This week the traveling road show is in Barcelona, where we are attending the annual meeting of the European Society of Cardiology. Immediately upon arrival at the convention center we were greeted by a 30 feet high banner from Novartis Pharmaceuticals that admonished us to “Aim Higher”, in reference to one of their newer high blood pressure medications. It wasn’t clear whether the reference was to aiming at higher drug costs or higher levels of blood pressure control, but we all know that what Novartis really wants is the former, although they might try and convince you that they are interested in the latter.

I noticed that the line for cabs was about 200 cardiologists long, while there were hardly any cabs pulling up. I personally prefer taking public transportation in foreign cities as you get a better idea of the city and it is, well, cheaper and better for the environment. With the metro stop right next door it makes you wonder what lengths those cardiologists will go to to avoid mixing with the rabble.

Anyhoo upon passing the snaking line of cardiologists I was handed a card by a young lady as I entered the convention center. I thanked her and looked at the card as I walked in. Surprisingly it was for the El Cabaret Strippers Club in Barcelona. I immediately twittered the news and received various feedback including laughter and being accused of being a misogynist. As I continued following the signs to the hall where Mrs. Bremner was to lecture on Non-obstructive coronary artery disease in women, or Syndrome X, the signs routed me directly through the cavernous exhibit hall where drug and device manufacturers tout their wares. After freaking out about a 40 foot high model of a person with pulsating veins suspended from the ceiling, I tried to scuttle past the vendors averting their eyes and looking for the ephemeral lecture hall. I couldn’t help but be distracted, though, by the Medtronics booth, who I wrote about a while back in reference to their picking up the tab in the VIP room of the Platinum Club strippers place in Memphis for a bunch of surgeons who were brought in to learn more about Medtronics spinal devices. Inhibiting the urge to ask them if they were picking up the tab for the ESC meeting too, I continued on to the lecture, where we learned that 50% of women who undergo diagnostic catheterization do not have evidence of coronary artery obstruction, versus 20% of men.

As I left the convention center attractive young women were seen walking around holding signs over their heads saying ‘Novartis’ and ‘GSK’, followed by laughing groups of cardiologists.

As I reflected on my experiences I wondered who in fact were the hookers and the patrons. Were the physicians the patrons of prostitutes, or was it the other way around, were the physicians prostituting themselves to device and drug makers?

I tried to get a picture of the El Cabaret but got the following message when I searched for it on the internet.

La página que desea visualizar ha sido filtrada por el sistema, ya que su contenido ha sido clasificado dentro de las categorías no permitidas.
	permite limitar el acceso a páginas web con contenidos no apropiados, eliminar la publicidad y controlar la descarga de determinados archivos. Si considera que ha habido un error, por favor, seleccione su caso en el siguiente formulario, pulse el botón enviar y si nos indica un email le daremos una respuesta una vez hayamos analizado su petición:

Accompanied by a pair of happy Catalonian children surfing the net. I guess they were too prudish in my apartment here to let me look up El Cabaret. I think the cardiologists at ESC should pick up some pointers from them.

Plos Medicine has just release over 1500 documents which you can peruse here on ghost writing which they obtained through legal action in cases on use of hormonal replacement therapy (HRT) in post-menopausal women. You can plod through the individual Tiff files but the always useful University of California at San Francisco Drug Document archive will soon be putting them up in indexed format here so you can soon be reading about Timothy Kuklo MD and all of your other friends like the guy from Columbia who published a fraudulent article on the power of prayer for in vitro fertilization who I found on there right away.

Speaking of Columbia, their medical school seems to be putting out their fair share of turds recently, to whit the professor who was quoted in the NYT article on ghost writing for prempro that it was “too much work” to actually look up and read all of the articles required for a review paper. She of course had a ghost writer do it for her, for which she got a pay check and a free publication, which helped her get academic promotion, and more “writing” gigs presumably. I find that particularly depressing since I have written numerous reviews for which I spent hundreds of hours and did painstaking research and didn’t have someone do it for me.

I have been amazed at how many physicians continued to write about the benefits of HRT even after (as I wrote in my book, see sidebar) studies like the Women’s Health Initiative (WHI) showed that they increased the risks of cancer and heart disease, rather than decrease them. Now I think I understand why, since Wyeth financed the writing of over 60 papers about HRT which they hired private “ghost writing” firms to write, and then recruited academic physicians to put their names on as authors to add prestige and credibility. It only leads me to the conclusion that my profession is filled with corrupt sociopaths and that the publishing companies who participated in this scam are part of the problem.  

Plos was able to get the judge in the HRT litigation to release these 1500 documents because he appropriately concluded that this practice was putting the public health at risk by creating a biased and at times fraudulent body of “scientific literature” that leads to misinformation.

As other bloggers have pointed out medical schools seem to have an inordinate amount of corruption and cheating. I think that is because MDs have a sense of entitlement and because so called non profit academic medical centers are really anything but. It is all driven by money, and many academic physicians use their record of publishing as a way of getting lucrative consulting and speaking gigs. Then the drug companies pay them to put their names on papers, which helps the drug companies, but also helps the academic physicians have longer publication records. Drug companies also help them make more contacts and in general become more successful so it is a win-win situation. We used to call these charmed individuals “shining lights”.

Grady Hospital, the public hospital here in Atlanta GA that provides care for the indigent sick, has been having financial troubles in recent years with multimillion deficits. Now based on the recommendations of an outside consulting firm they have proposed saving money by denying dialysis treatments to Non-citizens. For those who are not familiar with it, dialysis is a procedure performed two or three times a week in patients with kidney failure which uses a machine to remove toxins from the body that are normally removed by the kidneys. Taking away dialysis is a death sentence. The brilliant plan of Grady includes giving people plane tickets to Connecticut or back to their home countries, or letting them go to the Emergency Room if and when they start dying.

This is so obviously an unethical procedure that it makes you wonder how anyone who calls him/herself a member of the medical profession can go along with this. It obviously is a violation of the Hippocratic oath which states that doctors should not do harm. Come to think about it, our entire medical system, which has people making a profit from people’s sickness, along with everything that goes along with that, like riscission (insurance companies dropping people after they develop a chronic illness), churning tests and procedures that do not benefit patients health, and now making non-citizens walk the plank in the name of saving money, is a violation of the Hippocratic oath. I think a system that incentivizes medical personnel to undercut health is immoral.

Our letter to the New England Journal of Medicine on CBT and Zoloft for childhood anxiety disorders based on original post here (”Effects of Zoloft on Childhood Anxiety Incredible Indeed“) was published here with several others as well as a response from the authors. Mrs. Bremner and I criticized the use of “somewhat improved” over a continuous measure of anxiety but they responded that their outcome was “science” so I guess it is hard to argue with that.

Billy Tauzin, head of PhRMA, scored today when he revealed that he had struck a secret deal with the White House when he negotiated an agreement that the pharmaceutical industry wouldn’t have to give up more than 80 billion dollars in profits. This came about when it was revealed that the House was discussing a plan to (gasp) give the government the right to negotiate drug prices in any new public option healthcare plan.

Billy Tauzin, head of PhRMA, strutting his stuff.

Anyone who can go from negotiating the Medicare Prescription Drug Act as a congressman, a huge windfall for pharma that eliminated the right of the government to negotiate prices, to a bonus of 2 million dollars as head of PhRMA, without a federal enditement, deserves some kind of prize.

Why we have to negotiate with these guys who probably should be behind bars for how they have screwed the American public over the past decade or two is beyond me.

However if you take away the right to negogiate prices then sooner or later you are going to get runaway medical costs.

Meanwhile, those large crowds of chowder headed peoples that are being herded onto buses to mob Congressman and shout out angry statements about healthcare are being organized in part by convicted criminal Rick Scott who as head of the for profit hospital chain HCA had to pay 1.7 billion in fines for fraud. He now heads the healthcare industry front organization Conservatives for Patient Rights.

Karen Ignagni, head of the American Insurance Health Plans (AHIP), the health insurance lobby, gets the Golden Greed award for electing to make no concessions and choosing to go full bore against public option healthcare insurance. Why we should continue to pay bloated and ineffecient healthcare insurance companies just because, well, they want us to, any more than we should pay Chrysler to make cars we don’t want, is beyond me. They use a lot of bogus rhetoric about stopping socialized medicine and innovation in healthcare but it is all just a bunch of nonsense. They have the gravy train going and they don’t want it to stop.

Karen Ignagni, head of AHIP health insurance lobby

 Karen my dear I think you may find yourself out in the cold and all your friends may have run off with all of the yummies. Obama is not gonna wanna play with you anymores. Especially when you wouldn’t give insurance coverage to his momma when she was dying of cancer. Oops.

Amidst all the bluster and misinformation here was an interesting piece on cbsnews.com called “Top 10 myths about healthcare reform”

1. The House Health Care Bill Mandates or Encourages Euthanasia

At a tele-town hall meeting with members of the senior advocacy group AARP last month, President Obama could not help but describe one question he received as “kind of morbid.”

“I have been told there is a clause in (the health care bill) that everyone that’s Medicare age will be visited and told to decide how they wish to die,” said a caller named Mary from North Carolina. “This bothers me greatly, and I’d like for you to promise me that this is not in this bill.”

There is nothing in any health care reform bill before Congress that would require people to “decide how they wish to die.” Conservative talking points from activists and legislators, however, would suggest otherwise.

In fact, section 1233 of the House bill would allow Medicare for the first time to cover patient-doctor consultations about end-of-life planning, including discussions about drawing up a living will or planning hospice treatment. Patients would, of course, seek out such advice on their own — they would not be required to. The provision would limit Medicare coverage to one consultation every five years.

2. Americans Will Lose Their Private Insurance

A prevalent conservative talking point is that the proposed government-sponsored health insurance plan, or “public option,” could drive private insurers out of business and that millions of Americans would lose their current health insurance.

 

In fact, that figure represents Americans who would presumably change their plans voluntarily. The bill does not force private insurers out of business or force people onto the public plan.

 

 

 

3. You Will Be Able to Keep Your Plan

 

 

 

“Here’s a guarantee that I’ve made,” the president said at the AARP tele-town hall conference. “If you have insurance that you like, then you will be able to keep that insurance.”

Democrats would indeed compel employers to continue to shoulder some of the cost burden of health care by creating a “pay or play” mandate, requiring companies to either provide insurance for their workers or pay a fine. However, employer coverage would have to meet certain requirements; for example, plans would not be allowed to charge co-pays for preventive care. It is possible some companies would have to alter their coverage, or would instead choose to drop their coverage all together and pay a fine.

4. The Blue Dogs Are Primarily Interested in Cutting Government Costs in Health Care Reform

“I think, rightly, a number of these so-called Blue Dog Democrats — more conservative Democrats — were concerned that not enough had been done on reducing costs,” Mr Obama said in an interview with CBS News.

Indeed, the Blue Dogs convinced their Democratic colleagues to cut government costs by reducing the amount the government will spend in subsidies to make health care more affordable for low- and middle-income Americans. The compromise also shifts some of the cost of expanding Medicaid from the federal government to the states.

However, the compromise also would require the government-sponsored health insurance option that would be created to negotiate its own payment rates, rather than using Medicare payment rates. This would create a more level playing field for private insurers, Blue Dogs said. The compromise also exempts more small businesses from the “pay or play” mandate, giving businesses a smaller share of the cost burden.

“Allowing doctors and other health care providers to negotiate rates with the government under a public option would cost the government about $60 billion, according to a preliminary CBO estimate,” Politico reported.   “And exempting small businesses with a combined salary of $250,000-a-year to $500,000-a-year would cost the government $30 billion, according to the same estimates.”

5. The Health Care Legislation Mandates Taxpayer Dollars Pay for Abortions

Anti-abortion rights advocacy groups and legislators alike have complained that the health care legislation includes a “hidden abortion mandate,” as some congressmen have put it.

 

In late June, 19 Democrats sent a letter to House Speaker Nancy Pelosi calling the issue a deal-breaker. “Plans to mandate coverage for abortions, either directly or indirectly is unacceptable,” they wrote.

6. Health Care Reform Will Be Paid For

“Health insurance reform cannot add to our deficit over the next decade, and I mean it,” Mr. Obama has said on numerous occasions.

Lawmakers are still grappling with ways to pay for the large cost of expanding health care to all, but they will use at least one accounting trick to make the legislation appear deficit-neutral over 10 years. As part of the proposed reform package, Democratic legislators want to reform projected Medicare payments to avert a 20 percent pay cut to doctors — creating $245 billion in new costs that have not been accounted for.

Democrats argue it does not have to be paid for because they already exempted it from congressional “pay-as-you-go” rules, the AP reported.

Furthermore, while lawmakers focus on trying to create a bill that is deficit-neutral over 10 years, the longer-term costs may be even more difficult to predict. The Congressional Budget Office recently concluded that the legislation under consideration in both the House and Senate would not control costs.

Mr. Obama has said that there will be savings from the efficiencies implemented into the nation’s health care system through the legislation, but those savings are impossible for the CBO to score.

7. Cuts to Medicare?

Republicans have blasted Democrats for planning cuts to Medicare, a program that benefits millions of seniors. President Obama has insisted that there will be no reductions to benefits.

Technically, Republicans are right that health care reform plans include cuts to Medicare’s projected budget; however, Mr. Obama has given specific examples of how cuts can be made by rooting out waste from the program.

The House bill reduces projected increases in Medicare payments to providers by more than $500 billion over 10 years, the Associated Press reports, but puts nearly $300 billion in new provider payments back into the program (as explained in myth No. 7). That creates a net cut of $200 billion.

 

 

“What we hear from our members is that to them Medicare savings sounds like cuts,” Nora Super, AARP’s chief health care lobbyist, told the AP. “Our members over 65 really value their Medicare program … and numbers like $500 billion are huge numbers, so that is really scary to our members.”

Mr. Obama said at the AARP tele-town hall meeting in July that there is no discussion of cutting Medicare benefits.

“Nobody is talking about reducing Medicare benefits,” he said. “What we do want is to eliminate some of the waste that is being paid for out of the Medicare trust fund that could be used more effectively to cover more people and to strengthen the system.”

8. Americans Don’t Want a Government-Run Health Care Plan

 

Republicans have consistently berated the proposal for a government-sponsored health insurance plan, or “public option,” as unpopular.

http://www.cbsnews.com/stories/2009/08/05/politics/main5215880.shtml

 

“The American people oppose a government takeover of health insurance, and they know if the Democrats and the administration get their way and create a new government-run plan, tens of millions of Americans will lose their health insurance,” Rep. Mike Pence (R-Ind.), chairman of the Republican Conference, said on Fox News Sunday.

In fact, a CBS/New York Times poll  from late July shows that, even though doubts have grown in recent months about Mr. Obama’s health care proposals, 66 percent of Americans still want the government to provide a health insurance plan like Medicare to compete with private health insurers.

9. Rationing of Care

One of the misleading buzzwords in the health care debate is “rationing” — the idea that patients will have limited treatment options if the government becomes more involved in health care delivery.

In fact, Americans will not face “rationing” in health care any more than they do now. While a public plan would not be able to cover all procedures, private insurance plans do not either.

“We don’t want to ration by dictating to somebody, ‘Okay, you know what? We don’t think that this senior should get a hip replacement,’” Mr. Obama said at the AARP tele-town hall. “What we do want to be able to do is to provide information to that senior and to her doctor about this is the thing that is going to be most helpful to you in dealing with your condition.”

10. A Health Care Bill Will Bring Quick Changes

Democrats have created a misleading sense of urgency over health care reform. The president has spoken about suffering Americans who need help right away. It is a talking point more commonly used by liberal grassroots groups rallying support.

However, significant provisions of the health care legislation under consideration — including the federal health insurance exchange, the public option, subsidies and the employer mandate — would not go into effect until 2013.

Mr. Obama addressed this fact at an Ohio town hall.

“Most of these changes would be phased in over several years,” he said. “So it’s not as if you’re going to wake up tomorrow and suddenly the health care system is all changed completely. We are going to phase this in, in an intelligent, deliberate way.”

The letter specifically referred to the “essential benefits package” a Health Benefits Advisory Committee and the Secretary of Health and Human Services would be responsible for defining. Nothing in the legislation, however, has “mandated” that abortion services be included in the benefits package.

In fact, the House Energy and Commerce Committee on Thursday adopted an amendment, proposed by Rep. Lois Capps (D-Calif.), that would prohibit taxpayer dollars from funding abortions. The amendment would not allow the federal government to either require or prohibit abortion coverage by private insurers. It requires at least one plan from the federal health insurance exchange in each region of the country to cover abortion, and at least one of the plans to not cover abortion.

“Private health care providers are free to cover abortion, but not with federal funds,” reports Dan Gilgoff of U.S. News and World Report. “The public plan would cover abortion, but not with federal funds; a Capitol Hill aide tells me money for abortions would come from what participants pay into the public plan.”

It has yet to be determined how this issue will finally be settled.

Mr. Obama told CBS Evening News anchor Katie Couric in July that “I’m pro-choice, but I think we also have the tradition in this town, historically, of not financing abortions as part of government-funded health care.”

Two articles in today’s New England Journal of Medicine are the first randomized placebo controlled trials of vertebroplasty, a procedure which involves injecting cement into the vertebrae of people who have suffered from painful osteoporotic fractures of the vertebrae. In the first study 78 patients got either vertebroplasty or a fake procedure. There was no difference in pain ratings measured at several time points out to six months.

The second study involved 131 patients who got either a sham or vertebroplasty procedure. There were no differences in the primary outcomes of pain or disability at one month after treatment. There was a pattern of clinical improvement in pain (30% reduction in pain, 64% v 48%, p=0.06) that was not one of the original study outcomes. The group that got the sham procedure, however, were more likely to request a repeat procedure (i.e. got a vertebroplasty in the end) (43% v 12%, p<.05). Some of the authors said they were “shocked” by the results and others said they should do “more research” or that it “might help some patients” or “maybe they want a placebo” since the fake group got better as well as the vertebroplasty group. Maybe they should pay the $4,000 for the MRI and procedure out of their pockets rather than billing it to Medicare so that they have a better placebo response. That would help out on President Barack Obama’s plans to reduce US healthcare costs by eliminating the 30% of tests and procedures that have been found to be useless. He can add this one to the list.