We hear about these great new advances in medicine that are finally released on the market. Maybe its a new drug, a new test, a new device. It doesn't really matter. It is hailed as progress. But progress often comes at a cost - we are slowly learning.
When any medical advance comes with a price tag, the question is then who pays? It comes from one of two places - the patient's pocket through a higher payment or through the insurers pocket which really means all of us pay for it.
So new diabetes pumps were introduced that offer more features, blah, blah, blah. The medical device marketing companies promote them heavily to patients. Each one costs $2500 and has a planned obsolescence every three years. Insurance companies will replace them every four years.
Diabetes is not an inexpensive disease. Patients with insurance spend more than $4000 annually even with insurance. Another $20,000 plus is covered by insurance (or the rest of us). This is called progress.
What kills me about this in an age where recycle/reuse has become more and more important, why are companies introducing something that has a planned obsolescence in three years? Wouldn't it be better to create something that might be upgradable and would last ten years? Thus reducing costs for all of us.
So every time we hear about a new medical device, tests, medication or whatever, we need to ask ourselves - what is the cost? Being covered by insurance is not the right answer.
The real answer should be: the per patient cost per dose/year of coverage is $X so we can see the real cost. Transparency should be required for all new advances and all new developments in the pipeline should have a plan for end patient cost that is justifiable and medical devices should focus on long term use instead of planned obsolescence.
Showing posts with label medical improvements. Show all posts
Showing posts with label medical improvements. Show all posts
Wednesday, April 9, 2014
Wednesday, December 26, 2012
Go P53! Rah Team P53!
[But before I begin this morning you will note the little new badge to the right-->
where you can vote for my blog for one of the best breast cancer blogs of 2012. Click on the little link and then find my blog and vote for it. When I last checked it was on the top of page 6 when sorted alphabetically. I have no votes yet so I'm feeling a little lonely - but it only started yesterday.]
Anyhow we are on Team P53 now. Here's a bit of an explanation of who P53 is and why we want to be on their team:
"Normal healthy cells have a mechanism that tells them to die if their DNA is too badly damaged to repair. Cancer cells have grotesquely damaged DNA, so ordinarily they would self-destruct. A protein known as p53 that Dr. Gary Gilliland of Merck calls the cell’s angel of death normally sets things in motion. But cancer cells disable p53, either directly, with a mutation, or indirectly, by attaching the p53 protein to another cellular protein that blocks it. The dream of cancer researchers has long been to reanimate p53 in cancer cells so they will die on their own."
P53 has been known about for about 20 years. It was Science Magazine's (don't laugh) Molecule of the Year in 1993 and even had the cover for a month. (Really! So its already cool so we want to be on its team.)
It was also called, in an editorial, “a cure of a terrible killer in the not too distant future.” So even its hero status has been known for a long time. This is the Joe Namath-Bobby Orr-Yogi Berra-Neil Armstrong-Nelson Mandela-Mick Jagger-Winston Churchill-Dr Salk-Mother Theresa MVP of the year protein. We want to be on the team P53.
Right now there are three drug companies - Merck, Sanofi, and Roche - about to begin testing a new drug each that will work on a wide variety of cancers - breast, lung, prostate, and liver - that will work with P53 to help reanimate it so the cancer cells die off.
"Great uncertainties remain, but such drugs could mean new treatments for rare, neglected cancers, as well as common ones. Merck, Roche and Sanofi are racing to develop their own versions of a drug they hope will restore a mechanism that normally makes badly damaged cells self-destruct and could potentially be used against half of all cancers"
So the thought is that in the future, the organ where the cancer is based will become less important than its molecular make up.
This will have a very significant impact on a range of issues related to cancer. One result, the philanthropy and awareness efforts surrounding different types of cancer will shift their goal and pool their resources. Groups that now focus on a single type of cancer, such as the Komen-for-a-Cure pink cult will become a way of the past (and we never thought we could get rid of them) as research is pooled and focus on the genes and molecular impact. So team P53 will not even have pink cheerleaders.
I'm all for Team P53 here. Please join me.
You can read the full article here.
where you can vote for my blog for one of the best breast cancer blogs of 2012. Click on the little link and then find my blog and vote for it. When I last checked it was on the top of page 6 when sorted alphabetically. I have no votes yet so I'm feeling a little lonely - but it only started yesterday.]
Anyhow we are on Team P53 now. Here's a bit of an explanation of who P53 is and why we want to be on their team:
"Normal healthy cells have a mechanism that tells them to die if their DNA is too badly damaged to repair. Cancer cells have grotesquely damaged DNA, so ordinarily they would self-destruct. A protein known as p53 that Dr. Gary Gilliland of Merck calls the cell’s angel of death normally sets things in motion. But cancer cells disable p53, either directly, with a mutation, or indirectly, by attaching the p53 protein to another cellular protein that blocks it. The dream of cancer researchers has long been to reanimate p53 in cancer cells so they will die on their own."
P53 has been known about for about 20 years. It was Science Magazine's (don't laugh) Molecule of the Year in 1993 and even had the cover for a month. (Really! So its already cool so we want to be on its team.)
It was also called, in an editorial, “a cure of a terrible killer in the not too distant future.” So even its hero status has been known for a long time. This is the Joe Namath-Bobby Orr-Yogi Berra-Neil Armstrong-Nelson Mandela-Mick Jagger-Winston Churchill-Dr Salk-Mother Theresa MVP of the year protein. We want to be on the team P53.
Right now there are three drug companies - Merck, Sanofi, and Roche - about to begin testing a new drug each that will work on a wide variety of cancers - breast, lung, prostate, and liver - that will work with P53 to help reanimate it so the cancer cells die off.
"Great uncertainties remain, but such drugs could mean new treatments for rare, neglected cancers, as well as common ones. Merck, Roche and Sanofi are racing to develop their own versions of a drug they hope will restore a mechanism that normally makes badly damaged cells self-destruct and could potentially be used against half of all cancers"
So the thought is that in the future, the organ where the cancer is based will become less important than its molecular make up.
This will have a very significant impact on a range of issues related to cancer. One result, the philanthropy and awareness efforts surrounding different types of cancer will shift their goal and pool their resources. Groups that now focus on a single type of cancer, such as the Komen-for-a-Cure pink cult will become a way of the past (and we never thought we could get rid of them) as research is pooled and focus on the genes and molecular impact. So team P53 will not even have pink cheerleaders.
I'm all for Team P53 here. Please join me.
You can read the full article here.
Tuesday, September 13, 2011
A good change
In 2009, I believe, a law went into effect in Massachusetts prohibiting drug and medical device companies from paying doctors to promote their products. I think a stricter federal law which will be along the same line is coming. Now that we have some data, the numbers are dropping significantly.
I am all for this. While I do believe everyone should be allowed to earn extra money in anyway they (legally) can, sometimes we need to put some reins on what people are doing. If a doctor is making significant income from a drug or medical device company, their loyalties are clearly to their richest employer. So are they then a doctor or are they a professional promoter?
I want a doctor who is focused on treating patients impartially with what is best for the patient in mind. Not with how they, the doctor and his pockets, will benefit the most. If a doctor wants to work for the pharmaceutical companies and promote their products because they get paid better, are sick of treating patients, or whatever, then they should consider themselves a professional promoter and not a doctor.
I also like to see that doctor's employers are making it easy for the doctors too. They are incorporating these restrictions into their employees requirements. I realize that until the federal law kicks in, in 2012 or 2013 (I think), the drug and medical device companies are getting doctors as speakers from other states. But once the law does kick in, they will need to change how they promote their drugs.
My background is marketing so I can understand this. By hiring the doctors to speak about their products, they are hiring the decision makers to influence their peers from a medical point of view, instead of just being a sales pitch from another corporation. It gives a lot more credibility to their products to have a peer stand up and say 'it works very well'. Now they will need to find another way to promote their products. Millions of television ads promoting the medications to the general public really aren't effective as they raise awareness of a product's name but the patient can only ask their doctor about it, they can't go buy it themselves. I see a real restructuring of their promotional programs as a result.
But as a patient, I am very happy about all this change. I see it as just another step of change in the bigger healthcare reform where the patient's improved care is more of a focus than deep pockets by doctors, hospitals, medical centers, insurance companies, and medical device and drug manufacturers. The goal is to have the patient win in the end - which makes it a good change.
I am all for this. While I do believe everyone should be allowed to earn extra money in anyway they (legally) can, sometimes we need to put some reins on what people are doing. If a doctor is making significant income from a drug or medical device company, their loyalties are clearly to their richest employer. So are they then a doctor or are they a professional promoter?
I want a doctor who is focused on treating patients impartially with what is best for the patient in mind. Not with how they, the doctor and his pockets, will benefit the most. If a doctor wants to work for the pharmaceutical companies and promote their products because they get paid better, are sick of treating patients, or whatever, then they should consider themselves a professional promoter and not a doctor.
I also like to see that doctor's employers are making it easy for the doctors too. They are incorporating these restrictions into their employees requirements. I realize that until the federal law kicks in, in 2012 or 2013 (I think), the drug and medical device companies are getting doctors as speakers from other states. But once the law does kick in, they will need to change how they promote their drugs.
My background is marketing so I can understand this. By hiring the doctors to speak about their products, they are hiring the decision makers to influence their peers from a medical point of view, instead of just being a sales pitch from another corporation. It gives a lot more credibility to their products to have a peer stand up and say 'it works very well'. Now they will need to find another way to promote their products. Millions of television ads promoting the medications to the general public really aren't effective as they raise awareness of a product's name but the patient can only ask their doctor about it, they can't go buy it themselves. I see a real restructuring of their promotional programs as a result.
But as a patient, I am very happy about all this change. I see it as just another step of change in the bigger healthcare reform where the patient's improved care is more of a focus than deep pockets by doctors, hospitals, medical centers, insurance companies, and medical device and drug manufacturers. The goal is to have the patient win in the end - which makes it a good change.
Sunday, March 27, 2011
Mammograms aren't as useful after breast cancer
Well, yip-diddy-doo-dah! After breast cancer treatment, they send you on your way in your life and tell you, 'be vigilant, follow up with your doctors, and get regular mammograms'. Now they say 'mammograms are not as useful after breast cancer - they are less effective/less sensitive. The study (of course another study) recommends ultrasounds, MRIs and possibly the new 3D mammograms which were just approved by the FDA.
Thank you for confusing me and stressing me out some more (I am supposed to reduce the stress in my life). I do know where I go for treatment, first of all if you have any previous history, you get the specialized super duper digital mammograms as opposed to the regular digital mammograms. And if there is any question, you get sent for an ultrasound right then and there. But an MRI as well? I'll have to ask both my doctors and my insurance company.
I know I have blogged about this before but the continued new studies and medical advances, while they show progress and advances, they also have a niggling way of tugging at the back of your mind - what if the treatment I got was proved to be ineffective or even harmful?
I know we have learned in the past centuries that leeches and blood letting is not necessarily the best treatment for the flu. Or that while bottles of a snake oil salesman's opiates sold in the 18th and 19th centuries will certainly make you feel better but wont due much for curing you as well. More recent treatments, such as treatment for lymphoma involving radiation to the chest has cured one ailment but resulted in breast cancer decades later in many of those treated. These were the best standard of care at the time.
But as medical science progresses, will any of the treatments that I have received turn out to be ineffective or have caused long term harm to my body? I just have to stop holding my breath and go about my life and hope for the best. Because there is no way of knowing what will be learned in the future.
Thank you for confusing me and stressing me out some more (I am supposed to reduce the stress in my life). I do know where I go for treatment, first of all if you have any previous history, you get the specialized super duper digital mammograms as opposed to the regular digital mammograms. And if there is any question, you get sent for an ultrasound right then and there. But an MRI as well? I'll have to ask both my doctors and my insurance company.
I know I have blogged about this before but the continued new studies and medical advances, while they show progress and advances, they also have a niggling way of tugging at the back of your mind - what if the treatment I got was proved to be ineffective or even harmful?
I know we have learned in the past centuries that leeches and blood letting is not necessarily the best treatment for the flu. Or that while bottles of a snake oil salesman's opiates sold in the 18th and 19th centuries will certainly make you feel better but wont due much for curing you as well. More recent treatments, such as treatment for lymphoma involving radiation to the chest has cured one ailment but resulted in breast cancer decades later in many of those treated. These were the best standard of care at the time.
But as medical science progresses, will any of the treatments that I have received turn out to be ineffective or have caused long term harm to my body? I just have to stop holding my breath and go about my life and hope for the best. Because there is no way of knowing what will be learned in the future.
Sunday, February 27, 2011
Speaking of medical records
I didn't realize the government was pushing all this technology on to hospitals and doctors but they are. They are spending billions of stimulus dollars to get away from pen and paper. They have a long way to go, only 30% of doctors are using electronic records. Apparently the system works for hospitals but not independent practices. Hospitals can afford to go electronic. Doctors who are independent it is a bigger step - even with stimulus money.
Where I am treated, starting a year or so ago, they went electronic. First they had two years worth of medical records put into the system. Then everything going forward is electronic. You are never greeted by a nurse with a big medical file (mine was getting big enough to get require a hand cart to lug around) but now they carry a laptop. In addition, now they are working backwards to get earlier records into the system.
I think this is all great. They can see what is going on with a patient much easier. They can pull up test results and even view images from tests right away. I realize that proportionally it is a long of work for the independent practitioner but in the long run, patients will get better care. Patients will no longer have to get medical records back and forth from different places they are treated. I know many people who get different treatments in different places and then they have to get reports back and forth to different places. I have enough problems getting places without having to remember anything.
HOWEVER (yes a big fat pause here), the biggest push for these electronic records are the insurance companies... They claim it is because it saves on unnecessary tests and hospitalizations, etc as the information is shared between doctors. Medicare and Medicaid are going to require doctors to report electronically. But what about regular health insurance companies - they should not have access to the information.
This is the scary part: By mining its patient data, Kaiser, for example, was first to identify a link between the pain-relief drug Vioxx and a higher risk of heart failure, well before Merck pulled the drug off the market in 2004.
I don't think I mind that the information is electronic so we aren't buried in paper ( see my post about this a few days ago) but I think I do think I mind insurance companies accessing it even if it isn't tied to a patient's name. So Kaiser dug through the data and found out that people who took Vioxx had a higher risk of heart failure, but what if they started going through the data and saying things like 'people who are on this drug are more likely to die, so we don't want to insure them any more'. So if you are on something like Tamoxifen, that means you had breast cancer. Or if you are on Avastin for a brain tumor, what if they didn't want to insure you? Keep the insurance companies away from medical records.
I think in the long run, paper is expensive and a vertical way to keep and use medical records. Insurance companies are not supposed to know what is wrong with you but somethings are pretty obvious when they pay bills for brain MRIs or EKGs. But should they be allowed to mine this data to make decisions about coverage? Or make any decisions on care? This is the scary part. I guess I just don't trust them any more. They aren't doctors, they are out for the bottom line. Its not the patients that matter, its the money.
Where I am treated, starting a year or so ago, they went electronic. First they had two years worth of medical records put into the system. Then everything going forward is electronic. You are never greeted by a nurse with a big medical file (mine was getting big enough to get require a hand cart to lug around) but now they carry a laptop. In addition, now they are working backwards to get earlier records into the system.
I think this is all great. They can see what is going on with a patient much easier. They can pull up test results and even view images from tests right away. I realize that proportionally it is a long of work for the independent practitioner but in the long run, patients will get better care. Patients will no longer have to get medical records back and forth from different places they are treated. I know many people who get different treatments in different places and then they have to get reports back and forth to different places. I have enough problems getting places without having to remember anything.
HOWEVER (yes a big fat pause here), the biggest push for these electronic records are the insurance companies... They claim it is because it saves on unnecessary tests and hospitalizations, etc as the information is shared between doctors. Medicare and Medicaid are going to require doctors to report electronically. But what about regular health insurance companies - they should not have access to the information.
This is the scary part: By mining its patient data, Kaiser, for example, was first to identify a link between the pain-relief drug Vioxx and a higher risk of heart failure, well before Merck pulled the drug off the market in 2004.
I don't think I mind that the information is electronic so we aren't buried in paper ( see my post about this a few days ago) but I think I do think I mind insurance companies accessing it even if it isn't tied to a patient's name. So Kaiser dug through the data and found out that people who took Vioxx had a higher risk of heart failure, but what if they started going through the data and saying things like 'people who are on this drug are more likely to die, so we don't want to insure them any more'. So if you are on something like Tamoxifen, that means you had breast cancer. Or if you are on Avastin for a brain tumor, what if they didn't want to insure you? Keep the insurance companies away from medical records.
I think in the long run, paper is expensive and a vertical way to keep and use medical records. Insurance companies are not supposed to know what is wrong with you but somethings are pretty obvious when they pay bills for brain MRIs or EKGs. But should they be allowed to mine this data to make decisions about coverage? Or make any decisions on care? This is the scary part. I guess I just don't trust them any more. They aren't doctors, they are out for the bottom line. Its not the patients that matter, its the money.
Wednesday, February 9, 2011
Treatment advances and changes
As in the proverbial Ginzu knife commercials, "but wait, there's more!" But what if isn't more, there is less? We are always hearing about the newest medical treatment protocol. You have already been through 8,937 treatment protocols and have acquired a second bedside table to contain your prescription bottles and have set up a third spreadsheet to manage them. And then your doctor says, again, for the 8,938th time 'there has been a new treatment protocol - and I would like you to try one of these once a day. Its a new medication and should help you.' You have heard this again and then head to the pharmacy to visit your friends at the prescription pick up counter and pick up another vial of pills. Blah, blah, blah.
But what if your doctor said 'take this instead of these other six prescriptions'. You mean less is better? Is this possible? But sometimes it is. It is a different way of thinking in the medical world. But sometimes it seems they forgot what they told us before.
Think of it this way, for decades doctors told women with a breast cancer diagnosis, they clear path for survival was a radical mastectomy where all under arm lymph nodes were removed before chemotherapy (and I don't even want to think about this surgery 100 years ago - scary). Now they break it out into two steps - lumpectomy or mastectomy and check the sentinel node or two under the patients arm. If the nodes are negative, no more digging for radical surgery is needed. Less risk of long term complications.
Well whoop-di-doo. Less can be more. But the problem I have with this is that the story ran in today's newspaper as if it was news. I don't understand what is so new about it as it is the treatment protocol that I had 3.5 years ago. Was there some new news or new research that was just released that reinforces what has been going on for several years now? Or has the rest of the world just figured out that less is more? Call me confused for the day
But what if your doctor said 'take this instead of these other six prescriptions'. You mean less is better? Is this possible? But sometimes it is. It is a different way of thinking in the medical world. But sometimes it seems they forgot what they told us before.
Think of it this way, for decades doctors told women with a breast cancer diagnosis, they clear path for survival was a radical mastectomy where all under arm lymph nodes were removed before chemotherapy (and I don't even want to think about this surgery 100 years ago - scary). Now they break it out into two steps - lumpectomy or mastectomy and check the sentinel node or two under the patients arm. If the nodes are negative, no more digging for radical surgery is needed. Less risk of long term complications.
Well whoop-di-doo. Less can be more. But the problem I have with this is that the story ran in today's newspaper as if it was news. I don't understand what is so new about it as it is the treatment protocol that I had 3.5 years ago. Was there some new news or new research that was just released that reinforces what has been going on for several years now? Or has the rest of the world just figured out that less is more? Call me confused for the day
Wednesday, July 14, 2010
Concepts I can live with
I have followed the transition of the hospital where I am treated from paper to electronic records. This is going on everywhere and promises to help patients and improve their care. A long time ago, you would check in and they would call the nurses station and tell them you were there. Then they added computers and the nurses would be notified electronically and would come out with a medical file to get you from the waiting room. Now they come out with a laptop (I wonder how often one gets dropped) to get you from the waiting room and bring you back to (the closet) where you will wait for your doctor. Everything is electronic. Well almost. I have been told that the next step in the transition is to have all patient notes be typed in electronically. And now they are working backwards from 2005 to put in all medical records. They currently have 2005 to present electronically.
I see the results in talking to my many doctors. They can review what everyone else has said about me (all nice I am sure) to learn about my oh-so-complicated medical history. It makes it easier on me. We can discuss my issues instead of have a question and answer session. They can easily review my past before I get there. Also, my medication list has somewhat reduced in importance as they have it online and it is up to date. Now they use it to confirm what I am taking. I think I can live with this. I'm just waiting for my medical records from 1981 to be updated.
Another concept I like is same day medical appointments.
Back when I was a child and doctors made house calls when you were really sick. (And milk was delivered in glass bottles magically out side the door. The knife sharpening man came by in his little truck. And the world was flat and black and white, but I digress). Then managed health care raised its ugly head and you needed referrals for everything. You waited months for an appointment and doctors really had no choice but to send you to the ER for stupid things because they couldn't get you in to see them. For many reasons, this has changed. Insurance companies are pressuring patients not to go to the ER unless they are very sick. I have been to the ER several times in recent years but I was always admitted so I never got hit with a big fee.
I have also seen the hospital where I am treated change and adapt as well. First they instituted a walk in clinic where you could see a doctor after a relatively short wait for any sort of minor ailment (you with the chest pains, go to the ER). The latest twist is now they tell you to call your regular doctor's office first to see if you can see your doctor or another in the same department that day. If not, then go to the walk in. I have done this and seen a doctor who knows my doctor. They also have my medical record on a laptop when I get there.
I think I can deal with these changes. I feel my care has improved and I don't wait weeks for an appointment for something that I have no longer have.
Well I have to motivate again this morning. We have an electrician coming to fix an electrical something and I need to get dressed before he shows up. Then I am meeting old friends for lunch at a fancy restaurant. Which should be fun.
I see the results in talking to my many doctors. They can review what everyone else has said about me (all nice I am sure) to learn about my oh-so-complicated medical history. It makes it easier on me. We can discuss my issues instead of have a question and answer session. They can easily review my past before I get there. Also, my medication list has somewhat reduced in importance as they have it online and it is up to date. Now they use it to confirm what I am taking. I think I can live with this. I'm just waiting for my medical records from 1981 to be updated.
Another concept I like is same day medical appointments.
Back when I was a child and doctors made house calls when you were really sick. (And milk was delivered in glass bottles magically out side the door. The knife sharpening man came by in his little truck. And the world was flat and black and white, but I digress). Then managed health care raised its ugly head and you needed referrals for everything. You waited months for an appointment and doctors really had no choice but to send you to the ER for stupid things because they couldn't get you in to see them. For many reasons, this has changed. Insurance companies are pressuring patients not to go to the ER unless they are very sick. I have been to the ER several times in recent years but I was always admitted so I never got hit with a big fee.
I have also seen the hospital where I am treated change and adapt as well. First they instituted a walk in clinic where you could see a doctor after a relatively short wait for any sort of minor ailment (you with the chest pains, go to the ER). The latest twist is now they tell you to call your regular doctor's office first to see if you can see your doctor or another in the same department that day. If not, then go to the walk in. I have done this and seen a doctor who knows my doctor. They also have my medical record on a laptop when I get there.
I think I can deal with these changes. I feel my care has improved and I don't wait weeks for an appointment for something that I have no longer have.
Well I have to motivate again this morning. We have an electrician coming to fix an electrical something and I need to get dressed before he shows up. Then I am meeting old friends for lunch at a fancy restaurant. Which should be fun.
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