung-transplant team could not operate on him.

Four months earlier, the man had been admitted to another hospital because he was having trouble breathing. There, despite the man’s history of lymphoma treatment, which can cause scarring, a cardiologist wondered whether the shortness of breath might be due to a blocked artery. As with the executive, the cardiologist recommended a catheter. Unlike the executive, however, this man, like most patients, agreed to the procedure. It revealed a partial blockage of one coronary artery. So, doctors implanted a stent, even though there was no clear evidence that the blockage was responsible for the man’s shortness of breath — which was, in fact, caused by the lung scarring. . .

Continue reading.

Written by LeisureGuy

22 February 2017 at 2:48 pm

Now That They’re In Charge, Republicans Suddenly Not in Favor of Chaos in the Insurance Market

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What’s interesting about Kevin Drum’s report is that the GOP quite clearly does not a whit about the impact on people. It’s all about scoring political points against Democrats, with the GOP perfectly willing to do harm to the public if the result makes the Democrats look bad to those not paying close attention (which, after all, seems to be around 90% of the public). In other words, the GOP does not lack principle, but the primary principle seems to be to win no matter what the cost to the public.

Kevin Drum posts this:

Charges of hypocrisy in politics are kind of tedious. However, last night TPM reported a bit of hypocrisy that’s considerably worse than the usual kind. It’s all about a suit brought by House Republicans against Obamacare that would have killed any payouts to insurance companies for something called Cost Sharing Reduction. These are additional subsidies that reduce your out-of-pocket max, and they apply only to silver plans for families who make less than about $40-50,000. In other words, the working class and the working poor.

CSR subsidies are paid directly to insurance companies, but Republicans argued that although Obamacare authorized the subsidies, the House hadn’t voted to appropriate the funds—and had no plans to do so. If Republicans won the case, it would have caused considerable chaos in the market as insurers scrambled to make up for payments they had been promised but weren’t going to get.

Last year a judge ruled in favor of the Republicans, and the Obama administration appealed. In December Republicans asked for a temporary stay to give them time to sort things out legislatively now that they controlled all branches of government. The stay was granted, and now Republicans are back in court. Here is Alice Ollstein:

In a joint motion (see below) filed Tuesday, the two branches of government asked the court not to rule yet on the legality of these subsidies “to allow time for a resolution that would obviate the need for judicial determination of this appeal, including potential legislative action.”…The new motion seeks to extend the current stay indefinitely to give lawmakers on Capitol Hill time to figure out the future for the entirety of the health care reform law, including the cost-sharing subsidies.

Translation: back when Democrats would have been responsible for the chaos this ruling unleashed, Republicans were all in favor of unloading both barrels on Obamacare. But now that Republicans would have to deal with the chaos, they’ve suddenly gotten gun shy. . .

Continue reading.

Written by LeisureGuy

22 February 2017 at 10:16 am

Is the violence across North Africa and the Middle East caused by leaded gasoline?

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As Kevin Drum has noted in various posts and articles, there is strong and (to me) compelling evidence that children raised in a lead-polluted environment grow up to be violent adults, and the most pervasive form of lead pollution has been leaded gasoline. The US discontinued leaded gasoline around 1980 (there was a phase-in period when both leaded and unleaded gasoline were sold), and 20 years later, violent crime began a remarkable decline. This phenomenon—discontinuing leaded gasoline followed 20 years later by a significant decline in violent crime—has now been seen in any countries.

This chronology of leaded gasoline history (PDF) is quite interesting as it marks significant dates from the introduction of leaded gasoline in 1923. The PDF notes that Tetra-ethyl lead (TEL or “ethyl”) was the invention of Thomas Midgley, who was posthumously declared to be “responsible for more damage to Earth’s atmosphere than any other single organism that has ever lived.” (Walker 2007) Some of that is because Midgley was also responsible for the adoption of fluorocarbons as propellants for aerosol cans, and fluorocarbons turned out to be vastly destructive of the ozone layer, so those too were phased out.

In a post this morning (mainly on the new Trump aide Sebastian Gorka) has this interesting chart:

blog_middle_east_leaded_gasoline_phaseout_0

Drum’s post is worth reading for the information on Gorka.

Written by LeisureGuy

21 February 2017 at 10:32 am

Violent Crime Peaked In Britain in 2006 Because….

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Kevin Drum has a very interesting post at Mother Jones:

I missed this when it was first written—probably because it was only a week after Donald Trump won the election—but Robert Waldmann decided to check out a few of his predictions:

In April 2008, I predicted that the UK violent crime rate would peak some time around 2008. I just googled and found that it peaked in around 2006 or 2007.

Here’s the chart, courtesy of the Institute for Economics and Peace:

blog_iep_crime_britain

Note two things here. First, Britain’s violent crime rate peaked about 15 years after it did in the US. Second, it dropped a lot faster than it did in the US. Why?

Because, first, Britain adopted unleaded gasoline about 13 years after the US (1988 vs. 1975). And second, because it phased out leaded gasoline a lot faster than the US. Within four years Britain had cut lead emissions by two-thirds, which means there was a very sharp break between infants born in high-lead and low-lead environments. Likewise, this means there was a sharp break between 18-year-olds with and without brain damage. In 2006, nearly all 18-year-olds had grown up with lead poisoned brains. By 2010, that had dropped substantially, which accounts for the stunning 40 percent drop in violent crime in such a short time.1

This is one of the reasons the lead-crime hypothesis is so persuasive. Not only does recorded crime fit the predictions of the theory—both in timing and slope—but it does so in . . .

Continue reading.

Note this, later in his post:

Anyway, I might as well take this opportunity to repeat my prediction that terrorism in the Middle East will begin to decline between 2020-30. You heard it here first.

Written by LeisureGuy

17 February 2017 at 5:42 pm

Someone on Quora.com asked, “How can I be happy in 2017?”

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Quora provides a way for people to post questions and get answers, but recently when I tried to submit my answer it didn’t work. Since I had spent some time and thought on it, it occurred to me that one approach would be to post it here and then provide a link to this post. Here’s the answer I wrote:

It depends on your situation and the particular barriers to happiness you encounter. Internal barriers may involve combatting addictions (addictions can easily undermine happiness) or clinical depression (cognitive behavioral therapy has been proven to be helpful). External barriers may involve many things.

You might find A Life of One’s Own, by Joanna Field to be of interest. It’s a nonfiction account of her decision to keep a diary and note how happy she was each day. She was about 20 years old, and she thought that, over time, in reading the diary she could discover those things that tended to make her happy, and then do more of those and less of the other sorts of things.

It turned out that it was not quite so simple as she expected, and the book is a fascinating exploration of her explorations and discoveries, including some useful tactical ideas—e.g., when she was walking along a country lane on a beautiful day, she was somehow removed from the scene, observing it as though from afar, and unaffected by what she saw. So she started saying aloud what she was observing and feeling, and that reconnected her to the experience.

In any event, it’s an intriguing book and you might well get some good ideas from it. Even if not, you’re likely to enjoy it. I certainly did. The link above is to inexpensive secondhand copies.

A more directly relevant book is Flow: the Psychology of Optimal Experience, by Mihály Csíkszentmihályi (again the link is to inexpensive secondhand copies). Csíkszentmihályi investigated a particular state of mind that he called “flow,” which seems to correspond to being happy. It involves focused attention, immediate feedback, a level of difficulty great enough to avoid boredom but not so great as to induce anxiety or hopelessness (he estimates it at about 85% of one’s capabilities in whatever area), a loss of the sense of passage and time, and so on. It’s quite an interesting book, and he discusses some people who quite deliberately and systematically arrange their lives to increase the opportunities for flow to occur. His later book, Finding Flow: The Psychology of Engagement with Everyday Life, is also worth reading. (Again, link is to inexpensive secondhand copies.)

You might also enjoy and find useful Learned Optimism: How to Change Your Mind and Your Life, by Martin Seligman, yet another book by an experimental psychologist, this one the man who discovered that learned helplessness and depression are closely related and perhaps the same. He describes some interesting experiments and offers useful thoughts based on what he discovered. (The experiments are quite interesting, BTW.)

Finally, I recommend Mindset: The New Psychology of Success, by Carol Dweck, who is a Stanford psychologist. The book describes her research and experiments in seeking to understand why some kids enjoy challenges and others shirk from them. It has useful insights and, among other things, suggest that when you are learning something new—a language or a practical skill or whatever—you focus on your progress rather than the results you get. At the beginning of learning anything—playing the piano, for example—the results are not going to be all that great for most, but progress is quite good: rapid improvement from session to session. The rate of progress naturally will slow, but by then the results are usually good enough to motivate one.

All the books listed are quite enjoyable to read, at least for me. But people differ, which takes us back to my first answer: it depends. 🙂

BTW, for those who want to combat addiction, Changing for Good: a Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward, by Prochaska et al., is both interesting and useful. He got his entry into this by trying to find ways to help people break their addiction to cigarettes (which turn out to be highly addictive as well as deadly). It was in looking at his research that he discovered the six stages, which turn out have to be done sequentially with certain tasks that must be completed at each stage before the next stage can be successfully addressed.

Written by LeisureGuy

17 February 2017 at 4:05 pm

The GOP Senator is right that Trump’s press conference consisted mostly of what he should say to his therapist

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A therapist, I might add, who seems to be doing no good whatsoever. John Cassidy in the New Yorker:

It was “insane,” a “marathon rant” at the media, and “a press conference for the ages.” Before you accuse me of liberal bias, these were the terms that Fox Business Channel’s Charles Gasparino, the home page of the New York Post, and Fox News’s Shepard Smith used, respectively, to describe the performance that Donald Trump put on during a lengthy press conference in the East Room of the White House on Thursday.

Nominally, the White House had hastily scheduled the press conference so that Trump could announce he was nominating Alexander Acosta, the dean of Florida International University College of Law, for the post of Labor Secretary. But it was clear something strange was afoot when Trump walked in alone—without Acosta. Then, when the President started to talk, his tone was one of thinly suppressed fury.

After briefly lauding Acosta’s credentials, Trump thanked Paul Singer, a conservative Wall Street billionaire who used to oppose him and now supports him, for paying him a visit. (One of the few things Trump seems actually to like about being President is having supplicant rich guys come and pay homage to him.) Then he changed tack and said, “I’m here today to update the American people on the incredible progress that has been made in the last four weeks since my Inauguration . . . I don’t think there’s ever been a President elected who in this short period of time has done what we’ve done.”

What Trump has actually done, of course, is demonstrate his manifest unsuitability for the job he now holds. He has also signed a bunch of papers, most of which have had little immediate effect, and one of which—his anti-Muslim travel ban—plunged America’s airports into chaos before being put on hold by a federal judge. For the past week, his Administration has been consumed by damaging stories about his ties to Russia, and his firing of his national-security adviser, Michael Flynn.

Four weeks into its first term, the Obama Administration had already passed the biggest economic stimulus since the Great Depression and a sweeping fair-pay act. It had also announced a troop surge in Afghanistan. By comparison, Trump has achieved virtually nothing, except scaring the bejesus out of the world.

In his mind, of course, things are very different. For more than hour on Thursday, he stood at a White House lectern, the yellowness of his hair accentuated by the gold drapes hanging behind him, and demonstrated, again, that he long ago escaped the bounds of reality that restrict most mortals. He talked about his various executive orders, his meetings with the leaders of the United Kingdom and Canada, and his fifty-five-per-cent approval rating in the latest Rasmussen poll. (For some reason, he didn’t mention his forty-per-cent approval rating in a Gallup poll, the lowest on record for a President in his first month in office.) “I’m keeping my promises to the American people,” he said.

He returned, yet again, to the subject of the election. After pointing out that he got three hundred and four votes in the Electoral College, he added, “I guess it was the biggest Electoral College win since Ronald Reagan.” It wasn’t anything of the sort—Obama, for one, received higher vote counts—but Trump didn’t let that bother him. He spoke of the campaign-style rally he is scheduled to attend on Saturday, near Orlando, Florida—many observers suspect his handlers organized the event to cheer him up—and said that he had “heard that the crowds are massive that want to be there.”

About the only bit of real news came when Trump confirmed, from his own mouth, that he didn’t have a problem with the fact that Flynn had discussed U.S. sanctions with the Russian Ambassador to Washington three weeks before the Inauguration. The reason he fired Flynn, he said, was because he subsequently misled Vice-President Mike Pence.

In a more fractious political setting—the British Parliament, say—Trump would have been shouted down by howls of derision. There in the East Room, the members of the White House press corps sat meekly as the President offered them up as chum to conservative talk radio and other redoubts of alternative-reality Trumpery. “I turn on the TV, open the newspapers, and I see stories of chaos,” he said, striking a note of incredulity. “Chaos. Yet it is the exact opposite. This Administration is running like a fine-tuned machine, despite the fact that I can’t get my Cabinet approved.”

Evidently, Trump was so pleased with that bit of Newspeak—“fine-tuned machine”—that he used it twice. He also dismissed a Times report that said some of his campaign aides were in regular touch with Russian intelligence officials. “The three people that they talked about all totally deny it,” he said. “And I can tell you, speaking for myself, I own nothing in Russia. I have no loans in Russia. I don’t have any deals in Russia. . . . Russia—this is fake news put out by the media.” Speaking more generally, he declared, “The press, honestly, is out of control. The level of dishonesty is out of control.’’

Nobody can argue with that last sentence—but not in reference to the press. . .

Continue reading.

Written by LeisureGuy

16 February 2017 at 6:35 pm

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