Medical Industrial Complex

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Living under Neoliberalism with its "greed is good" mentality and "homo homini lupus est" slogan is indeed dangerous  and requires knowledge of elementary "self-defense" strategies. this is especially important in order to avoid misdiagnosis and mistreatment by "medical-industrial complex". 

Neoliberalism completely corrupts medicine moving it from First, do no harm principle to "let's milk the suckers" principle. In other words, in no way medical industrial complex obeys "no harm" principle. It is strictly about profits.  The slogan is "Profits before people's health". Falsified drugs trials, over-prescription of drugs (with little concern about their possible interaction) the concept (and frantic search) of "blockbuster" drugs, useless surgeries such as  Overuse of Cardiac Stents  are just the tip of the iseberg.

Most destructive has been the commercialization of medicine as a big business — healing art transformed into profitable cash cow. Perverse financial incentives encourage disease mongering, false advertising, over testing, quick diagnosis, and unnecessarily aggressive treatment.

Medical marvels are oversold and overbought. Doctors need to be more humble and safety-conscious. We can’t overstep our knowlege base without putting our patients at risk.

Patients and doctors need to accept the uncertainty and limits of medicine. False certainty leads to terrible decisions.

Medical–industrial complex - Wikipedia, the free encyclopedia

The medical–industrial complex is the network of corporations which supply health care services and products for a profit. The term is analogous to "military–industrial complex" and builds from the social precedent of discussion on that concept.

The medical–industrial complex is often discussed in the context of conflict of interest in the health care industry.

The concept of a "medical–industrial complex" was first advanced by Barbara and John Ehrenreich in the November 1969 issue of the Bulletin of the Health Policy Advisory Center in an article entitled "The Medical Industrial Complex" and in a subsequent book (with Health-PAC), The American Health Empire: Power, Profits, and Politics (Random House, 1970). The concept was widely discussed throughout the 1970s, including reviews in the New England Journal of Medicine (Nov. 4, 1971, 285:1095). It was further popularized in 1980, Arnold S. Relman while he served as editor of the The New England Journal of Medicine.[1] in a paper titled "The New Medical-Industrial Complex." Relman commented, "The past decade has seen the rise of another kind of private "industrial complex" with an equally great potential for influence on public policy — this time in health care..." Oddly, Relman added, " In searching for information on this subject, I have found no standard literature and have had to draw on a variety of unconventional sources..."[1] Subsequently, this paper and the concept have been discussed continually.[2] An updated history and analysis can be found in John Ehrenreich, "Third Wave Capitalism: How Money, Power, and the Pursuit of Self-Interest have Imperiled the American Dream" (Cornell University Press, May 2016).

Manufacturers of medical devices fund medical education programs and physicians and hospitals directly to adopt the use of their devices.[3]

The management of health care organizations by business staff rather than local medical practice is one of the trends of the increasing influence of the medical-industrial complex.[4]

Another trend is that increased pressure to generate profit for providing services can decrease the influence of creativity or innovation in medical research.[5]

In the 1970s profit-seeking companies became significant stakeholders in the United States healthcare system.[6]

The influence of economic policy on the practice of medicine has a long history.[7]

Because the General Agreement on Trade in Services regulates international marketplaces, in countries where the industrial-medical complex is more strong there can be legal limitations to consumer options for accessing diverse healthcare services.[8]

Because the industrial-medical complex funds continuing medical education, this education has a bias to promote the interests of its funders.[9]

Market conditions for providing pain management services are influenced significantly by the medical-industrial complex.[10]


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Old News ;-)

[Jan 15, 2017] Doctors in the United States get paid on average more than $250,000 a year

Jan 15, 2017 | economistsview.typepad.com
libezkova -> anne... , January 14, 2017 at 10:45 PM
"Doctors in the United States get paid on average more than $250,000 a year,"

I am sure that this is a right estimate. Certain specialties probably yes (dentists, cardiologist, gastroenterologists, neurosurgeons, etc), but family doctors, probably no.

[Jan 15, 2017] The Congressional defeat, insured by Democrats, of the proposal by Bernie Sanders to allow the import of drugs from Canada to lower drug prices in the United States

Jan 15, 2017 | economistsview.typepad.com
JohnH -> anne... , January 14, 2017 at 08:00 AM
The Congressional defeat, insured by Democrats, of the proposal by Bernie Sanders to allow the import of drugs from Canada to lower drug prices in the United States.
'
This is only the beginning of Democrats' appeasement of Trump and Republicans...it will be stunning to watch how much damage Republicans can do during Trump's first 90 days with only a slim majority in the Senate. During the first 90 days under Obama, who had a true electoral mandate and big majorities in both houses, Democrats basically sat on their hands, blaming Republicans for their unwillingness to do much for the American people.
Observer -> anne... , January 14, 2017 at 08:50 AM
So if we matched Canada, we'd see a 30% decrease, of a segment which comprises 10% of health care spending, or 3% overall decrease.

"PwC's Health Research Institute projects the 2017 medical cost trend to be the same as the current year – a 6.5% growth rate."

So reaching Canadian spending levels would counter ~ 6 months of health care cost increases. Reaching OECD levels buys you another couple of months.

Put another way, reaching OECD levels for drug spending closes 10% of the US-OECD spending gap.

Not nothing, but "fixing" drug prices seems more like an emotional (i.e. political) talking point than a real silver bullet for health care costs.

http://www.pwc.com/us/en/health-industries/health-research-institute/behind-the-numbers.html

pgl -> Observer... , January 14, 2017 at 11:17 AM
Ever noticed that marketing costs are 30% of revenue? This is a by product of the monopoly power in this sector. Dean Baker has often noted we could have the government do the R&D and then have real competition in manufacturing.
libezkova -> Observer... , January 14, 2017 at 10:40 PM
Don't be a lobbyist for Big Farma.

You forgot that those researchers often produce useless or even dangerous drags, which are inferior to existing. Looks as scams practiced with hypertension drugs.

This rat race for blockbuster drugs is the same as corruption in financial industry.

http://www.alternet.org/story/148907/15_dangerous_drugs_big_pharma_shoves_down_our_throats

pgl -> anne... , January 14, 2017 at 11:16 AM
Actually the industry profile is very relevant but goes in a different direction - if US firms were compelled to charge market (not monopoly) prices, we would better compete with foreign firms.
pgl -> Observer... , January 14, 2017 at 11:14 AM
Any excuse to charge sky high prices for drugs that don't cost that much to manufacture? If these monopoly profits were not so high, we would buy more drugs and employ more people.
Observer -> pgl... , January 14, 2017 at 12:57 PM
Do you think we would really buy materially more drugs if prices were lower? Particularly enough more, at those (30-50%?) lower prices, to generate the funds to employ more people?

(If that actually generated at much or more funds, it would seem like the pharma companies, seeking to make as much money as possible, would have already set prices at that lower per unit level.)

In any case, that seems like a LOT more drugs.

Perhaps Anne has data on the number of scripts per person in the US vs OECD.

pgl -> Observer... , January 14, 2017 at 01:06 PM
There are lots of poor people who don't take drugs because they can't afford them. This will become especially true if the Republican repeal Obamacare.
anne -> Observer... , January 14, 2017 at 09:05 AM
The point of course is wildly exploiting ordinary people in need of healthcare in every possible way, or a reflection of what we have come to. Returning now to the market...

[Jan 14, 2017] Insurance overhead runs are probably the best argument for single payer

Jan 14, 2017 | economistsview.typepad.com
pgl -> Fred C. Dobbs... , January 13, 2017 at 06:14 AM
There are 3 ways we could reduce what we pay for health care:

(1) Ending the oligopoly power of the health insurance companies;

(2) Ending the doctor cartel;

(3) Reducing the monopoly power of Big Pharma.

Alas, the Republicans have no intention in doing any of this. So when they tell people they want to lower their costs, they are talking to rich people. The cost to the rest of us will go up if they have their way.

Observer -> pgl... , -1
From what I read, and recall from data Anne has posted a number of times, pharma costs are about 10% of total health care costs, and run about 2X EU average, or Canada, if we adopt that as a reference baseline. If we cut it in half, that would reduce our costs about 5%.

Doctors fees (physicians and clinical services in this reference) are about 20%. I think you have mentioned before we pay about 2X typical EU wages. So if we cut that in half, it reduces our costs about 10%.

Taken together, that's ~ 15% reduction. Not nothing, but in a few years of cost growth we are back to current cost levels.

Do you see that differently?

I don't have offhand figures for what insurance overhead runs. I think reducing that is probably the best argument for single payer, although comparisons to medicare overhead seem suspect (I'd expect much lower overhead percentages when much of your costs you are processing are $40K end of life hospital events vs. routine GP visits.) So one might zero out the profit, and reduce costs by having one IT/billing system. What's the scale of the opportunity here - another 15%?

https://www.cdc.gov/nchs/fastats/health-expenditures.htm

[Jan 13, 2017] Reducing the cost of healthcare

Jan 13, 2017 | economistsview.typepad.com
pgl -> Fred C. Dobbs... , January 13, 2017 at 06:14 AM
There are 3 ways we could reduce what we pay for health care:

(1) Ending the oligopoly power of the health insurance companies;

(2) Ending the doctor cartel;

(3) Reducing the monopoly power of Big Pharma.

Alas, the Republicans have no intention in doing any of this. So when they tell people they want to lower their costs, they are talking to rich people. The cost to the rest of us will go up if they have their way.

Observer -> pgl... , January 13, 2017 at 07:12 AM
From what I read, and recall from data Anne has posted a number of times, pharma costs are about 10% of total health care costs, and run about 2X EU average, or Canada, if we adopt that as a reference baseline. If we cut it in half, that would reduce our costs about 5%.

Doctors fees (physicians and clinical services in this reference) are about 20%. I think you have mentioned before we pay about 2X typical EU wages. So if we cut that in half, it reduces our costs about 10%.

Taken together, that's ~ 15% reduction. Not nothing, but in a few years of cost growth we are back to current cost levels.

Do you see that differently?

I don't have offhand figures for what insurance overhead runs. I think reducing that is probably the best argument for single payer, although comparisons to medicare overhead seem suspect (I'd expect much lower overhead percentages when much of your costs you are processing are $40K end of life hospital events vs. routine GP visits.) So one might zero out the profit, and reduce costs by having one IT/billing system. What's the scale of the opportunity here - another 15%?

https://www.cdc.gov/nchs/fastats/health-expenditures.htm

anne -> Observer... , January 13, 2017 at 07:37 AM
https://www.nytimes.com/2017/01/12/us/politics/health-care-congress-vote-a-rama.html

January 12, 2017

Senate Takes Major Step Toward Repealing Health Care Law
By THOMAS KAPLAN and ROBERT PEAR

In its lengthy series of votes, the Senate rejected amendments proposed by Democrats that were intended to allow imports of prescription drugs from Canada, protect rural hospitals and ensure continued access to coverage for people with pre-existing conditions, among other causes....

[Jan 13, 2017] What was at stake why Cory Booker joined Senate Republicans to kill a measure to import cheaper medicine

Jan 13, 2017 | economistsview.typepad.com
anne -> Observer... , January 13, 2017 at 07:39 AM
https://twitter.com/lhfang/status/819677587408568320

Lee Fang ‏@lhfang

What was at stake & why Cory Booker joined Senate Republicans to kill a measure to import cheaper medicine:

https://theintercept.com/2017/01/12/cory-booker-joins-senate-republicans-to-kill-measure-to-import-cheaper-medicine-from-canada/

BERNIE SANDERS INTRODUCED a very simple symbolic amendment Wednesday night, urging the federal government to allow Americans to purchase pharmaceutical drugs from Canada, where they are considerably cheaper.

2:49 PM - 12 Jan 2017

Peter K. -> anne... , January 13, 2017 at 09:33 AM
Cory Booker, another progressive neoliberal....
pgl -> Observer... , January 13, 2017 at 09:37 AM
Very good. On health insurance, they get 20% gross margins. I have argued many times we can cut this to 10%.

[Jan 12, 2017] Almost six in 10 Americans don't have enough savings to pay for a $500 car repair or a $1,000 emergency room bill

Jan 12, 2017 | www.nakedcapitalism.com
Class Warfare

"In a report from Bankrate.com, the firm found that almost six in 10 Americans don't have enough savings to pay for a $500 car repair or a $1,000 emergency room bill" [ 247 Wall Street ]. "While Millennials may be looked down on by older demographics, they are the most equipped generation to pay for an unexpected expense using their savings. It was found that 47% of those within the ages of 18 to 29 responded that they would use their savings to cover such a burden, up from 33% in 2014." I'd argue that's not virtue, but a rational response to the neoliberal destruction of universal benefits and government services generally.

Knifecatcher , January 12, 2017 at 2:12 pm

Re: Bankrate story – is there such thing as a $1k ER bill anymore? We paid nearly $3k for our unexpected trip, which involved 15 minutes with the doc, no tests or scans, and only a single dose of Childrens' Tylenol for consumables. (5 year old tried to poke his eye out with a stick and failed – but only just).

And of course our crapified insurance hadn't hit the deductible so we had to pay the whole bill out of pocket.

Vatch , January 12, 2017 at 2:31 pm

I'm lucky - I only have a $150 deductible, which is what I paid when I needed five stitches in my hand last year. The total bill was "only" about $1250, probably because I never saw an actual doctor. A nurse practitioner sewed me up. The explanation of benefits from the insurance company later showed that they only paid the hospital about one third of the billed price. I'm sorry that you had to pay the whole thing; I guess the insurance companies only enforce their standard payable fees when it's their money on the line.

optimader , January 12, 2017 at 2:58 pm

The kids I grew up with, that would have been crazy-glue/packaging-tape unless a finger articulation was compromised

http://morethanjustsurviving.com/stitches-bandages-or-super-glue/

btw..Animal bites should be left open and bandaged and treated w/ antibiotic so they heal from the inside out..

I remember in my misspent college youth an idiot scuba diver in Honduras (feeding a moray eel cheese wiz out of a can, guess what happened when she ran out?) who came to my friend's dad (a surgeon) insisting he sew her up.
He only bandaged her with butterfly bandages and gave her some kick-ass antibiotics. She was sure she was being undeserved (w/ gratis treatment) because he refused to sew her up, potentially trapping an infection.

ian , January 12, 2017 at 2:43 pm

I had a similar experience: 3 stitches on my sons finger. Treated by nurse (no doc), sutures and lidocaine was $1800. It got me wondering about how anyone could hope to reform health care when the accounting is so completely out of whack with reality.

[Jan 12, 2017] Cory Booker understands that a candidate cannot expect the Democratic nomination if he/she goes against the interests of BigPharma.

Jan 12, 2017 | www.nakedcapitalism.com
Benedict@Large , January 12, 2017 at 2:53 pm

Cory Booker understands that a candidate cannot expect the Democratic nomination if he/she goes against the interests of BigPharma.

RUKidding , January 12, 2017 at 3:26 pm

After spending day time hours publically going after Jeff Sessions (good), Booker uses the cover of darkness to reveal who he really works for.

Here's a clue: it isn't any of the 99%, whether in NJ or elsewhere.

Talk's cheap, but money walks – eh, Booker?

EndOfTheWorld , January 12, 2017 at 3:40 pm

Somewhere I saw that Bernie praised Trump taking on Big Pharma.

curlydan , January 12, 2017 at 3:33 pm

'specially if you're from Jersey. Kind of like Biden, Delaware, and credit cards. The strings on the puppets are awfully tight.

[Jan 12, 2017] 200PM Water Cooler 1-12-2017 naked capitalism

Jan 12, 2017 | www.nakedcapitalism.com
Class Warfare

"Hierarchies aren't natural phenomena within the human race. Outside of parenting, human beings aren't born with the inclination to be ruled, controlled, 'managed,' and 'supervised' by other human beings" [ The Hampton Institute ]. Hierarchies are artificial constructs designed to serve a purpose. They are a necessity within any society that boasts high degrees of wealth and power inequities. They are a necessity for maintaining these inequities and ensuring they are not challenged from below."

"In a report from Bankrate.com, the firm found that almost six in 10 Americans don't have enough savings to pay for a $500 car repair or a $1,000 emergency room bill" [ 247 Wall Street ]. "While Millennials may be looked down on by older demographics, they are the most equipped generation to pay for an unexpected expense using their savings. It was found that 47% of those within the ages of 18 to 29 responded that they would use their savings to cover such a burden, up from 33% in 2014." I'd argue that's not virtue, but a rational response to the neoliberal destruction of universal benefits and government services generally.

"[A] good deal of [Wallace] Stevens's poetic output conveyed a feeling of sehnsucht ("inconsolable longing"). For example, in 'Sad Strains of a Gay Waltz,' Stevens writes of American southerners (although the words just as easily apply to their author) as 'voices crying without knowing for what, / Except to be happy, without knowing how.' The object of Stevens's inconsolable longing changed over time. In his early professional days, when he first moved to New York City, it was his hometown of Reading, Pa. Writing to his future wife, Elsie, Stevens lamented that he 'lost a world' when he left there" [ The American Conservative ].

Knifecatcher , January 12, 2017 at 2:12 pm

Re: Bankrate story – is there such thing as a $1k ER bill anymore? We paid nearly $3k for our unexpected trip, which involved 15 minutes with the doc, no tests or scans, and only a single dose of Childrens' Tylenol for consumables. (5 year old tried to poke his eye out with a stick and failed – but only just).

And of course our crapified insurance hadn't hit the deductible so we had to pay the whole bill out of pocket.

Vatch , January 12, 2017 at 2:31 pm

I'm lucky - I only have a $150 deductible, which is what I paid when I needed five stitches in my hand last year. The total bill was "only" about $1250, probably because I never saw an actual doctor. A nurse practitioner sewed me up. The explanation of benefits from the insurance company later showed that they only paid the hospital about one third of the billed price. I'm sorry that you had to pay the whole thing; I guess the insurance companies only enforce their standard payable fees when it's their money on the line.

optimader , January 12, 2017 at 2:58 pm

The kids I grew up with, that would have been crazy-glue/packaging-tape unless a finger articulation was compromised

http://morethanjustsurviving.com/stitches-bandages-or-super-glue/

btw..Animal bites should be left open and bandaged and treated w/ antibiotic so they heal from the inside out..

I remember in my misspent college youth an idiot scuba diver in Honduras (feeding a moray eel cheese wiz out of a can, guess what happened when she ran out?) who came to my friend's dad (a surgeon) insisting he sew her up.
He only bandaged her with butterfly bandages and gave her some kick-ass antibiotics. She was sure she was being undeserved (w/ gratis treatment) because he refused to sew her up, potentially trapping an infection.

ian , January 12, 2017 at 2:43 pm

I had a similar experience: 3 stitches on my sons finger. Treated by nurse (no doc), sutures and lidocaine was $1800. It got me wondering about how anyone could hope to reform health care when the accounting is so completely out of whack with reality.

[Jan 11, 2017] the DEPRAVED nature of the American "Health Kare" system

Jan 11, 2017 | www.nakedcapitalism.com
clarky90 , January 10, 2017 at 6:12 pm

For me, often it is the "small crimes" that exemplify the DEPRAVED nature of the American "Health Kare" system. (See the right hand panel of The Last Judgment Bosch triptych) https://en.wikipedia.org/wiki/The_Last_Judgment_(Bosch_triptych)

US drugmaker charges 200 times UK price for common worm pill

A US drugmaker has put a price tag of more than $800 on a pinworm treatment - 200 times more expensive than the equivalent medicine on British pharmacy shelves, in the latest example of "price gouging" in the world's largest healthcare market.
Impax Laboratories (Bastards!) started selling mebendazole this year at an average wholesale price of $442 per pill, according to figures seen by the Financial Times, which were checked with several US pharmacy chains including Walgreens and CVS.

Most cases of pinworm, a parasitic infection also known as threadworm, require two pills, meaning a course of treatment costs about $884. The drug is available prescription-only in the US but can be bought over the counter in the UK, where Boots, a British chemist chain, charges £6.99 for a pack of four pills, or £1.75 each.

The pinworm parasite, which is common in children, affects 200m people a year worldwide and up to 40m in the US. It is recommended that family members are treated for the highly contagious infection at the same time, meaning a household of five's treatment costs more than $4,400.

https://www.ft.com/content/f0080fe4-c3ad-11e6-9bca-2b93a6856354

"Mebendazole came into use in 1971, after it was developed in Belgium.[4] It is included in the WHO Model List of Essential Medicines, the most important medications needed in a basic health system .[5] Mebendazole is available as a generic medication.[6] The wholesale cost in the developing world is between 0.004 and 0.04 USD per dose .[7] In the United States a single dose is about 884.00 USD as of 2016.[8]

https://en.wikipedia.org/wiki/Mebendazole

[Jan 02, 2017] U.S. Healthcare Is A Global Outlier (And Not In A Good Way)

Jan 02, 2017 | www.zerohedge.com

Historically, the United States has spent more money than any other country on healthcare.

In the late 1990s, for example, the U.S. spent roughly 13% of GDP on healthcare, compared to about a 9.5% average for all high income countries.

However, as Visual Capitalist's Jeff Desjardins notes, in recent years, the difference has become more stark . Last year, as Obamacare continued to roll out, costs in the U.S. reached an all-time high of 17.5% of GDP . That's over $3 trillion spent on healthcare annually, and the rate of spending is expected accelerate over the next decade .

HIGH COSTS, HIGH BENEFIT?

With all that money being poured into healthcare, surely the U.S. must be getting better care in contrast to other high income countries.

At least, that's what one would think.

Today's chart comes to us from economist Max Roser (h/t @NinjaEconomics ) and it shows the extreme divergence of the U.S. healthcare system using two simple stats: life expectancy vs. health expenditures per capita.

Courtesy of: Visual Capitalist

THE DIVERGENCE OF U.S. HEALTHCARE

As you can see, Americans are spending more money – but they are not receiving results using the most basic metric of life expectancy. The divergence starts just before 1980, and it widens all the way to 2014.

It's worth noting that the 2015 statistics are not plotted on this chart. However, given that healthcare spend was 17.5% of GDP in 2015, the divergence is likely to continue to widen. U.S. spending is now closing in on $10,000 per person.

Perhaps the most concerning revelation from this data?

Not only is U.S. healthcare spending wildly inefficient, but it's also relatively ineffective. It would be one thing to spend more money and get the same results, but according to the above data that is not true. In fact, Americans on average will have shorter lives people in other high income countries.

Life expectancy in the U.S. has nearly flatlined, and it hasn't yet crossed the 80 year threshold. Meanwhile, Chileans, Greeks, and Israelis are all outliving their American counterparts for a fraction of the associated costs. buckstopshere , Jan 1, 2017 10:02 PM

A shorter life expectancy makes Social Security look more solvent.

Cooking the books.

junction buckstopshere , Jan 1, 2017 10:08 PM
The chart shows that Monsanto and the New World Order are succeeding, that more glyphosate herbicide in the food, more toxic chemtrails and more unneccessary operations are having the desired effect, to cull the American population. Helped immeasurably by the cocaine and heroin flown into the USA by the Bush Crime Cartel on Air Force cargo planes.
cheka junction , Jan 1, 2017 10:10 PM
nyc runs US health care. that tells one all he needs to know.
Pinch Dog Will Hunt , Jan 2, 2017 12:58 AM
Republitards and Freedumb-lovers need to watch Michael Moore's movie about this called "Sicko"

https://www.youtube.com/watch?v=thkBLpRwdSM

You need MORE socialism, not less.

Tards.

Chief Wonder Bread balolalo , Jan 1, 2017 10:42 PM
Australia, Norway, Switzerland, Germany, South Korea, Japan, Italy, U.S.

Which of these countries is not like any of the others? Haha. Multiculturalism is such a fantastic deal. Some "cultures" just don't make good lifestyle decisions such as thinking that grape drank and swisher sweets are healthful choices.

philipat cheka , Jan 1, 2017 10:35 PM
It is, of course, in part a "Lifestyle" issue but the US system is grossly inefficient because there are adverse incentives built in (Adverse selection etc.). The US still uses a "Fee for service" model which has never been able to control costs anywhere in the world. On top of that, high pharmaceutical prices in the US account for up to 90% of total Big Pharma profits ane Medical Malpractise insurance not only directly adds large costs but indirectly forces the use of an unnecessary number of tests and the use of the newest drugs etc. Without any sensible controls at any point in the system it will only continue to get further out of control, as ACA has illustrated.
Ballin D philipat , Jan 1, 2017 10:41 PM
What's the alternative to "fee for service?" Seems pretty standard to charge for services rendered.
philipat Ballin D , Jan 1, 2017 11:47 PM
Except that more services = more fees = higher costs. Hence multiple tests, multiple procedures and multiple drugs = higher costs and higher fees = inefficiency bias and higher still costs. Physicians are human and the Healthcare providers have become experts at maximising costs to breaking point. There are many alternative models within which to control costs through negotiated standard procedures and fixed costs for each procedure and drug formularies (including the use of generic drugs) etc. Single payer is used by much of the developed world where the supplier agrees to supply at a negotiated price or doesn't get to participate, which focuses their attention nicely. The benefits of scale, in whatever system is used, should result in lower prices but don't in the US where USG is already the largest single provider of healthcare (Medicare/Medicaid etc).
Canoe Driver philipat , Jan 2, 2017 12:36 AM
A lot of people, certainly not just doctors, are making a lot of money from this dysfunctional medical system. That is the difference no one is talking about. The money is not disappearing down a rabbit hole. It is being pocketed by thousands of multi-millionaires. It is a profit-based system. Medicine is the one field where Capitalism has no hope of efficiency. Why? Because the demand is infinite and inelastic. A recipe for the financial rape of millions.
dogsandhoney2 junction , Jan 2, 2017 12:43 AM
yeah,
and it also shows the effect of a
30% increase in psychological stress since 1980.
stress = ^stress hormones = stressed immune system =
anxiety/depression/cardiovascular disease/hyper inflammatory response/etc..

all to be treated by those in the stressed-out health care system,
usually with hyper-cost pharmaceuticals.

it's well past due date for the u.s. to become civilized by starting
single payer medical plans.

health insurance corporations = the terror.

sinbad2 heresy101 , Jan 1, 2017 10:48 PM
I wouldn't count on it.

Private healthcare and insurance is very profitable 2 of the 3 trillion the US spends on healthcare would go to shareholders and management of healthcare companies.

Mr Trump is a businessman and a realist. The media would be calling him a commie if he tried to fix it.

sinbad2 , Jan 1, 2017 10:38 PM
Americans would not have it any other way.

The countries that have the most cost effective healthcare, are countries that provide government run health insurance.

Americans would never tolerate claiming helthcare costs back from a Government run health providor, like in Australia, or waisting taxpayers money building hospitals.

Americans have to pay for their belief that private for profit health insurance is cheaper and better than government provided insurance.

Xena fobe sinbad2 , Jan 1, 2017 11:41 PM
Americans would accept single payer. But insurance companies would not.
TheEndIsNear I Write Code , Jan 2, 2017 12:05 AM
250,000 deaths in 2015 were due to medical error, the third leading cause of death in the U.S.
http://www.hopkinsmedicine.org/news/media/releases/study_suggests_medica...

38,300 people were killed on U.S. roads in 2015.
http://www.newsweek.com/2015-brought-biggest-us-traffic-death-increase-5...

33,636 deaths due to "Injury by firearms" of which only 11,208 were homicides, 21,175 were self inflicted suicides, and the remainder were due to accidental/negligent discharge of a firearm or "undetermined intent".
https://en.wikipedia.org/wiki/Gun_violence_in_the_United_States

brooklinite8 , Jan 1, 2017 11:07 PM
When I was visiting India I saw few women administer a baby birth basically in few minutes with bare hands, water, oil and some sarees. Here in the US I believe the bill comes around 5-10k at the least. Did we ever ask the question as to why do we need insurance to afford health care? Did we ever ask how has it become so out of control? Why has healthcare become such a big business? Where are the morals of humanity?

In USA the welfare of the state takes precedence to the welfare of the people. Human beings are valued at no different rate in USA than India. Welcome to the Land of the Free, Home of the Brave. Good Old USA. We are outliers and Everything we do should be an outlier. If not we will revisit and make sure it becomes an outlier. Lol

Canoe Driver brooklinite8 , Jan 2, 2017 12:57 AM
The total cost per childbirth in the US is said to be $50-65k. This figure is so outrageous that it is impossible to correlate it with the cost of providing the services. It is simply a bunch of profiteers taking their cut. And the profit can be several hundred percent of the underlying cost, precisely because the "customer" has no choice at all. Capitalism, which works well in many contexts, fails miserably in medicine. Demand is infinite and inelastic in the medical field.
hairball48 , Jan 1, 2017 11:15 PM
A shitty diet of sugar laden, high carbohydrate fast food products is what contributes to most Americans' shorter life spans, not "poor health care".

Health care is expensive because it's run by a de facto "health care mafia". I worked in the technical field of health care for 28 years. Excessive regulation is but just one reason health care is so expensive in the USA. Barriers to entry are another. Try to establish a medical school. See how long it takes. Fewer docs, the higher the price of docs. ECO 101. Don't look for a change anytime soon.

hairball

Miffed Microbio... hairball48 , Jan 2, 2017 12:14 AM
When I was an intern for clinical microbiology they gave us $300/month as a stipend. Today an internship costs $24k. This is on top of the 4 years degree. Plus the mechanization of the lab is continuing every year to the point there will be fewer jobs in the future. Hate to say it but my field is fucked. Much of my time is spent meeting regulatory compliance and it gets worse every year.

Miffed

tyberious , Jan 1, 2017 11:52 PM
Me, 20 years in Healthcare BS, MSPH, , started in reference labs, then trauma center, biotech and now in healthcare insurance quality improvement (Medicare). 1st of all the money is in the government, we all know that!

But my main response to the article is that the America sheep are being sheared! The assault starts at birth with 21 vaccines by adulthood( infant mortality), hormones in the food (preteen secondary sex characteristics)(breast cancer)(prostate cancer) , HFC (diabetes, heart diseases, and other complications) GMO's, glycophosphates, glutens, and the multitude of useless pharmaceuticals.

My point is Americans are being poisoned, not so much intentionally, but through fascist business models.

So recap: Chronic preventable illnesses, extensive bureaucracy, poor food choices (# 1 in my book), and a government that cares zero fucks about you!

chosen , Jan 2, 2017 12:18 AM
Doctors are way overpaid. Hospitals charge ridiculous prices that have no relation to reality. Insurance companies screw us even more.

The US medical system is worse than the university system. Both are scams whose main goal is to make the providers more and more money, and the users poorer and poorer. It is sick.

Canoe Driver chosen , Jan 2, 2017 1:12 AM
Basically, you are right. The idea is that the price is all the funds the "customer" has in the world, every time there is significant illness. This is because the demand for healthcare is essentially infinite and inelastic. If you want to live, pay us everything you have, then declare bankruptcy. That is what happens naturally in a for-profit medical system.

[Dec 30, 2016] Payment for Emergency Ambulance Services.

Dec 30, 2016 | dfs.ny.gov
The Office of General Counsel issued the following opinion on June 7, 2006, representing the position of the New York State Insurance Department.

Payment for Emergency Ambulance Services.

Re: Payment for Emergency Ambulance Services.

Questions Presented:

1. Pursuant to the New York Insurance Law, may a medical provider, such as an ambulance company issued a certificate to operate under N.Y. Pub. Health Law § 3005, bill a patient directly for prehospital emergency ambulance services where a New York authorized insurer or health maintenance organization ("HMO") has made partial payment of a bill?

2. Pursuant to the New York Insurance Law, may a medical provider, such as an ambulance company issued a certificate to operate under N.Y. Pub. Health Law § 3005, bill a patient directly for prehospital emergency ambulance services where a New York authorized insurer or health maintenance organization has denied payment entirely?

Conclusions:

1. Pursuant to N.Y. Ins. Law §§ 3216(h)(24), 3221(l)(15) and 4303(aa) (McKinney Supp. 2006), the ambulance company may not bill a patient directly for prehospital emergency ambulance services where a New York authorized insurer or HMO has made partial payment of a bill under an insurance contract that provides major medical or similar comprehensive-type coverage. However, if such a contract is not involved, these provisions do not apply and there is no prohibition in the Insurance Law against the ambulance company billing the patient directly for the balance of the bill.

2. Yes. The ambulance company may bill a patient directly for prehospital emergency ambulance services where a New York authorized insurer or HMO has denied payment entirely, subject to the remedies available to the patient.

Facts:

This inquiry is general in nature.

Analysis:

N. Y. Ins. Law § 4303 (McKinney Supp. 2006) applies to non-profit health plans and HMO's. Although HMO's are primarily regulated by the New York Health Department, their subscriber contracts are regulated by the Insurance Department as if they were subscriber contracts of non-profit health insurers. See N.Y. Public Health Law § 4406(1) (McKinney 2002).

N.Y. Ins. Law § 4303(aa) (McKinney Supp. 2006) provides, in relevant part, as follows:

(aa)(1) Every contract issued by a hospital service company or health service corporation which provides major medical or similar comprehensive-type coverage shall include coverage for prehospital emergency medical services for the treatment of an emergency condition when such services are provided by an ambulance service issued a certificate to operate pursuant to section three thousand five of the public health law.

(2) Payment by an insurer pursuant to this section shall be payment in full for the services provided. An ambulance service reimbursed pursuant to this section shall not charge or seek any reimbursement from, or have any recourse against an insured for the services provided pursuant to this subsection, except for the collection of copayments, coinsurance or deductibles for which the insured is responsible for under the terms of the policy.

(3) An insurer shall provide reimbursement for those services prescribed by this section at rates negotiated between the insurer and the provider of such services. In the absence of agreed upon rates, an insurer shall pay for such services at the usual and customary charge, which shall not be excessive or unreasonable.

(4) The provisions of this subsection shall have no application to transfers of patients between hospitals or health care facilities by an ambulance service as described in paragraph one of this subsection. . . .

N.Y. Ins. Law § 3221(l)(15) (McKinney Supp. 2006), which applies to group or blanket accident and health insurance policies issued by commercial insurers and N.Y. Ins. Law § 3216(h)(24) (McKinney Supp. 2006), which applies to individual accident and health insurance policies issued by commercial insurers contain identical provisions.

In accordance with the above, if the insurance contract provides major medical or similar comprehensive-type coverage, it must include coverage for prehospital emergency medical services for the treatment of an emergency condition when such services are provided by an ambulance service issued a certificate to operate pursuant to section three thousand five of the public health law. The insurer must provide coverage for emergency ambulance services based upon the rates negotiated between the insurer and the provider of such services. If no participating provider contract exists, the insurer must pay for the services at the usual and customary charge, which shall not be excessive or unreasonable.

Once the insurer makes payment at the usual and customary charge, the provider must accept such payment as payment in full. The provider may not bill the patient directly for emergency ambulance services for the balance of a bill, except for the collection of copayments, coinsurance or deductibles that the insured is responsible for under the terms of the insurance contract.

Please note that N.Y. Ins. Law §§ 3216(h)(24), 3221(l)(15) and 4303(aa) (McKinney Supp. 2006) are applicable only to insurance contracts that provide major medical or similar comprehensive-type coverage. Thus, if such a contract is not involved, these provisions do not apply and there is no prohibition in the Insurance Law against the ambulance company billing the insured directly. In addition, these provisions do not address a situation in which a New York authorized insurer or HMO has denied payment entirely for emergency ambulance services (i.e. where the insurer or HMO states that coverage was not in effect or that treatment was not medically necessary). In such cases, the ambulance company may bill the patient directly, subject to the remedies available to the patient.

If the ambulance company or patient disputes a payment made by the insurer or HMO as not constituting the usual and customary charge or disputes the fact that no payment was made, the ambulance company or patient may raise the issue with the insurer or HMO and/or file a complaint with the Department's Consumer Services Bureau.

Lastly, the New York Attorney General's Office has conducted an investigation on balance billing by ambulance companies. For further information, the inquirer was directed to contact the Attorney General's Office at (518)474-7330 or access their web site which is located at http://www.oag.state.ny.us.

This opinion does not provide an analysis of the No-Fault Insurance Law, which would result in a different analysis and conclusion, since the inquirer already had OGC Opinions on this subject. 1 Please note also that this opinion is limited to an interpretation of the New York Insurance Law. No opinion is rendered on any other laws.

For further information you may contact Associate Attorney Pascale Jean-Baptiste at the New York City Office.


1 See OGC Opinion No. 03-02-18, dated Feb. 18, 2003 and OGC Opinion No. 03-04-36, dated April 30, 2003; see also OGC Opinion No. 05-05-29, dated May 28, 2005.

[Dec 30, 2016] 20 things to know about balance billing

Notable quotes:
"... Balance billing is on the rise nationally. In 2011, around 8 percent of privately insured individuals used out-of-network care, 40 percent of which resulted in unanticipated medical costs due to balance billing, reports Health Services Research . ..."
"... Balance billing complaints are up 1,000 percent in Texas . ..."
"... The rise in balance billing is partially attributable to a lack of network transparency with patients. ..."
"... The New York Times ..."
"... Kaiser Health News ..."
"... In 2014 Aetna sued a physician at Monmouth Medical Center in Long Branch, N.J., a hospital within Aetna's network, who did not notify a patient he would not accept Aetna's discounted reimbursement rate, according to the lawsuit. The physician charged Aetna $31,939 to treat abdominal pain in the patient. After Aetna paid the amount it deemed reasonable - $2,811, based on Medicare rates - the physician balance billed the patient for an additional $10,635. ..."
"... Montana Public Radio ..."
"... Sunshine State News ..."
"... The New York Times ..."
"... The New York Times ..."
Dec 30, 2016 | www.beckershospitalreview.com

Patients, caught in the financial crosshairs, often feel powerless to negotiate costs. Consumer advocacy groups and federal and state legislators are turning their attention to balance billing practices this year with renewed vigor, forcing payers and providers to find other ways to settle financial disagreements.

Here are 20 things to know about balance billing.

1. Balance billing is on the rise nationally. In 2011, around 8 percent of privately insured individuals used out-of-network care, 40 percent of which resulted in unanticipated medical costs due to balance billing, reports Health Services Research . In 2015, a nationwide study from Consumers Union found nearly one third of privately insured Americans received an unanticipated bill when their health plan paid less than expected for medical services within the past two years.

2. Balance billing complaints are up 1,000 percent in Texas . According to the Texas Department of Insurance , balance billing complaints rose from 112 in 2012 to 1,334 in 2015, an increase of 1,000 percent.

3. Lack of provider, network transparency. The rise in balance billing is partially attributable to a lack of network transparency with patients. In many cases patients are unaware they have received out-of-network care until they receive a balance bill in the mail. Nearly 70 percent of individuals with unaffordable out-of-network medical bills did not know the healthcare provider was not in their plan's network at the time of care, according to a survey conducted by Kaiser Family Foundation and The New York Times .

4. Emergency room services to blame, in part. A Health Services Research survey found in 2011, 68 percent of inpatient involuntary contact with out-of-network physicians was related to emergency care. These kinds of unanticipated medical bills may arise when a hospital participates in an insurer's network but its employed emergency physicians do not. For example, more than half of the hospitals in some Texas insurers' networks did not have a single physician on staff covered by the insurer, according to a 2015 study from the Centers for Public Policy Priorities in Austin.

5. Balance billing and contracted physicians. Many hospitals use physician outsourcing firms for anesthesiologists, emergency physicians, pathologists and radiologists, or will bring in an outside assistant surgeon to help with procedures. In many cases, these physicians do not participate in the same network as the hospital, unbeknownst to the patient. When physician groups and insurers are unable to resolve reimbursement disputes, patients can be served with much higher out-of-network charges. In Texas, for example, the specialty services most likely to submit balance bills are anesthesiologists, lab services, surgery and radiology, reports the Texas Department of Insurance .

6. Payers will fight out-of-network physicians with lower reimbursement rates. Last year, health insurance giant UnitedHealthcare said it would scale back how much it pays out-of-network physicians who practice at in-network hospitals, accusing physicians of demanding excessively high reimbursement levels, according to Kaiser Health News . During a billing dispute with out-of-network Bayonne (N.J.) Medical Center, the insurer accused the hospital of charging out-of-network rates 10 to 12 times higher for a medical service than area hospitals participating in United'snetwork. If a payer refuses to match physician reimbursement rates, the financial burden is passed on to the patient. In the aforementioned dispute between Bayonne and UnitedHealthcare, the patient was balance billed $1,170 for a total of five stitches.

7. Insurers are narrowing networks in an effort to reduce costs. As insurance companies have narrowed provider networks to keep premiums down, the number of patients who inadvertently received out-of-network care has jumped at hospitals, particularly with regard to contracted physicians.

8. Payers have sued providers for 'excessive' out-of-network fees. Aetna has sued a half dozen out-of-network physicians in recent years, alleging gross over charging for medical services. In 2014 Aetna sued a physician at Monmouth Medical Center in Long Branch, N.J., a hospital within Aetna's network, who did not notify a patient he would not accept Aetna's discounted reimbursement rate, according to the lawsuit. The physician charged Aetna $31,939 to treat abdominal pain in the patient. After Aetna paid the amount it deemed reasonable - $2,811, based on Medicare rates - the physician balance billed the patient for an additional $10,635.

9. Balance billing can occur even when a payer adjusts out-of-network emergency bills to in-network rates for patients. A patient recently accused Duke University Medical Center in Durham, N.C., of balance billing his account for an out-of-network rate after the patient submitted in-network payment rates to Blue Cross Blue Shield. Owing to the medical emergency of his situation, Matthew Aitken said he received an in-network rate from Blue Cross Blue Shield of North Carolina. However, Mr. Aitken alleged Duke proceeded to charge him for the remainder of the bill at the higher out-of-network rate, resulting in a bill nearly double that of Mr. Aitken's out-of-pocket limit.

10. Air ambulance billing disputes, complaints on the rise. In rural areas of the U.S. the high price for life-saving air ambulance flights has grabbed media attention as rural residents, faced with excessive balance billing, have turned to state and federal auditors for intervention. Those in rural areas often must rely on air ambulance flights in life-or-death situations in lieu of feasible ground transportation. Reimbursement rate disputes between payers and medical air transport companies have strapped patients with devastating medical bills. When Amy Thomson's newborn daughter was in heart failure, Ms. Thomson had to use an air ambulance service in rural Montana for transport to a more capable facility. At the time her insurance company, PacificSource, did not have an in-network air ambulance company near her family, reports Montana Public Radio . Ms. Thomson received a $43,000 balance bill from Airlift Northwest after PacificSource contributed a policy cap of $13,000.

11. Provider-based billing practices. Consumers have been increasingly vocal about surprise medical bills derived from provider-based billing practices. Provider-based billing allows a healthcare organization to bill patients for physician care in addition to a service charge for the patient's use of hospital facilities and equipment. In some cases, a patient may be responsible for the service bill if their insurance declines to pay or if the patient has a high deductible health plan. Large hospitals like Cleveland Clinic have faced increased scrutiny for provider-based billing practices. After paying a $30 copayment for in-network care with a Cleveland Clinic chiropractor, Julie Beinhardt reported receiving a balance bill of $3,000 for provider-based service fees her insurance plan refused to cover.

12. President Barack Obama signed legislation against provider-based billing. Last year, President Obama signed legislation outlawing provider-based billing at off-campus outpatient facilities. The legislation does not apply to existing outpatient centers that already engage in the practice, however.

13. The president's 2017 budget proposal includes a provision to eliminate surprise medical bills. Although details are minimal, the president's 2017 budget proposal includes a provision to eliminate balance billing privately insured patients. The administration would address the issue by requiring physicians who regularly provide services in hospitals to accept in-network rates for service reimbursement, even if they aren't in the insurer's network.

14. About a quarter of U.S. states have laws that protect consumers from out-of-network medical bills incurred by emergency care. According to a study from Kaiser Family Foundation , 24 states have implemented laws that restrict providers from balance billing in emergency care situations, including California, Delaware, New Jersey, New York and Pennsylvania, among others.

15. More states are proposing independent dispute resolution between payers and providers in balance billing cases. Independent dispute resolution establishes a legal space in which providers and health insurers can settle disagreements regarding balance billing without involving the patient. The states of Illinois and New Yorkhave arbitration methods in place, and Florida , Washington and Pennsylvania are currently considering a similar resolution methods.

16. New York has some of the strongest consumer protection laws. Under New York law , consumers are generally protected from owing more than their in-network copayment, coinsurance or deductible on bills they receive for out-of-network emergency services. Patients can complete an assignment of benefits form that absolves them of financial responsibility and allows the provider to pursue payment from the health plan in balance billing disputes.

17. Florida state legislature is currently embroiled in a fight to pass balance billing laws. Legislation to outlaw balance billing in Florida has continued to creep through the state legislature since last fall. Introduced in both the house and senate, the bills have sparked conflicting and outspoken opinions from patients, payers, hospitals and physicians. Hospitals have largely denounced the bill, blaming balance billing disputes on payers that demand allegedly unsustainable reimbursement rates, reports Sunshine State News .

18. The "End Surprise Billing Act". Federal lawmakers are making moves to outlaw balance billing nationally. Co-sponsored by 25 lawmakers, the End Surprise Billing Act would protect patients from balance billing who went to in-network facilities for emergency services, reports Consumerist . In non-emergency cases, it would require providers to notify patients within 24 hours if an out-of-network specialist will be involved in an episode of care.

19. Consumers don't know how to navigate the legal waters. According to a Consumer Union report, 57 percent of patients who encountered balance billing from contracted physicians within the last two years paid in full because they didn't know their rights to fight the bills. An overwhelming majority (87 percent) did not know which agency or department in their state government is tasked with handling complaints about health insurance. "So many times, people just give up [in surprise billing disputes]," Elisabeth Benjamin, vice president of health initiatives with Community Service Society of New York, told NPR .

20. The New York Times dedicated a series to consumer encounters with surprise healthcare bills. Elisabeth Rosenthal's series in The New York Times entitled Paying Til it Hurts examined the personal and financial implications of excessive, unexpected medical costs on Americans, their families and their healthcare consumption. Ms. Rosenthal's installments often feature individuals with unaffordable balance bills like Peter Drier , who was served a $117,000 balance bill for an out-of-network physician's assistant he never knew was present during surgery.

[Dec 26, 2016] Are Psychiatric Medications Hurting More Patients Than They Help?

Notable quotes:
"... Scientific American ..."
Dec 26, 2016 | science.slashdot.org
(scientificamerican.com) 431

Posted by EditorDavid on Sunday December 18, 2016 @01:34PM from the depressing-anti-depressant-news dept.

An anonymous reader quotes Scientific American 's Cross-Check blog :

Two new posts on this website have me contemplating, once again, the terrible possibility that psychiatry is hurting more people than it helps. Reporter Sarah G. Miller notes in "1 in 6 Americans Takes a Psychiatric Drug" that prescriptions for mental illness keep surging. As of 2013, almost 17 percent of Americans were taking at least one psychiatric drug , up from 10 percent in 2011, according to a new study. "Antidepressants were the most common type of psychiatric drug in the survey, with 12 percent of adults reporting that they filled prescriptions for these drugs..."

This increase in medications must be boosting our mental health, right? Wrong. In "Is Mental Health Declining in the U.S.?," Edmund S. Higgins, professor of psychiatry at the Medical University of South Carolina, acknowledges the "inconvenient truth" that Americans' mental health has, according to some measures, deteriorated ...

It's all more evidence of something their blogger wrote in 2012. "American psychiatry, in collusion with the pharmaceutical industry, may be perpetrating the biggest case of iatrogenesis -- harmful medical treatment -- in history ."

[Dec 26, 2016] 5 Ways to Lower Your Medical Bills Personal Finance

Notable quotes:
"... "One should know what the cost of the procedure is, and that is something that is just impossible to figure out before or after the procedure," Luthra says. "I had no way of knowing beforehand there were going to be these six different types of providers . . . sending me bills." ..."
Nov 29, 2007 | US News

Insurance companies aren't the only ones who can negotiate a lower price -- you can, too. Here's how.

By U.S. News & World Report

Sanjiv Luthra of Los Altos, Calif., suffered from the pain and fatigue of rapid-onset arthritis so severe that he couldn't walk 10 feet until he underwent double knee-replacement surgery in 2006. Now, two years later, he can walk and run, but he still suffers the fallout from another ailment: medical bills.

Six hours in an operating room, two knee replacements, medications and a five-day hospital stay added up to a bill of $80,000, Luthra estimates. That's not counting bills for an anesthesiologist, physical therapy, additional medicines and special exercise equipment to help him recover.

"One should know what the cost of the procedure is, and that is something that is just impossible to figure out before or after the procedure," Luthra says. "I had no way of knowing beforehand there were going to be these six different types of providers . . . sending me bills."

Luthra's insurance company was able to negotiate with the hospital so that it paid about $20,000, and he parted with about $5,000, including expenses outside the hospital.

But individual patients can haggle for lower medical bills, too. Here are tips on how to go about it.

Work up the courage to ask. It's not just insurance companies that can negotiate.

"The typical insurer gets about a 60% discount," says Gerard Anderson, the director of the Johns Hopkins Center for Hospital Finance and Management. "If you go into the hospital and ask the chief financial officer , you may get a 30% discount, but you have to ask for it. It's totally up to the discretion of the CFO how much they or the person in the billing office are willing to give you."

Although it's common to negotiate with a real-estate agent or car salesperson you probably never will see again, it's much more difficult to negotiate with a doctor you trust to make you well and to provide continuing care for your family. Only 31% of Americans have tried to negotiate the price of medical bills, a survey by Consumer Reports National Research Center indicated. But of those who tried, 93% have been successful at least once, and more than a third saved more than $100.

Explore low-cost treatments. Many doctors incurred large loans to finance medical school and probably understand the need to get a fair price as well as you do.

But even though almost 80% of physicians will prescribe a generic medication over a brand-name drug to save patients money, far fewer consider patient costs when recommending diagnostic tests (51%) or choosing between hospitalization and outpatient treatment (40%), according to a survey of physicians by the Center for Health System Change and the University of Chicago

If money is an issue, you need to ask your doctor if cheaper, medically sound options are available. The trick is to keep it friendly and ask nicely. For minor health ailments such as ear infections and pinkeye, drugstore clinics list reasonable prices upfront, with no negotiating required.

Find the correct person. Although they are heavily involved in treatment decisions, doctors may not be directly involved in other billing issues, so you need to find a person with the ability to adjust your bill.

"I would suggest the consumer go to the office manager," says Timothy Cahill, a health-care consultant in Louisville, Ky., who has negotiated hospital bills on behalf of patients. The office manager should be able to direct you to the person in charge of billing.

Offer cash payments. This could be a mutually beneficial solution for you and the medical establishment.

"Paying cash is worth a lot to a doctor in terms of time and trouble, and it is a lot less complex for the hospital to deal with," says Shankar Srinivasan. He is a co-founder and the chief technology officer of Vimo.com, a company that uses public records to figure out what prices insurers negotiate with hospitals. Cash, he says, saves hospitals the trouble of negotiating financing terms, paying credit card transaction fees and sending collection agencies after patients who fail to pay.

Scrutinize the bill and your insurance. If you don't have the cash to pay a large medical bill, you need to educate yourself about what your insurance should cover and try to negotiate a discount off the sticker price.

"As a consumer, just like a detective, you have to really understand the specifics of your insurance benefit plan, take the initiative of setting up conference calls (including yourself, the hospital and your insurance company) proactively, and you have to document everything," says Luthra, who is chief operating officer of the health-care-consulting company Benu. "You don't just pay the bill as is."

This article was reported and written by Emily Brandon for U.S. News & World Report.

[Dec 26, 2016] How to avoid and handle surprise medical bills

Notable quotes:
"... The average balance billed to patients was $622.55 , though the study reported bills as high as $19,603.30. But, ERs are not the only source of surprise bills. ..."
"... Even when a patient goes to a hospital for routine surgery, and takes care to choose an in-network hospital and in-network surgeon, the anesthesiologist, radiologist or pathologist assigned to the case may be out of network, and follow up with a surprise bill. ..."
"... If you have a serious medical emergency, your nearest hospital may not be in-network and all your treatment may result in out-of-pocket expense for high surprise bills. But, even if you visit an in-network ER, you have little control over the choice of doctor: By definition, you are facing an emergency, and must take whoever is available. ..."
"... Check with your state insurance regulator to see if your state has any consumer protections against surprise bills. ..."
"... At present, California, Colorado, Connecticut, Florida and New York do have such protections against unexpected balance bills - either for out-of-network ER situations alone or for additional types of surprise bills. ..."
"... If your state does not offer protection against surprise bills, check first to make sure the provider is really not in your network. Back offices and billing companies deal with many plans and sometimes make mistakes. Providers who are in your network have to accept the insurer's contracted rate. ..."
"... If the provider is out of network, do some research on an independent website, such as fairhealthconsumer.org , to estimate what the procedure typically costs in your locality. ..."
"... If neither the insurer nor the provider is willing to budge, do not be afraid to seek help. If you get your insurance through your employer, your human resources department may be able to intervene. Call your state representative or your local consumer protection office. With the right assistance, you might be able to reduce the bill, if not make it go away entirely. ..."
thehill.com
Surprise bills are never a welcome surprise. Typically, they arrive after you arranged care from a doctor and a hospital that were both in your health plan's network, but then you were unexpectedly treated by one or more other providers who, unbeknownst to you, were outside that network.

When these out-of-network providers send you a bill for their services, you may have to pay the full amount out of pocket or, if your health plan covers out-of-network care, to pay the balance of the bill that your insurance fails to cover. And the balance bill generally requires you to pay more than the out-of-pocket amount you would have owed if you had been treated by an in-network provider.

Emergency rooms are one of the most common locations where healthcare results in surprise bills.

As detailed recently in an article by two Yale scholars in the New England Journal of Medicine, in more than one in five cases nationwide, ER visits to an in-network facility involved out-of-network physicians. The average balance billed to patients was $622.55, though the study reported bills as high as $19,603.30. But, ERs are not the only source of surprise bills.

Even when a patient goes to a hospital for routine surgery, and takes care to choose an in-network hospital and in-network surgeon, the anesthesiologist, radiologist or pathologist assigned to the case may be out of network, and follow up with a surprise bill.

Several states have already enacted laws to protect consumers against surprise bills, although some of the statutes protect patients only in the case of balance bills for out-of-network ER services for a serious medical emergency. Currently, the issue is being discussed in a number of statehouses. In the meantime, here are steps you can take to protect yourself from such surprises.

Prevent surprise bills

The best defense against a surprise bill is prevention. If you have a serious medical emergency, your nearest hospital may not be in-network and all your treatment may result in out-of-pocket expense for high surprise bills. But, even if you visit an in-network ER, you have little control over the choice of doctor: By definition, you are facing an emergency, and must take whoever is available.

However, for a planned surgery or other procedure, you probably have time to speak up. Make sure that your doctor and hospital are in your plan's network. Check with them and with your plan. Ask your physician and your hospital in advance if they can arrange to have only in-network providers treat you.

Some hospitals may have no in-network specialist for care you might require. Find out if another hospital in your area can provide all your necessary services on an in-network basis. In some areas, there may be no in-network specialists available of the type you need. In that case, inform your plan that its network lacks necessary services and find out if the terms of the plan or state law provide you protection from large balance bills in such circumstances.

Always refer to your plan by its exact official name. Often insurers have multiple plans with similar names but different networks. If you use the wrong plan name when inquiring about a plan's network, you may get a wrong and costly answer. Make your inquiries and requests in writing so you have documentation. Ask for the names of the providers who will be involved in your care, and check with your insurer and with the providers themselves to see if they are all in your plan's network.

Check if your state protects consumers

If you do get a surprise bill, take action. Check with your state insurance regulator to see if your state has any consumer protections against surprise bills. Many states have laws that require HMOs to protect consumers from surprise bills, especially with respect to necessary ER services. Fewer states have similar protections for other types of health plans, such as PPOs and EPOs.

At present, California, Colorado, Connecticut, Florida and New York do have such protections against unexpected balance bills - either for out-of-network ER situations alone or for additional types of surprise bills. Generally, these laws provide that the consumer is required to pay only the amount he or she would owe for the services if provided in-network. States have different mechanisms for settling the balance, but they generally involve the insurer and the provider, not the patient.

If your state does not provide protection

If your state does not offer protection against surprise bills, check first to make sure the provider is really not in your network. Back offices and billing companies deal with many plans and sometimes make mistakes. Providers who are in your network have to accept the insurer's contracted rate.

If the provider is out of network, do some research on an independent website, such as fairhealthconsumer.org, to estimate what the procedure typically costs in your locality. If your plan's reimbursement is based on an amount that is less than the typical charge, you can use this information to ask the plan to pay the provider on the basis of at least the typical rate. If the out-of-network provider's charge is higher than the typical rate, you might be able to negotiate with the provider to reduce your costs. You can try to persuade the provider to reduce the charge, or to discount an excessive balance bill, by showing the provider that his or her charge is above the typical market rate.

If neither the insurer nor the provider is willing to budge, do not be afraid to seek help. If you get your insurance through your employer, your human resources department may be able to intervene. Call your state representative or your local consumer protection office. With the right assistance, you might be able to reduce the bill, if not make it go away entirely.

Robin Gelburd, JD, is the president of FAIR Health, a national, independent nonprofit with the mission of bringing transparency to healthcare costs and insurance reimbursement. FAIR Health oversees the nation's largest repository of private healthcare claims data, comprising over 21 billion billed medical and dental charges that reflect the claims experience of over 150 million privately insured Americans. Follow on twitter @FAIRHealth

[Dec 25, 2016] How to Fight Back Against Outrageous E.R. Bills

Two excellent resources-Healthcare Blue Book and FAIR Health-can give you estimates of how much health care services should cost in your area. Plus, your insurer's website may also provide a tool that will allow you to compare costs.
Notable quotes:
"... But the bill did come-all $9,000 of it. The ambulance company charged $6,500, including a $300 fee for the linens and a $30 charge for aspirin. The E.R. billed the remaining $2,500. "My mouth literally dropped open when I saw the cost," she says. ..."
"... "I've always heard emergency room visits were costly, but $9,000 for nothing more than a conversation that lasted one minute? That's robbery," she says. ..."
"... "Employers often try to stay away from filing a claim under worker's compensation, so it does not impact their experience rating or trigger an [occupational safety and health administration] review, but it would save her money." ..."
"... This piece is by Drew Anne Scarantino ..."
www.thefiscaltimes.com

It's no secret that hospital bills in the U.S.-especially ones from the E.R.-can often hit astronomical proportions.

According to a recent cost study conducted by researchers at Stanford University, the University of Minnesota, the University of California, San Francisco and the Ecologic Institute, the median charge for an emergency room trip in the U.S. comes in at $1,233. But where it really gets interesting is when you look at the specific reasons for those E.R. visits: The researchers found that the treatment price for a headache could range from $15 to a whopping $17,797. As for a sprained ankle, it could set someone back a paltry $4 or up to $24,110!

So what gives with these wildly fluctuating price points?

For starters, most emergency room prices are inflated based on the rates at which insurance companies will reimburse the hospital on a patient's behalf. That's why a single aspirin can cost $30 per pill in the E.R., which is more than six times the price for a bottle of them at the drug store.

On the flip side, patients will often contact the hospital or surgeon's billing office to ask for a cost reduction, further adding to the inconsistency in pricing. It's a practice that often works in a patient's favor, says billing advocacy specialist Sharon Salters of Medical Cost Advocatea professional medical bill negotiation service.

And then there's also the fact that most hospitals offer discounts to self-paying individuals-especially if there's a risk that they might not pay at all.

So to help shed some light on the complexities of hospital medical billing for the average consumer, we asked three people to share their craziest emergency room stories, the even crazier bills that followed-and the steps they took to remedy them.

... ... ...

The Emergency: Head Injury
The Bill: $9,000

A few months ago, Amanda Harris, 27, of Morristown, N.J., fainted at work, hitting her head in the process. Due to liability concerns, her production company required Harris to take an ambulance to the emergency room, despite her refusal. "I didn't even have a cut on my head, just a slight bump. No headache, no nausea, no confusion, nothing," she says.

Harris waited for over an hour in the E.R. before her husband told the nurse that they were leaving. Minutes later, a doctor spoke to Harris for under a minute, confirming that she was fine to go. "He didn't do any tests-no light in my eyes, no blood pressure," says Harris. "I left thinking I wouldn't even get a bill."

But the bill did come-all $9,000 of it. The ambulance company charged $6,500, including a $300 fee for the linens and a $30 charge for aspirin. The E.R. billed the remaining $2,500. "My mouth literally dropped open when I saw the cost," she says.

RELATED: Hospital Costs Explode: Between $127 and $151 Billion

What This Patient Did: Harris called her insurer and fought the bill. Luckily, her insurance covered all but a $3,000 deductible-but she was too exhausted to push for more. "I've always heard emergency room visits were costly, but $9,000 for nothing more than a conversation that lasted one minute? That's robbery," she says.

What the Expert Says: Even though Harris didn't want to take an ambulance, Salters says that her company's suggestion was well-advised. "However, she should consider working with her employer to file the claim with her company's worker's compensation carrier," says Salters. "Employers often try to stay away from filing a claim under worker's compensation, so it does not impact their experience rating or trigger an [occupational safety and health administration] review, but it would save her money."

How You Can Avoid Outrageous E.R. Bills (Really!)

When it comes to a trip to the E.R., the reality is that there's usually no time to shop around and compare prices in advance. But if you do some research before an emergency happens, you could potentially keep costs significantly down.

The negotiation can seem like a lot of extra work, but the payoff can be tens of thousands of dollars in savings shaved off a potentially outrageous E.R. bill.

This piece is by Drew Anne Scarantino.

[Dec 04, 2016] The goal of the majority of providers is to increase total sales by ordering many procedures and or drugs that are not needed. Much of this is done from ignorance and is not necessarily indicative of a purely capitalistic motive.

Notable quotes:
"... The goal of the majority of providers is to increase total "sales" by ordering many procedures and or drugs that are not needed. Much of this is done from ignorance and is not necessarily indicative of a purely capitalistic motive. ..."
www.amazon.com
Dwight Clark on May 1, 2013
An author that really knows and understands the complexities of the healthcare (sickcare) industry

I was a practicing cardiologist in the US for over 30 years. I, as most other practicing cardiologist, was trained and fully believed the prevailing methods of diagnosis and treatment were not only correct but absolutely necessary. Several decades of experience taught me this is not close to being accurate. The majority of medical tests, and much of the treatment, is not only unnecessary, but harmful and/or dangerous. The goal of the majority of providers is to increase total "sales" by ordering many procedures and or drugs that are not needed. Much of this is done from ignorance and is not necessarily indicative of a purely capitalistic motive.

David Goldhill is one of the few authors that have experienced this travesty and is educated and intelligent enough to understand the consequences of this nationwide epidemic and the needless, wasteful, and dangerous care. His ability to sort through all of the "noise" prevalent in the governmental and media diatribe and isolate the real problem as full insurance for everyone is unique. This system is doomed for failure. There will never be enough resources to fund medical care as long as the consumer is not the payer. They will always demand more and the providers are happy to accommodate them.

I have left the US and am presently living in Beijing, China, attempting to establish purely preventive heartcare clinics. This is more general education regarding diet, smoking, sedentary lifestyle, and alcohol abuse. than traditional western medicine. Less income, but certainly more satisfying.

[Nov 27, 2016] The likely death toll from Voixx had actually been several times greater than the FDA estimate

Nov 27, 2016 | www.unz.com
Author James Bovard has described our society as an "attention deficit democracy," and the speed with which important events are forgotten once the media loses interest might surprise George Orwell.

Consider the story of Vioxx, a highly lucrative anti-pain medication marketed by Merck to the elderly as a substitute for simple aspirin. After years of very profitable Vioxx sales, an FDA researcher published a study demonstrating that the drug greatly increased the risk of fatal strokes and heart attacks and had probably already caused tens of thousands of premature American deaths. Vioxx was immediately pulled from the market, but Merck eventually settled the resulting lawsuits for relatively small penalties, despite direct evidence the company had long been aware of the drug's deadly nature.

Our national media, which had earned hundreds of millions of dollars in advertising revenue from Vioxx marketing, provided no sustained coverage and the scandal was soon forgotten.

Furthermore, the press never investigated the dramatic upward and downward shifts in the mortality rates of elderly Americans that so closely tracked the introduction and recall of Vioxx; as I pointed out in a 2012 article , these indicated that the likely death toll had actually been several times greater than the FDA estimate. Vast numbers Americans died, no one was punished, and almost everyone has now forgotten.

[Nov 24, 2016] Cost of an Angiogram - Consumer Information

Nov 24, 2016 | health.costhelper.com
What People Are Paying - Recent Comments
Angiogram of heart
Amount: $55,150.00
Posted by: Pamela Garrett in Palm Springs, FL. Posted: September 1st, 2015 07:09PM
Physician: Medical Center: Jfk medical center
Had this procedure done to check heart due to abnormal stress test. Did not need any stents or any other procedure as everything was negative. I about had a heart attack when I opened the bill!!!
Was this post helpful to you? yes no Report prohibited or spam
Angiogram
Amount: $30,000.00
Posted by: StubbsMagoo in Richland, WA. Posted: January 20th, 2015 08:01PM
Physician: Doctor Korimerla Medical Center: Kadlec Medical Center Richland, WA.
My angiogram was done through the wrist area, with no stents, and was over in 20 minutes. 30 k ...really? I wish I was one of the millions in the U.S. that had no insurance to rape, then I could have gotten it for free. So now I am looking at 2k I owe immediately!!!!! This price is ridiculous and Kadlec Medical Center in Richland Washington should be ashamed and the community should be appalled. Shame on you Kadlec!!!!
Was this post helpful to you? yes no

[Nov 24, 2016] How to Fight Back Against Outrageous E.R. Bills

Two excellent resources-Healthcare Blue Book and FAIR Health-can give you estimates of how much health care services should cost in your area. Plus, your insurer's website may also provide a tool that will allow you to compare costs.
Notable quotes:
"... The ambulance company charged $6,500, including a $300 fee for the linens and a $30 charge for aspirin ..."
www.thefiscaltimes.com

It's no secret that hospital bills in the U.S.-especially ones from the E.R.-can often hit astronomical proportions.

According to a recent cost study conducted by researchers at Stanford University, the University of Minnesota, the University of California, San Francisco and the Ecologic Institute, the median charge for an emergency room trip in the U.S. comes in at $1,233. But where it really gets interesting is when you look at the specific reasons for those E.R. visits: The researchers found that the treatment price for a headache could range from $15 to a whopping $17,797. As for a sprained ankle, it could set someone back a paltry $4 or up to $24,110!

So what gives with these wildly fluctuating price points?

For starters, most emergency room prices are inflated based on the rates at which insurance companies will reimburse the hospital on a patient's behalf. That's why a single aspirin can cost $30 per pill in the E.R., which is more than six times the price for a bottle of them at the drug store.

On the flip side, patients will often contact the hospital or surgeon's billing office to ask for a cost reduction, further adding to the inconsistency in pricing. It's a practice that often works in a patient's favor, says billing advocacy specialist Sharon Salters of Medical Cost Advocatea professional medical bill negotiation service.

And then there's also the fact that most hospitals offer discounts to self-paying individuals-especially if there's a risk that they might not pay at all.

So to help shed some light on the complexities of hospital medical billing for the average consumer, we asked three people to share their craziest emergency room stories, the even crazier bills that followed-and the steps they took to remedy them.

... ... ...

The Emergency: Head Injury
The Bill: $9,000

A few months ago, Amanda Harris, 27, of Morristown, N.J., fainted at work, hitting her head in the process. Due to liability concerns, her production company required Harris to take an ambulance to the emergency room, despite her refusal. "I didn't even have a cut on my head, just a slight bump. No headache, no nausea, no confusion, nothing," she says.

Harris waited for over an hour in the E.R. before her husband told the nurse that they were leaving. Minutes later, a doctor spoke to Harris for under a minute, confirming that she was fine to go. "He didn't do any tests-no light in my eyes, no blood pressure," says Harris. "I left thinking I wouldn't even get a bill."

But the bill did come-all $9,000 of it. The ambulance company charged $6,500, including a $300 fee for the linens and a $30 charge for aspirin. The E.R. billed the remaining $2,500. "My mouth literally dropped open when I saw the cost," she says.

RELATED: Hospital Costs Explode: Between $127 and $151 Billion

What This Patient Did: Harris called her insurer and fought the bill. Luckily, her insurance covered all but a $3,000 deductible-but she was too exhausted to push for more. "I've always heard emergency room visits were costly, but $9,000 for nothing more than a conversation that lasted one minute? That's robbery," she says.

What the Expert Says: Even though Harris didn't want to take an ambulance, Salters says that her company's suggestion was well-advised. "However, she should consider working with her employer to file the claim with her company's worker's compensation carrier," says Salters. "Employers often try to stay away from filing a claim under worker's compensation, so it does not impact their experience rating or trigger an [occupational safety and health administration] review, but it would save her money."

[Nov 24, 2016] Legislature's ambulance bill is too costly

Notable quotes:
"... Price-gouging by ambulance services, including those run by municipalities, was always a disreputable exercise, preying on people who suffer emergency illnesses or injuries. ..."
"... The federal Medicare rate isn't usually high enough to cover all the ambulance costs, so the Legislature is right to go above it. But 300 percent is too high. ..."
The Boston Globe

When the Legislature finally produced a measure to prevent ambulance companies from gouging out-of-network patients and their insurers, it set a limit of 300 percent of the federal Medicare reimbursement rate or the ambulance's regular fee, whichever is lower. This is a ceiling that might function more like a floor, pushing ambulance firms to raise their rates to 300 percent of Medicare. It's a bad idea.

Price-gouging by ambulance services, including those run by municipalities, was always a disreputable exercise, preying on people who suffer emergency illnesses or injuries. And when insurers decided to fight back by reimbursing patients a set amount, rather than pay whatever the ambulance demanded, they, too, threw patients under the wheels: Ambulances expected the patients to make up the difference between the insurers' rate and the ambulance's. Few situations better illustrate patients' frustrations with the health care system.

So the unwanted task of deciding on an appropriate level of reimbursement fell to the state. And it should surprise no one that both insurers and ambulance services are lobbying for the best possible deal, while grumbling about government interference. Fire departments and other municipal offices that operate ambulances are hoping their friends in the Legislature can deliver a generous fee.

The federal Medicare rate isn't usually high enough to cover all the ambulance costs, so the Legislature is right to go above it. But 300 percent is too high. Patrick should veto the bill and ask the House and Senate to send it back to him with a lower price ceiling.

[Nov 23, 2016] 7 Tips For Fighting And Paying A Big Hospital Bill

Notable quotes:
"... Also consider using Medicare rates as a guide; the federal health system for people 65 and older typically has the lowest reimbursement rate for hospitals and medical providers. Your hospital may not agree to charge you its Medicare fee, but this figure is a good starting point for any negotiation. ..."
"... don't hesitate to appeal its decisions. You'd be surprised how often carriers overturn their earlier rejections. ..."
Sep 17, 2013 | www.forbes.com

Conversely, you may be able to wrangle a cash discount for agreeing to pay your entire cost at once.

You may also be able to successfully bargain down the particular dollar amounts you've been charged.

Tell the billing department that if your insurance requires, say, a 20% co-payment to the hospital, you'll pay only 20% of the insurer's negotiated rate with that hospital. That's usually far less than the initial rate quoted - the figure charged to uninsured patients.

Go online to check the rates other local hospitals charge for the procedure you had. Then, if you find your bill was way out of line, use this data as ammunition to try to get your fees lowered. You can get this type of information at such sites as Clear Health Costs, Healthcare Blue Book and FAIR Health.

Also consider using Medicare rates as a guide; the federal health system for people 65 and older typically has the lowest reimbursement rate for hospitals and medical providers. Your hospital may not agree to charge you its Medicare fee, but this figure is a good starting point for any negotiation.

2. Vigilantly review the bills. "It's very common for hospital bills to contain errors and overcharges, so make sure you've actually received the services they said you did," Detweiler says.

Candice Butcher, vice president of Medical Billing Advocates of America, says if you're discharged in the morning (as most patients are), protest if you're socked with a full daily-room rate for the date you left the hospital.

And if you brought your medications with you, make sure you weren't charged for them by the hospital. "This frequently happens," Butcher says.

Also, dispute any additional fees on the bill for routine supplies, like gowns, gloves or sheets. These items should be factored into the hospital daily-room charge, because, Butcher says, they are "considered the cost of doing business."

3. Challenge your health insurer's decisions, when warranted. Keep track of any hospital bills the company rejects on grounds that the procedure or drug isn't covered by your policy. If you believe the insurer should be paying more, don't hesitate to appeal its decisions. You'd be surprised how often carriers overturn their earlier rejections.

4. Negotiate bills once you know how much you'll have to pay out of pocket. If you just want extra time to send the money, Dale says, "it is relatively easy to speak with hospital or clinic business office staff to arrange a payment plan."

Conversely, you may be able to wrangle a cash discount for agreeing to pay your entire cost at once.

You may also be able to successfully bargain down the particular dollar amounts you've been charged.

Tell the billing department that if your insurance requires, say, a 20% co-payment to the hospital, you'll pay only 20% of the insurer's negotiated rate with that hospital. That's usually far less than the initial rate quoted - the figure charged to uninsured patients.

Go online to check the rates other local hospitals charge for the procedure you had. Then, if you find your bill was way out of line, use this data as ammunition to try to get your fees lowered. You can get this type of information at such sites as Clear Health Costs, Healthcare Blue Book and FAIR Health.

Also consider using Medicare rates as a guide; the federal health system for people 65 and older typically has the lowest reimbursement rate for hospitals and medical providers. Your hospital may not agree to charge you its Medicare fee, but this figure is a good starting point for any negotiation.

5. Consider hiring a pro. Since hospital bills are hairy, messy beasts, it may be worth your while to bring in a patient- or medical-billing advocate (Detweiler recommends the advocacy firm Copatient.com, which charges 30% of what it saves you) or an attorney. "It's like hiring a CPA to do your taxes," Dale says.

Be sure you won't be required to pay this expert any fees upfront. Patient advocates typically charge 20 to 30% of your savings; some put a cap on their fees. Karis' firm, for example, charges no more than $3,000. Attorneys often charge 30% of the savings they achieve.

... ... ...

Caroline Mayer is a consumer reporter who spent 25 years working for The Washington Post. Follow her on Twitter TWTR -0.69% @consumermayer.

[Nov 23, 2016] How Can I Negotiate A Sky-High Ambulance Charge On My Medical Bill

Notable quotes:
"... My husband suffered a heart attack when we were on vacation, and I called an ambulance. He's OK now, but we've been billed more than $6,000 for his 15-minute ride to the hospital. As it turns out, the ambulance service wasn't in our health insurer's network, so they paid only a small portion of the bill. We're making small payments on the balance, but the initial bill seems so high. The collector calls all the time to demand we pay the balance in full. Is there anything we can do to get the bill looked at and possibly lowered? ..."
"... Fortunately, medical bills are not always set in stone, and there may be ways for you to negotiate a lower balance. ..."
"... I recommend you first review an itemized copy of the bill for any errors. Look for duplicate charges, inaccurate service dates or incorrect mileage. If you spot any errors, take it up with the billing department immediately. ..."
"... Standard practice for insurers is to negotiate with providers to pay merely a fraction of the cost. ..."
"... Medicare negotiates, on average, a 73% discount. ..."
"... Negotiating with an ambulance service or any medical provider is not easy, but it is possible. Be persistent. If your efforts prove fruitless, you can always consider hiring a professional ..."
| www.forbes.com

... ... ...

Question:

My husband suffered a heart attack when we were on vacation, and I called an ambulance. He's OK now, but we've been billed more than $6,000 for his 15-minute ride to the hospital. As it turns out, the ambulance service wasn't in our health insurer's network, so they paid only a small portion of the bill. We're making small payments on the balance, but the initial bill seems so high. The collector calls all the time to demand we pay the balance in full. Is there anything we can do to get the bill looked at and possibly lowered?

Answer:

I'm glad to hear your husband is recovering, but I am sure the stress of an unexpected medical bill isn't helping him heal. Ambulance bills are notoriously costly, but yours seems to be inflated. Fortunately, medical bills are not always set in stone, and there may be ways for you to negotiate a lower balance.

I recommend you first review an itemized copy of the bill for any errors. Look for duplicate charges, inaccurate service dates or incorrect mileage. If you spot any errors, take it up with the billing department immediately.

Even if the bill is correct, you should still set up a time to speak with someone in the billing office-someone with the authority to negotiate on your balance. Go into the conversation equipped with the knowledge that Medicare and insurance companies rarely pay the hefty price tags that consumers see.

Standard practice for insurers is to negotiate with providers to pay merely a fraction of the cost. In the case of inpatient hospital bills, for example, a NerdWallet study found Medicare negotiates, on average, a 73% discount. While the ambulance service may not agree to such a large discount for you, coming to any negotiation equipped with such knowledge will put the company on notice that you aren't going to lay down and take its bullying or an inflated bill.

... ... ...

Negotiating with an ambulance service or any medical provider is not easy, but it is possible. Be persistent. If your efforts prove fruitless, you can always consider hiring a professional . A medical billing advocate is able to represent clients' interests much in the way an attorney would advocate for you in a courtroom. Their experience and expertise in the field can sometimes prove more effective (and less stressful) than taking on a stubborn provider alone.

See also

[Nov 23, 2016] 7 Steps in Appealing a Health Insurance Denial

Notable quotes:
"... As a practicing physician who is fed up with the way insurance carriers have managed to take over the delivery of health care in this country, my comments, I warn you, will be brutally frank. The way the game is played, the providers of health care bill as much as they believe they can get away with. ..."
"... That's because they are in business to make money - that's why it's called "for profit" health care. The insurance carriers try their damn best to find excuses to not pay as many of these charges as they can. Same reason. These two conspirators become co-conspirators when they play the game of "crap runs down hill". ..."
"... So here's my advice. Don't pay any "balance billing" no matter what they choose to call it. Activate the pump that sends the crap back uphill. Write letters to the provider asking for specifics as to the balance billing. ..."
Nov 23, 2016 | blogs.nytimes.com
MJ Columbus OH July 12, 2011

Unfortunately sometimes the only way to get around denial of precertification is to ask your doctor to lie. I had an MRI after a fainting episode that showed possible MS, which runs in my family. All other diseases were excluded. The medical recommendation is to get a follow-up MRI in 6-months. Because I wasn't having active symptoms, the follow-up MRI was not precertified when ordered by my neurologist. I went to my family physician for help, she requested the MRI, saying I was having headaches (everybody gets one occasionally, right?). I immediately got the necessary MRI and am now being treated. I think the insurance company didn't really want to deny the MRI, they wanted to delay expensive treatment, which was the likely outcome.

o'keefe illinois July 12, 2011

I am currently appealing a claim with HealthLink. Too long to go into but it involves an Intensive Outpatient Treatement program for my 20 year old son. There own guidelines state that this may well be the best initial choice for treatment. However, they advised us when they would not precertify that he needs to fail at out patient treatment and community support. Really? So I get to the External appeal process. Healthlink contracts with MCMC to provide the physician to do the reveiw. Can we say conflict of interest? She spits out the same verbage used to deny the precertification but mentions criteria that is no longer being used to asses such cases. Or and then there is the mention of my son's "wearable cardioverter defibrillor" has nothing to do with our case. So I appeal to the State of Illinois (eye roll) and am told I cannot appeal a denial of a precertification. I must have a denied claim. OK, but I can't get to the denied claim as HealthLInk won't even percert the care. Who are these people?

Clint N. NYC July 12, 2011

I recently had to deal with the insurance company VS primary care provider VS patient VS lab test provider. Its a cluster-expletive. Even trying to keep track of who said what when is difficult. Not too mention the hours upon hours of your precious time it *will* consume.

Short summary:

I had a severe flu (possibly swine flu) and made a doctor's appointment. They were very busy and couldn't see me for 2 weeks. When I came in for my appointment, I had recovered from the flu. My appointment was reclassified as well-care. My job's health insurance plan was revised two months prior to exclude well-care. I was now on the hook for 100% of the cost of the visit. The doctor ordered a full blood work since I was a new patient.

I realize it was my fault that I didn't know well-care wasn't covered. Lesson learned - I've read my EOB a couple times now, cover to cover. Unfortunately, I still only kind of know what is covered.

Anne Marie Bryn Mawr, Pa. July 12, 2011

As a practicing physician who is fed up with the way insurance carriers have managed to take over the delivery of health care in this country, my comments, I warn you, will be brutally frank. The way the game is played, the providers of health care bill as much as they believe they can get away with.

That's because they are in business to make money - that's why it's called "for profit" health care. The insurance carriers try their damn best to find excuses to not pay as many of these charges as they can. Same reason. These two conspirators become co-conspirators when they play the game of "crap runs down hill".

That's when they come up with things like "co-pays", "deductibles", "co-insurance", and a whole host of creative ways of attempting to coerce the patient to pick up the tab.

So here's my advice. Don't pay any "balance billing" no matter what they choose to call it. Activate the pump that sends the crap back uphill. Write letters to the provider asking for specifics as to the balance billing.

Don't accept their response. Write again. Write to the insurance carrier and appeal.

Then write the provider with the appeal number from the insurance company. Keep it going round and round. If contacted by a collection agency, write back explaining your appeals and that your financial condition won't allow you to pay without getting a disposition from your claim, and a better explanation from the provider as to why the procedure wasn't covered. Tell them to not contact you again. Tell them that you refuse to pay until you get a decent explanation. Dare them to sue you. CC a law firm on all correspondence. Make the providers get hurt enough to fight against the carrier. Bust up their friendship. Neither will hire a lawyer to get you. The publicity is the only thing they are afraid of.

KR NYC July 11, 2011

I am in the process of filing a claim for the first time ever. Cigna denied coverage for an operation after the fact. This was not even a marginal case, it was an obvious medical need. I suspect that insurance companies simply play the odds, deny and spread the costs to hospitals, surgeons, patients and maybe themselves. A lot less than paying the whole thing. This has nothing to do with medicine, as I have discovered. It is about how to boost revenues and damn fairness and the patient. Plan to fight and publicize my fight. This is as clean cut a case that can be found.

Walter San Diego, CA July 11, 2011

Having handled over 4000 health care appeals over the past 15 years, this article is a pretty good basic overview (so long as most of the Comments are ignored). The Affordable Care Act may ultimately be helpful in making this hodgepodge of rules more uniform, but that remains to be seen. The ultimate message for patients must remain clear: It is imperative to FIGHT for the care you need using all available resources and expertise at your disposal!

Frederick Willman Madison, WI July 11, 2011

One more reason why we must furiously resume pushing for medicare for all to replace the GOP health solution of just die folks.

FW
Madison, WI.

Lisa NYC July 11, 2011

#7 is correct: it is a game to the health insurance companies. They routinely deny perhaps 40% of all claims thinking that most people will just shrug off the denial and go away. The key is to keep calling, resubmitting and fighting the portion that they have denied. I have received initial denials for the most ludicrous reasons: the doctor retired; there is no such doctor at that address, etc... It is a game designed for the health insurance companies to win UNLESS you fight back.

Mollace Toledo, Ohio July 11, 2011

"If you feel too frail or overwhelmed to pursue an appeal yourself, nonprofit groups like the Patient Advocate Foundation can provide guidance for free."

A single person battling a life-threatening illness or condition is, of course, going to be overwhelmed and frail. Insurance companies bank on it. My suggestion is to start with advocacy first. Insurance companies make things difficult because they are in the business of making money, not helping patients. They want you to give up. When you have another person or two in your corner everything moves along better. Especially when the advocate knows how to fight hard and isn't afraid to speak frankly. There are witnesses to what is happening and you are taken more seriously.

It is ironic that there is now Health Proponent, a company that will fleece you in order to "advocate" for you. Only in America, folks.

Susan is a trusted commenter Eastern WA July 11, 2011

I had to have all my teeth extracted before I could begin treatment for throat cancer. I did not have enough dental insurance, and the oral surgeon's office told me that medical had informed them it would not pay the remainder.

I contacted mymedical insurance company, which recommended that I wait for a denial and then appeal. I pointed out that by that time I would be quite sick from the radiation, and would like to deal with it while I was still capable. Turns out there is a board that considers these things, so I had both of the oral surgeons, my oncologist, and my ENT all write letters to this board. The medical insurance company paid for the whole thing, since it was proven to be a medical necessity.

Now, if we could just get the oral surgery place to refund all that we paid, plus the dental insurance, so that the dental insurance can in turn use my benefit to help repay us for the dentures . . .

Michael in Vermont North Clarendon, VT July 11, 2011

This happens all the time. There are gajillions of codes used by the insurance companies. If your healthcare provider uses an incorrect code, then the insurance company won't pay the bill. Call the insurance company and find out what the codes should be. Then call or visit your health care provider and bring them up to date on the codes. Blue Cross and Blue Shield have all of their codes listed on their Internet site.

tough old bird Virginia July 11, 2011

sounds like Chinese water torture.

Harry St. Louis, MO July 11, 2011

You start off with the most important thing in any claim or grievance, and in almost any business deal - get it (and put it) in writing!

All the phone calls in the world will not help you but just trip you up. (And if you have to hire an attorney, this will save time and money.)

Robert Leff Cambridge, MA July 11, 2011

I have a friend who broke his back in a car accident and as a result has had ongoing medical issues. He told me that he treats the denials as a game. You submit the entire claim, they reject part of it, you resubmit the rejected part, they pay part and reject part, and you keep on going until you get your money. It seems cruel, but an insurance company's profit is the amount of money each year that they do not pay out in claims, so the incentive to deny is very strong.

Caught in the Middle Tenafly, NJ July 11, 2011

After some back and forth, Medicare paid its share of a claim that I, rather than my doctor, submitted,
I then submitted the claim to my secondary insurer who, after further back and forth, said that it could not pay the claim because it had been agent for my former employer and no longer had access to the employer's funds. The employer in turn, after more back and forth, says it plans tosubmit this and other claims to the current secondary employer for payment rather than pay them directl y. The process seems to go on forever.

mary browning is a trusted commenter miami beach, FL July 11, 2011

Good heavens, why should it take instructions that would require a graduate degree? In other countries none of this mess would be required. Disgraceful.

If you are sick and don't feel up to doing things, how, indeed could you do what you are said to do to simply get what is required or due to you?

George Eliot Annapolis, MD July 11, 2011

Stop. Just sue them and put them on the defensive. Denial of claims is the way the criminal health insurance companies provide record salaries to the gangsters who run the companies, and big dividends to their share holders.

All hail the American Plutocracy!

Barry New Jersey July 11, 2011

Appealing a health insurance denial which involves a substantial financial liability can be viewed like any other do-it-yourself endeavor. If you are comfortable handling a matter upon which, say, $75,000 or more is at stake (which is not uncommon), good luck. On the other hand, if the stakes are high, you may want consider having it handled by an attorney who specializes in this area of practice

TB is a trusted commenter Philadelphia July 11, 2011

As someone who went through this process recently, I would make the following suggestions:
1) Be very legalistic in your approach to the appeal, and quote appropriately from the policy and from law (this of course assumes you have a solid legal basis for your appeal).
2) Inform the insurance company in writing that if they require a full appeal, you will hire legal counsel to research and document your appeal.
3) Remind the insurance company that under ERISA, if you ultimately win, you are entitled to reimbursement of your legal fees and expenses.

This won't win obviously if you are on shaky legal ground. But if the insurance company is on shaky ground and just trying to avoid paying a claim (which was the case with us), this sort of saber rattling can help resolve the question quickly before you end up in a formal appeal. The insurance company doesn't want you to hire a lawyer if you have a good chance of winning.

stevesw1 Baltimore, MD July 11, 2011

Assistance with appeals and grievances from denials of health insurance claims is a service that many state Attorneys General provide for free, so check with your Attorney General's office before paying someone to assist you with the process.

[Nov 22, 2016] Hiring a Guide to the Medical Bill Maze

Notable quotes:
"... As part of her husband's benefits package, Isaac had access to a medical billing assistance company called Health Advocate . It negotiated with the physician's health-care group to reduce her bill to $7,000. ..."
Apr 29, 2013 | Bloomberg

When Annrose Isaac's twins were born prematurely, she thought her insurer would cover their stay in the neonatal intensive care unit. "The hospital was in our network, but it turned out the physician in the NICU who saw our daughters didn't participate with our insurer," says the Westwood (New Jersey)-based financial planner. "All of a sudden we were getting bills for over $30,000."

As part of her husband's benefits package, Isaac had access to a medical billing assistance company called Health Advocate. It negotiated with the physician's health-care group to reduce her bill to $7,000.

More than 60 percent of all U.S. personal bankruptcies are linked to illness and unpaid medical bills, according to a 2009 Harvard University study, even though 78 percent of those filing for bankruptcy because of illness have some form of health insurance. So hiring a medical billing advocate can be an essential part of the cure to financial ills.

Yet finding the right advocate can be tough, and those in the direst situations can ill afford the typical $75- to $130-an-hour rate. "This business is painfully slow-growing," says Becky Stephenson, co-president of the Alliance of Claims Assistance Professionals (ACAP), an advocate trade group. "There are a lot of people with problems but not a lot of people willing to pay you to help them." Despite long experience, Stephenson herself has trouble making a good living purely from advocacy, so she supplements her income by serving as an expert witness in medical lawsuits.

Employees working at sizable companies may already have access to a health advocate. Just over half of U.S. companies with more than 500 employees offer it as a benefit, according to Steven Noeldner, a senior consultant for Mercer's Total Health Management practice. Many employees don't know the benefit exists, he says, and the services generally aren't as customized as those of an independent billing advocate.

Credential Check

Unlike with more established professions such as accounting or law, there is no standard credential to look for when seeking a qualified advocate. At the most basic level you should ask if an advocate has certifications in medical bill coding from either the American Academy of Professional Coders or the American Health Information Management Association.

Many people with those designations aren't advocates, however, working instead for hospitals or insurers. And understanding the codes is only half the battle. Because of the complexity of our health-care system, you'll need someone who specializes in your specific kind of billing problem.

A good place to start is Claims.org, ACAP's website. It lets you search for experienced advocates by state. In a case like Isaac's, you'd need someone who specializes in hospital bills. Other advocates specialize in Medicare appeals, long-term care insurance, workers' compensation and insurance for special needs children.

Privacy Issues

The best way to find the right specialist is to ask the advocate for a resume and references. This can be tricky, because laws about disclosing private medical information are so strict that some advocates have difficulty providing references. In order to do so, their clients must agree to discuss their medical history.

Stephenson specializes in hospital bill audits. She studies itemized bills line by line, identifies padding and mistakes and negotiates lower rates. Prior to starting her Austin (Texas)-based advocacy firm VersaClaim in 2002, she ran an organization that helped doctors affiliated with hospitals set up their practices. That included all aspects of hospital billing.

A registered nurse for 12 years, Stephenson has an intimate knowledge of medical terminology and hospital procedures. "I ask questions like, Are there dosages of medications that are not compatible with my medical experience in real life?" she says. "Do the charges look realistic, or is there an $85 Tylenol?"

Location Matters

Another important factor to consider is an advocate's location. State laws vary in how they regulate insurers and hospitals. For Katalin Goencz, an advocate in Stamford, Connecticut, location is often irrelevant because she specializes in Medicare appeals: "The rules for Medicare are federal and pretty much universal, so the client's location doesn't really matter."

For a patient negotiating a lower bill directly with a local hospital or private insurer, having an advocate who knows the specific state regulations helps. State rules for advocates can also vary dramatically. Florida has some of the strictest. "Due to the large senior population in our state, we have a strong urge to make sure our people adjusting medical claims are licensed, competent and held to a high standard," says Matthew Guy, a spokesman for Florida's Division of Agent and Agency Services, which licenses and regulates advocates.

The state's Public Adjuster license for advocates requires licensees to be fingerprinted, have a criminal background check and hold a $50,000 surety bond. "If there's any wrongdoing by the adjuster, we can take the bond amount and use that towards restitution for the consumer," Guy says. Adjusters must pass an exam and take 24 hours of continuing education classes every two years.

Contingency Basis

A handful of advocates will work on contingency if they think you have a negotiable claim. Most will impose strict conditions to ensure they get paid if they win. "When I started my practice, I did everything on contingency but learned very quickly that a lot of consumers who want you to take their case on contingency in the end don't want to pay you," says Sheri Samotin, a billing advocate at Life Bridge Solutions in Naples, Florida.

Now Samotin requires a credit-card authorization up front for an amount sufficient to cover what her estimated contingency fee will be if her work succeeds. If the client doesn't pay within 10 days of a settlement being reached, she charges the card. Her fee is 35 percent of the client's medical bill savings.

Samotin is unusual in the advocacy world as she is more of a generalist, taking on all kinds of medical billing problems, including those of the uninsured. She has 25 years of experience in the health-care industry, so she has the knowledge to handle different kinds of problems, Samotin says. For a monthly $285 fee she will manage her clients' entire billing life -- a common need for seniors who have lost their capacity or desire to manage daily finances.

Instead of being a member of ACAP, Samotin is a member of the American Association of Daily Money Managers, a trade group for generalists. Only a handful of the AADMM's 700-plus members have the skills to also handle medical billing advocacy, Samotin says. Nor does she expect rapid growth in the field.

"Because this is a disorganized profession, people entering the field have to be entrepreneurs," she says. "They have to hang out their shingle and go out and get clients. In my experience, the majority of people who are good medical analysts and advocates are not necessarily good business getters."

So until the profession matures, finding a good advocate will remain difficult, no matter how vital the service is.

(Lewis Braham is a freelance writer based in Pittsburgh.)

To contact the editor responsible for this story: Suzanne Woolley at swoolley2@bloomberg.net

[Nov 22, 2016] Negotiating can cut hundreds off your medical bills

Notable quotes:
"... There are also companies who claim they have a network of physicians throughout the state who offer medical services for 50 percent off or more. ..."
13 WTHR Indianapolis
But you can fight back against skyrocketing medical costs.

"I've heard discounts up in the area of 30 percent sometimes, which can be pretty significant," said Cathryn Perron, director of program development with Consumer Credit Counseling.

She says it's possible to negotiate down your medical bills - everything from ambulance rides to surgery. She says you can also bargain with your dentist, the lab that does your blood tests, the eye doctor - even the company that makes you prescription medication.

"Each company has a specific number you can call to fill out an application and many times, you'll get a discount, or you'll get the product free through the drug companies, if you qualify financially," Perron said.

All you have to do, with or without insurance, is make a call. Each case is handled differently. In most cases, everyone wants to pay the bill, but they're afraid to contact their doctor or hospital. They'll work with you to make sure the cost is paid.

So how do you pay less?

There are a number of options:

  • Offer to pay in cash - You may get an up-front discount of 10 percent or more.
  • Ask about a payment plan - They're usually interest-free and determined by your budget.
  • If you don't have insurance - Some hospitals will give you a discount that is equal to what it may have given the insurance company.

Charity care - Bills are forgiven, based on your income and expenses, but you'll have to fill out hardship paperwork.

"You'll most likely have to provide proof of income, they'll ask about your monthly living expenses and your other bills that you have to pay every month," said Perron.

Sholar called Indianapolis EMS.

"He says, 'Sir, you got to pay for the ambulance, all the stuff in the ambulance, the two people who drive the ambulance. That's just the way it is'," he said.

But he didn't give up.

"This bill says $1,300. She said, 'Yeah, that sounds about right.' I said, 'Let me talk to a supervisor'," Sholar said. "The supervisor's name is John. John wasn't too happy."

Mike put on the pressure and the bill was reduced by $532. The wounds to his buttocks are healed, but the other injury he got that night, on his thumb, is a constant reminder of the cost of healthcare.

"I don't need no X-rays, I don't need no other stuff. Just give me the stitches and I still haven't received a bill for that," he said.

But he's ready to negotiate and he says, in the future, he'll also weigh the costs before calling 911.

"I would have put a rag over it and got a ride here," he said.

Tips to Negotiate Your Medical Costs

Consumer Credit Counseling and Apprisen offer tips to get your medical bills reduced:

First and foremost be informed. Understand what type of medical insurance coverage you have and what your co-pays or financial responsibilities are. Some insurance companies have contracts with certain medical providers to offer a discount if you receive treatment from a "preferred provider." We encourage individuals to meet with their Human Resource department or contact their insurance company to speak with a representative about their coverage and benefits prior to receiving medical treatment. This could reduce your financial responsibility significantly.

Apprisen recommends for you to review your itemized statement from your medical provider. If you feel there are discrepancies or charges in question, contact your medical provider to meet with their Patient Account Specialist to discuss your questions or discrepancies. Communication is a vital part of resolving your issues. Simply ignoring communication from your medical provider will not resolve the issue and could potentially lead to a negative impact on your credit rating if resolution is not reached.

Whether you have insurance or not, you are encouraged to contact your medical provider prior to treatment (if possible) to discuss costs associated with your treatment and to work out the possibility of negotiating those costs down. Many medical providers will consider giving discounts to individuals who are willing to pay the balance in full upon services rendered or within a short period of time after receiving treatment. If you find yourself in a position where you are not able to pay the balance in full, consider negotiating with your medical provider for a monthly repayment plan interest free. You are encourage to analyze your personal budget to insure you are able to make the financial commitment to your medical provider. Negotiating your medical bill then failing to follow through with the financial payment arrangement could negate your hard effort to reduce your medical bill.

If you are uninsured, you are encouraged to meet with a Patient Account Specialist or a "decision maker" to see if you qualify for any financial hardship programs. Most hardship programs require you to provide evidence of your financial situation and the award is based on financial need. Be prepared to give a full budget disclosure in order to be considered for the hardship program.

Apprisen's mission is "To help people improve their financial well-being through counseling, community outreach and financial education."

You can call Apprisen at 1-800-355-2227 or visit apprisen.com.

There are also companies who claim they have a network of physicians throughout the state who offer medical services for 50 percent off or more. You can find out more about those companies at objectivedx.com.

[Nov 21, 2016] Pharmaceutical Executives Indicted: Protectionism Leads to Corruption

Notable quotes:
"... Every economist in the world can quickly explain how a 10 percent tariff on imported steel will lead to corruption. The same logic applies to drug patents, although since they are the equivalent of tariffs many thousand percent (they typically raise the price of protected drugs by factors of ten or even 100 or more), the incentives for corruption are much greater. ..."
"... kickback scheme between a major drug manufacturer and a mail order pharmacy. ..."
"... Gary Tanner, the former Valeant executive, entered into a secret relationship with Philidor's chief executive, Andrew Davenport, federal authorities said. ..."
Nov 19, 2016 | economistsview.typepad.com

anne : November 18, 2016 at 05:00 AM , 2016 at 05:00 AM

http://cepr.net/blogs/beat-the-press/pharmaceutical-executives-indicted-protectionism-leads-to-corruption-43-641

November 18, 2016

Pharmaceutical Executives Indicted: Protectionism Leads to Corruption #43,641

Every economist in the world can quickly explain how a 10 percent tariff on imported steel will lead to corruption. The same logic applies to drug patents, although since they are the equivalent of tariffs many thousand percent (they typically raise the price of protected drugs by factors of ten or even 100 or more), the incentives for corruption are much greater.

This is why every economist in the world should have been nodding their heads saying "I told you so" when they read this New York Times article * about a kickback scheme between a major drug manufacturer and a mail order pharmacy. Unfortunately, there were no economists mentioned in this piece. And, it is quite possible that most economists support this form of protectionism, in spite of the enormous inefficiency and corruption that results. (Yes this is a major point in my free book, "Rigged: How Globalization and the Rules of the Modern Economy Were Structured to Make the Rich Richer." ** )

* http://www.nytimes.com/2016/11/18/business/valeant-philidor-fraud-kickback-scheme.html

** http://deanbaker.net/books/rigged.htm

-- Dean Baker

anne -> anne... , November 18, 2016 at 05:06 AM
http://www.nytimes.com/2016/11/18/business/valeant-philidor-fraud-kickback-scheme.html

November 17, 2016

Former Valeant and Philidor Executives Charged in Kickback Scheme
By KATIE THOMAS and MATTHEW GOLDSTEIN

Gary Tanner, the former Valeant executive, entered into a secret relationship with Philidor's chief executive, Andrew Davenport, federal authorities said.

[Nov 01, 2016] Guillotine Watch, Health Care Edition

Nov 01, 2016 | www.nakedcapitalism.com
allan November 1, 2016 at 8:36 pm

Guillotine Watch, Health Care Edition

Divorce trial 'lifestyle analysis': Ex-wife needs $5 million a year [Chi Trib]

With multiple homes, a full-time private chef, vacations, entertainment and $746 for pet care, Alicia Stephenson needs more than $400,000 a month to meet her living expenses, according to testimony from a financial expert who specializes in divorces.

Cathleen Belmonte Newman, a certified divorce financial analyst, said she completed a "lifestyle analysis" to determine that Stephenson would need $433,991 "net" in monthly maintenance to keep up a standard of living similar to what she had during her marriage to Richard Stephenson, the multimillionaire founder of the Cancer Treatment Centers of America hospital network. …

Much of the trial, now in its third week, has featured testimony from Alicia Stephenson's friends and business associates who have outlined her lavish lifestyle during the marriage: trips on private jets, several homes complete with staff and high-end furnishings and artwork, millions of dollars in jewelry, couture clothing, fancy parties, expensive vehicles, motorcycles and yachts. …

All paid for by cancer patients and, truth be told, by their insurance companies.

Edit: from a comment on the article, a story about CTCA:

http://scienceblogs.com/insolence/2013/03/07/the-cancer-treatment-centers-of-america-cherry-picked/

[Oct 25, 2016] Cholesterol Down Ten Simple Steps to Lower Your Cholesterol in Four Weeks--Without Prescription Drugs

Oct 25, 2016 | www.amazon.com
by Janet Brill

5.0 out of 5 stars /span> By Kelly Jadon on September 28, 2008 Format: Paperback

10 Simple Steps To Naturally Lower Your Cholesterol From: [...]

Book Review: Cholesterol Down by Dr. Janet Brill

Cholesterol Down is for the 105 million Americans who have high cholesterol. The author, Dr. Janet Brill, a registered and licensed dietitian/nutritionist, exercise physiologist, and certified wellness coach has spent years counseling patients on cardiovascular disease prevention, researching, and writing on the subject of cholesterol. Her work has been published in the International Journal of Obesity and the International Journal of Sport Nutrition.

Cholesterol Down provides readers with the information they need regarding cholesterol -- what it is and how it works both for and against the body. It is significantly endorsed by Dr. Jennifer H. Mieres, the National Spokesperson for the American Heart Association. She states, "The simple, consistent, and inexpensive lifestyle therapy outlined in her {Dr. Janet Brill's} Cholesterol Down Plan could be the most important investment you make in your future health." Dr. Brill explains LDL, the bad portion of cholesterol, and offers an effective combination therapy of foods, scientifically based, that are as effective as statins. Besides lowering LDL, the following ten-step program also offers further health benefits.

First, eat 1 cup of oatmeal every day. The U.S. Department of Agriculture recommends three whole-grain servings daily. This is linked to reduced risk of heart disease, stroke, type 2 diabetes, obesity, some cancers, lower blood pressure, and improved bowel movement. Oatmeal lowers LDL, may raise HDL--the good portion of cholesterol, and studies show that the more consumed, the greater the benefit.

Second, eat a handful of almonds daily, approximately 30. Read more › 2 Comments 238 people found this helpful. Was this review helpful to you? Yes No Sending feedback... Thank you for your feedback. Sorry, we failed to record your vote. Please try again Report abuse

5.0 out of 5 stars /span> By Dr. Jonathan Dolhenty on February 17, 2007 Format: Paperback
Must Reading for Those Interested in Their Health I have a personal interest in this particular subject so I was pleased to be asked to read and review "Cholesterol Down," a book which definitely should be read by anyone with a current cholesterol problem and, for that matter, by anyone in the younger set who wants to prevent such a problem from occurring in his or her future. If I had had this information many decades ago, I probably could have prevented or at least delayed the coronary problems I am now fighting. After my first heart attack five years ago, I had to face the fact that some extraordinary changes were necessary and at the top of that list was diet. I was placed on a "Mediterranean" diet which is very similar to the diet which Dr. Brill recommends in her book.

Dr. Brill suggests ten simple steps to lower one's cholesterol without resorting to prescription drugs. I am all in favor of that because nothing disturbs me more within the medical area of my life than the taking of prescription drugs. I try to avoid that sort of thing like the plague. I much prefer to utilize "natural" remedies whenever and wherever possible. So far I've been fairly successful, having to take only one prescription medication (an anti-clotting drug) and only because I have found no comparable natural remedy.

This book is divided into two parts plus an appendix. The first part of the book provides the reader with information about cholesterol and heart disease, basically the scientific foundations upon which Dr. Brill's ten-step plan is based. This can be read first but it is not necessary. I read the second part first, which actually describes the ten-step cholesterol down plan, because I was specifically interested in reviewing what the author suggests; one can always go back to the scientific rationale later. Read more › 27 Comments 502 people found this helpful. Was this review helpful to you? Yes No Sending feedback... Thank you for your feedback. Sorry, we failed to record your vote. Please try again Report abuse

5.0 out of 5 stars /span> By Tom Bruce on November 25, 2007 Format: Paperback Verified Purchase
Good for what ails you The book promises "10 Simple Steps to Lower Your Cholesterol" and it delivers. The first section of this book deals with what cholesterol is and what it does, and as this reader-friendly author suggests, "If science is not your cup of tea, simply cut to Part II." Part II is the meat of the book, listing the ten simple - and they are - steps to lowering your cholesterol. Not only simple, but affordable, too - much more so than prescribed medicine. With each step, the good Doctor explains how each process helps us reach our medical goal, gives the medical proof that exists for each, presents case histories, and lists further options and tips on how to additionally simplify each step. Yet, if you're not into the medical jargon, this section of the book is formated so you can skip over much of the material presented and get the basic information you need in a few short paragraphs. She does make it easy. The third and final section of the book offers charts to help you follow this course, if you're into such regimentation. There are also a few dozen healthful recipes, few of which appealed to me. Now here's the bonus part: as Brill explains, each of these steps will also help in lowering blood pressure, aiding diabetics, fighting obesity, forestalling aging, even stopping hair loss. So, if you suffer from any of these ills and more, you can't go wrong with this basic recipe for good health. After five weeks on this regimen, my cholesterol numbers were back to normal. The one problem I found with this diet, it was almost too much to eat. Well, not too much, but very filling. I have followed a modified version of the plan, mainly keeping in the oatmeal and heart-friendly orange juice, and my numbers continue to be where they should be months later. Comment 61 people found this helpful. Was this review helpful to you? Yes No Sending feedback... Thank you for your feedback. Sorry, we failed to record your vote. Please try again Report abuse

[Oct 15, 2016] How Big Pharma's Industrial Waste Is Fueling the Rise in Superbugs Worldwide

Oct 15, 2016 | www.truth-out.org
Sep 22, 2016 | www.truth-out.org
Written by The Bureau of Investigative Journalism | Report Pharmaceutical companies are fuelling the rise of superbugs by manufacturing drugs in factories that leak industrial waste, says a new report which calls on them to radically improve their supply chains.

Factories in China and India -- where the majority of the world's antibiotics are produced -- are releasing untreated waste fluid containing active ingredients into surrounding areas, highlights the report by a coalition of environmental and public health organisations.

Ingredients used in antibiotics get into the local soil and water systems, leading to bacteria in the environment becoming resistant to the drugs. They are able to exchange genetic material with other nearby germs, spreading antibiotic resistance around the world, the report claims.

Ahead of a United Nations summit on antimicrobial resistance in New York this week, the report -- by the European Public Health Alliance (EPHA) and pressure group Changing Markets -- calls on major drug companies to tackle the pollution which is one of its root causes.

They say the industry is ignoring the pollution in its supply chain while it drives the proliferation of drug resistant bacteria -- a phenomenon which kills an estimated 25,000 people across Europe and globally poses "as big a threat as terrorism," according to NHS England's Chief Medical Officer Dame Sally Davies.

If no action is taken antimicrobial resistance (AMR) will kill 10 million people worldwide every year -- more than cancer -- according to an independent review into AMR last year led by economist Professor Jim O'Neill.

Changing Markets compiled previous detailed reports and conducted its own on-the-ground research looking at a range of Chinese and Indian drug manufacturing plants making products for some of the world's biggest pharmaceutical companies. One of the world's biggest antibiotic production plants, in Inner Mongolia, was found in 2014 to be "pumping tonnes of toxic and antibiotic-rich effluent waste into the fields and waterways surrounding the factory," according to Chinese state television.

In India, where much of the raw material produced by Chinese factories is turned into finished drugs, various studies have found "high levels of hazardous waste" and "large volumes of effluent waste" being dumped into the environment. About a quarter of UK medicines are made in India.

[Oct 12, 2016] Managing hyperlipidemia means controlling cholesterol and triglycerides.

Aug 01, 2021 | www.heart.org

Hyperlipidemia is a mouthful, but it's really just a fancy word for too many lipids – or fats – in the blood.

That can cover many conditions, but for most people, it comes down to two well-known terms: high cholesterol and high triglycerides . Our bodies make and use a certain amount of cholesterol every day, but sometimes that system gets out of whack, either through genetics or diet. Higher levels of the "good" HDL cholesterol are associated with decreased risk of heart disease and stroke. HDL helps by removing cholesterol from your arteries, which slows the development of plaque. The "bad" LDL cholesterol, on the other hand, can lead to blockages if there's too much in the body.

What's the treatment?

If you are diagnosed with hyperlipidemia, your overall health status and risks will help guide treatment . Making healthy diet choices and increasing exercise are important first steps in lowering your high cholesterol . Depending on your overall risk, your doctor may also prescribe medication in conjunction with healthy eating and regular exercise.

"The combination of diet and regular physical activity is important even if you're on medication for high cholesterol ," said Dr. Vincent Bufalino, an American Heart Association volunteer. "It's the most critical piece."

Consulting a doctor is important, since each condition has it quirks. For people with high triglycerides, for example, alcohol can be particularly dangerous. But for those with high cholesterol, a daily glass of wine or other alcohol, along with healthy eating and exercise, may actually help, Dr. Bufalino said.

Once I have it, can I reverse it?

Hyperlipidemia can be improved in many cases through healthy eating and regular exercise.

Here are some tips on how to manage your risk of high cholesterol. Learn more about cholesterol:

[Oct 12, 2016] What You Need to Know about the New Cholesterol Guidelines CHI Health Blogs

Feb 25, 2015 | blogs.chihealth.com

In late 2013, after an extensive review of evidence, the National Heart, Lung and Blood Institute updated cholesterol guidelines. Why did they do this? These new guidelines better identify those at risk of atherosclerotic cardiovascular disease (ASCVD), and also better diagnose people who already have ASCVD. Patients who have ASCVD are more likely to suffer a heart attack or stroke.

To determine if someone is at risk of developing ASCVD a risk estimator is available through Cardio Source. Information including Systolic Blood Pressure, a patient's race, HDL Cholesterol and more are entered.

Depending on the level of risk, patients should take different courses of action. For all patients who are determined to be at risk for ASCVD there are behavioral modifications they should implement. These include: eating a heart-healthy diet, regularly exercising, avoiding tobacco products and maintaining a healthy weight.

For lower risk individuals, there are other items to take into account on whether they are likely to develop ASCVD. These include a family history of premature ASCVD, LDL greater than 160, high sensitivity C-reactive protein, Coronary calcium score and Ankle/brachial index.

For those with a high likelihood of developing ASCVD and for those individuals who already have ASCVD, statins should be taken. The guidelines have also been updated. There are non-statin medications also available for those patients unable to take statins (due to side effects or drug interactions). Talk with your doctor to determine which medicine is best for you.

[Oct 12, 2016] Doctors Behaving Badly

Notable quotes:
"... Doctors Behaving Badly ..."
Oct 12, 2016 | blogs.chihealth.com

CHI Health Blogs CHI Health Heart

Cardiology
Eric Van De Graaff, M.D.
May 14, 2012 As odd as this might sound, my mother was upset when I declared my intention to go to medical school.

It wasn't the mountain of debt I was sure to incur since I'd already figured out how to get Uncle Sam to pick up the bill (a small deal that put me in a military uniform for a decade). It wasn't the fact that medical school would delay the litter of bouncing grandbabies she wanted to fawn over. And it certainly wasn't because she'd miss me-she'd already seen too much of me and my dirty laundry on weekends during college.

No, my mother was legitimately disappointed in me for choosing to enter the medical profession simply because she had a deep-seated disdain for doctors. I could almost envision her sad disgrace as she chatted with the neighbors during my final year as a resident in brain surgery:

Mom: "What's little Festus up to these days?"

Neighbor 1: "Oh he's doin' real good. He's got hisself a carwash business up in Magna that pulls in a couple hundred a week. Lookin' to buy a bass boat for him and the misses."

Mom: "And Cletus?"

Neighbor 2: "Almost done with his ten years up at the state pen in Bluffdale. Won an award for license plate stampin'. Trixie and the boys are real proud of him."

Neighbor 1: "And what's Eric doing?"

Mom: "He's still not married."

My mother never told me why she disliked doctors so much. I'm left to assume that she'd had a number of bad interactions with them over the years, but she never bothered to back up her expressions of disapproval with any sort of details. It took several years for my mother to warm up to the idea that I had not turned to the dark side by becoming a doctor. I think a lot of it had to do with inertia-by the time she finally decided to express any acknowledgement of my career decision, two more of us boys were in medical school and I supposed she realized she couldn't be disappointed in all of us.

Now that I've been in practice a number of years I've finally learned what it was that so intensely turned my mother off about doctors: they can be arrogant, condescending and impolite. Of course, many of my readers are at this moment wondering if I'm also going to reveal other mysteries such as "birds fly" and "dogs bark."

I had a roommate in medical school who was a great guy. He studied hard, didn't party too much, and always managed to put the toilet paper on the right way (rolling out from the top down, in case you were wondering). Years after we graduated and had gone our separate ways I had a phone conversation with a physician assistant who'd gone to work for my old roommate. "It must be great working for Dr. X," I added. A pause on the phone. "No," he said slowly, "he's a total jerk. Everybody hates him."

I have two theories. One is that all medical students believe they will go on to become an Albert Schweizer in their field-kind, self-sacrificing, benevolent-but somewhere along the way a certain fraction of them let the glory of their career go to their heads and begin to treat patients and underlings like chewing gum on a movie theater floor. What constitutes that percentage is in the eye of the beholder. For my mother it was some where around the 98% mark. I'm a little more generous-I'll say 20%.

My second theory is that all doctors believe themselves to be noble, kind, and beloved by all. Rarely do I come across an arrogant doctor who recognizes him- or herself as such. Rather, almost all of us think we're appropriately mannered. And we are . . . most of the time.

The rubber hits the road, though, when job-related stress enters the picture. A physician who ends up an hour behind in a busy clinic can become snappy at his nurses and receptionists. A surgeon who is elbow-deep in a case gone awry will turn her anger toward the anesthesiologist and scrub techs. In both cases, the doctors in question feel they were simply reacting appropriately to the situation: "Of course I yelled at my nurse. Doesn't she realize she is making me later than I already am?" or "Of course I hurled the Metzenbaums across the room. Am I the only one in the OR who cares what happens to this patient?!"

As any nurse will tell you, the true measure of a doctor's demeanor is not how he or she acts during times of ease. Instead, the nature of a physician's soul is uncovered precisely during those times when he or she has the most right to explode in a volcano of vulgarities and instrument-throwing. A doctor who can keep cool while juggling 3 phone calls, a clinic filled with patients, and a patient exsanguinating on the operating table is both rare and worthy of high esteem.

In fellowship I had the misfortune to work under a cardiologist described by all other fellows thus: "She's fun socially but awful to work with." This proved to be true: at a staff party she was great to have around, but when faced with the challenge of rounding on 15 patients in a two-hour period she transformed into Medusa. Yet, I'm sure, if asked, she would maintain that she is polite, kind, and patient-as long as the situation doesn't demand otherwise. The problem is that her definition of "situation" was pretty much every day at work.

We doctors have chosen professions that are inherently filled with stress, deadlines, and treading in deep emotional waters. None of that grants us a free pass to behave like spoiled toddlers. As I see it, doctors should always follow 2 simple rules:

Rule #1: It is simply not allowable to be impolite, mean, nasty or snippy with staff or patients even when you are in a stressful situation.

Rule #2: Whatever is stressing you is probably stressing those around you as much or more. Under those circumstances you have to go out of your way to be kinder and more understanding. As a doctor, you control the mood in the clinic and operating room even if you can't control the situation.

I freely admit I am unable to always adhere to these rules but I at least recognize them and intend to spend the rest of my career trying to do better. My mother passed away many years ago but I'm hoping that somewhere up there she can look down and see that I didn't turn out to be so terrible after all.

This entry was posted in Cardiology . Bookmark the permalink .

8 Responses to Doctors Behaving Badly

  1. Loan Eby says: May 15, 2012 at 4:26 pm Bedside manner
    I was with my mom when her doctor told her she had Stage IV pancreatic cancer. After learning my mom had 6-months to live, I remember walking out of Good Sam in Kearney and running into my high school friend who was a nurse there. My friend greeted me with a smile because she had not seen me in years. I told her the devastating news and how awful the doctor was to my mom. She told me he was one of the best oncologists around. If he was the best round, I would have hated to see their worst. Thank you for your post.
  2. Nikki says: May 15, 2012 at 4:44 pm It's refreshing to read Dr. Van De Graaff post. I have worked with many Dr. and nurses in my time in the medical field. Sometime you get the nice fun loving Dr. / nurse or sometimes they are possessed, as a clinic worker it's my job ( and I take pride in it) to not let it get so bad in the clinic and if it does everyone better start doing their best to make the situation the best they can. I don't think that there is a day that goes by we aren't laughing even when we are all a little crazy. It's nice to know that when you behave badly you know you shouldn't….
  3. Lance Taylor says: May 15, 2012 at 10:53 pm Treat other how you would expect to be treated, and all will be well.
  4. Sandra says: May 18, 2012 at 8:42 am My mother also had the same attitude towards physicians. However, my mother took everything in stride and always voiced her opinion. A few times she would bluntly express to the physician/nurse when they were not very nice and did not answer her questions. It was interesting to see the look on the physician/nurse's faces; it is evident that they were not aware how they come across to their patients at any given time. Sometimes it is up to the patient to express to their care provider how they are treating the patient. I saw first handed how their attitudes changed each time my mother came into the clinic for the chemo/radiation treatments. I would advise others to ask the provider/nurse how is your day going, it is amazing how their attitude can fall into a positive manner when someone shows interest in them as a person not just a physician/nurse. Thanks for sharing your story Dr. V.
  5. RS says: June 26, 2012 at 11:00 am I have to say, your mother raised you right! Its not everyone that knows the correct way to put the toliet paper on! Your attitude is refreshing and you make your profession proud! Your well written article should be a reminder to everyone that we should all treat those around us with dignity and respect.
  6. Leslie says: August 13, 2012 at 10:22 am I am a retired respiratory therapist, my father was a pharmacist who owned his own pharmacy and I have 3 cousins and an uncle who are physicians. I say that because I want you to know that I have been around physicians all of my life. All that being said I would come alot closer to your mother's 98%(probably around95%) than your generous 20%. That would include my uncle. To find a physician who is both a good dr and a good person is rare indeed. For decades I had to endure tamtrum throwing doctors. Now we have added millions of doctors from middle eastern countries who have NO respect for women, zero manners and have such thick accents the poor little old people have no clue what the physician just said, let alone who he actually was(no name, no specialty, no time for questions, no business card).
    My opinion has been for years that if you can't keep your cool under stressful conditions then you need to be a plumber. Anyone who doesn't think that every level of healthcare is extremely stressful-think again. Yelling at people who have done no wrong only makes them more nervous and more likely to really make a mistake. Yep, a plumber. You can make as much money(perhaps more). You can make your own hours. No insurance companies to deal with.
    Think about it. Some people make everyone happy by entering a room…and others by leaving.
  7. Jonathan hersch says: August 14, 2012 at 2:05 pm I find that my patients say the same thing about other doctors as your mother. Certainly many have let this career go to their head. I have many techniques to control my anger and frustration when things are going bad in the operating room. It's hard but a must.

    I find myself hanging out with doctors who are like myself. Laid back and don't take life too serious. The rest are hard to get along with. Patients feel the same.

  8. KEITH BARKLEY says: April 10, 2013 at 9:34 am I had the privelege of meeting DR. van de Graaf after a trip to the hospital via rescue squad. These people really saved my life.I was near death and Dr van de Graff helped preform a miracle for me.I haved been exposed to many medical people over the past 80+ years and I will critisize few of them – – but Dr van de Graff is truly a special person – as well as Dr.

[Oct 12, 2016] The American Heart Association -- Protecting Industry Not Patients

Dec 16, 2013 | www.huffingtonpost.com
The American Heart Association (AHA) and the American College of Cardiology (ACC) recently released new cardiovascular disease prevention guidelines . They are an egregious example of much that is wrong with medicine today.

The guidelines propose a vast expansion of the use of statins in healthy people, recommending them for about 44 percent of men and 22 percent of healthy women between the ages of 40 and 75. According to calculations by John Abramson, lecturer at Harvard Medical School, 13,598,000 healthy people for whom statins were not recommended based on the 2001 guidelines now fall into the category of being advised to take moderate or high intensity statin therapy.

The American Heart Association (AHA) is a nonprofit organization with a mission to "build healthier lives free of cardiovascular disease and stroke." Yet in its 2011-2012 financial statement , the AHA noted $521 million in donations from non-government and non-membership sources and many well-known large drug companies, including those who make and market statins, contribute amounts in the $1 million range.

Even as many in the medical community suspected the guidelines were a ploy to help the AHA's drug partners sell statins, it was revealed that the guideline's online calculator to determine cardiac disease risk over predicts risk by an astonishing 75 to 150 percent. But the guideline writers are standing firmly behind their faulty calculator.

Seven of the 15 authors disclosed ties to industry. Originally, the panel chair, Neil J. Stone, MD of Northwestern University, declared that he has had no ties to industry since 2008. Jeanne Lenzer, writing in the British Medical Journal (BMJ) last month, interviewed Dr. Stone who said: "When I was asked by NHLBI [National Heart, Lung and Blood Institute] to chair the [cholesterol] panel, I immediately severed ties with all industry connections prior to assuming my role as chair." However, prior to 2008, he accepted funding and consultancy fees from multiple pharmaceutical companies, including Abbott, AstraZeneca, Pfizer, Merck, and Schering-Plough among others. Dr. Stone also told the BMJthat he will "definitely" not take any industry funding for two years. Are we to believe that by severing his ties in 2008 his mind became an instant tabula rasa, completely devoid of any conscious or unconscious bias towards the drug companies which had been paying him? To do so strains the bonds of credulity past the breaking point.

The financial ties between large pharmaceutical companies and the AHA are numerous and very remunerative for the AHA, including huge donations from Abbott, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb (BMS), Eli Lilly, Merck and Pfizer. BMS, along with Merck and Pfizer are national sponsors of AHA's Go Red For Women> heart disease awareness campaign whose web site tells patients "If your doctor has placed you on statin therapy to reduce your cholesterol, you can rest easy-the benefits outweigh the risks" The site also proclaims that "Zocor and Pravachol - have the fewest side effects," and "statins may only slightly increase diabetes risks." The Women's Health Initiative , a federal study of over 160,000 healthy women to investigate the most common causes of death, disability and poor quality of life in postmenopausal women, showed that a healthy woman's risk of developing diabetes was increased 48 percent compared to women who were not on a statin. And contrary to what statin apologists say about statins only increasing diabetes risk in people who are at high risk of developing it anyway, for example the obese, women on statins in the Women's Health Initiative who were of normal weight increased their risk of diabetes 89 percent compared to same weight women not taking a statin.

In 2010, AHA received $21,570 from statin maker AstraZeneca to run an AHA course about "emerging strategies with statins" at the Discovery Institute of Medical Education and almost $100,000 for learning projects including "debating controversial topics in cardiovascular disease." The AHA defended the deceptively marketed and controversial cholesterol drug Vytorin. Did that have anything to do with the $2 million a year the AHA was taking from marketer Merck/Schering-Plough Pharmaceuticals?

The AHA also rakes in millions from food companies which are also million dollar donors and which pay from $5,490 to $7,500 per product to gain the "heart-check mark" imprimatur from the AHA, renewable, at a price, every year. The foods so anointed have to be low in fat, saturated fat, and cholesterol yet Boar's Head All Natural Ham somehow made the cut as did Boar's Head EverRoast Oven Roasted Chicken Breast . Such processed, high-sodium meats raise blood pressure, the risk of cardiovascular disease and the risk of diabetes. A review of almost 1,600 studies involving one million people in ten countries on four continents showed that a 1.8-ounce daily serving of processed meat raised the risk of diabetes by 19 percent and of heart disease by 42 percent.

The new guidelines might make sense if statins were truly as effective as their proponents claim, and if they had no adverse effects. But they have an increasing list of side effects, which affect at least 18 percent of people who take them. These range from muscle pain, weakness and damage to cataracts, cognitive dysfunction, nerve damage, liver injury and kidney failure.

As Jerome Hoffman, M.D., Professor Emeritus of Medicine at UCLA wrote recently with regard to these guidelines: "How did we arrive at a place where conflicted parties get to make distorted semi-official pronouncements that have so much impact on public policy?" How indeed? By Barbara Roberts, M.D. is an Associate Clinical Professor of Medicine at the Alpert Medical School of Brown University. She is the author of The Truth about Statins and How to Keep from Breaking Your Heart: What Every Woman Needs to Know about Cardiovascular Disease . Martha Rosenberg is a health reporter and author of Born with a Junk Food Deficiency.

[Oct 11, 2016] Doctors perform thousands of unnecessary surgeries

Notable quotes:
"... A 1982 study in the journal Medical Care found that a mandatory second opinion program for Massachusetts Medicaid patients led to a 20% drop in certain surgeries, such as hysterectomies, that were considered more likely to be done unnecessarily. ..."
"... "We expect the physician to know what's best for a patient," says William Root, chief compliance officer at Louisiana's Department of Health and Hospitals. "We put so much faith and confidence in our physicians, (and) most of them deserve it. But when one of them is wrong or goes astray, it can do a lot of damage." ..."
Oct 11, 2016 | www.usatoday.com
June 20, 2013 |

Jonathan Stelly was 22, a semi-pro baseball player aiming for the big leagues, when a fainting spell sent him to his cardiologist for tests. The doctor's office called afterward with shocking news: If Stelly wanted to live to age 30, he was told, he'd need a pacemaker.

Stelly knew it would be the end of his baseball dream, but he made a quick decision. "I did what the doctor said," he recalls. "I trusted him."

Months after the surgery, local news outlets reported that the Louisiana cardiologist, Mehmood Patel, was being investigated for performing unnecessary surgeries. Stelly had another doctor review his case. Then another. And another. They all agreed: He needed blood pressure medication, but he never needed the pacemaker.

Today, Patel is in prison, convicted of billing Medicare for dozens of unnecessary heart procedures. Stelly, now 34, still has the pacemaker – but the doctors shut it off years ago.

"Baseball was my life, and he took that away," Stelly says. "For nothing."

... ... ...

Tens of thousands of times each year, patients are wheeled into the nation's operating rooms for surgery that isn't necessary, a USA TODAY review of government records and medical databases finds. Some, such as Stelly, fall victim to predators who enrich themselves by bilking insurers for operations that are not medically justified. Even more turn to doctors who simply lack the competence or training to recognize when a surgical procedure can be avoided, either because the medical facts don't warrant it or because there are non-surgical treatments that would better serve the patient.

... ... ...

Since 2005, more than 1,000 doctors have made payments to settle or close malpractice claims in surgical cases that involved allegations of unnecessary or inappropriate procedures, according to a USA TODAY analysis of the U.S. government 's National Practitioner Data Bank public use file, which tracks the suits. About half the doctors' payments involved allegations of serious permanent injury or death, and many of the cases involved multiple plaintiffs, suggesting many hundreds, if not thousands, of victims. <

... ... ...

A 2011 study in the Journal of the American Medical Association reviewed records for 112,000 patients who had an implantable cardioverter-defibrillator (ICD), a pacemaker-like device that corrects heartbeat irregularities. In 22.5% of the cases, researchers found no medical evidence to support installing the devices.

... ... ...

"Don't just take a doctor's word," says Patty Skolnik, who founded Citizens for Patient Safety after her son, Michael, died at 22 from complications in what she says was unnecessary brain surgery. "Research your doctor, research the procedure, ask questions, including the most important one: 'What will happen if I don't get this done?'"

... ... ...

A 1982 study in the journal Medical Care found that a mandatory second opinion program for Massachusetts Medicaid patients led to a 20% drop in certain surgeries, such as hysterectomies, that were considered more likely to be done unnecessarily. A 1997 study in the Journal of the American College of Surgeons looked at 5,601 patients recommended for surgery and found that second opinions found no need for the operation in 9% of the cases. Among those who got the countervailing second opinion, 62% opted not to have the operation.

But many patients simply aren't inclined to question their doctors.

"We expect the physician to know what's best for a patient," says William Root, chief compliance officer at Louisiana's Department of Health and Hospitals. "We put so much faith and confidence in our physicians, (and) most of them deserve it. But when one of them is wrong or goes astray, it can do a lot of damage."

[Oct 10, 2016] Report Highlights Prevalence of Diagnostic Errors

medstak.com
"Everyone will experience one meaningful diagnostic error in their lifetime," Dr. John Ball recently told NBC News. Ball, who chairs the Committee on Diagnostic Error in Medicine, helped draft a report on the alarming rates of late or misdiagnosis in U.S. healthcare settings – the consequences of which are often catastrophic if not fatal for some patients.

Prevalence of medical misdiagnoses

According to the study:

In sum, the majority of American adults will suffer the effects of misdiagnosis or diagnostic error at some point in their lives.

Doctors afraid to admit their mistakes

The report suggests that better training and guidelines can help reduce incidence of diagnostic errors in clinical settings. However, we live in a culture where doctors and hospitals are not always willing to speak freely about mistakes, making it that much more challenging to learn from near misses.

"If people are afraid to speak up, then bad things can continue to happen," Ball said.

This sentiment was echoed back in 1998 by The Institute of Medicine, which found that medical errors and surgical mistakes claimed the lives of tens of thousands of American patients each year. The organization also called for a "culture of confession" in the hopes that healthcare professionals wouldn't be afraid to fess up their blunders. With a more open dialogue among medical providers regarding botched surgeries and missed diagnoses, new approaches could be developed to help prevent the same errors from repeating themselves.

Ball also says that pathologists and radiologists should get more involved in clinical care and patient diagnosis for more accurate testing.

Real life examples of diagnostic errors

The life-altering consequences of diagnostic mistakes are all too familiar to Susan Sheridan of Boise, Idaho. Sheridan's husband died after his doctors failed to diagnose an aggressive cancer in his spine, and her child – who is now an adult – was rendered permanently disabled after physicians failed to treat his infant jaundice.

In 1995, her newborn son Cal developed a dangerous condition known as kernicterus which is caused by high levels of bilirubin. At just a few days old his skin had turned a bright orange, but Sheridan's concerns were continually dismissed by pediatricians. By the time the correct diagnosis was finally made, Cal had suffered extensive brain damage leading to cerebral palsy. He is both hearing and speech impaired, uses a walker and will need medical care for the remainder of his life.

Sheridan hopes that other families will never have to endure similar heartache and loss and has since become the director of patient engagement for the Patient-Centered Outcomes Research Institute (PCORI). Still, Sheridan laments that there is no organization or system where medical errors can be logged and tracked.

"The first thing I wanted to do was tell somebody, so they could make sure that will never happen again."

[Oct 10, 2016] The FDA is compromised and they can't be trusted

Oct 10, 2016 | www.nakedcapitalism.com

patrick October 10, 2016 at 7:27 pm

The FDA is compromised and they can't be trusted. http://ssrn.com/abstract=2282014

[Oct 10, 2016] The moment you see the phrase 'surrogate outcome' you know they aren't looking at the disease anymore

Oct 10, 2016 | www.nakedcapitalism.com

paul October 10, 2016 at 10:26 am

The moment you see the phrase 'surrogate outcome' you know they aren't looking at the disease anymore.

Gee October 10, 2016 at 10:50 am

Absolutely.

See page 6 for a good summary of the ways surrogates can be problematic.

http://depts.washington.edu/ssbiost/PRESENTATIONS/DeMets.pdf

SpringTexan October 10, 2016 at 7:16 pm

Great reference with good list of trials that make the point; thanks!

[Oct 10, 2016] Is it any coincidence that the US is one of the few developed countries that allows drug advertising on television

Notable quotes:
"... Is it any coincidence that the US is one of the few developed countries that allows drug advertising on television ? I've lost count of the number of times I've wanted to throw something at the TV when I hear the phrase " … ask your doctor whether Drug X is right for you !". ..."
"... Better yet, just avoid the TV at all costs. You are simply being manipulated. ..."
"... If you did not choose to put something in front of your eyeballs, you can be highly confident that somewhere, there's a serious conflict between the message being delivered and your best interests. ..."
Oct 10, 2016 | www.nakedcapitalism.com

JustAnObserver October 10, 2016 at 1:04 pm

Is it any coincidence that the US is one of the few developed countries that allows drug advertising on television ? I've lost count of the number of times I've wanted to throw something at the TV when I hear the phrase " … ask your doctor whether Drug X is right for you !".

OTOH maybe that's a plus. If its being promoted on TV then avoid it at all costs until you've read the independent trial evidence.

Anonymouse October 10, 2016 at 3:09 pm

Better yet, just avoid the TV at all costs. You are simply being manipulated.

If you did not choose to put something in front of your eyeballs, you can be highly confident that somewhere, there's a serious conflict between the message being delivered and your best interests.

And even if you did choose it, be careful what the producer's motives were…

[Oct 10, 2016] When profit motive replaces Hippocratic oath terrible things happen

Notable quotes:
"... We are talking about "medical industrial complex" here. So this is a systemic problem: Dangerous drugs, "blockbuster drugs" are just the tip of an iceberg. ..."
"... Hospitals became more of a money making machines and the duration of your stay in hospital often is determined by the insurance you have and doctors financial motives, not by your disease. ..."
"... First step of the government take over all pharmaceutical research could be government paying for all clinical trials. What could the industry object? It would mean much less financial risk for the firms - an incentive. ..."
"... Read more about this for profit fantastic here - I think I've got it right: http://ontodayspage.blogspot.com/2016/06/will-500000-americans-year-die-for-lack.html ..."
Oct 10, 2016 | www.nakedcapitalism.com

likbez October 10, 2016 at 1:30 pm

We are talking about "medical industrial complex" here. So this is a systemic problem: Dangerous drugs, "blockbuster drugs" are just the tip of an iceberg.

When profit motive replaces Hippocratic oath terrible things happen. And this is what happened under neoliberalism. "Greed is good" is the new morality.

That include useless surgeries, such as cardiac stenting (which is a mass practice in the USA).

See

Actually any area where control is difficult and the same doctor recommends the procedure and later does the surgery is suspect. When you're a hammer everything looks like a nail.

Hospitals became more of a money making machines and the duration of your stay in hospital often is determined by the insurance you have and doctors financial motives, not by your disease.

Denis Drew October 10, 2016 at 1:43 pm

First step of the government take over all pharmaceutical research could be government paying for all clinical trials. What could the industry object? It would mean much less financial risk for the firms - an incentive.

No matter who pays for the research it is the same university researchers doing the work - as far as I know. Government could fund the whole thing without any need for greed.
* * * * * *
Right now, 10,000 Americans die weekly (!) of heart failure. Formerly there was no improvement and certainly no cure. In 2012 a small clinical trial or a balloon inserted around the heart to assist pumping ended with 5 actual cures, most improved and a few held steady. A much larger trial of 200 is being attempted to get FDA approval …

… but is in Limbo (from my reading) by inability to get investors to pony up for more than 100 of the 200 - $30 million short being the reason. The flip side of profit based research ripoff.

I'm sure today's 5 million heart failure sufferers in the US would gladly pony up $6 apiece. Maybe one of them should start a go-fund-me for $30 million. Maybe investors would not want them to.

Read more about this for profit fantastic here - I think I've got it right: http://ontodayspage.blogspot.com/2016/06/will-500000-americans-year-die-for-lack.html

* * * * * *
Gilead - the same company that brought us Sovaldi - now has developed a drug that claims to be 95% effective against all versions of hepatitis: Epclusa. At $75,000 a treatment (that may only cost them $150 to manufacture) X 300 million worldwide sufferers, that comes to $22.5 trillion (with a "t") to treat all. I'm sure they need most of that for future research (or divert it to pay for the living and business expenses for every man, woman and child in the US, Canada and Mexico for one year).

http://www.marinij.com/article/NO/20160710/FEATURES/160719994

[Oct 10, 2016] Never to take any drug that hasn't been on the market for at least 5 years. The FDA is toothless and is corrupt

Notable quotes:
"... A pharmacist friend of mine told me never to take any drug that hasn't been on the market for at least 5 years. The FDA is toothless and is corrupt just like every other regulatory agency in this country. Big pharma is primarily concerned with huge profits like "blockbuster" (expensive) and drugs that you have to take over a long period of time and this is probably one reason why a lot of research on superbugs isn't being done. There's no money in it. ..."
Oct 10, 2016 | www.nakedcapitalism.com

Elizabeth October 10, 2016 at 3:14 pm

A pharmacist friend of mine told me never to take any drug that hasn't been on the market for at least 5 years. The FDA is toothless and is corrupt just like every other regulatory agency in this country. Big pharma is primarily concerned with huge profits like "blockbuster" (expensive) and drugs that you have to take over a long period of time and this is probably one reason why a lot of research on superbugs isn't being done. There's no money in it.

[Oct 10, 2016] Why Useless Surgery Is Still Popular

Notable quotes:
"... An accompanying editorial came to a scathing conclusion: The surgery is "a highly questionable practice without supporting evidence of even moderate quality," adding, "Good evidence has been widely ignored." ..."
"... "We have randomized clinical trials that produce the highest quality of evidence. They strongly suggest that the procedure is next to useless. If there is any benefit, it is very small and there are downsides, expense and potential complications." ..."
"... What decisions in medicine today give priority to what is best for the patient? Unnecessary surgery is only one component of patient care taking a back seat to money. Pharmaceutical companies remove lower-priced drugs from market and set sky-rocketing prices for drugs that remain. Devices, such as morcellators that spread cancer during surgery and vaginal mesh that can irreversibly ruin a woman's health, are still being used despite their terrible impacts because of the money in it for the device makers and doctors who use them. ..."
"... Capitalism works when consumer protection laws are enforced to protect consumers from predatory suppliers. American consumers have been left to fend for ourselves. We must not trust our doctors to provide sound health care. Instead, we are forced to do our own research and draw our own conclusions from credible, independent sources, to the extent they still exist. ..."
"... DO NOT look to news articles for medical advice! And lastly, know that medical doctors are often biased too much against surgery, while surgeons are often biased too much in favor of surgery. ..."
"... As a physician, and this is me speaking for myself, I feel that unnecessary surgeries, procedures, and diagnostic tests are a byproduct of a culture where people would prefer a pill or surgery to behavioral change and where doctors are compensated well to provide this (called the "perverse incentive." ) ..."
"... Patients demand surgery, demand an MRI and feel upset if physical therapy doesn't fix their problem instantly. Ironically, I am a physician who eschews any diagnostic or procedure that I don't deem necessary, but some patients will complain if they don't get their quick fix and will deem you a bad physician. If orthopedic surgeons perform fewer of arthroscopies they will see their salaries slashed. ..."
"... One of my former surgical professors, the head of the department of surgery in a major New York teaching hospital once told me "Asking a surgeon if you need an operation is like asking a barber if you need a haircut." Obviously it is more complicated than that and I am not suggesting that surgeons do not carefully consider the needs of the patients. It is true that when your background and training is in surgery, or any particular discipline, that becomes the lens through which you view the world. ..."
Oct 10, 2016 | www.nytimes.com

Before a drug can be marketed, it has to go through rigorous testing to show it is safe and effective. Surgery, though, is different. The Food and Drug Administration does not regulate surgical procedures. So what happens when an operation is subjected to and fails the ultimate test - a clinical trial in which patients are randomly assigned to have it or not?

The expectation is that medical practice will change if an operation turns out not to help.

If only.

It looks as if the onus is on patients to ask what evidence, if any, shows that surgery is better than other options.

Take what happened with spinal fusion , an operation that welds together adjacent vertebrae to relieve back pain from worn-out discs. Unlike most operations, it actually was tested in four clinical trials. The conclusion : Surgery was no better than alternative nonsurgical treatments, like supervised exercise and therapy to help patients deal with their fear of back pain. In both groups, the pain usually diminished or went away.

The studies were completed by the early 2000s and should have been enough to greatly limit or stop the surgery, says Dr. Richard Deyo, professor of evidence-based medicine at the Oregon Health and Sciences University. But that did not happen, according to a recent report . Instead, spinal fusion rates increased - the clinical trials had little effect.

Spinal fusion rates continued to soar in the United States until 2012, shortly after Blue Cross of North Carolina said it would no longer pay and some other insurers followed suit.

"It may be that financial disincentives accomplished something that scientific evidence alone didn't," Dr. Deyo said.

Other operations continue to be reimbursed, despite clinical trials that cast doubt on their effectiveness.

In 2009, the prestigious New England Journal of Medicine published results of separate clinical trials on a popular back operation, vertebroplasty , comparing it to a sham procedure. They found that there was no benefit - pain relief was the same in both groups. Yet it and a similar operation, Kyphoplasty, in which doctors inject a sort of cement into the spine to shore it up, continue to be performed.

Dr. David Kallmes of the Mayo Clinic, an author of the vertebroplasty paper, said he thought doctors continued to do the operations because insurers pay and because doctors remember their own patients who seemed better afterward.

"When you read a study, you reflect on whether it is representative of your patient population," Dr. Kallmes said. "It is easy to conclude that the answer is 'no.' The mean age in the study is different or 'I do it differently.'"

"I think there is a placebo effect not only on patients but on doctors," Dr. Kallmes adds. "The successful patient is burned into their memories and the not-so-successful patient is not. Doctors can have a selective memory that leads them to conclude that, 'Darn it, it works pretty well.'"

The latest controversy - and the operation that arguably has been studied the most in randomized clinical trials - is surgery for a torn meniscus , a sliver of cartilage that acts as a shock absorber in the knee. It's a condition that often afflicts middle-aged and older people, simply as a consequence of degeneration that can occur with age and often accompanying osteoarthritis . The result can be a painful, swollen knee. Sometimes the knee can feel as if it catches or locks. So why not do an operation to trim or repair the torn tissue?

About 400,000 middle-aged and older Americans a year have meniscus surgery. And here is where it gets interesting. Orthopedists wondered if the operation made sense because they realized there was not even a clear relationship between knee pain and meniscus tears. When they did M.R.I. scans on knees of middle-aged people, they often saw meniscus tears in people who had no pain. And those who said their knee hurt tended to have osteoarthritis, which could be the real reason for their pain.

Added to that complication, said Dr. Jeffrey N. Katz, a professor of medicine and orthopedic surgery at Harvard Medical School, is the fact that not everyone improves after the surgery. "It is not regarded as a slam-dunk," he said. As a result, he said, many doctors have been genuinely uncertain about which is better - exercise and physical therapy or surgery. That, in fact, was what led Dr. Katz and his colleagues to conduct a clinical trial comparing surgery with physical therapy in middle-aged people with a torn meniscus and knee pain.

The result: The surgery offered little to most who had it. Other studies came to the same conclusion, and so did a meta-analysis published last year of nine clinical trials testing the surgery. Patients tended to report less pain - but patients reported less pain no matter what the treatment, even fake surgery.

Then came yet another study , published on July 20 in The British Medical Journal. It compared the operation to exercise in patients who did not have osteoarthritis but had knee pain and meniscus tears. Once again, the surgery offered no additional benefit.

An accompanying editorial came to a scathing conclusion: The surgery is "a highly questionable practice without supporting evidence of even moderate quality," adding, "Good evidence has been widely ignored."

So what should patients be told? Should they even be offered the surgery?

Patients should be told that physical therapy is a good first-line therapy for pain relief, Dr. Katz said, but that surgery also relieves pain. Pain relief can take longer with physical therapy, he says. With surgery, he said, patients have to recover from the operation but are likely to be back at work within two weeks.

"At the end of the day," he said, "patients ought to choose."

Of course, how they choose might depend on how the choice is presented.

Here's how Dr. Gordon H. Guyatt, a professor of medicine and epidemiology at McMaster University in Hamilton, Ontario, who wrote the editorial in The British Medical Journal, would deal with the clinical trial data:

"I personally think the operation should not be mentioned," he says, adding that in his opinion the studies indicate the pain relief after surgery is a placebo effect. But if a doctor says anything, Dr. Guyatt suggests saying this: "We have randomized clinical trials that produce the highest quality of evidence. They strongly suggest that the procedure is next to useless. If there is any benefit, it is very small and there are downsides, expense and potential complications."

Hearing that, he says, "I cannot imagine that anybody would say, 'Go ahead. I will go for it.'"

Sandra Adams Half Moon Bay, CA August 5, 2016

Dr Deyo's comment, "It may be that financial disincentives accomplished something that scientific evidence alone didn't," may be the biggest understatement made about how modern medicine works.

What decisions in medicine today give priority to what is best for the patient? Unnecessary surgery is only one component of patient care taking a back seat to money. Pharmaceutical companies remove lower-priced drugs from market and set sky-rocketing prices for drugs that remain. Devices, such as morcellators that spread cancer during surgery and vaginal mesh that can irreversibly ruin a woman's health, are still being used despite their terrible impacts because of the money in it for the device makers and doctors who use them.

Capitalism works when consumer protection laws are enforced to protect consumers from predatory suppliers. American consumers have been left to fend for ourselves. We must not trust our doctors to provide sound health care. Instead, we are forced to do our own research and draw our own conclusions from credible, independent sources, to the extent they still exist.

MD NY August 5, 2016

Invasive treatments require careful scrutiny of the risk/benefit ratio and an individual approach. While the risks are fairly easy to quantify, this article just begins to skim the surface of an incredibly complex research problem: how to evaluate the benefit and effectiveness of a surgical intervention such as knee surgery? what do you compare it to? medicine? physical therapy? a sham procedure? all of the above? How do you measure quality of life? functional outcome? While the author hits upon some real issues in health care, I would issue this statement of caution: Medical research is full of bias that is usually invisible to the lay audience.

The conclusions of such research can be overblown by the media looking for sensational content. DO NOT look to news articles for medical advice! And lastly, know that medical doctors are often biased too much against surgery, while surgeons are often biased too much in favor of surgery.

C Fu California August 4, 2016

As a physician, and this is me speaking for myself, I feel that unnecessary surgeries, procedures, and diagnostic tests are a byproduct of a culture where people would prefer a pill or surgery to behavioral change and where doctors are compensated well to provide this (called the "perverse incentive." )

Patients demand surgery, demand an MRI and feel upset if physical therapy doesn't fix their problem instantly. Ironically, I am a physician who eschews any diagnostic or procedure that I don't deem necessary, but some patients will complain if they don't get their quick fix and will deem you a bad physician. If orthopedic surgeons perform fewer of arthroscopies they will see their salaries slashed.

The US has one of the least cost effective medical systems in the world, and despite all of the money spent, we still have some of the worst preventative care and highest infant mortality rates in the developed world. I used to work in private practice and now work at an HMO because I was tired of being asked to recommend more studies or surgeries to make more money. Our healthcare needs and overhaul, but the American people also need to shift their beliefs about what is good healthcare. More is not always better.

Jeffrey New York, NY August 4, 2016

One of my former surgical professors, the head of the department of surgery in a major New York teaching hospital once told me "Asking a surgeon if you need an operation is like asking a barber if you need a haircut." Obviously it is more complicated than that and I am not suggesting that surgeons do not carefully consider the needs of the patients. It is true that when your background and training is in surgery, or any particular discipline, that becomes the lens through which you view the world.

[Oct 09, 2016] With Health Care, the Profit Motive is Infectious

Notable quotes:
"... -Melody Petersen, Our Daily Meds, p.144-145 ..."
"... the drug companies are truly into discovery they would've gone straight after the helicobacter...Had these drugs [Tagamet and Zantac] not existed, the drug companies would have jumped on our findings ..."
"... Petersen, p.144 ..."
"... New York Magazine cover story "Corruption in the Kitchen," Oct. 17, 1988. ..."
Oct 09, 2016 | www.huffingtonpost.com
Jonas Salk discovered a polio vaccine in 1955 and the world cheered. Polio deaths declined from 37,476 in 1954 to 910 cases in 1962. Salk refused to patent it. "Can you patent the sun?" he asked. Barry Marshall discovered a cause [helicobacter] and cure for stomach ulcers in 1984 and practically nobody heard about it for more than 10 years. What was the difference? Ulcer victims were being treated with two multibillion-dollar pharma palliatives, Tagamet and Zantac. These expensive drugs relieved the symptoms but didn't cure the disease. The bottom line was greed. The powerful industries making huge profits from ulcers were simply not interested in curing their patient-customers if it meant losing their profits.

America's medical industrial complex became so wedded to the heavily marketed pills that it was not until 1994, 10 years after [Marshall's discovery] that a government panel announced that ulcers should be treated with antibiotics. One year after that announcement only about 5% of ulcer patients were receiving antibiotics. And by 1997 the government had been forced to begin a public information campaign urging doctors to change their practices. The government pointed out that curing an ulcer with a 17 day course of antibiotics cost less than $1,000. This was less than 1/10 of the expense of using years of the expensive acid suppressing drugs. -Melody Petersen, Our Daily Meds, p.144-145

After Marshall and his collaborator J. Robin Warren were awarded the Nobel Prize for Medicine in 2005, Marshall said, "If the drug companies are truly into discovery they would've gone straight after the helicobacter...Had these drugs [Tagamet and Zantac] not existed, the drug companies would have jumped on our findings ." ( Petersen, p.144 )

The fact that the medical industrial complex suppressed the cure for stomach ulcers for nearly 15 years raises crucial questions about trusting a system which demonstrably favors corporate profits over patient health. If a young scientist like Barry Marshall were to step outside the box of traditional thinking today and discover a cheap, relatively easy cure for cancer, could we be sure that the medical establishment, now making billions of dollars on cancer treatments, would rush to support such a breakthrough? Or would they hem and haw, procrastinate, find excuses, and sweep it under the rug, as they did for 15 years with the antibiotic treatment for ulcers?

In this critical time of medical reform, the ulcer story rings loud warning bells against sustaining a business controlled system whose first concerns are maximizing the bottom line rather maximizing public health. It is a powerful case example of the fundamental corruption underlying the very idea of a profit oriented health system. Legislators reexamining and revising our health system need to dissect this travesty and put it under a powerful microscope to see how doctors and Pharma conspired to suppress a basically simple discovery of a cure for a widespread disease. This story shows the need for building in powerful public interest safeguards into any reformed system to prevent such a travesty from occurring in the future. The ulcer story is strong evidence why the influence of profit-making interests need to be treated like malignant cancer cells and carefully excised from any reformed medical system so that doctors judgments are always and incontrovertibly made in the best interests of their patients, not pharma or the insurance corporations, nor their own fees.

You don't have to be a "communist" or "socialist" to realize that there is an inherent contradiction between the profit motive and the health motive. All you have to be is a caring person with a loved one mistreated by the current failed health care system. When people are able to find health though simple or cheap regimes, the current profit-oriented medical system has no motive to encourage those methods or systems to develop or be widely known. The "alternative medicine"movements spawned by the Sixties cultural revolution have clearly been responding to the issues raised by a pharma driven health culture.

Besides the ulcer story, another damning example against bottom line medicine is Celiac disease and its sibling gluten intolerance. Celiac disease afflicts an estimated 2 million Americans, yet only five percent of the people afflicted by it are aware of the nature [and cure] of their illness. Many people suffering from it are misdiagnosed as having "irritable bowel syndrome" or another chronic digestive disease, or when their symptoms are anemia and fatigue, they are liable to being misdiagnosed as having chronic fatigue syndrome, depression, or other fatigue-causing disorders.

Why is there such confusion? Again the crucial factor is that Celiac disease is inexpensive to cure. There is no medicine, no surgery, all there is, is dietary change-removing foods containing gluten [wheat, rye, barley] from the diet. Unfortunately, dietary cures are of little or no interest to our profit oriented medical system. When nobody but the patient profits from a cure based upon dietary change, American medicine has little motivation for diagnosing and spreading the word that something as universal as "the staff of life" might be making you or your loved ones sick. As Celiac disease is not immediately life threatening, undiagnosed people with gluten intolerance are treated symptomatically with palliatives with little or no attention paid to the cause and cure to the problem. The fact that there is a genetic tie-in to Celiac disease makes the failure of the medical system to identify it and treat it even more egregious. The customary medical history that patients fill out could ask about a family history of Celiac disease or its defining, often confused, symptoms, to alert doctors of the possibility of the presence of Celiac through a genetic relationship.

I gained first hand experience with the degradations of the profit motive upon public health when I worked three illuminating years as a New York City health inspector. ( New York Magazine cover story "Corruption in the Kitchen," Oct. 17, 1988. ) Doing health inspections, it became obvious that most exterminator companies were not committed to doing their job completely. If they did, it might put them out of business. Over time I learned that the use of certain exterminator companies strongly correlated with the presence of vermin, while others, a distinct minority, correlated with cleanliness. Dominance of the palliative mind set keeps exterminators and drug companies in business. Customers always need more treatment. The bugs go into hiding, but are not exterminated and the bugs' hosts need to keep coming back and paying for more treatment whether it be for mice, roaches, or ulcers.

Ideally a medical system effectively working to maximize health would not only treat illness with the most effective treatments, it would also focus upon preventative medicine by working to raise public awareness of the threats of customary addictive substances like nicotine and alcohol. Upgrading the U.S. to a socially advanced medical system that the nation could be proud of would start with deprogramming America's hidden cradle-to-grave advertising persuaders that addict the masses to tobacco, alcohol, and unhealthy food and drinks. Mary Louise Hartman gets it in a letter published in the New York Times [9/21/09]:

I recently toured the Coca Cola center in Atlanta. The marketing glitz was beyond belief. It's no wonder that half the world is now addicted to sugary beverages. If this same marketing genius was used to promote healthier foods and beverages, we wouldn't have to deal with the current obesity epidemic and its ensuing health care demands.

A progressive new approach to advancing public health might begin with levying taxes on the promotion of unhealthy products like alcohol, tobacco, fatty foods and, of course, sugary Coca Cola-and its competitors, and channel the revenues into a national public health fund. If we had pro-active taxes on the advertising of cigarettes, alcoholic beverages, sugar drinks, and fatty foods, the culturally conditioned abuse of these products might decline and revenue from their would be used pay to treat the deleterious effects of their consumption. This would lead producers to create healthier products, as has recently been seen in the mainstreaming of the grass roots organic food and alternative health care movements that arose from the Sixties.

Those politicians with direct personal experience with the failings of our medical system have the best motivation for bringing change in our healing institutions. President Obama's indelible experience with his mother's cancer and the late Senator Kennedy's family's cancer experiences led them to put their exceptional powers of persuasion to work making the health care system work better. And even conservative legislators like Barry Imhof [Oklahoma] and Ben Nelson [Nebraska] appear to have some personal connections to Celiac disease, and have taken baby political steps to raise awareness of gluten intolerance in the form of a Senate resolution. [Sept 13, 2006]

I, too, know personally of what I speak. This blogger watched his wife turn pale and balloon to frightening dimensions in the hospital after eating a piece of toast two days following an appendectomy. She then suffered through a week's worth of horrific testing trying unsuccessfully to diagnose the problem. When she was gingerly recovering at home a week later, [still undiagnosed and released against the head surgeon's advice] she asked to change her breakfast menu from oatmeal to Cream of Wheat for variety's sake, and took a radical turn for the worse. In a fortuitous post-op visit with her surgeon, she was pale again and could hardly stand. Fortunately her doctor's old college roommate was a leading food allergist and he asked what she had been eating. When we listed the change to Cream of Wheat, he asked if anyone in the family was gluten intolerant. My wife's aunt was. Bingo!

Considering gluten intolerance in the U.S., we are talking about an estimated 2 million undiagnosed or wrongly diagnosed people. For those who are finally diagnosed, it is estimated that it takes 11 years of suffering to find the source of their illness. In perhaps the most famous case of Celiac disease, Elisabeth Hasselbeck's self diagnosis and recovery had to come from a cultural trip back into the pseudo-primitive world of reality TV. As a contestant on the Survivor reality show, Hasselbeck voluntarily took up a pre-agricultural [pre wheat] "primitive" diet, and to her surprise discovered that her chronic stomach distress disappeared - only to return again when she came back to "civilized life" and gluten foods.

When we come face to face with the illness and disease of people we deeply care for, the obscenity of roadblocks created by criteria of profit and loss or artificial lines of political philosophy becomes crystal clear. Would John McCain, whose wife Cindy has a terrible migraine headache condition, want to see a cure for migraines suppressed the way the cure for ulcers was? When it comes to sickness and health, politics or profits should be the last concern. As Kennedy and Obama have so eloquently put it, doing what is right about universal health care is a matter of our national character. Human beings, someone's child, someone's parent, someone's mate, someone's employee should have access to the best known knowledge, analyses, and cures. This great country needs to construct a health system that puts the causes and cures of the sick and suffering first and foremost, whether they be cheap or expensive. The decisions defining the causes and cures of illness should not, cannot, be left in the hands of people and corporate powers whose primary concerns are the bottom line. We cannot patent the sun and we cannot patent good health, nor should we.

[Oct 08, 2016] My Summary of a Great Conference Preventing Overdiagnosis 2015 Huffington Post

Notable quotes:
"... Medical mistakes are the third leading cause of death in the U.S. - and are often occasioned by excessive testing and treatment delivered in an uncoordinated way by doctors who know lab tests, but don't know their patients. ..."
"... Clearly, too much medicine can be very bad for your health ..."
"... The biggest culprit in overtreatment is over testing. We have developed sophisticated technology that discovers incidental "diseases" that would have little or no impact on our lives and then treats them with disproportionately blunderbuss interventions that often cause more harm than good. ..."
"... Aggressive treatments that are delivered for non-aggressive "diseases" cause more problems than they solve. ..."
"... Not so long ago, doctors routinely bled their patients, gave them emetics and cathartics, and poisoned them with heavy metals. Future observers of our current practice will find some of what we are doing now equally wrong headed and harmful. ..."
"... Diagnostic inflation has also resulted in overtreatment of diabetes, hypertension, osteoporosis, attention deficit disorder, most problems that lead to orthopedic surgery, and lots more of what constitutes everyday medical practice. ..."
"... Most destructive has been the commercialization of medicine as a big business - healing art transformed into profitable cash cow. Perverse financial incentives encourage disease mongering, false advertising, over testing, quick diagnosis, and unnecessarily aggressive treatment. ..."
"... Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force. ..."
Oct 08, 2016 | www.huffingtonpost.com
wrote that the first "Preventing Overdiagnosis" conference was easily the most important meeting I had ever attended.

Last week's third "Preventing Overdiagnosis" conference, held at the National Institutes of Health in Washington, D.C. was even better. The conference was sponsored by the National Cancer Institute in collaboration with Oxford University, the British Medical Journal, Consumer Reports, and Bond and Dartmouth Universities. Hundreds of presentations covered the causes, consequences, and cures of overdiagnosis from every conceivable angle and laid out an agenda for future action. The international audience of 350 was as bright a group as I have ever encountered in almost 50 years of attending medical meetings.

The topic is the highest priority public heath problem we face in the U.S. and increasingly around the world. Medical mistakes are the third leading cause of death in the U.S. - and are often occasioned by excessive testing and treatment delivered in an uncoordinated way by doctors who know lab tests, but don't know their patients.

Clearly, too much medicine can be very bad for your health . And it is also a disaster for the health of our economy. The U.S. spends $3 trillion a year on heath care - more than the GDP's of all but four countries in the world. Because one-third of this enormous investment is sheer waste, it is no surprise that we get lousy outcomes compared to countries that spend much less, but spend much more wisely.

The biggest culprit in overtreatment is over testing. We have developed sophisticated technology that discovers incidental "diseases" that would have little or no impact on our lives and then treats them with disproportionately blunderbuss interventions that often cause more harm than good.

Rates of breast, prostate, and thyroid cancer increased dramatically not because people are sicker, but because disease definition has been broadened to inflate diagnosis. Much of what is now called "cancer" is not really cancer at all, or so slow growing that it is not really health or life threatening.

Aggressive treatments that are delivered for non-aggressive "diseases" cause more problems than they solve. Our current excess of therapeutic zeal follows a long historical tradition of well intended, but overly exuberant, doctors harming their patients with really terrible treatments. Not so long ago, doctors routinely bled their patients, gave them emetics and cathartics, and poisoned them with heavy metals. Future observers of our current practice will find some of what we are doing now equally wrong headed and harmful.

Diagnostic inflation has also resulted in overtreatment of diabetes, hypertension, osteoporosis, attention deficit disorder, most problems that lead to orthopedic surgery, and lots more of what constitutes everyday medical practice.

Overtreatment is driven by many powerful and interacting forces and will be difficult to tame.

Most destructive has been the commercialization of medicine as a big business - healing art transformed into profitable cash cow. Perverse financial incentives encourage disease mongering, false advertising, over testing, quick diagnosis, and unnecessarily aggressive treatment.

Often the best medical decision is to cautiously watch and wait, but this is discouraged by reimbursement mechanisms that favor quickly jumping in with potentially harmful, very expensive, and often unnecessary treatments. The powerful medical-industrial complex will exert all its considerable financial and political might to protect its profits, even if this means compromising patient welfare and eating up the economy. The obvious solution here is to substitute capitation for crazy fee-for-service incentives that reward the health system for doing more.

Too much medicine has also been driven by a medical research enterprise that systematically rewards scientists, journals, and the media for hyping often-false positive findings. Negative findings that would encourage the public to have a healthy skepticism about exaggerated claims are buried.

The result: patients accept, and even clamor for, testing and treatment that is more likely to harm than help. People fear the risks of illness too much and fear risks of treatment far too little. A great deal of conference time was thus productively devoted to the communication tools necessary to help right this imbalance. Patients must become informed consumers to balance the benefits of treatment with its risks and protect themselves from a system pushing them to always want more than may be good for them.

Regulators of medical excess no longer regulate. Seven years ago, the Food and Drug Administration, approved only one third of drug applications. This year, it has approved 96 percent. And drug companies are increasingly winning the right to mislead both the public and physicians, with false advertising and pushing off-label prescription.

Quality Assurance programs also play an unwitting role. Historically, QA has focused on identifying the things that should have been done during the course of treatment, but were left out. As a result, nine tenths of QA measures tap errors of omission, only one-tenth errors of commission. Unless this imbalance is redressed, QA will continue to drive doctors to do too much, even in situations where less would be more.

Unless applied cautiously, 'Personalized' or 'Precision' medicine may make things worse, becoming the next slick advertising gimmick to justify the use of treatments that have failed to prove their effectiveness in large groups. A more precise medicine would offer much less, not more, treatment.

The battle to tame medical excess is classic David vs. Goliath. But, fortunately, David has some potentially effective pebbles and might sometimes does come from being in the right. Thirty years ago, Big Tobacco seemed as impregnable as the medical-industrial complex, but it was toppled by its obvious outrageousness, dedicated opposition, public and media awakening, and lawsuits. The same combination, along with the inevitable need for cost containment, will eventually tame the medical beast- the question is how long will this take and how much harm will be done to patients and the economy before we get back to patient-driven, rather than profit driven medicine.

The conference wasn't perfect. There was a preaching to the choir feeling. Future conferences should invite debate with leaders from the forces promoting overtreatment - e.g., the insurance industry, Pharma, hospital associations, physician specialty groups, and consumer advocacy. Government and employers wind up footing the lion's share of medical costs and need to hear how much of their expenditure is not only wasteful financially, but also bad for the people they are trying to help.

The conference was attended by about a dozen science writers interested in the topic, but it did not itself become the big media story it can and should be. More intense public relations could lead to numerous stories alerting the public about which specific tests and treatments are most overdone and most risky.

And there could have been more discussion about how best to unite the various groups fighting against medical excess and hype. 'Choosing Wisely'; the Lown Foundation's 'RightCare' initiatitive; the HeathNews Review; the British Medical Journal; Consumer's Reports; and the many researchers and educators engaged in the field are all individually wonderful, but might collectively be more effective if their efforts were better coordinated.

Bottom line: Medical marvels are oversold and overbought. Doctors need to be more humble and safety-conscious. We can't overstep our knowlege base without putting our patients at risk. Patients and doctors need to accept the uncertainty and limits of medicine. False certainty leads to terrible decisions.

We must not ignore the most important ethic in medicine laid out 2500 years ago by Hippocrates: First Do No Harm.

Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.

[Oct 07, 2016] Dare to Be 100 The Last Well Person

Notable quotes:
"... British Medical Journals ..."
www.huffingtonpost.com

Huffington Post


Meador's perspective faults the medical industrial complex (MIC) for its encouragement of sickness - after all, that is how it makes money, by repairing people, surgery and drugs.


To gain more immediate access to people's anxieties, their underlying hypochondiasis, "The Last Well Person" takes aim at all the innuendos and commercial strategies that the MIC uses to gain access. The response of the young doctor when he or she is asked to define a healthy person replies "a healthy person is one who has not been fully worked up" is prescient, always another test to be done another treatment to be given.


All of this streams from the simple fact that no one of us is emotionally or intellectually strong enough to withstand constant intensive self-scrutiny. The magnifying mirror reveals many imperfections that the medical system is eager to take care of


The whole array of pre-diagnoses, pre-cancer, pre-hypertension, pre-dementia feeds into this pattern. I have personally participated in this labeling frenzy. I wrote a book "Diabetes Danger" that is actually not about having diabetes but about not getting diabetes in the first place. In it I coined the new term "pre-pre-diabetes" to classify those millions of people who do not yet qualify for the specific diagnosis of diabetes or pre-diabetes (fasting blood sugar over 100, or a two-hour after eating blood sugar over 140). There are 150 million Americans who are overweight or obese. There are 200 million Americans who are physically inactive who are primed to become first pre-diabetic and then frankly diabetic. They all have pre-pre-diabetes.


WHOA! HEADS UP!


My issuance of a blinking yellow or red light is certainly not intended to promote a doctor's visit or a pill or even worse surgery. It is intended to inform. But when does health information overstep into medicalization?


This is the precise critique given by editorials in recent British Medical Journals about the World Health Organization's use of the word "complete" well-being in its reach for world health standards. Insisting on the qualifier "complete" leads to the notion that we are all sick or trying to become sick.


This is what "The Last Well Person" essay was all about.


It teaches that semantics matter a lot.

[Oct 07, 2016] The Medical-Industrial Complex Have We Made Any Progress in the 21st Century

Aug 11, 2014 | Huffington Post

On June 17, 2014, Dr. Arnold Relman, editor of the prestigious New England Journal of Medicine from 1977-1991, passed away. During his tenure as editor, Dr. Relman highlighted health care policy as a major issue for the Journal by publishing commentary and studies about the delivery of health care and writing editorials about how health care is practiced and paid for.

Throughout his career, Dr. Relman was a champion for focusing on patient care rather than the business of medicine. In his writings, he expressed concern about the "commercialization" of medicine, reminding his colleagues that medicine was a calling and not a trade. He wrote thought-provoking articles on the conflict of interest of for-profit hospitals, nursing homes, and diagnostic laboratories that put profits ahead of what he considered the patients' best interests. As early as 1980, he was quoted as saying, "If we are to live comfortably with the new medical-industrial complex we must put our priorities in order: the needs of patients and of society come first ... How best to ensure that the medical-industrial complex serves the interests of patients first and of its stockholders second will have to be the responsibility of the medical profession and an informed public."

Today, new therapeutics for specific diseases such as certain cancers and hepatitis C can cost tens of thousands of dollars each month. Likewise, the costs of certain diagnostic tests are skyrocketing, and hospital and physician expenses are billed on a procedure basis rather than on successful outcome. And to make matters worse, the major expenses in the health care system are for the treatment of chronic diseases, and these continue to escalate out of control. The business of medicine has created a multitude of profitable treatments for chronic disease, but we continue to see these diseases progressing in number and severity. Why? Is it because we find ourselves locked into a financial model for disease prevention and treatment that puts the patient second behind the preservation of the status quo in the medical-industrial complex? I believe that this is part of the answer. We know the answer to the chronic disease epidemic is not to be found in the development of another expensive medicine alone, but rather in harnessing what we know now about the importance of applying personalized lifestyle medicine.

The patients' best interests are found in the understanding of how genetic uniqueness interacts with lifestyle, diet, and environment. Through this understanding we will be able to design and implement programs for individuals with proper support and incentives that will turn back the rising tide of chronic disease. We need to return to the patient-centered care that Dr. Arnold Relman advocated for throughout his professional life rather than continue with the present disease-centered system if we truly want to reduce the burden of disease.

References:

Snyder A. Arnold "Bud" Relman. Lancet. 2014 Jul 12;384(9938):126.

Relman AS. Medical professionalism in a commercialized health care market. JAMA. 2007 Dec 12;298(22):2668-70.

Relman A. The new medical-industrial complex. N Engl J Med. 1980;303:963-70.

Bloom DE, Cafiero ET, Jané-Llopis E, Abrahams-Gessel S, Bloom LR, et al. 2011. The Global Economic Burden of Noncommunicable Diseases. Geneva: World Economic Forum.

[Oct 07, 2016] The Dangers of the Medical Industrial Complex - Dr. Mark Hyman

YOUR DOCTORS THINK they make decisions based on medical evidence.

But they don’t!

In fact, half of medical evidence is hidden from your doctors. And the half that’s hidden is the half that shows drugs don’t work.

The bad news is that drug companies are not policed by the Food and Drug Administration (FDA) the way they should be. A drug should be proven both effective and safe BEFORE it is prescribed to millions of people.

Sadly, that often isn’t the case.

Let me share with you two recent examples that highlight the dangerous collusion between drug companies and our government agency. They show why the FDA should really stand for “Federal Drug Aid.”

First, we now know that the cholesterol-lowering drug Zetia actually causes harm and leads to faster progression of heart disease DESPITE lowering cholesterol 58 percent when combined with Zocor.

This challenges the belief that high cholesterol causes heart attacks and shakes the $40 billion dollar cholesterol drug industry at its foundation.

Second, it’s come to light that nearly all the negative studies on antidepressants – that’s more than half of all studies on these drugs – were never published, giving a false sense of effectiveness of antidepressants to treat depression.

Don’t get me wrong.

I’m not telling you to blame your doctor.

Instead, blame deceptive scientific practices and industry-protective government polices. Let’s talk a closer look at these findings and their implications.

I once had a patient who worked in the drug approval division of the FDA. She taught me a very important lesson.

When a drug company designs and performs a study, it has to be registered with the FDA and ALL the results must be submitted to the FDA. But it doesn’t work that way.

Instead, the pharmaceutical companies ONLY submit the data they want to get published to medical journals. That means that any negative studies are hidden from the scientific community and from the public.

And when drug studies are sponsored by drug companies – as most are – they find positive outcomes at 4 times the rate of independently funded studies. This is also true for nutrition studies funded by the food industry that show the benefits of dairy or high-fructose corn syrup.

The FDA does not release this information.

Since drug companies fund most of the research in the world, other therapies that work better – such as diet and lifestyle or nutritional therapies – never get enough funding.

That was, it didn’t until 2004 when all the major scientific journals banded together and refused to publish any data from any drug study that did not list the results of all trials, either positive or negative, in a central database. (1)

Well, that sounds good – but listing obscure, unpublished studies buried deep in a hard-to-navigate public database run by the National Institutes of Health is hardly visible public disclosure.

Sure, the research studies are at least listed, but try to find out the results. After a few hours searching around on the website clinicaltrials.gov, I gave up.

Last year, Congress passed legislation expanding how much detail must be listed, but at the end of the day, who even looks at that? Most doctors don’t even have time to read the medical journals they receive. They get tiny bits of information from drug reps, who come to their office with free lunch and a sound bite about their drug.

They get slightly more information from researchers who are funded by pharmaceutical companies and present their findings at conferences sponsored by pharmaceutical companies, using presentations prepared for them by pharmaceutical companies. Not exactly independent, evidence-based medicine!

Now let’s get back to the news about Zetia. Zetia is a new drug that lowers cholesterol by a different mechanism than statin drugs like Lipitor and Zocor.

Why does this matter?

Well, doctors have been brainwashed to think that cholesterol is the cause of heart attacks even though half of all people who have heart attacks have NORMAL cholesterol. And it seemed like the statins, which lowered cholesterol, actually reduced heart attacks.

Seems logical. If you lower cholesterol, you reduce heart attacks, right?

No!

I believe that the reason statins lower risk is NOT because they lower cholesterol, but because they reduce inflammation. In fact, studies by Dr. Paul Ridker of Harvard show that the risk of heart attacks was only reduced if inflammation was lowered along with LDL cholesterol – but not if LDL cholesterol was lowered alone. (2)

So then along comes a drug that can be combined with statins to lower cholesterol even more. Great idea? Not really.

You see, the FDA approved Zetia without any proof that it lowered heart attacks or reduced the progression of heart disease. The drug was approved solely on the basis that it lowered cholesterol.

Yet Zetia was given to 5 million people – and made the drug companies $5 billion a year. That’s almost $14 million a day! And once Zetia was approved, its makers had no incentive to prove that it actually did what it was thought to do – lower heart attacks.

They dragged their feet doing the studies and then released the negative data (which they did only under pressure from news agencies and Congress) after a long delay.

Wouldn’t you drag your feet too if you were making $14 million a day?

But the FDA had the negative data on Zetia – and it didn’t speak up. The data that was withheld proved that Zetia did not reduce heart attacks but actually INCREASED fatty plaques in the arteries despite lowering cholesterol.

Let that sink in for a moment.

That’s right: Lowering cholesterol led to more heart disease!

That turns our whole medical model upside down. It shows us that high cholesterol is NOT a disease and may or may not be related to heart attacks.

Another recent study put another nail in the coffin of the Cholesterol Myth.

A major new cholesterol drug, torcetrapib, was pulled from the pipeline in December 2006 because despite lowering LDL cholesterol and raising HDL cholesterol in 15,000 people, it caused MORE heart attacks and strokes. (3)

This was to be the new cholesterol wonder drug. Oops.

All this points to a big research mess that is flawed in three ways.

First, what gets studied depends on who is funding it.

Since drug companies fund most of the research in the world, other therapies that work better – such as diet and lifestyle or nutritional therapies – never get enough funding.

Second, drug companies are aided by the FDA, which suppresses, hides, and doesn’t publish negative studies on drugs, only positive ones. This leads doctors to think they have all the evidence when they don’t.

Third, doctors, patients, and the media believe they have the whole truth, often until it is too late, like with Zetia or Premarin or Vioxx.

The evidence was there, but no one looked or publicized it. This makes it very difficult for consumers to get the best treatments for their health and the whole truth about drugs.

Here’s my advice on how to make sense of things.

  1. Follow the money. Look carefully at who funded the study. Be suspicious if it was funded by drug companies.
  2. Call or email your congressperson or Senator to demand better legislation providing an easy-to-navigate database of all drug trials, with consumer-friendly summaries of both published AND unpublished data submitted to the FDA so you can look up the drug you are prescribed and have a balanced opinion.
  3. Don’t assume that drugs are the answer to your health problems. Heart disease is NOT a Lipitor deficiency but the result of your lifestyle interacting with your genes.
  4. Learn to ask the question “why?” – and search for the answers. Dealing with lifestyle and environmental factors (the basis of UltraWellness) almost always works better for chronic illnesses. Drugs are there as a backup only if needed.

So take a closer look at the information you’ve been given about drugs. You might be surprised by what you find.

Now I’d like to hear from you…

Were you aware of the studies I’ve mentioned today?

Which of the steps here do you plan to follow?

What has you experience been with medications compared to lifestyle measures?

Please share your thoughts by leaving a comment below.

To your good health,

Mark Hyman, MD

REFERENCES:

(1) Laine C, Horton R, DeAngelis CD, Drazen JM, Frizelle FA, Godlee F, Haug C, Hébert PC, Kotzin S, Marusic A, Sahni P, Schroeder TV, Sox HC, Van der Weyden MB, Verheugt FW.Clinical trial registration: looking back and moving ahead. JAMA. 2007 Jul 4;298(1):93-4.

(2) Ridker PM, Cannon CP, Morrow D, Rifai N, Rose LM, McCabe CH, Pfeffer MA, Braunwald E; Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) Investigators. C-reactive protein levels and outcomes after statin therapy. N Engl J Med. 2005 Jan 6;352(1):20-8.

(3) Kastelein JJ, van Leuven SI, Burgess L, Evans GW, Kuivenhoven JA, Barter PJ, Revkin JH, Grobbee DE, Riley WA, Shear CL, Duggan WT, Bots ML; RADIANCE 1 Investigators.Effect of torcetrapib on carotid atherosclerosis in familial hypercholesterolemia. N Engl J Med. 2007 Apr 19;356(16):1620-30.

[Apr 05, 2013] How to handle medical bill problems

Notable quotes:
"... Most states have laws saying that patients are entitled to an itemized medical bill that details what services and supplies are included in their charges. ..."
"... In 2006, California passed a law to prevent hospitals from collecting more money from uninsured patients than what Medicare or other public programs would pay for the same service. ..."
"... "Once a patient contacts the hospital and shows evidence of their financial situation, state law requires us to offer a discount based on Medicare rates," says Jan Emerson-Shea, vice president of external affairs for the California Hospital Assn. ..."
"... All communications with a provider should be in writing, experts say. Insist that your account be placed on hold until the dispute is resolved to avoid having the bill sent to collections. ..."
"... If you meet with resistance, don't waste time by calling back the customer service line or billing department. Go straight to the top. ..."
"... filing a complaint with your state's department of insurance. ..."
Apr 05, 2013 | http://articles.latimes.com/2013/apr/05

For those with confusing or huge hospital bills, experts advise knowing rights, getting written explanations, turning to the right places for help and filing complaints if necessary.

When Keith Yaskin and his wife, Loren, rushed their 2-year-old son to the hospital with a dangerous infection in his neck, they weren't thinking about how much his care would cost. After his three-day inpatient stay with nonstop intravenous antibiotics, they were hit with $8,900 in charges.

But the toughest lesson for the Scottsdale, Ariz., couple came a month or so later when they began to sort out the hospital bills. Their insurance policy had a $10,000 deductible. So they scrutinized every item, made some calls and had a few surprises.

When, for instance, they asked a medical group they had never heard of why it was charging them $839.25, they said they got no clear answers, just threats if they failed to pay.

After 21/2 months of calls and a complaint to their state attorney general, the Yaskins finally learned that a pediatrician affiliated with the group had treated their son in the hospital. The medical group eventually cut the bill in half.

None of this surprises Pat Palmer, the founder of Medical Billing Advocates of America. "We get feedback from consumers saying that providers are telling them 'We can't give you an itemized statement' or 'You should have asked for it before you left the hospital.'"

The idea is to discourage patients from asking for the details behind the charges, she said.

Experts offer a range of suggestions for dealing with medical billing problems.

Know your rights. Most states have laws saying that patients are entitled to an itemized medical bill that details what services and supplies are included in their charges.

"You can't be billed if they can't tell you what they are charging for," Palmer says.

Contact the billing department at either the hospital or medical group where you received services, she said. Let them know that you want an itemized bill, and tell them you are aware of your legal right to have it.

Also, a few states have laws limiting how much hospitals can charge patients who pay for care on their own. In 2006, California passed a law to prevent hospitals from collecting more money from uninsured patients than what Medicare or other public programs would pay for the same service.

"Once a patient contacts the hospital and shows evidence of their financial situation, state law requires us to offer a discount based on Medicare rates," says Jan Emerson-Shea, vice president of external affairs for the California Hospital Assn.

Get explanations in writing and take protests to the top. All communications with a provider should be in writing, experts say. Insist that your account be placed on hold until the dispute is resolved to avoid having the bill sent to collections.

If you meet with resistance, don't waste time by calling back the customer service line or billing department. Go straight to the top.

Address a certified letter to the chief executive or chief financial officer of the hospital or medical group explaining that you have tried to resolve billing issues but have hit a brick wall. "The CEO and CFO will take it very seriously," Palmer says.

Get help from your insurer. In the Yaskins' case, both the hospital and the medical group were in their insurer's network and had contracts to provide services at a negotiated discount.

"If you are in network - and this is one of the good reasons to stay in network - you can go to your insurer for help. It has a responsibility to some degree to what happens between you and a contracted physician," says Susan Pisano, spokeswoman for the trade group America's Health Insurance Plans.

Also, ask to make sure you're getting the rate your insurer has negotiated with in-network providers, says Lynn Quincy, senior health policy analyst for Consumers Union, the policy arm of Consumer Reports. Insurers often pass claims through without processing them at the reduced rate. Ask your insurer to re-process the claim if the discount wasn't applied.

Seek help and file complaints. If your bill is large or you're having a hard time making headway, patient advocates can help sort things out. For either a flat fee or a share of the money you save, organizations such as Medical Billing Advocates of America (www.billadvocates.com) and Health Proponent (www.healthproponent.com) can help you fight charges or lower your bill.

If you're being stonewalled by your healthcare provider, and your insurer hasn't helped, Quincy of Consumers Union suggests filing a complaint with your state's department of insurance. In California, patients with HMO coverage can file a complaint with the California Department of Managed Health Care by calling (888) 466-2219 or visiting healthhelp.ca.gov. Californians with PPO coverage should try the Department of Insurance at (800) 927-HELP (4357) or visit http://www.insurance.ca.gov. If your provider isn't contracted with your insurer, your state's attorney general's office is a place to turn for help.

The Yaskins ultimately enlisted the services of an advocate to help them sort through all their billing questions.

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