September 3, 2011
Once Again, Health Care Leads an Anemic Jobs Market
The WSJ Health Blog reports:
The overall jobs picture is looking pretty dismal, with no net growth at all in nonfarm payrolls in August and the unemployment rate stuck at 9.1%. (Here’s the government’s press release on the report.).The health-care sector, however, continued to add jobs last month — some 29,700 positions, on top of a revised 29,800 new positions in July. Here’s the Bureau of Labor Statistics chart with all the details. As you can see, while jobs were added, growth was only about 0.2% from July’s base of about 14.1 million jobs.
Where exactly are those jobs coming from? That was a popular question when we reported on the health-care industry job growth seen in July. The stats permit us to see the specific industries that are hiring, but not the specific jobs. The BLS classifies under health care ambulatory health-care services — which includes doctors’ offices, outpatient-care centers and home health-care services — hospitals and nursing and residential-care facilities. Ambulatory services added 18,100 jobs in August, with doctors’ offices adding 5,600 positions, outpatient centers 1,400 jobs and home health-care 6,300 positions.
Hospitals, meantime, added 7,700 jobs while nursing and residential-care facilities added 3,900. Nursing homes specifically didn’t add any new jobs last month. As the WSJ reports, health-care companies are at the top of SimplyHired.com’s September hiring outlook.
September 2, 2011
Call for Papers: Criminology, Criminal Justice, and Public Health Studies
Justice Quarterly invites submissions for a special issue, "Criminology, Criminal Justice, and Public Health Studies." The goal of this special issue is to begin the discussion of health-related outcomes from within criminology and to ultimately build public health-criminology collaborations. Both quantitative and qualitative approaches are appropriate. Theoretical and analytical papers are appropriate and welcomed as well. The submission deadline is December 31, 2011. Click here for more information.
Worth Reading This Week
Gabriel H. Teninbaum, How Medical Apology Programs Harm Patients, SSRN
Leonard H. Glantz, J.D., and George J. Annas, Impossible? Outlawing State Safety Laws for Generic Drugs, NEJM
Katherine Baicker & Amitabh Chandra, Aspirin, Angioplasty, and Proton Beam Therapy: The Economics of Smarter Health Care Spending, Jackson Hole Economic Policy Symposium
September 1, 2011
Guest Blogger Jan OseiTutu: Counterfeit Medicines & Intellectual Property Enforcement
The global sale and trafficking of “counterfeit” medicines is dangerous, and the effects can be devastating. The World Health Organization (WHO) International Medical Products Anti-Counterfeiting Task Force (IMPACT) is part of an international effort, led by WHO, to tackle the problem of counterfeit medicines. These fake medicines are a threat to public health in both developed and developing countries. However, it is estimated that the percentage of counterfeit drugs is higher where the regulatory structure is weaker. Intellectual property advocates and pharmaceutical company representatives portray the poor global enforcement of intellectual property rights as part of the problem. On the other hand, some scholars suggest that intellectual property rights are the very reason that counterfeiting is profitable.
here is no doubt that fake medicines pose an unacceptable public health risk. But, it is not always clear what is meant by the term “counterfeit” medicines, and this can obscure the line between private intellectual property rights and public health matters. When the term “counterfeit” is used, it could mean a number of things. The medications may be understood to be “counterfeit” in the intellectual property sense. Indeed, trademarks, copyright or patents may be infringed when medicines are sold using the packaging or drug formulations that belong to legitimate innovator or generic companies. Sometimes generic drugs are also confused with counterfeit medicines. However, a generic medicine is not the same as a counterfeit medicine, but rather is a less expensive equivalent to the brand (innovator) medication. The reference to “counterfeit” drugs could also mean that the medication is “fake” because it contains toxic ingredients, or insufficient therapeutic ingredients, and has been manufactured under dangerous conditions. This medication is “counterfeit” in the sense that it is fake medication that can be harmful or even fatal. The sale of these fake medications normally involves the infringement of intellectual property rights as the counterfeiter attempts to have the fake drug pass as the real thing. This is why the global intellectual property enforcement agenda has been linked to public health.
Arguably, the challenge of dealing with fake or “counterfeit” drugs would be most appropriately addressed by national health institutions, relying on health based criminal penalties rather than on intellectual property offenses. Naturally, the health authorities would need to cooperate with criminal and border enforcement agencies, working in concert with their global counterparts. While increased border enforcement could focus on some health-oriented criteria, it could equally mean heightened monitoring and enforcement of intellectual property rights. My current project explores whether, bearing in mind the concern about the impact of intellectual property rights on access to medicines in developing countries, the need to protect the public health presents a strong case for increased global enforcement of intellectual property rights.
 A generic medication is not necessarily identical to the medication manufactured by the innovator company. However, depending on the applicable law of the country in which it is being sold, it would have been determined to be sufficiently equivalent to be used as a substitute for the brand.
American Society of Law, Medicine & Ethics (ASLME) will co-sponsor the upcoming “Conflicts of Interest in the Practice of Medicine: A National Symposium.”
On October 27-28, the American Society of Law, Medicine & Ethics (ASLME) will co-sponsor the upcoming “Conflicts of Interest in the Practice of Medicine: A National Symposium.” Click here to view the conference agenda.
Conference Goals: This one-and-a-half day conference will feature an array of recognized national experts who will discuss, debate, and propose best practices and approaches to the problem of conflicts of interest. This conference intends to foster a cross-disciplinary perspective on pertinent issues, and by the end of the conference, attendees will (1) learn about current consensus panel recommendations regarding management of conflicts of interest, (2) be able to describe remaining challenges to regulating conflicts of interest in key areas of research and medical practice, and (3) help fashion recommendations for the key players and identify other key steps in moving forward. The findings of the conference will be published in a special issue of The Journal of Law, Medicine & Ethics, a leading health law journal read by many academics and policymakers in this field.
The conference is generously funded by a grant from the Highmark Foundation of Pittsburgh, Pennsylvania, with additional funding contributed by the Jewish Healthcare Foundation, the University of Pittsburgh Schools of the Health Sciences, and by the University of Pittsburgh School of Law.
Visit ASLME's calendar page at http://www.aslme.org/Calendar for additional conference information. If you have any questions about this conference, please email Katie Johnson, Conference Director, at firstname.lastname@example.org or call (617) 262-4990.
Assessing Medicaid Managed Care
The Washington Post has featured two interesting pieces recently on Medicaid managed care. Christopher Weaver reported on a battle between providers and insurers in Texas. Noting that "federal health law calls for a huge expansion of the Medicaid program in 2014," Weaver shows how eager insurers are to enroll poor individuals in their plans. Each enrollee would "yield on average $7 a month profit," according to recent calculations. Cost-cutting legislators see potential fiscal gains, too, once the market starts working its magic. There's only one problem with those projections: it turns out that "moving Medicaid recipients into managed care 'did not lead to lower Medicaid spending during the 1991 to 2003 period,'" according to a report published by the National Bureau of Economic Research this month. Sarah Kliff is surprised to find that this is "the first national look at whether Medicaid managed care has actually done a key thing that states want it to do."
I share the frustration that we don't have enough information on key policy issues. On the other hand, I can see why economists and other social scientists would be reluctant to pronounce on the efficacy of Medicaid managed care. The NBER study suggested that Medicaid rates are often already "low enough that private insurers couldn’t negotiate a similar payment" rate. When the managed care insurers did manage to reduce overall spending, they usually did so in states with above-average compensation rates for Medicaid providers. So how would we judge an insurer which managed to reduce spending in a state with average or below average rates for providers? Probably not that highly if the strategy focused on delaying or denying access to needed care. Discussing past problems in managed care, one health law casebook notes that an "HMO was accused of putting its enrollment office on the third floor of a building without an elevator, and another tried to attract healthy elderly subscribers by holding square dances."*
There are a wide range of insurer activities that can add or reduce costs to a system. But how do we assure that we are measuring the effects of an intervention correctly? Some laudable innovations, for example, may be costly upfront, but will end up saving many times the initial spend years down the road. "Meat ax" rationing of pills or procedures may reduce spending now, but worsen health conditions that eventually become extremely expensive.
And when we consider quotidian decisions about denying or approving care, value judgments become even more complex. Accurate coding of whether a certain denial of coverage was actually appropriate can be very difficult. Empirical facts can be subject to widely divergent interpretations.
This is not to say that more studies on Medicaid managed care, and other health system innovations, should not be done. (It would be interesting to add up how much study spending was commissioned by the ACA (and even Dodd-Frank), as compared with policies like ELSI (which mandated a certain percentage of grants for the Human Genome Project to study its ethical, legal, and scientific implications).) I am just flagging the difficulties in obtaining "hard," "objective" proof of the value of certain policies. There is usually plenty of room to massage the numbers. [FP]
X-Posted: Health Reform Watch.
August 31, 2011
Interesting issues being discussed at ongoing meeting of Presidential Commission for the Study of Bioethical Issues. Washington Post article dealing with the Commission's recommendation of compensation for research-related injuries is here. [NPT]
August 30, 2011
Allowing Public Scrutiny of Science
Over two years ago, when President Obama eased restrictions on stem cell research, the President urged researchers in all areas to “follow science and not ideology,” reported here. One of the only ways the public can be assured this is happening is if scientists are allowed to talk freely to reporters about their work — without approval or chaperones from the public affairs office. That is one of the reasons agency policies need to undergo scrutiny.
This month, The Environmental Protection Agency released its draft scientific integrity policy. According to a report by the Society of Environmental Journalists (SEJ), the policy is troubling. SEJ contends that “the policy leaves political appointees with dominant authority for message control,” and contains ambiguous wording that “may mean scientists must get permission before talking to a reporter,” and that reporters "might not be allowed to talk to the specific scientist they ask to interview.” The policy was also criticized in a comment letter by the Public Employees for Environmental Responsibility as leaving whistle blowing scientists vulnerable to official reprisal.