Drug Ads on Hospital TV

The 24-hour Patient Channel provides healthcare TV programs telling hospitalized viewers how to diagnose, treat, and manage diabetes, high blood pressure, stroke, and other diseases. Interspersed with the programs are prescription drug ads. The service is available in more than 600 hospitals nationwide, but some are banning it.

Proponents claim the channel is educational, while opponents say it is advertising masquerading as education and call its targeting of vulnerable in-patients, who may assume that the hospital endorses the products advertised, as unethical. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) would seem to agree: It has refuted the channel’s claim that its programming helps meet JCAHO requirements for patient education.

Reference: Pugh, Tony (2003). “Patient Channel in hospitals sparks controversy.” Mercury News, May 27.

Drug Costs

A new drug for the rare but devastating Hurler Schie Syndrome was provided free to three children in a family during clinical trials, and it dramatically improved and prolonged their lives. But out of trials, the drug will cost the family $450,000 a year. Who will pay? And if no-one will or can pay for high-cost drugs for small populations, will for-profit manufacturers continue to develop and produce them?

The 1983 Orphan Drug Act tried to address this problem by giving the manufacturers tax breaks, help with funding, and a seven-year monopoly on drugs developed for diseases afflicting fewer than 200,000 people. Some 240 such “orphan drugs” have been developed, and some have been enormously profitable, leading to allegations of over-charging. In January, the Centers for Medicare and Medicaid Services slashed payments for most of the orphan drugs used to treat Medicare patients.

Reference: Elias, Paul (2003). “Drugs save lives, but who will pay?” Associated Press article carried in Miami Herald.

Pharmas Use IT to Track Physicians and Patients

Pharmaceutical manufacturers buy enormous amounts of detailed information about almost every US physician, mostly from large pharmacy chains, via third-party information brokers. They use the information to compile “prescriber profiles” so reps can custom-tailor their pitch to the individual physician.

Ever more sophisticated data are gathered ever more quickly from ever more sources, including the American Medical Association, which sells biographies on its 850,000 physician members (some of whom have complained about the practice.)

Data on individual patients and the medications they’re taking are purchased from pharmacies, which say they remove patient names and identifying details. But the data include insurance provider details, all the drugs the patient takes, and their doses, so the drug companies can see whether doctors are prescribing competitors’ drugs to new patients and whether they’re moving existing patients from one drug to another.

Debate about the ethics of these practices seems almost pointless, given the speed at which storage and transmission technologies develop and in turn enable data to proliferate. The race is to the swift, and ethicists are slow.

Reference: Kowalczyk, Liz (2003). “Drug companies’ secret reports outrage doctors.” Boston Globe, May 25, p. A1.

Drug-eluting Stents

The new class of drug-eluting stents will undoubtedly lower healthcare costs by reducing the need for repeat procedures and lessening the need for bypass surgery. But at least in the short term, hospitals could take a hit, because Medicare and Medicaid reimbursements are not enough to cover the extra cost of the new stents. Most large managed care companies are paying for the new stents, but extraordinary demand and anticipated over-utilization could change that.

Reference: Boulton, Guy (2003). “Technology For Heart Pumps Up Price Of Care.” Tampa Tribune, May 23.

Why Language Technology is Important

HFD frequently mentions quickening developments in automatic language translation and interpretation, because it is a solution to a growing problem as the ethnicity of the American population diversifies. For example, according to a recent study, 20 percent of health maintenance organizations in California do not offer interpreters (face-to-face or by telephone) for physicians and patients, yet more than a third of Californians enrolled in HMOs speak a language other than English or in addition to English at home.

Reference: Lyons, Julie Sevrens (2003). “Study: HMOs lag in language help.” Mercury News, May 23.

Physician Temps

Locum tenens physicians are temps with a fancy Latin name meaning “one holding a place” or filling a vacancy. Somewhere between four to eight percent of doctors nationwide, or 25-50,000, are estimated to be temps, and “the field is booming,” with one industry publication reporting 20 percent annual growth in locum tenens operations since 1997. One specialist found that as a temp he could work eight months a year for what he earned in 11 months in his former group practice, and he eliminated the administrative and billing headaches of running a private practice.

This is indeed an interesting trend, and one probably fueled in part by advances in information technologies that enable the traveling doctor to stay in close touch with family, colleagues, continuing education, and patients. If that is so, then improving technologies could further accelerate the trend.

Reference: Dorschner, John (2003). “Have stethoscope, will travel: It’s the latest trend for doctors who want to leave their worries behind.” Miami Herald, May 25.

Moonlighting

More powerful yet lower-cost surgical technologies enable small specialty facilities to compete with hospitals, but this then leads to competition for scarce medical staff resources, as Denver hospitals are discovering as they are forced to shut down operating rooms on occasion due to lack of available anesthesiologists. The shortage has grown so bad that Colorado recently allowed nurse anesthetists to sedate hospital patients without physician supervision.

More than half of all surgeries in Denver are now done in an outpatient setting, and they all need anesthesiologists. Demand is exacerbated by population growth and by medical and technological advances that create more types of surgical procedure. Outpatient facilities tend to cherry-pick the easier and more lucrative surgeries, such as cosmetic surgeries, which means that hospital patients in need of the more difficult and serious surgeries, often most affecting the poor and the elderly, increasingly have to take second place.

Colorado is only the second state in the nation to allow specially trained nurse anesthetists to sedate patients without a doctor overseeing the procedure. New Hampshire was the first, following changes to a federal rule effectively requiring hospital physicians to supervise nurse anesthetists. Anesthesiologists say the change endangers patient safety, and are suing.

References: (1) Austin, Marsha (2003). “Doctor shortage stalling surgeries: Suburbs lure urban anesthesiologists.” Denver Post, May 22; (2) Austin, Marsha (2003). “Colo. allows nurses to step in.” Denver Post, May 22.