Oncologists Were Paid to Prescribe Generic Chemotherapy (Here’s Why It Didn’t Change a Thing)

Brand-name chemotherapy is often incredibly expensive, in excess of $100,000 per patient. Sometimes there are excellent generic alternatives, but many oncologists are hesitant to prescribe generics because such prescriptions cost them money. For many medicines, you see, oncologists receive a 6% markup, meaning when they infuse a patient with a $10,000 monthly course of chemotherapy, their practice yields an extra $600. By contrast, if the practice treated that patient with a generic chemotherapy, they’d be out most of that extra money.

A private insurer, UnitedHealthcare, tried to incentivize oncologists to prescribe generic chemotherapies by giving them financial bonuses for doing so. For example, a generic medication that would have previously been accompanied by a $12 markup now received a $500 one. That’s a lot of money; but, from the insurer’s perspective, it would have been more than made up by the savings accompanying the use of the generic drug. (In this case, the brand name drug costs $7,000 more than the generic equivalent.)

Fantastic idea, yes? Unfortunately, it didn’t increase generic prescribing one iota.

To read the rest of this piece, please visit Forbes.

Fact-checking COVID-19 Stats

A U.S. Senator mistakenly tweeted that 14% of UNC students have COVID-19. A local news station fact-checked that tweet, explained the math, and the Senator didn’t back down. Sigh…

The University of North Carolina made national news after reporting a coronavirus outbreak shortly after students returned to campus.

Before students could even get their first assignments, university administrators abandoned their plans to hold in-person classes. The football team, however, is still scheduled to move forward with a modified Atlantic Coast Conference schedule.

That upset U.S. Sen. Chris Murphy, a Democrat from Connecticut. The University of Connecticut was the first major football program to cancel its season due to the pandemic.

“Notre Dame and UNC are sending kids home because of COVID outbreaks (at UNC 14% of students tested positive),” Murphy tweeted on Aug. 18, adding: “But…not football players! They need to stay no matter the risk, because the college football money machine needs to keep churning.”

His tweet linked to a New York Times story about the situation at UNC.

Murphy was clearly trying to make a point about college athletes being exploited. While doing so, however, he failed to provide the full context of UNC’s outbreak.

Is it true that 14% of students tested positive, as Murphy said? Not exactly.

To read the rest of this story, please visit WRAL.

Critics Wonder Whether the FDA Is Too Slow to Handle a Pandemic

The FDA plays a critical role in our nation’s response to the COVID-19 pandemic. It helps decide which medicines are safe and effective to treat the disease. It evaluates the accuracy and reliability of laboratory tests. And it will play a central role in assessing potential vaccines.

But will the FDA bureaucracy move with the kind of speed necessary to deal with such a crisis? Some critics are concerned it will not. Even before the rush of the pandemic, the Agency was accused of being slow to evaluate drugs; critics also complained that it denied access to life-altering medications for desperately ill patients.

If it were still the 1970s, these criticisms would be well placed. Back then, it took more than three years, on average, for the FDA to review drugs. Review time is now less than one year. Back in the 1970s, it was rare for pharmaceutical companies to obtain expedited review for new medications. Now, these kind of Abbreviated New Drug Applications – or ANDAs – are quite common.

To read the rest of this article, please visit Forbes.

An 18th-Century Lesson on How to Stay Healthy during a Pandemic

Evidence is now overwhelming that wearing face masks slows the spread of the COVID-19 virus. But Americans haven’t universally donned these coverings. An effective leader would find a way to encourage people to adopt this lifesaving behavior.

Take sauerkraut, for example. My German father tried his best to get me to eat it when I was a child. He failed – I hate the stuff. But in the 18th century, sauerkraut was the difference between life and death for many sailors, meaning their leaders, their captains, had to find a way to convince them to swallow the vile stuff.

To read the rest of this piece, please visit Forbes.

Concerning Trend for Rural Physicians Makes a Risky Business Even Riskier

The COVID-19 virus is wreaking havoc on healthcare providers. Hospitals and outpatient practices are struggling from a combination of lost revenue, from people delaying or canceling appointments, and increased expenses, related to the measures they are taking to reduce the spread of the virus within healthcare settings.

As always, when American healthcare providers are in trouble, rural providers will be in even more trouble. Which makes it all the more concerning to see what’s been happening to rural physicians over the last couple decades.

To read the rest of this piece, please visit Forbes.

It Should Scare Us That Tuition Is A Tiny Amount Of Medical School Revenue

Medical school is expensive. Tuition for private medical schools average more than $60,000 per year. That’s tuition, folks; not tuition, room, and board. At the University of South Carolina, out-of-state tuition is more than $90,000 a year.

But don’t assume your local medical school depends on tuition dollars for its financial well-being. The contribution of tuition towards medical school revenue is a tiny fraction of what it once was.

To read the full article, please visit Forbes.

Science Isn’t Meant To Be Followed

President Trump has taken a pointedly anti-scientific approach to the Covid-19 pandemic. When he is not hiding data, gagging public health experts, or touting unproven cures, he is downplaying the toll the virus is taking on people’s lives.

In the face of such indifference to facts, it is understandable that many people, including both Republican and Democratic governors, contend that politics should stand aside while science leads us out of this mess. For instance, a pact among Eastern states promises to coordinate their pandemic response in a manner “driven by data and experts, not opinion and politics.” A pact of western states put it even more tersely, vowing that “health outcomes and science – not politics – will guide these decisions.”

Unfortunately, that belief reveals a deep misunderstanding of the proper role of science in guiding public policy-making. Science cannot lead us out of the pandemic. Whatever paths we take to navigate COVID-19 need to be chosen through political processes. The true role of science is to illuminate these pathways, guiding our policy choices by showing us what’s at stake.

As an analogy, consider the role of science in helping a person newly diagnosed with advanced cancer. As a physician who studies medical decision-making, I would never recommend this patient choose a treatment without help from medical science. But science alone doesn’t always point to an obvious choice. Perhaps one chemotherapy has a small chance of curing the cancer but a risk of serious side effects, while another, gentler chemotherapy will slow down, but not cure, the cancer. This patient faces a difficult trade-off between chance of cure and likelihood of experiencing miserable side effects. In this situation, the best choice isn’t a matter of science, but instead hinges on a value judgment: on how an individual patient weighs the pros and cons of the alternatives.

Like a patient stricken with illness, the United States needs to decide how to treat the COVID-19 pandemic, with every pathway forward confronting us with tragic trade-offs. What can science do to help us navigate these trade-offs?

To read the full article, please visit Forbes.

Smoking Cigarettes (My Circumstances Made Me Do It)

Rates of cigarette smoking have dropped substantially in the US over the past few decades. But lots of Americans still smoke, and the burden of tobacco-related illness does not fall evenly across our population. That is tragic under normal circumstances, with tobacco use leading to heart attacks, strokes, cancers, and emphysema, to name but a few relevant illnesses. In the face of the Covid-19 pandemic, it’s even more tragic, because tobacco smoking significantly increases the lethality of the virus.

So why isn’t tobacco use evenly spread across the population? In part, it’s because the more challenges a person faces in life, the more likely they are to smoke.

To read the rest of this piece, please visits my column on Forbes.

A Shameful American Fact: Enormous Racial Disparities In Death Rates From Lupus

Photo Credit: Getty

I recently came across a disturbing picture. I know that life in America is unfair. That access to medical care is uneven. That the chance of living a long life is often heavily influenced by socioeconomic disparities. But this figure still astonished me. It shows mortality for people suffering from Systemic Lupus Erythematosus, better known simply as lupus.

Lupus is systemic: it strikes practically every part of the body.

It is an autoimmune disorder: people’s own immune systems attack their vital organs.

It is chronic: people diagnosed with lupus generally require lifelong treatment with powerful and expensive immunosuppressants (medicines that dampen their immune systems).

(To read the rest of the article, please visit Forbes).