Friday, July 27, 2007
The New Republic has an article by Jonathan Cohn discussing whether medical care is better in Europe. This has developed into a rather hot topic recently due to the scholarly articles (most recently JAMA) reporting that other countries with universal coverage spend less and receives better care and due also to SICKO (the movie) has made some comparisons between the United States health care system and other systems. The article is here and is well worth a read. (you do need to register - but it is free).
Kevin Drum at the Washington Monthly provides a brief overview of the article's findings:
I suppose you're all getting tired of hearing this, but the conclusion here is pretty much the same as it is every time you look at the U.S. vs. Europe: the differences are almost entirely about money. If you have a national healthcare system but you spend way less than the United States (as Great Britain does), you can provide good but not great service. If you spend modestly less than the United States (as France does) you can provide healthcare every bit as good as ours — and cover every single citizen in the bargain.
And what if you actually spend as much as the United States — but you have to put up with our ragtag private delivery system? Then you get healthcare about as good as France's, except that it doesn't cover everyone, it bankrupts large companies, and it goes away anytime you get laid off. And all for only about 40% more than anyone else in the world pays. Pretty good system, eh?
Happy "Special" Birthday to Professor Paul Caron - a terrific colleague, wonderful mentor and founder of the LawProfBlog network. I feel truly lucky to work with Paul. I don't know how many of you have experienced a wish to attend one of your colleagues classes because you know that it would be enjoyable to learn more about a topic from such a terrific professor. I must admit, I would love to take Paul's tax classes - there is a lot I don't know about tax law and policy and I cannot say that it is a big interest - but with someone like Paul - it would be a great experience.
Thursday, July 26, 2007
National Public Radio and other news outlets announced the news yesterday that the long-held medics (nurses and a doctor) had been released from Libya. These individuals had been accused of deliberating infecting children with the HIV virus. Here is the NPR story. The blog, the Next Hurrah, has further information on the story as well.
The newly revised FDA Revitalization Act (also formerly known as the FDA Enhancing Drug Safety and Innovation Act or FDA Amendments Act) deserves more attention as it moves through Congress for reconciliation. One of the readers sends in this news about a portion of the Act that should be of concern to all of us.
He writes of his condition called Intestinal Pseudo-Obstruction and is essentially a chronic, congestive failure of the entire digestive tract. He was one of many individuals who were taking Zelnorm, a powerful digestive prokinetic agent, manufactured by Novartis.
On March 30, 2007, FDA banned Zelnorm after a study showed 0.11% of the individuals taking the drug were at risk for myocardial infraction, angina or stroke. This compares quite favorable for the overall baseline risk in the overall population and even more favorably to the risks of Erythromycin (an antibiotic used to restore peristalis) which has a well-known risk of cardiac side effects and Reglan, a medication that has been available for about 40 years and causes a form of Parkinson’s Disease either temporarily or permanently in about half of the people who take it.
Though FDA promised to work with Novartis to hold a Advisory Committee Meeting to reassess the risks of Zelnorm, we are now at close to the four month mark and no advisory committee meeting has been scheduled. It is unlikely that such meeting will be scheduled before year end 2007.
It is in this context that I noted with concern the House’s passage of the FDA Revitalization Act. One of the provisions of the bill allows for the creation of a Drug Safety Oversight board. Normally, most FDA advisory boards allow for patient participation in the form of a patient representative and/or outside doctor representation. The current version of the bill does not; in addition, the bill only allows for the participation of officers from the FDA, NIH, HHS and “other appropriate federal agencies”. Therefore, decisions made by this board will be made in a “star chamber” that omits the expertise of patients and their doctors who have the best real-life experience in dealing with the implications of the risks and benefits of various pharmaceuticals. This provision only serves to continue the drug regulation trend where the most important participants in the process simply do not have a voice in its most important steps.
I was unaware of this provision of the Act until notified by this reader. Please contact your congressperson if you share these concerns.