Princess Health and King/Drew, Again: Putting Symbols Ahead of Patient Care?. Princessiccia

Princess Health and King/Drew, Again: Putting Symbols Ahead of Patient Care?. Princessiccia

King/Drew Medical Center Mismanagement

Gusty 11:49 Add Comment

The Martin Luther King Jr/ Drew Medical Center in Los Angeles is back in the news again, unfortunately for all the wrong reasons. The Los Angeles Times major investigative series on the troubles at the hospital suggested many of them appeared attributable to mismanagement. A local pundit had suggested that viewing the hospital as a revered political symbol (of political progress for African-Americans living in the Watts ghetto) prevented people from addressing the real failings of its very human leaders, as we mentioned in Health Care Renewal in December, 2004.
Things at King/Drew do not appear to be getting better, even after Los Angeles County hired Navigant Consulting, to use its turn-around expertise to improve hospital management. The Los Angeles Times has just reported another series of apparently avoidable patient deaths. Meanwhile, county politicians are continuing their noisy debate. For example, Supervisor Yvonne Brathwaite Burke, who represents the district in which King/Drew is located, declared, "I'll tell you this: That hospital will be closed over my dead body." Supervisor Zev Yaroslavsky countered, "The only dead bodies I'm concerned about are the dead bodies that we're seeing here."
A Los Angeles Times editorial blamed a "culture of finger-pointing and blaming." Its examples included that an anesthesologist did not respond to a "code blue" because he had never received a pager. Hospital doctors, through their lawyer, blamed Navigant, which "hasn't gotten around to distributing ... pagers." The editorial wondered "what kind of doctor would sit around and wait for someon to hand out pagers." Whatever the reason, that physicians in an urban American hospital in 2005 do not have them seems absurdly at odds with the hospital's stated mission, "To provide quality comprehensive Medical Care that is Accessible, Acceptable and Adaptable to the needs of the community we serve."
Furthermore, another Times editorial charged that the current Mayor of Los Angeles is using "the hospital born of the Watts riots ... [as] a powerful black symbol," even while he fails to "denounce the death of so many patients, most of them poor, virtually all black or Latino." Thus, the editorial charged "he is pandering to those who see King/Drew as a symbol of power, not protecting the patients who rely on its care."
Again, this is a tragic story which suggests the bad results of putting politics before the core health care mission, and of letting hospital managers hide behind the revered image of their institution, even as it crumbles around them.

Princess Health and King/Drew, Again: Putting Symbols Ahead of Patient Care?.Princessiccia

Princess Health and King/Drew, Again: Putting Symbols Ahead of Patient Care?.Princessiccia

King/Drew Medical Center Mismanagement

Gusty 11:49 Add Comment

The Martin Luther King Jr/ Drew Medical Center in Los Angeles is back in the news again, unfortunately for all the wrong reasons. The Los Angeles Times major investigative series on the troubles at the hospital suggested many of them appeared attributable to mismanagement. A local pundit had suggested that viewing the hospital as a revered political symbol (of political progress for African-Americans living in the Watts ghetto) prevented people from addressing the real failings of its very human leaders, as we mentioned in Health Care Renewal in December, 2004.
Things at King/Drew do not appear to be getting better, even after Los Angeles County hired Navigant Consulting, to use its turn-around expertise to improve hospital management. The Los Angeles Times has just reported another series of apparently avoidable patient deaths. Meanwhile, county politicians are continuing their noisy debate. For example, Supervisor Yvonne Brathwaite Burke, who represents the district in which King/Drew is located, declared, "I'll tell you this: That hospital will be closed over my dead body." Supervisor Zev Yaroslavsky countered, "The only dead bodies I'm concerned about are the dead bodies that we're seeing here."
A Los Angeles Times editorial blamed a "culture of finger-pointing and blaming." Its examples included that an anesthesologist did not respond to a "code blue" because he had never received a pager. Hospital doctors, through their lawyer, blamed Navigant, which "hasn't gotten around to distributing ... pagers." The editorial wondered "what kind of doctor would sit around and wait for someon to hand out pagers." Whatever the reason, that physicians in an urban American hospital in 2005 do not have them seems absurdly at odds with the hospital's stated mission, "To provide quality comprehensive Medical Care that is Accessible, Acceptable and Adaptable to the needs of the community we serve."
Furthermore, another Times editorial charged that the current Mayor of Los Angeles is using "the hospital born of the Watts riots ... [as] a powerful black symbol," even while he fails to "denounce the death of so many patients, most of them poor, virtually all black or Latino." Thus, the editorial charged "he is pandering to those who see King/Drew as a symbol of power, not protecting the patients who rely on its care."
Again, this is a tragic story which suggests the bad results of putting politics before the core health care mission, and of letting hospital managers hide behind the revered image of their institution, even as it crumbles around them.

Princess Health and AARP: Wholesale Drug Prices Rise Faster Than Inflation. Princessiccia

Princess Health and AARP: Wholesale Drug Prices Rise Faster Than Inflation. Princessiccia

Gusty 13:01 Add Comment

The AARP has just published its annual survey of the wholesale prices of brand-name drugs commonly taken by older Americans.
In short, prices rose by 7.1% in 2004, while the Consumer Price Index rose 2.7%. Since 1999, the increase was 35.1% while inflation was 13.5%.
The news story in USA Today is here. The actual report is here.
A spokesman for the Pharmaceutical Research and Manufacturers of America called the results "exaggerated and misleading."
Let's see who gets the blame for this...

Princess Health and AARP: Wholesale Drug Prices Rise Faster Than Inflation.Princessiccia

Princess Health and AARP: Wholesale Drug Prices Rise Faster Than Inflation.Princessiccia

Gusty 13:01 Add Comment

The AARP has just published its annual survey of the wholesale prices of brand-name drugs commonly taken by older Americans.
In short, prices rose by 7.1% in 2004, while the Consumer Price Index rose 2.7%. Since 1999, the increase was 35.1% while inflation was 13.5%.
The news story in USA Today is here. The actual report is here.
A spokesman for the Pharmaceutical Research and Manufacturers of America called the results "exaggerated and misleading."
Let's see who gets the blame for this...

Princess Health and Matthew Herper: "If the Cash Were Handed Out in Broad Daylight, It Would Be a Lot Less Likely to Look Like a Bribe". Princessiccia

Princess Health and Matthew Herper: "If the Cash Were Handed Out in Broad Daylight, It Would Be a Lot Less Likely to Look Like a Bribe". Princessiccia

Gusty 12:41 Add Comment

Forbes published a proposal by Matthew Herper for better disclosure of conflicts of interest affecting US Food and Drug Adminstration (FDA) expert panels.
He noted that "from breast implants to pain pills, the perception that top US medical experts have been paid off by drug and medical device companies is tarnishing debates that should be about science and patient safety."
So, "instead of telling us whom they work for, maybe medical experts should consider disclosing exactly how much they're being paid." Thus, "If the cash were handed out in broad daylight, it would be a lot less likely to look like a bribe."
Of course, as others have noted, I think that if the FDA looked, they could find at least some experts in the ranks of generalists and primary care physicians, and of statisticians and other methodologists, who could leaven the sub-specialist make-up of their panels, and are unlikely to have the sort of major financial relationships with drug and device companies that may "look like a bribe." But there is no argument that once again "sunlight is the best disinfectent."

Princess Health and Matthew Herper: "If the Cash Were Handed Out in Broad Daylight, It Would Be a Lot Less Likely to Look Like a Bribe".Princessiccia

Princess Health and Matthew Herper: "If the Cash Were Handed Out in Broad Daylight, It Would Be a Lot Less Likely to Look Like a Bribe".Princessiccia

Gusty 12:41 Add Comment

Forbes published a proposal by Matthew Herper for better disclosure of conflicts of interest affecting US Food and Drug Adminstration (FDA) expert panels.
He noted that "from breast implants to pain pills, the perception that top US medical experts have been paid off by drug and medical device companies is tarnishing debates that should be about science and patient safety."
So, "instead of telling us whom they work for, maybe medical experts should consider disclosing exactly how much they're being paid." Thus, "If the cash were handed out in broad daylight, it would be a lot less likely to look like a bribe."
Of course, as others have noted, I think that if the FDA looked, they could find at least some experts in the ranks of generalists and primary care physicians, and of statisticians and other methodologists, who could leaven the sub-specialist make-up of their panels, and are unlikely to have the sort of major financial relationships with drug and device companies that may "look like a bribe." But there is no argument that once again "sunlight is the best disinfectent."

Princess Health and Some FDA History, with "Safety ... at the Back of the Bus.". Princessiccia

Princess Health and Some FDA History, with "Safety ... at the Back of the Bus.". Princessiccia

FDA

Gusty 12:13 Add Comment

The Boston Globe provided some historical context for how the US Food and Drug Administration (FDA) got into its current troubles. Here are some salient points:

• In the late 1980's, the FDA was under pressure from gay activists to speed up its approval process for drugs for HIV infections. "Protesters stood atop buses and stopped traffic. Some broke into the FDA and smashed computers. They hung then-FDA commissioner Frank Young in effigy." Protesters chanted "Hey, hey, FDA, how many people have you killed today."
• Pharmaceutical companies also wanted to speed up the approval process, and threatened to "move research, development, and clinical studies abroad" if their wishes were denied.
• In 1992, in response to budget pressure, Congress passed the Prescription Drug User Fee Act, which would speed up the FDA review process in exchange for direct fees paid by the pharmaceutical companies.
• Since then, total user fees paid to the FDA have climbed from US $87.5 million in 1997 to $382 million this year. The speed of reviews has also increased.
• However, the need for speed, plus financing coming direct from pharmaceutical companies appeared to change the FDA culture. The article included several charges that FDA personnel were pressured and intimidated to speed drugs along even if they had doubts about their safety. For example, Dr. Jerry Avorn of Harvard alleged "the purposeful supppression of individuals within FDA who are concerned about problems and are told 'Don't make waves. We need to get this drug approved.'" Dr. Erick Turner said that reviewers who tried to delay approvals due to safety concerns were called before "tribunals." The reviewer who tried to delay the approval of Rezulin because he suspected it would cause liver problems was taken off the case after he got in a verbal altercation with an official of Rezulin's manufacturer, Warner-Lambert. Rezulin was taken off the market in 1997.
• The article ended with a quote from FDA whistle-blower David Graham, "Safety, as I a said before, is at the back of the bus."

A few more global comments.
One can sympathize with the "activists" who applied political pressure via 1960's style street theatre to try to speed up treatment for a then rapidly fatal disease. However, their pressure had broader effects than they intended, and hence unintended consequences.
It seemed reasonable to essentially tax pharmaceutical companies for a rapid review process that would benefit them (as well as the public, it was hoped.) However, sending the tax money direct to the FDA in the form of "user fees" created an institutional conflict of interest.
It is upsetting that so many of the stories we discuss on this blog culminate in the final common pathway of intimidation of well-meaning professionals, physicians, and scientists by overbearing bureaucrats and administrators. All too often the coincidence of self-interest and power leads to censorship and intimidation.