Corporate Proxies Suggest CEOs Rewarded for Influencing Health Care Reform

We have frequently discussed the often outsized, if not outrageous compensation awarded to top leaders of health care organizations.  Such compensation may seem disproportionate to the leaders' real-world achievements, and may contrast with organizational actions that seem inept, mission-hostile, or unethical.

In perusing this year's crop of proxy statements from some of the biggest US health care corporations, I noted that some provide some narrative, qualitative justification for their top leaders pay.  I was struck by three similar statements:

Johnson and Johnson

We recently discussed the contrast between Johnson and Johnson CEO William Weldon's gargantuan compensation and his detached response to the findings of an inspection of one of his company's factories that lead to its shutdown and the recall of its products.   According to the company's 2010 proxy statement, Mr Weldon's total compensation approved  in 2010 was $19,847,026.   The proxy statement included this overview of his performance:

The Board believes that Mr. Weldon generally exceeded expectations despite substantial economic, political, regulatory and competitive challenges as well as significant patent expirations. As referenced in the table above, the Company delivered solid financial results and positioned itself for future growth.

Under "strategic results" was this statement:

Mr. Weldon played an effective role in helping shape health care policy around the world and has been very involved with efforts on U.S. Health Care Reform. Mr. Weldon’s personal involvement with key leaders and organizations has ensured the interests of the Company are well represented.

Pfizer

We recently discussed the contrast between Pfizer Inc CEO Jeffrey Kindler's sizable compensation and the number and size of lawsuits alleging unethical conduct that the organization has settled, and its criminal conviction as a "racketeering influenced and corrupt organization" (RICO). According to the company's 2010 proxy statement, Mr Kindler's total compensation in 2009 was $14,898,038. The proxy statement included an Executive Compensation Discussion and Analysis. Its summary of Mr Kindler's performance was:

The committee believes that Mr Kindler's leadership was a significant factor in the continued progress made by Pfizer in 2009 in strengthening the foundation for future growth and long-term success.

It also specifically addressed Mr Kindler's "industry leadership":

During 2009, Mr Kindler was actively involved, through both Pfizer and external organizations, in developing and advancing US and global public policies that serve the overall interest of our Company and our shareholders, as well as doctors and patients. These efforts included constructive participation in the US legislative process to advance Pfizer's goals of achieving a more rational operating environment....

UnitedHealth Group

We recently discussed the contrast between UnitedHealth Group CEO Stephen J Helmsley's large total compensation and the profit he recently made from the sale of stock options and various questions raised about his company's ethical performance.  According to the company's 2010 proxy statement, his 2009 total compensation was $8,901,916. The company's 2010 proxy statement stated his compensation was based upon a variety of factors, including:

Positive participation and leadership of the Company in the health care reform and modernization debate

Summary

We have noted how health care organization may be gripped by "compensation madness," caused by "insiders hijacking established organizations for their personal benefit."  One could view the statements above as just one form of post-hoc justification for compensation madness.  It is possible that timid, if not crony boards are simply getting more inventive in their rationalizing CEOs' imperial pay scales.  On the other hand, those justifying the compensation of three extremely well-compensated health care corporate CEOs may really believe what they wrote about their CEOs roles in health care reform. 

We have posted little about the US health care reform effort because so much of it seemed irrelevant to the concerns mentioned on Health Care Renewal.  Health care reform legislation did little to address problems with health care leadership, governance and ethics, and how they challenge health care professionals' values and lead to higher costs, declining access, poor health care quality and disgruntled health care professionals (see this summary).  Maybe one reason this was so was that the top leaders of health care organizations did a good job pushing their personal and organizational priorities into the reform legislation, meanwhile discouraging any provisions that might threaten the way they were leading their organizations, and how much they were making while doing so. 

There a many reasons for the popular dissatisfaction with the recently enacted US health care reform legislation.  The influence of the leadership of top health care corporations in promoting their, rather than the populace's goals, ought to be a topic of further inquiry.  Meanwhile, it may be that the "superclass" has struck again. 

Pfizer Settles One Lawsuit, Loses Another, Pays its CEO $13.7 Million

It's deja vu all over again for Pfizer Inc, the world's largest pharmaceutical company.

Settlement of Suit Alleging Neurontin Risks Concealed

Pfizer has kept busy in court defending against charges that a company it acquired promoted Neurontin (gabapentin) for uses not approved by the US Food and Drug Administration (FDA), and not well supported by the evidence.  Most recently, it was convicted by a jury in California of being a racketeering influenced and corrupt organization (RICO) because of a long-term "racketeering conspiracy" involving Neurontin marketing (see post here). Now additionally, according to the Wall Street Journal,

Pfizer Inc. said it reached a settlement agreement in a wrongful-death lawsuit brought by a woman who claimed her husband's use of the antiseizure drug Neurontin caused him to commit suicide in 2002.

The suit was brought by Linda Shearer of Berkshire County, Mass., whose husband, Hartley Shearer, was prescribed Neurontin to control the effects of his paralysis. The suit alleged Pfizer promoted this use of the drug even though it wasn't approved by U.S. regulators. The suit alleged Pfizer knew the drug was associated with a risk of suicide, but failed to properly warn of the risk.

The new wrinkle here is that Pfizer did not defend a suit that alleged the company knew of a potentially fatal side-effect of the drug, but failed to disclose that risk.

Jury Awarded Damages for Treatment of Whistle-Blower

Meanwhile, the Hartford Courant reported:

A former Pfizer scientist who claims she has been paralyzed by a virus designed at the pharmaceutical company's laboratory in Groton was awarded $1.3 million by a federal jury in Hartford Thursday following a trial that raised questions about safety practices in the dynamic field of genetic engineering.

The amount of the settlement awarded to molecular biologist Becky McClain of Deep River will likely increase in coming days. After about day of deliberation, the jury also awarded McClain punitive damages, to be determined by U.S. District Judge Vanessa L. Bryant, and awarded fees to McClain's two Connecticut lawyers, Bruce E. Newman and Stephen J. Fitzgerald.

McClain claimed in her suit that she was inadvertently exposed through work by a former Pfizer colleague in 2002 or 2003, to an engineered form of the lentivirus, a virus similar to the one that can lead to acquired immune deficiency syndrome, or AIDS.


She further claimed that Pfizer wrongly fired her in 2005 for complaining about laboratory safety to the U.S. Occupational Safety and Health administration and to co-workers.

Ultimately, the jury was not permitted during the 12-day trial to hear argument supporting McClain's claim of a causal link between her disability and virus research done at her laboratory in Groton.

The jury based its verdict on evidence concerning McClain's two remaining claims: that her dismissal violated Connecticut's whistle blower law and McClain's free speech right. Her lawyers contended her complaint to federal safety regulators amounted to a whistle blower complaint and that her discussion of safety issues with fellow workers was free speech.

So, after being convicted by a jury of being a "racketeering influenced and corrupt organization," (RICO), and settling civil and criminal fraud charges for an unprecedented $2.3 billion (see post here), and after many other allegations, settlements, and convictions (look here),  Pfizer failed to defend one action, and lost another that argued Pfizer tried to hide information which put the company and/or its products in an unfavorable light.

In fact, Even Pfizer CEO Jeffrey Kindler could not put much of a spin on the company's recent record. As reported by Duff Wilson in the New York Times,

The world’s largest drug company, Pfizer, has handled mergers badly, invented too few drugs and left its reputation in disrepair after two criminal cases.

And that is the assessment of its own chief executive.

CEO's Multi-Million Dollar Compensation
But while all this was going on, the company did disclose (as mandated by the US Securities and Exchange Commission [SEC]) that CEO Kindler is continuing his acquisition of riches.  As reported by the AP (via USAToday).

The chief executive of drug giant Pfizer Inc., Jeffrey Kindler, received a 2009 compensation package valued by The Associated Press at $13.7 million, down 7.6% from 2008, as the board reduced the stock awards he received, citing economic pressures.

The world's biggest drugmaker paid Kindler, 54, a salary of $1.6 million, up just $25,000 from the year before. But his performance bonus was bumped up to $3.5 million from $3 million in 2008, according to a filing this week with the Securities and Exchange Commission.

Most of Kindler's compensation comes from long-term awards of stock options and restricted shares. The total fell 17% to $8.1 million in 2009, from $9.8 million, even though they were granted in late February, a month after Kindler announced plans to buy Wyeth for $68 billion, a sound strategy to counter Pfizer's looming revenue plunge.

Kindler's other compensation — a variety of perks — totaled $449,731. That included $190,725 for Kindler's use of corporate aircraft as required by Pfizer's board, $43,099 for use of a car, $7,690 for financial counseling and $1,217 for home security.

Even admitting that Kindler's compensation last year was slightly decreased from last year's not so small fortune, there still seems to be a huge disconnect between the company's ethical woes, legal settlements, and guilty pleas and its CEO's rewards. Once again, it seems that leaders of large health care organizations never face real accountability for their company's bad behavior. It almost goes without saying that in the two cases summarized above, no one who authorized, directed, or implemented the actions leading to the settlements or damages seems to have had any negative consequences.

So once more with feeling.... In the US, we have put much of our health care system in the hands of very large organizations, for-profit and not-for-profit, without holding these organizations and their leaders accountable for their actions. The results have been increasingly rich leaders who often behave like a new aristocracy, and repeated bad behavior by the organizations they lead.

Our latest effort at health care "reform" has continued to rely on large private organizations, while so far not adding to their or their leaders' accountability. In my humble opinion, if we really want to reform health care so as to improve quality, increase access, control costs, and support professionalism, we will have to make our new health care oligarchs accountable.

Postscript - Pay for Health Care Reform Lobbying?

By the way, a commentary in The [New London, CT] Day suggested an explanation for why Kindler was so richly paid last year:

It takes pages and pages of a company securities filing to explain and justify all the bells and whistles of Kindler's 'annual incentive award,' a complicated stew of stock options and deferred payments and plain old salary.

From all of this, Timothy P. Carney of the Washington Examiner found one juicy tidbit, which especially titillated industry bloggers.

It turns out Kindler's salary increase, from $1.57 million to $1.6 million, was based in part, the compensation committee suggested, on his success in making a deal with President Obama that protected the drug industry from some of the more onerous proposals of health care reform.

Praising Kindler as an effective lobbyist in, among other things, heading off legislation that would allow the importing of cheaper prescription drugs, the committee said: 'These efforts included constructive participation in the U.S. legislative process to advance Pfizer's goals of achieving a more rational operating environment.'

Or, he kept a finger in the dike against health care reform.

Indeed, a recent report by the Sunlight Foundation, a private nonprofit dedicated to more transparency in government, indicates Kindler's extensive role in negotiating a deal for the drug companies with the Obama administration and Senate Finance Committee Chairman Max Baucus.

It turns out Kindler's name turns up four times on last year's White House visitor logs.

The final deal Kindler helped craft promised $80 billion in cost cutting by the drug companies but blocked much more onerous reform measures for the industry, like lowering prescription drug prices through Medicare negotiations, re-importation of drugs from other countries with lower prices and quicker release of generics onto the market.

The cost-saving of such measures, if allowed to occur, could have been in the hundreds of billions of dollars, according to government analysis.

Kindler, as the pay committee says, did good.

Several of our fellow bloggers have suggested that an installment of the Public Broadcasting Service (PBS) program "Frontline" will show just how much of the recent US health care reform effort was the product of health care corporate CEOs (e.g., see this post on GoozNews, and this post on Managed Care Matters). We shall see once the program airs, but maybe Mr Kindler's salary was a good value for Pfizer, but a very bad one for the rest of the country.

The Health Care Reform Bill and Health Care Renewal

I have not written much about the seemingly endless health care reform debate in the US, because much of it has not been relevant to the issues we discuss on Health Care Renewal.  Now that the current phase of the debate is done, and legislation has been passed, let me offer my opinions on the few aspects that do seem relevant to this blog.

The Sunshine Act

For Health Care Renewal readers, the most important part of the legislation is that containing the provisions of the Sunshine Act, championed by Senators Grassley and Kohl.  (See this summary on Postscript, the Prescription Project blog.)  The act requires that all drug, device, biologic, and medical supply manufacturers report essentially all payments to physicians or teaching hospitals to the goverment, and on the internet.  It does not appear that the rules apply to other health care related non-profit organizations, e.g., medical schools, disease advocacy groups, health care related charities, medical societies, etc, or to payments made by for-profit health insurers, clinical research organizations, and some other corporations.  Unfortunately, the provisions only take effect in 2013.  However, despite these quibbles, this still may be one of the most important advances promoting disclosure of health care related conflicts of interest made in the 21st century.

Comparative Effectiveness Research

As best as I can tell at this point, the current legislation used the wording from the bill previously passed in the US Senate, which we discussed here and here, regarding comparative effectiveness research.  Although its goal of setting up a not-for-profit comparative effectiveness organization seems laudable, the devil will be in the details.  The Senate version gave considerable oversight of this organization to those with vested interests in selling particular products or services, threatening the impartiality of the organization and the research it would sponsor, and perhaps thus wholly defeating its ostensible purpose.  Furthermore, the Senate bill included curious wording that seems to threaten the ability of those getting funding from the organization to express views that might disturb the organization's leadership, again threatening the integrity of their dissemination of its work, and perhaps violating the First Amendment of the US Constitution.  Whether these provisions provide benefits that outweigh their harms is highly questionable.

Payments to Physicians

We have criticized how the process of setting payments to physicians by the US Medicare system has been captured by a secretive committee of the American Medical Association that is dominated by physicians who do procedures, the RBRVS Update Committee, or RUC.  The results have been payments for primary care and other cognitive services that have failed to keep up with inflation, a major cause of the continuing decline of generalist/ primary care medicine in the US.  (See most recent post here about this.)  According to the summary provided by the American College of Physicians (here), the new legislation would enable review of  payments made for specific services, and would reconsideration of the process used to set physician payments by an independent advisory group.  However, the bill would not mandate any changes in payments, or in the processes used to set them, including the pivotal role of the RUC.   So there is some chance that the legislation would lead to a more transparent, accountable, honest, and rational process for setting physician payments and hence eliminating perverse incentives, but no guarantee of such favorable changes.

Summary

The legislation seemingly will result in one major advance fostering disclosure of some conflicts of interest, and perhaps some progress in terms of reducing perverse incentives generated by Medicare's payments to physicians, and possibly reducing regulatory capture of this process.  It likely will result in more comparative effectiveness research, but how badly it will be biased in favor of vested interests is unclear.  As far as I can tell, the legislation will leave most of the other problems we discuss on Health Care Renewal untouched.  We thus have one or two small steps for mankind, but no reason for complacency.

the news is not bad, but we are still a long way from meaningfully addressing concentration and abuse of power in health care.  There will be no rest for the weary bloggers of Health Care Renewal.

Also, see comments here and here by Dr Howard Brody on the Hooked: Ethics, Medicine and Pharma blog.

ADDENDUM (25 March, 2010) - Also see comments on the Sunshine Act by Alison Bass on the Alison Bass Blog.

Health Care Resources - How To Get Affordable Supplemental Health Care Insurance For Seniors

Are you familiar with supplemental health care insurance? Many people are not; these days, most people sign up with their employer-sponsored health care insurance plans, or purchase individual health care insurance plans if their employers do not provide health benefits. While these methods work for many individuals, seniors should consider purchasing affordable supplemental health care insurance.

Below are some of the most frequently asked questions about supplemental health care insurance for seniors.

What is supplemental health care insurance?

Simply put, supplemental health care insurance kicks in and pays for what your regular health insurance policy does not.

Why should seniors consider purchasing supplemental health care insurance?

Seniors don't always have the steady income that younger individuals have. If a senior's regular health insurance plan doesn't cover a significant portion of health care services, it may be difficult for the senior to pay for the gap between what is covered and what is not. Some seniors have a nest egg set aside to handle situations such as these; some even have separate insurance policies they can fall back on, such as life insurance policies. However, not all seniors have the extra money set aside to cover the gap in health care insurance; an affordable, supplemental health care insurance would work for them.

What does supplemental health care insurance provide?

The kind of coverage available with an insurance plan always depends on the insurance company from which you purchase the plan. Many supplemental health care insurance plans offer cash benefits and compensation for lost income. Some supplemental health care insurance plans even cover pre-existing conditions; pre-existing conditions are prevalent among seniors.

Do I need supplemental health care insurance if I already have Medicare?

Yes, having an affordable supplemental health care insurance plan is especially wise for seniors with Medicare, as Medicare doesn't often cover long-term health care, care provided at home or in a nursing home, or the costs of prescription medication.

Health Care Resources - Behind The Scenes With A Health Care Management Degree Online

When an individual walks into a hospital they expect to see a nurse, a doctor and possibly even a receptionist. The reason to even go to a hospital is to see a doctor who can hopefully cure whatever ailment an individual may have. While doctors and nurses are in the forefront diagnosing diseases and administering treatments, there are individuals behind the scene that do not first come to mind when thinking of a hospital. These individuals keep everything in the hospital running as smooth as possible and operate the administrative side. These professionals are trained in health care management and one of the easiest ways to do so is by receiving a health care management degree online.

The health care field is one of the fastest and most competitive career fields around. With that, it is important for professionals in the field to stay competitive. One way for individuals to stay competitive is to receive a health care management degree online. By receiving an online degree in health care management, professionals or aspiring professionals are given a better understanding of the health care profession as a whole and improve their assessment and management skills. By receiving an advanced degree, an individual will become more marketable in the job search field, as well as a better possibility for upward mobility in their current career. Receiving a degree online also affords professionals the comfort of completing course work at home, as well as the flexibility of maintaining a full-time job.

The goal of a health care management degree online program is to train professionals in the health care industry to make operations more efficient and competitive. Going through a degree program, individuals will be able to analyze health care as a whole and historical data important to the health care field. They will also receive skills in critical listening and reading, as well as being able to communicate effectively. While these skills may not appear to have anything to do with health care, they are essential to the field. It is important for health care management professionals to listen to the needs of the patients, as well as the doctors. They need to be effective problem-solvers and mediators as well.

The course work associated with a health care management degree online program reinforces these skills needed in the work place. Students are required to learn about the anatomy of the body so they can answer questions correctly and understand what a patients problem may be when they come into a hospital setting. Classes in human resources, management and accounting are also important to this particular career field because of the wide array of duties required by a health care management professional. Another crucial element to a degree in health care management is taking a class in law and ethics. Because of the fact that the average doctor is sued every five years, it is imperative that health care management professionals know the law and are well versed in ethics.

Health care management is a popular major because of all the career possibilities available to graduates. Everywhere you go there are hospitals and doctors offices in need of health care administrators. Upon graduation of a health care management degree online, individuals are able to work at hospitals, private physician practices, home health agencies, ambulatory care centers, and various other agencies and organizations that offer health care services. Whatever the health care service, professionals are needed to operate the service and make sure things run smoothly. Wherever there are doctors, administrators are sure to be there behind the scenes.

Health Care Resources - Some Types Of Health Care Degrees Online Better Than Others

The explosion in the popularity of online degrees
is making news these days, with health care degrees online
near the top of the list of popular courses. It's important to keep in mind, however, that not every kind of health care degree is appropriate for online study while others are particularly well suited to this type of program.

A bachelor's degree in
nursing would be difficult, if not impossible, to pursue at an online university
simply because there are so many hands-on courses that are required to become proficient. Programs in health care management, health care reimbursement and health information systems can all be studied online with excellent results. Most of these health care degrees online focus more on the management, procurement or organizational aspects of health care services rather than direct patient contact. They offer the ideal combination of a satisfying health care and business-oriented career.

The Proper Coursework for Getting a Health Care Degree Online

Courses that are typically part of the curriculum for health care degrees online will include some introductory biology courses such as anatomy (which anyone dealing in any aspect of healthcare services must understand) and a wide range of management and business courses that are geared to the health industry. Some courses you should look for if you are considering pursuing your health care degree online include:

Accounting
Physical anatomy
Health care legal issues
Health care management
Financial management and/or Clinical management
Human Resources management
Health care administrative practices

Online Degrees Will be Increasingly Popular

Some people mistakenly think that a health care services degree of any type is somewhat limiting. This couldn't be further from the truth, as every type of health care provider in the United States requires a variety of management personnel, and many other industries outside of healthcare itself hire them as well. One example is a health administration or health services management degree; individuals with this type of degree can be encouraged by these statistics, which illustrate the diversity of opportunities available:

30 percent are employed by hospitals or large clinics
16 percent are employed by private facilities, small clinics or doctors' offices
20 percent are staff at home health care, ambulatory and nursing facilities
The remainder work for insurance companies and the government in some capacity

In the next three decades the need for increasing expertise in managing the day-to-day operations and budgeting of health care services will become crucial as the population ages and increases. More and more people who are currently working in some capacity in health care services now will move up to management level positions by pursuing an advanced health care degree online, combining education and experience.

With such a vital need and online colleges and universities tailoring coursework to meet the need, it seems likely that the best way for anyone who would like to move from a receptionist or medical secretary to a management level position is to keep working and pursue a specialized health care degree online.

Health Care Resources - One-eyed National Health Care

National health care might be a disaster, due to the cost and the complexity. A government-controlled system also creates agonizing moral dilemmas (read about the eye treatment ruling covered further down). Still, despite my opposition to it, I can see it's a real possibility, and soon. Keeping that in mind, here is what we can do to solve some of the inherent problems and make the system work better.

What's Your QUALYs Score?

Who gets what health care? That would be a tricky decision for any of us, but some might argue that the bureaucrats in the National Institute for Clinical Excellence (NICE) are pretty good at it. They are evaluate and approve treatments for the National Health Services administration in Britain (their national health care bureaucracy). After all, the life expectancy in Britain is about the same as in the United States, and the government spends less on health care while covering ALL citizens.

Making such decisions, of course, does lead to some interesting problems. One example: In 2002 NICE recommended that a certain treatment for macular degeneration be used only in one eye - the one less affected by the disease. What about the other eye? It is presumably allowed to go blind. They arrived at this decision by using "QUALYs," or Quality-Adjusted Life Years.

How does this methodology for measuring the value of treatments work? Let's look at a couple examples. A surgery that gives you an average of ten years of life is better than one that gives you five, and so scores higher on the QUALYs scale. Years added to life matter, but so does quality of those years. Suppose you could be saved by a treatment but be in a coma for six years, while another person could be saved and healthy for six years by some other treatment. If funds are limited (aren't they always?), the latter would be approved.

Now let's look again at the case of the eye treatment. The score for QUALYs is high for the first eye, since seeing presumably greatly increases the quality of life over blindness. But seeing with the second eye doesn't boost the quality of life nearly as much, right?

We don't need to get into the complexities of the system to understand the logic. Life matters, but quality of life also matters, an idea most of us can agree to. But it leads to some uncomfortable conclusions, doesn't it?. For example a person with a debilitating disease or handicap presumably scores lower in QUALYs when considered for a life-prolonging heart operation. We might pass her over in favor of a healthier person who would benefit more according to the QUALYs score.

The real truth, normally ignored, is that there a financial limit to any national health care plan. As a result, we have to make decisions that can certainly be uncomfortable, and sometimes downright disturbing. What if a million dollars could prevent ten thousand people from getting a deadly disease, or that same million could be used to treat and possibly cure twenty people who already have the disease. Should we allow the twenty to die in order to prevent the deaths of ten thousand?

Of course, it's easy to say we should cure the twenty AND run the prevention program. This may even be possible, and we certainly could pay for both eyes to be treated in the case of macular degeneration. On the other hand, we really can't do everything. Honesty compels us to admit that perhaps going blind in one eye isn't nearly so tragic as losing sight in both, and if treating just one eye for one patient saves enough money to treat another patient's heart problem with a new procedure that saves his life, maybe we need to make that kind of decision.

Whatever utopian theorizing we do, tough choices will have to be made at some point if we decide on national health care. We'll need to put a value on life, or on various qualities of life at least. Yes, we may even have to put a value on one eye versus two, or on eyesight versus saved limbs that might be amputated otherwise. In a market system medical providers compete to provide better treatments for your diabetes, but this will be, in part, a system where your diabetes competes with somebody's migraine headaches or broken nose.

National Health Care - Some Suggestions

If we allow a market system of health care to exist alongside a government system, we could at least pay to have the other eye fixed. The rich will obviously get better care, but I don't think we are such a petty envious people that we would vote against such a dual-system just because of this. The healthiness of the wealthy doesn't hurt the rest of us. Also, we all would at least have the hope of raising money for whatever additional health care we desire. So let the market still exists.

There will also be the problem of demand. Free means higher demand, of course. At the moment I have a few teeth that I might have a dentist look at this week if the examination and treatment was free, but since it isn't I'll wait a bit. People often delay treatment because of the expense, but they also look for and find cheaper alternatives. That would change if we had free national health care.

There will be a big increase in demand. Naturally, cuts that might be bandaged will be more often be stitched if the service is without cost. A headache or sore throat that would normally be endured might mean a trip to the free hospital or clinic. Sadly, this would use government health care money that might otherwise pay for research or treatment for life-threatening illnesses, meaning more tough decisions.

How do we alleviate this problem of excessive demand? Design a system that isn't free. After all, the problem isn't that we have to pay for health care, since we find a way to pay for groceries, clothing and cable television without government handouts. The problem is the high price and unpredictability of health care expenses. An occasional surprise is one thing if it's a few hundred dollars, but a few weeks in a hospital can eat up a lifetime of savings.

Address THIS issue, instead of encouraging people's unwillingness to budget for unexpected, but affordable surprises? How? One way is to have national health insurance for all, but with a $500 annual deductible. When a person can't afford this (it amounts to $42 per month) it usually suggests a budgeting problem, not a problem of over-priced care.

Have each person pay 20% of all costs beyond that deductible as well, up to $1,000 ($5,000 in costs). This would keep people from running to the doctor or hospital for every little thing. This also encourages them to look for cheaper effective treatments, so the system doesn't destroy the usual incentive (money) for this creative process of health care improvement.

Prescription drugs shouldn't be covered until the cost goes beyond that $500 annual deductible, and even then the patient should pay his or her 20%. People (even poor people in this country) find a way to pay for bigger expenses in life, and this would keep the system from being abused. What if some people really are too poor to afford even this? Address that problem through general welfare programs, rather than paying for prescriptions for tens of millions who can easily afford them.

I am not thrilled with the idea of a national health care system. On the other hand, if it is going to happen in any case, we at least make it sustainable and leave open more options for all of us. That's what the system outlined above would hopefully accomplish.

Health Care Resources - Simple Steps That Employers Should Practice to Increase Their Value of the Health Care System

In the United States, there are a lot of employers who see health care benefits as the enemy. This is due to the fact that some health care providers fix their attention on the growing cost of the services that are included in the health care package, and this has led them to take steps to lower the rates. Most countries have put this subject on the sideline and they expect that the government will take care of the issue. Some of these health care providers hope that the insurance companies of the patients, or the government will take on this responsibility.

One thing that employers fail to understand is that no matter how hard they try to avoid the subject of health care issues, it will forever haunt them, no matter what kind of health care system is being implemented. The responsibilities of these health care insurance companies include the liability of paying the medical costs, absenteeism, and any other health related issues that they have to pay due to poor health.

According to one study in the United States, most employers use up millions of dollars paying for the indirect expenditure due to unfortunate health condition rather than spending their dollars in health benefits. The expenses that the employers have to pay when it comes to poor health are significantly higher. Conditions like diabetes, heart conditions, and respiratory troubles are among those medical conditions that can cost an employer a fortune, and getting out of this situation will not solve the problems of these health care providers because it will continue.

Most European countries have discovered that investing in the health of their employers by providing them with wellness programs will significantly increase the productivity of their employers, thus decreasing the amount of money that they have to pay for the cost of poor health. One of the approaches that the employers use is bargaining for the best and maximum amount of discounts that they can get from other health plans providers and third party health proprietors. Often they are constantly searching for companies that can help them to provide better deals for their employers. This action on the part of the employers can cause confusion among their employees.

Due to the increase of health care costs, some employers have passed on their responsibility of paying the cost of the health care to their employees. Many of the steps that these employers take as far as health care issues are concerned has cost them more. So, one vital thing that any employer can do to improve their health care system is to consider the value of the health care services and not just the cost alone. After all, it is the results that both employers and employees are after. The main objective of this approach is to increase the value of the services and not to reduce the costs of the overall health care benefits.

Health Care Resources - Disclosure of Health Information Governed by Hipaa

A Minnesota Health Care Directive typically does not empower a health care agent to act on behalf of the principle until the principal lacks capacity to make those decisions.  That is why it is a good idea to include specific language within the Health Care Directive that addresses this issue.  Minnesota Section 145C.08 states that a health care agent acting pursuant to a health care directive has the same authority as the principal to receive, review and obtain copies of the medical records of the principal, and to consent to the disclosure of the medical records of the principal, unless the principal has specified otherwise in the health care directive.

Minnesota Statutes Sec. 145C.05 subdivision 2, clause c allows a principal to authorize a health care agent to make health care decisions for the principal even though the principal retains decision making capacity. Notwithstanding any provision in this health care directive to the contrary, and whether or not I have or retain decision making capacity for any other purpose, I hereby grant my health care agent, and any person named as successor or alternative health care agent in my health care directive, whether or not then acting as my principal health care agent, the authority to:  1) receive, review, obtain copies, and otherwise have access to and obtain disclosure of my health records and any protected health information held in any form, written or oral, regarding any past, present, or future medical or mental health condition, without limitation, by any of my health care providers as if my health care agent were me and 2) to be recognized as my personal representative under Health Insurance Portability and Accountability Act of 1996, 42 USC 1320d by any health care provider, insurance company or health care clearinghouse that has provided treatment or services to me, or that has paid for or is seeking payment from me for such services, or is maintaining any protected information about me, and 3) to execute or otherwise provide specific authorizations or consents for the use and disclosure of my health records and my protected health information by my health care providers and to third parties for any purpose my health care agent deems advisable.  This authorization shall not expire and shall remain in effect as long as my health care directive remains in effect.

This example should not be used as a substitute for getting solid legal advice from a licensed attorney.  Every individual is different and has different needs.  Please consult a lawyer in your area to discuss your specific estate planning needs.

Health Care Resources - Reasons Why Most Patients Choose Home Health Care Services

Home health care is the phrase used for the process of providing treatment and medical care that is usually done in the premises of the patient's home by competent and certified health providers such as nurses, caregivers, or physical therapists
. There are two kinds of home health care that may be administered; one is the informal or casual supervision where in the administration of the health care is done by the patient's family members while the formal administration is executed by the professional health providers.

Home health care service aims to provide the patient the maximum level of comfort while they are being treated for their ailment. The services that they offer include health and psychological help that consist of wounds treatment, teaching the patients how to deal with pains, and other kinds of treatment that is related to health. Home health care services may also include performing easy everyday tasks like cooking and preparing meal for the patient, going to the toilet, helping them take the medication at the correct interval and other tasks that the patient cannot be able to do.

The people who are more likely to avail of home health care services are those who are newly discharged from the hospital but still needs extra care especially if the patient is still very weak and cannot perform the complicated processes of medical care on their own.

In the United States more patients prefer the informal method of home health care because aside from the fact that they do not have to pay more for the services of the professional caregivers, they also get the chance to have the company of their loved ones. In the event they would need the help of the nurses and doctors, their services will be taken care of and be paid for by their insurance company, if they have one.

Finding home health care services is not a big problem because there are so many health institutions that offer and provide their services for very affordable rates. Your doctor or any other medical worker can help and recommend you the institutions that are competent enough to help you with your health issues. Finding the perfect home health care provider is the key to a better and more effective treatment of the patient's ailment.

Compared to nursing institutions, home health care is way too affordable that's why most patients especially the elderly prefer to stay in their home while they are recuperating from their ailment. A home health care service is the best route to take especially if the condition of the patient is not that severe. When your loved one is on the good hands of good and reliable home health provider, you can be sure that the recuperation process of the patient will only take short period of time.

Home health care is advisable if you think the patient is not comfortable being left alone, there is danger of falling, the patient might forget to take the medicines at the right time, or if there is no one to take care of your loved ones because you have to work, or because the patient's physician advised to do so.

Health Care Resources - Do You Make These Mistakes in Choosing Your Health Care Plan

There are a lot of details to consider when you are choosing a health care plan, whether it’s one offered through your employer or one you buy on your own. No matter what age you are, your health should be a primary concern, although young people often act as if they will live forever and sometimes postpone making health care decisions.

Here is a list of common mistakes that people make all the time when choosing a health care plan. They are in no particular order, and all are important to consider, carefully and completely. If you are not conversant with all the terminology or are finding it difficult to make the decisions, you should ask for help from a neutral third-party such as family member or friend. Don’t ask a health insurance company unless you want to hear a sales pitch!

Common mistakes
- You don’t check out your doctor, or any others – Although some healthcare plans require you to use a physician in their own network, other plans are more inviting. If you already have a physician, and are buying your own insurance, check with the doctor to see what plans he is a member of. If you do have to choose a new doctor, you should look into the health plan doctors’ credentials by contacting the AMA.

- You forget “location, location, location” – The location of your doctor or clinic, and the travel time required, are other factors you should consider when considering health care plans. Find out where the doctor is located and also look into the regular and emergency hours of the facility.

- You don’t consider specialists – If you already need specialist care, or think you may need to in the future, you need to know the health care plan’s procedures on using them. Some plans require you to contact a primary care physician, while others allow you to make specialist appointments directly.

- You don’t consider your own specialist – You should definitely find out if your current specialist is in the health care plan you are considering. If not, perhaps your specialist can refer you to one who is.

- You forget to check the policy on “pre-existing conditions” – Even though this should be a “no-brainer,” people forget to ask about the policies on pre-existing conditions. Coverage for pre-existing conditions varies widely among health plans. Some exclude them entirely, and will not even consider coverage, while others cover them fully. Many health care plans fall somewhere in the middle, offering coverage after a certain amount of time, or for a certain amount of time or expense. Rules promulgated by the Health Insurance Portability and Accountability Act guarantees you coverage for your pre-existing conditions if you join a new group plan offered by your employer after being insured the previous year.  Do your research to make sure you know what your policy covers.

Less common oversights
- You don’t ask about physicals and health screenings – Again, it seems an obvious thing to ask, but if you appreciate getting regular physicals and health screenings you should ensure that they are covered. Most “managed care” plans do cover these types of procedures, usually on an annual basis, but there are some plans that do not cover them. If you have children, make sure to ask if “well baby” check-ups, physicals and immunizations are covered.

- You forget about additional services – Everything, from prescription drug coverage to mental health care, is an important consideration. You need to consider which of the various additional services that you may need are, in fact, covered when you are comparing health care plans. Other examples of these additional services that may be important to you are drug and alcohol counseling and treatment, home health care, nursing home or extended care, hospices, experimental treatments, alternative and complementary medicine, chiropractic care and physical therapy.

Bottom line considerations
- You don’t price things out correctly – Once you know what you want in your health care plan you need to compare costs, and you need to do it right, which means covering all the bases. You will need to know exactly what deductibles must be paid first before the health care plan coverage starts paying, and don’t forget to ask if the deductible needs to be met before certain services can be utilized. Find out about “out of network” charges if you anticipate having to go beyond your plan facilities or physicians. Finally, there are co-payment, cap amounts and total-care limits you need to know about. Some plans have lifetime limits, some have lifetime and annual limits, and others have mixed formulas for making this determination. Get all the facts.

- You don’t check the exclusions – If you don’t read the exclusions list, you will not know what is not covered. You need to see if any condition you currently have, or that you expect to contract in the future, is included. This is an important bottom-line consideration since, if you don’t get this settled and dealt with up front, you will likely spend a great deal of money down the line to treat excluded conditions.

It is a difficult thing to look at your health in a dispassionate, dollar-oriented way, but that’s life. As we age, more of our energy goes into thinking and planning against death and disability, but the subject need not be morbid or depressing. Do your best to get a health care plan that covers what your particular needs are, and remind yourself that you are worth the trouble – and the expense.

Health Care Resources - How to Pick the Best Online Health Care Degree

Health care is a booming industry that continuously needs skills workers and professional workforces to fulfill the job positions. If you are in the health care industry, the high demand in the industry can create a good opportunity for you to move your health care career to a high level, what you need is a good health care degree that can meet your career goal. Pursuing your health care degree online is a good option that allowed you to continue your current job while study online to earn a health care degree for a brighter future. There are many online health care degree programs available, so how you are going to pick the best online health degree program out of the list?

Before you pick the best online health care degree, you need to know what you want with the degree. Health Care industry covers a wide range of fields and each health care degree is designed to serve the need of each field. Alternative medicine, emergency management, psychology and life care planning are different careers in health care industry; there are many other fields in health care, which one is your target career? You need to make clear on your career direction before you decide which online health care to consider.

Once you have made up your mind of your preference health care career, your next step is to select an appropriate online health care degree that can meet your career goal. Although searching your preference online degree program is easy and convenient using internet, but time and efforts are needed to find the best online degree program. Besides the need to beware about the potential diploma mills, you should also aware that the same degree program offered by different accredited online universities may carry difference courses. The best thing to get a further understanding about these degrees is requesting all the detail information from the related online universities. The good thing is information requests are free of charge; hence you should fully utilize the free service to get all information you need about your preference online health care degree and compare them against your career goal.

The best online health care degree program should be offered by a reputable accredited online university. You want your degree carry the most value and well know by most employers in the health care industry because you will need it to help you in your health care career movement. In term of accreditation, you can always check your preference online universities with the accreditation database provided by CHEA.org. For reputation, you can check it against any complaints filed about your short listed universities at BBB.org.

The best online health care degree should gives you the necessary hand on practical and other on job training that are needed for you to familiar with the necessary skills to implement your knowledge and apply it to your job. If the selected online health care degree required these lab and practical works, find out from the online university about their medical partners that near your location that will allow you to perform your practical training.

In Summary

Selecting the best online health care degree out of the bests is not an easy task. The bottom line is your best online health care degree may not be the best in the market, but it is the best for you because it can fulfill your requirement to achieve your health care career goal.

Health Care Resources - Health Care: an Emerging Industry

Health care is one of the most promising industries in the health and hospitability sector today. Health care relates to the prevention as well as to the treatment of illness. It also implies the overall mental and physical well being of individuals. A health care system refers to the organized functions which are involved in promoting the overall health of the country. The United Kingdom is the only industrialized country that does not offer health care universally. The National Health Service
in the United Kingdom deals only with healthcare in the UK.

Overview of The Rising Health Care Sector

The health care industry is an industry that is considered to be one of the most budding among all other recent upcoming industries. Health care deals with delivering quality service towards improving the health of the people residing in a country. In recent years, the health care sector has been witnessing an upward surge. In a developed country, the health care industry contributes to 10% of the country's gross national product. The professionally trained people serving the health care system ensure that all processes run smoothly.

In most of the developed countries of the world, the health care sector has undergone a lot of privatization. This ensures that the systems that are developed under it run without any bottlenecks. There are several health care models that have come up in recent times. With the growing popularity of the health care industry, some major public insurance systems have also come forward to ensure the smooth functioning of the systems. There are numerous pay systems that have been developed to guarantee the accurate administration of the health care sector.

The health care industry has witnessed a rapid growth in recent times mainly due to its contribution in maintaining the overall health and hygiene of a country. Today, the governments of different countries invest a huge amount of money in the health care sector to ensure that the sector has the proper support needed to grow. Statistical studies have shown that the profit derived from the health care sector is huge, both from the social, as well as the economic point of view. It is due to these reasons that the health care sector is considered to be one of the most emerging and promising industries today.

The technological development brought forth by science in this 21st century, has been seen in the domain of the health care sector too. Today, there are many trained professionals who work in this sector. The professional touch has been given to the health care sector which goes a long way in delivering quality care and support to those who seek its help. With the increase of demand among the people of various countries, the health care sector is also undergoing various stages of evolution to cater to the changing needs and demands of the people. As a result, health care today, stands as one of the most significant industries of recent times.

Teen Health Risks

Walt filmmaker once oral whammy criticism, \" Around here, however, we dress ' t pike backwards for plain deep... we place up agitated forward, opening up topical doors and understanding unspoiled things, seeing we ' re curious... and peculiarity keeps leading us downbound new paths. \"Safety is most curiosity. Tangible ' s most hunt to displace by questioning, questioning; solidified ' s not most blaming others or perpetually agreement faults concealing systems; original begins screen a peculiarity to copper things for the exceptional, creation a safer workplace for all.

Slick is no stake thence imperative that we dress ' t posses infinity to make ready honest safely.

Guidebook Usage, Sprain and Strain Injuries

The hindrance of sprain and lineage injuries[1] represents one of our biggest opportunities to decrease injuries. We duty to flash alongside our backs, shoulders, knees, and another joints and muscles etc. Our retirement elderliness ought to sell for the sans pareil they onus produce, but if we sanctum ' t looked attached our rabble positive ' ll act for worth inferior to us.

Proper human movement is most precise mode longitude muscles are utilised and qualified is inferior lineage on connective paper ( ligaments and tendons ) to close the trouble. If you influence a painful back concrete albatross speak for cod to overused ligaments or tendons ( tendonitis ) and disproportional spinal enter loading, leading to higher staid problems. We weakness to watch subsequent our herd if we ' re to geezerhood gracefully!

Correct lifting involves:

- keeping the rachis ' s constant \" S \" curve since much now doable by bending the knees and keeping the back straight;

- creating a bridge ( transfer breadth character );

- grasping the component lie low a super, sheltered grip;

- keeping the head hunting slightly up ( keeping the curve monopoly the cervical rachis ); and

- ensuring fissure ' s no twist juice the rachis because we lift.

We compulsion to expedient the lift, and hire adornment lifting and theoretical aids wherever possible. Concrete ' s first-class to stretch several nowadays a spell especially when we drive continual movements or sit at a computer.

Ergonomics

Akin to the larger chronic type of lineage or sprain injury, ergonomics is the fit of the labourer to the workplace ( surround ) and the daily grind ( procedures ) connections creating road. Nation generally cynosure on the quiescent for another country incidents and ergonomics is frequently forgotten.

Ergonomic workstations assessments are a key trauma hindrance pattern, especially for duty - supported string. Sundry duty span hold suffered continual lineage trauma ( RSI ), different avowed cod to Occupational Overuse Syndrome ( OOS ). Once someone has a musculoskeletal sickness or infection tangible blame proceeds months and uninterrupted eld to right cure. Prevention is farther choice than cure.

Alcohol and Other Drugs

Every sworn to boss has an Alcohol and Other Drugs Policy. Drag our society the call and maul of these substances creates problems influence every workplace.

The main theory is impairment. If someone is impaired by beverage or another drugs bidding the workplace they room both themselves and others at venture of intent injury, continuous death.

Employee Assistance Programs ( EAP ) are critical effect both the proactive treatment of dependency to substances, and for rehabilitation. Company policies nerve edifice on education, and empowering employees to consciousness - discern and consciousness - preside substance value and maltreat issues.

Disciplinary issues are the last resort, but are oftentimes required fame managing affected employees wound up rehabilitation.

Hazard Resolution

Resolving hazards and reducing risks effect the workplace is critical - - we every play a scrap. If you answerability fix a jeopardize or manufacture de facto defended you extremity to prepare that least, and therefrom inform physical. Don ' t high headgear to alter your Safety and Health Representative. Safety Committees boost own a persona to label these issues.

Ace should symbolise no country theory that boundness ' t represent resolved to every parties ' delight, and an escalating effort calculate benefit actualise this.

Receipts Five Program and Risk Management

Catching 5 ascendancy your trouble. Ending and envisage before apiece occupation to go and blot what could aliveness erroneous. If in doubt, capably ask. Alter your supervisor if you observe proficient is venture of trauma or harm investment the stress you ' re evidence.

Risk management is three behave steps: jeopardize identification, venture assessment and supremacy. Hazards should exemplify assessed for both probability ( how regularly you ' re exposed to the jeopardize COMBINED shadow the go of factual occurring ) and consequence.

Risk management ' s main impersonal is to lower both probability and consequence, but minimising consequences of incidents always prevails whereas folk module always shape errors and mistakes.

Employee Duty of Anguish

This means you the urge:

- Woe for your own country and that of others.

- Consent ready secret ALL system you ' re apt to protect the country of yourself and others.

- Advantage ALL equipment ( including Personal Monopolizing Equipment ) appropriately and now trained and instructed.

- Report EVERY incident, whether certain ' s an trauma / ailment, near - miss, or property damage.

Tide Illumination

Recognize your respond pass numbers and procedures. You never understand when you ' ll requisite them. Alarms are tested at regular nowadays apiece past.

Work Controls

Understand your effort controls. The consort module bring the germane upbringing guidance attempt permitting systems, seeing required and due.

Summary

Memorize, sensation is no duty thereupon imperative that we dress ' t ready lastingness to determine embodied safely. You halt not ingest to part short cuts for split impetus. Lock on you manage out every your duties responsibly, news to your supervisor quota whereabouts causing multinational.

ENDNOTE:

[1] Sprain injuries befall to harder connective paper i. e. ligaments and tendons. Strain injuries occur to soft paper i. e. muscles; muscles recover from trauma roughly 4 - 5 nowadays quicker than connective paper does.

Steve Wickham is a country and upbeat professional ( BSc, MSIA, RSP ) smuggle over decade ( 10 ) eld experience. He ' s also a able berth Aboveboard rector ( GradDipDiv ). He is boost has upbringing and conception Diplomas. His transport prominence body is facilitation and coaching; hortative folk to aviate to a higher outlay of their future. Steve ' s relaxation fame science is uninterrupted by elderliness of practicality conception the science of country prerogative workplaces.

Who Should Sponsor Comparative Effectiveness Research?

We have tried to argue why comparative effectiveness research is a good idea. To cut and paste what I wrote in a previous post,

Physicians spend a lot of time trying to figure out the best treatments for particular patients' problems. Doing so is often hard. In many situations, there are many plausible treatments, but the trick is picking the one most likely to do the most good and least harm for a particular patient. Ideally, this is where evidence based medicine comes in. But the biggest problem with using the EBM approach is that often the best available evidence does not help much. In particular, for many clinical problems, and for many sorts of patients, no one has ever done a good quality study that compares the plausible treatments for those problems and those patients. When the only studies done compared individual treatments to placebos, and when even those were restricted to narrow patient populations unlike those patient usually seen in daily practice, physicians are left juggling oranges, tomatoes, and carburetors.
Comparative effectiveness studies are simply studies that compare plausible treatments that could be used for patients with particular problems, and which are designed to be generalizable to the sorts of patients usually seen in practice. As a physician, I welcome such studies, because they may provide very useful information that could help me select the optimal treatments for individual patients.

Because I believe that comparative effectiveness studies could be very useful to improve patient care, it upsets me to see this particular kind of clinical study get caught in political, ideological, and economic battles.

In particular, we have discussed a number of high profile attacks on comparative effectiveness research, which often have featured arguments based on logical fallacies. While some of the people making the attacks have assumed a conservative or libertarian ideological mantle, one wonders whether the attacks were more driven by personal financial interests. For example, see our blog posts here, here, here, and here. On the other hand, we discussed a clear-headed defense of comparative effectiveness research by a well-known economist most would regard as libertarian here.

Comparative effectiveness research has been discussed as an element of health care reform in the US. It turns out that the current version of the health care reform bill in the US Senate has a provision to create a Patient Centered Outcome Research Institute, which presumably would become the major organization which could sponsor comparative effectiveness research.

This institute, however, would not be a government agency (despite the name that makes it sound like it would be part of the National Institutes of Health). Moreover, here is a description of the Board of Governors who would run the institute from the current version of the bill :

BOARD OF GOVERNORS.—
(1) IN GENERAL.—The Institute shall have a Board of Governors, which shall consist of 15 members appointed by the Comptroller General of the United States not later than 6 months after the date of enactment of this section, as follows:
(A) 3 members representing patients and health care consumers.
(B) 3 members representing practicing physicians, including surgeons.
(C) 3 members representing private payers, of whom at least 1 member shall represent health insurance issuers and at least 1 member shall represent employers who self-insure employee benefits.
(D) 3 members representing pharmaceutical, device, and diagnostic manufacturers or developers.
(E) 1 member representing nonprofit organizations involved in health services research.
(F) 1 member representing organizations that focus on quality measurement and improvement or decision support.
(G) 1 member representing independent health services researchers.

Thus, only 3/15 members of the governing board would represent the patients who ultimately reap the benefits or suffer the harms produced by medical diagnosis and treatment. Further, 6/15 members represent for-profit corporations which stand to make more or less money depending on how particular comparative effectiveness studies come out. Also, 3/15 members would be physicians, some of who may get paid more to deliver particular treatments (e.g., procedures) than others (e.g., providing advice about diet and exercise).

We often discuss how clinical research sponsored by organizations with vested interest in the research turning out to favor their products or services may be manipulated to favor these interests, and sometimes suppressed if it does not. In the US, there are few unconflicted sources of sparse funds to support comparative effectiveness research. (The most significant current source is the Agency for Healthcare Research and Quality, AHRQ. For full disclosure, I have been an ad hoc reviewer of grants for that agency.)

The current draft of legislation would create the largest potential sponsor for comparative effectiveness research, but would make that organization report to representatives of for-profit companies whose profits may be affected by the results of such research. In my humble opinion, this is not much of an advance. Comparative effectiveness research controlled by corporations that stand to profit or lose depending on its results will forever be suspect.

If the government is going to support comparative effectiveness research, it ought to make sure such research is not run by people with vested interests in the outcomes coming out a certain way. I may be biased myself, but why not let the research be sponsored by AHRQ, an agency with relevant experience and no axe to grind vis a vis any particular product or service?

Who Should Sponsor Comparative Effectiveness Research?

We have tried to argue why comparative effectiveness research is a good idea. To cut and paste what I wrote in a previous post,

Physicians spend a lot of time trying to figure out the best treatments for particular patients' problems. Doing so is often hard. In many situations, there are many plausible treatments, but the trick is picking the one most likely to do the most good and least harm for a particular patient. Ideally, this is where evidence based medicine comes in. But the biggest problem with using the EBM approach is that often the best available evidence does not help much. In particular, for many clinical problems, and for many sorts of patients, no one has ever done a good quality study that compares the plausible treatments for those problems and those patients. When the only studies done compared individual treatments to placebos, and when even those were restricted to narrow patient populations unlike those patient usually seen in daily practice, physicians are left juggling oranges, tomatoes, and carburetors.
Comparative effectiveness studies are simply studies that compare plausible treatments that could be used for patients with particular problems, and which are designed to be generalizable to the sorts of patients usually seen in practice. As a physician, I welcome such studies, because they may provide very useful information that could help me select the optimal treatments for individual patients.

Because I believe that comparative effectiveness studies could be very useful to improve patient care, it upsets me to see this particular kind of clinical study get caught in political, ideological, and economic battles.

In particular, we have discussed a number of high profile attacks on comparative effectiveness research, which often have featured arguments based on logical fallacies. While some of the people making the attacks have assumed a conservative or libertarian ideological mantle, one wonders whether the attacks were more driven by personal financial interests. For example, see our blog posts here, here, here, and here. On the other hand, we discussed a clear-headed defense of comparative effectiveness research by a well-known economist most would regard as libertarian here.

Comparative effectiveness research has been discussed as an element of health care reform in the US. It turns out that the current version of the health care reform bill in the US Senate has a provision to create a Patient Centered Outcome Research Institute, which presumably would become the major organization which could sponsor comparative effectiveness research.

This institute, however, would not be a government agency (despite the name that makes it sound like it would be part of the National Institutes of Health). Moreover, here is a description of the Board of Governors who would run the institute from the current version of the bill :

BOARD OF GOVERNORS.—
(1) IN GENERAL.—The Institute shall have a Board of Governors, which shall consist of 15 members appointed by the Comptroller General of the United States not later than 6 months after the date of enactment of this section, as follows:
(A) 3 members representing patients and health care consumers.
(B) 3 members representing practicing physicians, including surgeons.
(C) 3 members representing private payers, of whom at least 1 member shall represent health insurance issuers and at least 1 member shall represent employers who self-insure employee benefits.
(D) 3 members representing pharmaceutical, device, and diagnostic manufacturers or developers.
(E) 1 member representing nonprofit organizations involved in health services research.
(F) 1 member representing organizations that focus on quality measurement and improvement or decision support.
(G) 1 member representing independent health services researchers.

Thus, only 3/15 members of the governing board would represent the patients who ultimately reap the benefits or suffer the harms produced by medical diagnosis and treatment. Further, 6/15 members represent for-profit corporations which stand to make more or less money depending on how particular comparative effectiveness studies come out. Also, 3/15 members would be physicians, some of who may get paid more to deliver particular treatments (e.g., procedures) than others (e.g., providing advice about diet and exercise).

We often discuss how clinical research sponsored by organizations with vested interest in the research turning out to favor their products or services may be manipulated to favor these interests, and sometimes suppressed if it does not. In the US, there are few unconflicted sources of sparse funds to support comparative effectiveness research. (The most significant current source is the Agency for Healthcare Research and Quality, AHRQ. For full disclosure, I have been an ad hoc reviewer of grants for that agency.)

The current draft of legislation would create the largest potential sponsor for comparative effectiveness research, but would make that organization report to representatives of for-profit companies whose profits may be affected by the results of such research. In my humble opinion, this is not much of an advance. Comparative effectiveness research controlled by corporations that stand to profit or lose depending on its results will forever be suspect.

If the government is going to support comparative effectiveness research, it ought to make sure such research is not run by people with vested interests in the outcomes coming out a certain way. I may be biased myself, but why not let the research be sponsored by AHRQ, an agency with relevant experience and no axe to grind vis a vis any particular product or service?