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Posts Tagged ‘medicine’

The Unsustainable Economics of Cancer Drugs

In New York magazine, Steve Hall lays out the good, bad, and the ugly of cancer-drug economics. Warning: it is mostly bad and ugly.

The pharmacist e-mailed the numbers, and Saltz stared at the figures on his computer screen. Zaltrap, the drug that was extremely similar to Avastin, cost roughly $11,000 a month. (And because that extra 42 days wouldn’t be possible without taking the drug for, say, seven months before—which was roughly what was happening in clinical trials—the price for that six-week life extension could be as high as $75,000.)

“Wow,” he said to himself, “that’s a deal-changer for me.”

That may not seem like a heretical statement, but the unspoken rule in American health care is that doctors should never consider the cost of a medicine that might be beneficial to patients. When the FDA approves a new cancer drug, it analyzes safety and effectiveness only. Medicare is obliged to reimburse payment for the drug, and private insurers in most states must cover the cost. Any doctor who considers cost—or the value of a costly drug—risks being accused of “rationing” health care.


Beer for Babies and the Tapeworm Diet

In our podcast “100 Ways to Fight Obesity,” Steve Levitt and David Laibson discuss the possibility of using tapeworms to fight weight gain. (Seriously.) That prompted a reader named Scott Genevish to send us a real-seeming (?) old advertisement for “Sanitized Tapeworms, Jar Packed” (below). It was accompanied by a bunch of other old ads that are all, from the perspective of 2013, radically outdated for one reason or another. I have no idea if all the ads are real; I’m sure most of them have made the online rounds before. Still, it might be worth a look — especially when you think about how the line between repugnant and not repugnant can shift over time, sometimes faster and more dramatically than you’d ever predict.


"Under the Medical Tent at the Boston Marathon"

That is the title of an essay by Sushrut Jangi, in the New England Journal of Medicine:

Suddenly, there was a loud, sickening blast. My ears were ringing, and then — a long pause. Everyone in the tent stopped and looked up. A dehydrated woman grabbed my wrist. “What was that?” she cried. “Don’t leave.” I didn’t move. John Andersen, a medical coordinator, took the microphone. “Everybody stay with your patients,” he said, “and stay calm.” Then we smelled smoke — a dense stench of sulfur — and heard a second explosion, farther off but no less frightening. Despite the patient’s plea, I walked out the back of the tent and saw a crowd running from a cloud of smoke billowing around the finish line. “There are bombs,” a woman whispered. My hands began to shake. …

At the tent, I stood in a crowd of doctors, awaiting victims, feeling choked by the smoke drifting along Boylston. Through the haze, the stretchers arrived; when I saw the first of the wounded, I was overwhelmed with nausea. An injured woman — I couldn’t tell whether she was conscious — lay on the stretcher, her legs entirely blown off. Blood poured out of the arteries of her torso; I saw shredded arteries, veins, ragged tissue and muscle. Nothing had prepared me for the raw physicality of such unnatural violence. During residency I had seen misery, but until that moment I hadn’t understood how deeply a human being could suffer; I’d always been shielded from the severe anguish that is all too common in many parts of the world.


What If Your Future Had Been Decided By Someone Else's Coin Toss?

From a reader we’ll call O.X.H.:

I listened to your podcast on letting a coin decide your future – and wanted to make my own, small contribution to your piece. I am an attending physician now – but back when I was in medical school (early 2000s), I helped out with the admissions process by interviewing prospective candidates. On one day of interviews, my faculty colleague and I conducted six interviews – and by the end of the day, our job was to rank each of the candidates that we had interviewed. We independently agreed on No. 1 and No. 2 (and No. 5 and No. 6), but neither of us could decide between No. 3 and No. 4. He asked me how we should resolve this – and I (jokingly) suggested that we should flip a coin. Ironically, he loved the idea – and pulled out a coin, and then we assigned each candidate to heads/tails. We said that whoever won the coin toss would get 3rd. (Interestingly, we flipped the coin only once – not two out of three.)


Neighborhood, Race, and CPR

An New England Journal of Medicine article looks at the probability of a bystander performing CPR based on neighborhood characteristics including income and race:

Among 14,225 patients with cardiac arrest, bystander-initiated CPR was provided to 4068 (28.6%). As compared with patients who had a cardiac arrest in high-income white neighborhoods, those in low-income black neighborhoods were less likely to receive bystander-initiated CPR (odds ratio, 0.49; 95% confidence interval [CI], 0.41 to 0.58). The same was true of patients with cardiac arrest in neighborhoods characterized as low-income white (odds ratio, 0.65; 95% CI, 0.51 to 0.82), low-income integrated (odds ratio, 0.62; 95% CI, 0.56 to 0.70), and high-income black (odds ratio, 0.77; 95% CI, 0.68 to 0.86). The odds ratio for bystander-initiated CPR in high-income integrated neighborhoods (1.03; 95% CI, 0.64 to 1.65) was similar to that for high-income white neighborhoods.


Penicillin as an Aphrodisiac?

An interesting new paper (abstract; PDF) by the Emory economist Andrew M. Francis explores penicillin’s role in shaping modern sexuality:

It was not until 1943, amid world war, that penicillin was found to be an effective treatment for syphilis. This study investigated the hypothesis that a decrease in the cost of syphilis due to penicillin spurred an increase in risky non-traditional sex. Using nationally comprehensive vital statistics, this study found evidence that the era of modern sexuality originated in the mid to late 1950s. Measures of risky non-traditional sexual behavior began to rise during this period. These trends appeared to coincide with the collapse of the syphilis epidemic. Syphilis incidence reached an all-time low in 1957 and syphilis deaths fell rapidly during the 1940s and early 1950s. Regression analysis demonstrated that most measures of sexual behavior significantly increased immediately following the collapse of syphilis and most measures were significantly associated with the syphilis death rate. Together, the findings supported the notion that the discovery of penicillin decreased the cost of syphilis and thereby played an important role in shaping modern sexuality.

(HT: Marginal Revolution)


Do the Bacteria in Your Gut Also Influence Your Mind?

Last year, we put out a podcast called “The Power of Poop,” which looked at the use of fecal transplants (a.k.a. “transpoosions”) to treat everything from multiple sclerosis to Parkinson’s disease. A fascinating Scientific American article explores how gut bacteria may have even further-reaching functions:

In the past few years scientists have been discovering that these microscopic inhabitants of our body may be subtly altering our moods, emotions and perhaps even our personalities. Gut microbiota appear to alter gene activity in the brain and the development of key regions involved in memory and learning. These denizens of our intestines could help explain why psychiatric symptoms vary among individuals, as well as their responses to medications. Gut microbes could also account for some of the differences in mood, personality and thought processes that occur within and among individuals.

(HT: Market Design)


The Olympics and the Doctors

A New England Journal of Medicine article explores the history of the Olympic Games as an object of “medical scrutiny,” with some interesting highlights:

Physicians have been interested in the Olympics for many reasons. In the 1920s, they probed the limits of human physiology. One group studied the Yale heavyweight rowers who won gold in Paris. An ingenious contraption revealed that at their racing speed — 12 mph — the eight men produced four horsepower, a 20-fold increase over resting metabolism (1925). A 1937 study published in the Journal showed that athletes at the 1936 Berlin games consumed 7300 calories each day (1937).

Of course, physicians are currently most fascinated by the effects and progress of performance-enhancing drugs:


Why Do Patent Holders Sometimes Pay Patent Copiers?

Like a lot of products, pharmaceuticals get knocked off. And when that happens to a drug that’s protected by a patent, the next event is unsurprising: a lawsuit brought by the patent holder. But there is a very unusual twist in the pharma world. When the dust settles, quite frequently it is the major pharmaceutical firm that is paying the company that has knocked off their patented drug.

In one recent case involving Cipro, a widely-used antibiotic with annual sales exceeding $1 billion, Bayer (the patent owner) paid $400 million to a generic drug maker, Barr Laboratories, to settle their patent dispute. Why would the patent holder make such a huge payment to the knockoff artist, and not the other way around?


What Surgeons Get Paid, and What Patients Think Surgeons Get Paid

Jared Foran, an orthopedic surgeon in Denver, is a co-author of a new study called “Patient Perception of Physician Reimbursement in Elective Total Hip and Knee Arthroplasty” (PDF here). The authors surveyed 1,200 patients to see how much they thought orthopedic surgeons should make and what Medicare actually pays for a hip or knee replacement.

In an e-mail, Foran describes their results:

On average, patients thought that surgeons should receive $18,501 for total hip replacements,  and $16,822 for total knee replacements. Patients estimated actual Medicare reimbursement to be $11,151 for total hip replacements and $8,902 for total knee replacements.  Seventy per cent of patients stated that Medicare reimbursement was “much lower” than what it should be, and only 1% felt that it was higher than it should be.


End of Illness Author David Agus Answers Your Questions

We recently solicited your questions for David Agus, the oncologist author of The End of Illness. Now he’s back with answers, including: the numbers on taking aspirin, how to get the most from a doctor visit, and the top 10 actions to reduce your cancer risk. I can guarantee you that his answers will enlighten and thrill some people and enrage and confound others. Thanks to everyone for their participation, and especially to Agus for the thorough answers. 

Q. I’m a 4th year medical student, and I watched your interview on The Daily Show when it first aired and really took issue with the way you presented many of these things. It seemed that you simplified your “solutions” to the point that it may actually be dangerous for people to listen to what you suggested. For example, you implied that everyone should be taking aspirin.


Bring Your Questions for End of Illness Author David Agus

Here’s an obvious but sobering thought: every one of us will someday get sick and die. And here’s a happier thought: with ever-advancing medical technology and research, we can now avoid many kinds of illnesses and add more years to our lifespan.

The oncologist David Agus lives halfway between those two thoughts. He is a professor at USC, the founder of Oncology.com, a co-founder of Navigenics, and now the author of The End of Illness. Most impressively, perhaps, he was recently a guest on The Daily Show. 

The End of Illness is Agus’s take on how the body works and why it fails. Along the way, he challenges a lot of conventional wisdom about health with academic studies and his own medical experience. Arguments in the book include: that taking vitamins may increase the risk of cancer; that sitting at a desk all day may be as damaging as smoking; and that you can tell something about a patient’s health based on whether she wears high-heel shoes. One review of the book reads: “A ‘rock star’ doctor says throw away the vitamins, load up on baby aspirin, and keep moving.”


How to Make Tough Medical Decisions? Bring Your Questions for the Authors of Your Medical Mind

What do you do when the medical experts disagree? Should you have that PSA screening, or mammogram? Should you really be taking statins — and what about vitamins? On these and many other medical issues, consensus is hard to come by; individuals end up weighing the benefits and risks.

Jerome Groopman (more here) and Pamela Hartzband have written a book to address this conundrum, called Your Medical Mind: How to Decide What Is Right For You. The authors are both Harvard physicians, and they are also married to each other. To write the book, they interviewed a variety of patients with different medical problems, including those from various socioeconomic, religious, and cultural backgrounds. Along the way, the authors identified all sorts of different mindsets — proactive vs. passive, “believers” vs. “doubters,” and so on. They synthesize what they learned into a framework meant to help any one person try to figure out what’s the optimal treatment. Along the way, the authors ask a variety of tricky, compelling questions: how much autonomy do people really want in making treatment choices?


Aspirin and Cancer: A Seriously Cost-Effective Measure

At Freakonomics, we’re all about finding cheap, easy solutions to life’s big problems. And judging by the results of a new study published in The Lancet, a rather large one just came down the pike. Turns out that aspirin may be one of the most effective measures to combat colon cancer. The study found that taking two aspirin pills a day for two years reduced the risk of colorectal cancer by 63 percent in a group of 861 people who have Lynch syndrome, and are therefore at a high risk for the disease.

Though there have been previous studies that suggest aspirin may effectively reduce the risk of cancer (like this one from 2010), according to the BBC, this most recent study was the first randomized control trial specifically for aspirin and cancer to prove it. So, while we’ve spent what probably amounts to tens of billions of dollars in pharmaceutical R&D trying to come up with an effective cancer drug, one of the best methods may have been already sitting in our medicine cabinet, at just a few bucks a bottle.


The Power of the FDA

What exactly happens when the Food and Drug Administration (FDA) issues one of those ominous Public Health Advisories (PHAs) about a pharmaceutical product? A new paper by Rena M. Conti, Haiden A. Huskamp and Ernst R. Berndt investigates.

 

From the abstract:

We find firms targeted by an advisory have average stock price declines of 3% in three days and 11% in five days following the advisory release, and in turn appear to decrease total physician-directed promotion spending, journals ads and detailing visits significantly six months following the advisory release; the provision of free samples is unaffected. We find no changes among therapeutic substitutes unaffected by the advisory.


Do Results of Oregon's Medicaid Lottery Boost the Case for Obamacare?

One of the many debates over the new health care law is whether increased access to health insurance really improves the public’s overall health and financial security. Even though there are hundreds of studies comparing insured and uninsured groups of people, there’s nothing definitive so far that answers the question one way or the other. The problem is getting clean data which clearly demonstrates behavior before and after people have had access to health care, rather than comparing two separate groups of people.
But a new study by a group of economists and health care researchers may provide the first empirical evidence that shows expanding health care coverage to low-income individuals does result in better reported health, more preventative care, and improved financial well-being.


Another Batch of Poop-Loving Doctors

In this week’s Freakonomics Radio podcast, “The Power of Poop” (subscribe to iTunes here), we meet Alex Khoruts, an immunologist and gastroenterologist at the University of Minnesota whose research concerns the human gut. It turns out that human waste, which for centuries has been regarded with fear and wariness, is now being redefined as the largest organ in your body — and, more important, as a potential source for new ways to treat ailments ranging from constipation to obesity to Parkinson’s disease.


The Unintended Consequences of "Polio Eradication" in India?

A reader named Ed Woodcock writes to tell us of …: “[A] conversation I had with a WHO (World Health Org.) official I bumped into while touring the Taj Mahal for the first time about 5 or 6 years ago. We introduced ourselves and she told me that she was a “polio advocate,” which obviously led to the question, “What the heck does that mean?” She basically spent her time lobbying organizations for donations to help eradicate polio. Obviously a very worthy cause!”


The Real Cost of Unnecessary Breast Biopsies

Articles on the health-care industry are a fertile source of large numbers and, sometimes, large errors. It is estimated that nationally 300,000 women a year may be getting unnecessary surgery at a cost of “hundreds of millions of dollars.” I was happy to believe the figure of 300,000 women a year. However, the cost set off my number-sense alarm.


Sometimes the Cardio Ward Is Best

A new study out of England finds that, for heart-failure patients, being admitted to the general ward instead of the cardiology ward can mean death: “Half the patients were admitted to cardiology wards. Compared with those managed on general wards, they tended to be younger and were more likely to be men. Those admitted to general medical wards were twice as likely to die as those admitted to cardiology wards, even after taking account of other risk factors.”


Fix Medicare's Bizarre Auction Program

Harry Truman once quipped, “Give me a one-handed economist! All my economists say, ‘On the one hand, on the other'” Often even a lone economist has difficulty making a recommendation. While true on certain matters, there are many issues where economists do agree about the right and wrong course of action. A case in point is competitive bidding for Medicare supplies.


The Malaria Wars: Sonia Shah Answers Your Malaria Questions

We recently solicited your questions for Sonia Shah, author of The Fever: How Malaria Has Ruled Humankind for 500,000 Years. Her responses cover the effect of Rachel Carson and Silent Spring on malaria; bed nets and their alternatives; and the history of malaria in the U.S. Thanks to Sonia and everyone who participated.


Battling Malaria: Bring Your Questions for Sonia Shah, Author of The Fever

Malaria has been infecting and killing humans for many millennia, yet it continues to elude man’s efforts to control it. Sonia Shah’s fascinating new book, The Fever: How Malaria Has Ruled Humankind for 500,000 Years, describes our long relationship with the disease. Shah has agreed to answer your questions so fire away.


Reducing Hospital Bouncebacks

Zachary Meisel and Jesse Pines examine the issue of hospital “bouncebacks” — patients who return to the hospital shortly after discharge: “[B]ouncebacks are massively expensive-a recent study of Medicare patients found that one in five admissions results in a bounceback within 30 days of discharge, costing the federal government an estimated $17.4 billion per year.”


The Dangers of Too Much Data

Wondering whether aspirin will protect your heart or cause internal bleeding? Or whether you should kick your coffee habit or embrace it? It’s often hard to make sense of the conflicting advice that comes out of medical research studies.


This Is Your Market on Drugs

Sales of antidepressants remain brisk in spite (or perhaps because) of the recession. Slate reminds us of a decade-old study suggesting that widespread use of mood-lightening drugs could fuel irrational exuberance on Wall Street.