Teaching Hospitals’ Poor Safety Ratings: Due to Poor Safety or Better Record Keeping?

This Kaiser Health News article, produced in collaboration with the Boston Globe and the Washington Post, describes Medicare’s new hospital safety ratings, which surprisingly found that the nation’s major teaching hospitals were nearly 10 times as likely as other hospitals to be rated as having high rates of serious complications.

This new ratings system is mandated by the Patient Protection and Affordable Care Act. The stakes are high not only for obvious reasons of patient safety but also because Medicare and other insurers are moving toward linking reimbursement rates to quality rather than quantity of care. Safety ratings are one way that quality care is measured.

Teaching hospitals are crying foul, claiming that it is their more thorough record-keeping, rather than actual safety problems, that the Medicare ratings are capturing.

Officials at many of the hospitals listed as having high rates of complications say the measures are distorted in ways that exaggerate problems at hospitals that treat lots of complicated cases or very sick patients.

“Not all of these metrics are ready for prime time,” George Blike, who oversees safety at Dartmouth Hitchcock Medical Center and Mary Hitchcock Memorial Hospital in Lebanon, N.H., which Medicare ranked as having a high rate of complications. “It’s unfortunately going to create a lot of confusion for the public.”

The Medicare data show high rates of serious complications for elderly patients at 3 out of 10 major teaching hospitals, including some of the biggest institutions in Boston, Philadelphia, Los Angeles, Cleveland and Chicago.

I find it difficult to believe that institutions like Mount Sinai, Geisinger, Cleveland Clinic, Dartmouth Hitchcock and the like are less safe than the other hospitals. And because statistical measures of quality are now so deeply embedded in health policy planning, this is an issue that will have to be sorted out as quickly as possible. 

(h/t The Schwartz Report).

Interview with Harriet Washington (Part II): The Many Tentacles of Corporate Funding

Click here to read the introduction to this four-part interview or click here to read Part I.

Pulling the Plug on Unprofitable Research

Can you give another example?

Consider the case of Dr. Chris Parish in Australia, who was working on a very promising liver-cancer drug, PI-88, that was about to go into the final stage of trials. It had performed well in trials and looked as if it would be very effective. Liver cancer is a major killer worldwide. It’s the third largest cause of cancer deaths around the globe and we don’t have many drugs for it. And yet, Progen Pharmaceuticals Limited, the company sponsoring the drug’s development and testing, voiced concerns about factors “that impacted the commercial return” of PI-88, including the successful joint launch of Nexavar, a competing drug, by the Bayer and Onyx pharmaceutical companies. The company decided that it was not going to make them enough money to become its next billion-dollar blockbuster, so they pulled the plug.

What does this mean? This means that the drug will not be tested and therefore will not be approved and be put on the market. It also means that Chris Parish, who has devised the drug, has lost control of it. He can’t simply go to a different corporation and ask them to fund the research. He doesn’t hold the patent; the corporation does. So the corporation can decide to try again with a different trial, perhaps for a different application. Or the corporation can say, ‘We’re going to cut our losses and we’re not going to sponsor work on this drug anymore.” That means that nobody else can work on the drug. The drug is abandoned..

Junk Food Brings Disease and Economic Growth

The sale of foods that increase disease and the resulting use of medical services to treat that disease result in economic growth, increased employment and elevated stock prices.

This article by Harvard economics and public policy professor Kenneth Rogoff, a former International Monetary Fund chief economist, helps to explain the contradictions. At a minimum, it raises the right questions. It’s very difficult to arrive at the right answers without first asking the right questions.

Can we all agree that something is profoundly wrong with a calculus that judges poor health outcomes to be socially beneficial based on non-holistic economic reasoning that ignores all personal and social costs?

… I want to focus on the food industry’s link to broader problems with contemporary capitalism (which has certainly facilitated the worldwide obesity explosion), and on why the US political system has devoted remarkably little attention to the issue (though First Lady Michelle Obama has made important efforts to raise awareness).

Obesity affects life expectancy in numerous ways, ranging from cardiovascular disease to some types of cancer. Moreover, obesity – certainly in its morbid manifestations – can affect quality of life. The costs are borne not only by the individual, but also by society – directly, through the healthcare system, and indirectly, through lost productivity, for example, and higher transport costs (more jet fuel, larger seats, etc).

But the obesity epidemic hardly looks like a growth killer. Highly processed corn-based food products, with lots of chemical additives, are well known to be a major driver of weight gain, but, from a conventional growth-accounting perspective, they are great stuff. Big agriculture gets paid for growing the corn (often subsidised by the government), and the food processors get paid for adding tonnes of chemicals to create a habit-forming – and thus irresistible – product. Along the way, scientists get paid for finding just the right mix of salt, sugar and chemicals to make the latest instant food maximally addictive; advertisers get paid for peddling it; and, in the end, the healthcare industry makes a fortune treating the disease that inevitably results.

Coronary capitalism is fantastic for the stock market, which includes companies in all of these industries. Highly processed food is also good for jobs, including high-end employment in research, advertising and healthcare.

Interview with Harriet Washington (Part I): Patenting Life and Corporatizing the University

Click here to read the introduction to this four-part interview.

Two events took place in the United States in 1980 that, in retrospect, have dramatically changed the nature and direction of health sciences research. These were the Supreme Court decision in Diamond v. Chakrabarty that allowed the patenting of living things and the passage of the Bayh-Dole Government Patent Policy Act. To begin, could you please give us a broad-brush summary of these policy changes? 

Their import is that Diamond v. Chakrabarty removed the ambiguity about whether one could take out a patent on a product of nature. And specifically for our purposes, whether one is able to take out a patent on a living thing. Living things had occasionally been patented in the past. For example, when adrenalin was patented, there were objections that this was actually a discovery rather than an invention. Even Louis Pasteur faced questions when he patented a strain of yeast. Some said, “You didn’t invent this yeast; you just discovered it.”

So now we have a law that stipulates unambiguously that if something is living, that’s not a bar to its being patented. In addition, we have a second law saying that when a university holds a patent, it is legal for the university to license or sell that patent to a corporate entity. Previously, universities were not allowed to do that, the rationale being that these patents arose from research that was subsidized by the government — that is, by you and me. Our tax dollars paid for the development of these molecules, and the feeling was that a private corporation should not be allowed to profit from it. The 1980 Bayh-Dole Act, supplemented by other laws, changed all that, making it feasible and, in fact, making it desirable for the first time, for researchers to take out patents on living things, based on research performed in universities, and to sell and license them to corporations. Bayh-Dole was basically a golden key for corporations who could now profit from patents that they previously were unable to hold.

A Book Worth Reading: Deadly Monopolies by Harriet Washington

I recently interviewed Harriet Washington, a brilliant scholar and writer whose most recent book is Deadly Monopolies (Doubleday, 2011), a hard-hitting exposé where she insightfully explores several issues certain to have a dramatic impact on the future of healthcare and human freedom.

The interview will be published in the March 2012 issue of Pathways, a Washington, DC, community quarterly, and I’ll be posting it in sections over the next few days on Redwood HealthSpeak.

In this interview, Washington discusses the role of patents, particularly those held by profit-making private corporations on drugs, plants and the human genetic code; the drastic changes over the past generation in relationships between universities and corporations; the erosion of informed consent; and what she calls biocolonialism, including medical research by Western and Japanese corporations in developing nations that abandons the hard-won patient protections available to people in developed nations.

Washington’s earlier book, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, won a National Book Critics Circle Award, the 2007 PEN Oakland Award, and the 2007 American Library Association Black Caucus Nonfiction Award. 

She has been a fellow in medical ethics at the Harvard Medical School, a senior research scholar at the National Center for Bioethics at Tuskegee University, a fellow at the Harvard School of Public Health, and the recipient of a John S. Knight Fellowship at Stanford University.

U.S. Military Announces Major Nutrition Standards Upgrade

This is the inaugural post on my new health policy blog. I’m glad it’s about a positive development.  Whenever there’s a meaningful, health-affirming policy decision by any group in the public or private sector, it deserves to be celebrated. Particularly when it has the potential to help so many people, as is the case with this decision by the military.

From an Associated Press wire story in the Washington Post:

WASHINGTON — Hold the mystery meat: Military bases will soon be serving more fruits, vegetables and low-fat dishes under the first program in 20 years to improve nutrition standards across the armed services.

First lady Michelle Obama and Pentagon officials planned to announce the effort Thursday during a visit to Little Rock Air Force Base in Arkansas, where the military has been experimenting with the idea through a pilot program designed to improve the quality and variety of foods served on base…

The Department of Defense considers obesity not only a national problem, but a national security issue,” said Dr. Jonathan Woodson, assistant secretary of defense for health affairs. “About a quarter of entry-level candidates are too overweight to actually either enter the military or sustain themselves through the first enlistment.”

The Pentagon spends an estimated $4.5 billion a year on food services, and $1.1 billion a year on medical care related to excess weight and obesity.

Under the Military Health System’s new obesity and nutrition awareness campaign, more fruits, vegetables, whole grains and lower-fat entrées will be coming to the 1,100 service member dining halls in coming months. Healthier choices will be turning up in base schools, vending machines and snack bars, too.