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04/10/2014

More on Drug Prices and “Pay for Performance”

My post last week included a suggestion of “pay for performance” for expensive drugs.  That drew a comment raising concerns about paying physicians based on whether their treatments succeed. I’d like to clarify that my thoughts were limited to expensive new drugs.  The idea—which seems to be gaining currency among, to name one group, payers—is that, in the case of an expensive new drug that… // Read More »

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This entry was posted in Health Care and tagged , , . Posted by Jon Holmlund. Bookmark the permalink.

04/10/2014

National Healthcare Decisions Day – Minnesota

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This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

04/10/2014

More on Flu Drugs and the Broken Drug Research System

We’ve discussed the debate over oseltamivir (Tamiflu) and the problems in determining whether it offers advantages to flu patients, given how hard reviewers had to search to get all the data:

http://brodyhooked.blogspot.com/2009/12/bmj-medical-research-is-broken.html
http://brodyhooked.blogspot.com/2012/09/more-on-tamiflu-challenges-of-getting.html

The story led the editor of BMJ back in 2009 to proclaim about the scientific evaluation of drugs, The current system isn’t working. Worse than that, it gives a false sense of security.”

The latest BMJ readdresses the oseltamivir story, and if the system was broken in 2009, it has not gotten fixed since. The summaries of what they have to say can be found in two editorials:

http://www.bmj.com/content/348/bmj.g2630


http://www.bmj.com/content/348/bmj.g2548?ijkey=ded5662cf46f75236fb45a9cda0bb2a671ec0e98&keytype2=tf_ipsecsha&linkType=FULL&journalCode=bmj&resid=348/apr09_2/g2548&atom=/bmj/348/bmj.g2630.atom

In the previous blog posts, I reviewed how difficult it was for the authors of a Cochrane review of neuroaminidase inhibitors for influenza (the class of drugs to which oseltamivir belongs) to get their hands on all the relevant data from unpublished studies conducted by the manufacturer. Once they did get a reasonable amount of data, they found the data so voluminous that it took several person-years of labor to sort through it all. But they persevered, and what we now know is that drugs like oseltamivir may shorten your bout of flu, if you start taking the drug within the first two days of symptoms, by half a day. It may cause a number of worrisome side effects. And we have no reason to believe that the drug will prevent the bad complications of influenza requiring hospitalization and admission to an ICU (which is the anticipated benefit that led the WHO to champion the drug and many nations to spend billions of dollars stockpiling the drug as a public health precaution).

We also know that the published studies on these drugs, virtually all of which were conducted by the manufacturers, overstated the benefits and understated the adverse reactions. In short, if you went to legitimate, prestigious medical journals for information, as all us docs were taught to do in med school, you’d be mostly clueless.

The editors of BMJ gamely propose a list of reforms. But I believe that two conclusions are inescapable. First, if it took this much time and effort to get the goods on oseltamivir—and we still don’t know what the drug is really good for, if anything, since the really important studies of its potential value have not yet been conducted—then what about the hundreds of other drugs that have been introduced with great fanfare in the last few decades, and none of which have been subjected to anything like this degree of inquiry and investigation? Second, on what basis can we claim any longer that we should have any faith at all in drug research sponsored by manufacturers?

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This entry was posted in Health Care and tagged . Posted by Howard Brody. Bookmark the permalink.

04/10/2014

New Tools for HIV Prevention: Why I am a Truvada Whore

by Sean Philpott-Jones, Director of the Center for Bioethics and Clinical Leadership Although the epidemic likely started a decade or two earlier, AIDS wasn’t identified as a new disease until 1981. It took a few more years to isolate HIV, the virus that causes AIDS, and to develop reliable tests for diagnosing infection. In the thirty […]

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This entry was posted in Health Care, HIV/AIDS, Public Health and tagged , . Posted by The Bioethics Program. Bookmark the permalink.

04/10/2014

Health Care Decisions and the "F" Word: Counseling Clients about Medical Futility

Health Care Decisions and the “F” Word: Counseling Clients about Medical Futility


Date: Wednesday, April 23, 2014
Format: Live Webinar
Duration: 90 minutes
Register here
         
Sponsors


The American Bar Association Commission on Law and Aging, Senior Lawyers Division and Center for Professional Development
1:00 PM-2:30 PM Eastern
12:00 PM-1:30 PM Central
11:00 AM-12:30 PM Mountain
10:00 AM-11:30 AM Pacific


Program Description


Recent cases involving brain dead patients and resulting disputes over continuing organ-sustaining treatments have reignited debate over the appropriate use of medical technologies.  The family of Jahi McMath in Oakland, CA, fought to keep their daughter connected to a ventilator, while a hospital in Fort Worth, TX, sought to keep Marlise Muñoz, fourteen weeks pregnant, on a ventilator over the objection of her husband and family.  For terminally ill patients who are not brain dead, a family’s desire to “do everything possible” sometimes leads to insisting on medical interventions that medical professionals may deem inappropriate or “futile.”  


Objectives

  • Provide you with an understanding of the range of policy and practice issues concerning medical futility
  • Enable you to be accurate and supportive in counseling clients on these issues in the context of advance planning
  • Enable you to be more effective in counseling and dispute resolution when conflicts arise in end-of-life decision-making concerning the limits of care
  • The focus is not on litigation. 

Program Faculty

  • Robert L. Fine, MD, FACP, FAAHPM, Clinical Director, Office of Clinical Ethics and Palliative Care, Baylor Health Care System, Dallas, TX
  • Bernard “Bud” Hammes, Ph.D, Director of Medical Humanities, Gundersen Lutheran Medical Foundation, La Crosse, WI
  • Thaddeus Mason Pope, JD, PhD, Director, Health Law Institute & Associate Professor of Law, Hamline University School of Law, St. Paul, MN
  • Charles P. Sabatino, JD (Moderator), Director, ABA Commission on Law and Aging, Washington, DC

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This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

04/10/2014

Who Calls the Shots? Exploring the Authority of the Principal, Agent, and Provider under a Health Care Directive

The Health Law Section of the Minnesota State Bar Association is presenting a timely CLE:  ”Who Calls the Shots?  Exploring the Authority of the Principal, Agent, and Provider under a Health Care Directive.”

Date: Friday, April 18, 2014 8:00…

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This entry was posted in Health Care and tagged , . Posted by Thaddeus Mason Pope. Bookmark the permalink.

04/10/2014

Health Disparities: They’re Not Just for Patients Anymore

by Jacob Dahlke, Bioethics Program Alum (MSBioethics 2012) Much is written – and justifiably so – about the disparities that exist in our healthcare system in the U.S. The CDC, for example, reports a few: non-Hispanic blacks die more frequently from stroke and coronary heart disease than whites; homicide deaths are 2.5 times higher for men […]

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This entry was posted in Health Care and tagged , , , , . Posted by The Bioethics Program. Bookmark the permalink.

04/10/2014

Has Obamacare Made Restaurants Partisan?

Politics in the US is discouragingly partisan. National politics has become increasingly partisan since at least the late ’60s, when the passage of civil rights legislation influenced many conservative southern Democrats to join the Republican Party. Even state politics has become more … Continue reading

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04/10/2014

Artistic Inquiry: Obesity on Stage in Boston

BEI Young Professionals member Betsy Campbell covers artful media around the world that touches upon topics in bioethics. In 2013 a Hastings Center article, bioethicist Dan Callahan proposed an “edgier” approach to America’s obesity epidemic. His views in that article — particularly his point about the power of public disapproval — proved to be controversial, […]

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04/10/2014

Pharmaceutical or Illegal Drug: The Bizarre Case of Marijuana

by Craig Klugman, Ph.D.

After gay marriage, one of the most controversial issues in the United States today is the issue of marijuana. Twenty-one states have passed laws or referendums legalizing the use of marijuana for medical purposes. Two states (Washington and Colorado) have legalized small amounts of marijuana for recreational use. Sixteen other states have pending legislation. Some of these states allow physicians to prescribe it while others permit physicians to recommend it by certifying that a patient has a qualifying condition.

This is a far cry from the 1970s when marijuana was classified as a Schedule I drug meaning it has no medicinal use and is highly addictive.…

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This entry was posted in Cultural, Featured Posts, Health Regulation & Law, Pharmaceuticals and tagged . Posted by Craig Klugman. Bookmark the permalink.