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The title of this post may sound a little Tea Partyish, but stick with me here…

Medicare is projected to go broke by 2024.  We need to do something about it.  Here are a couple of news articles this week that identify some low hanging fruit.

1.  Rita Redberg, UCSF cardiologist and editor of the respected Archives of Internal Medicine, had a terrific op-ed piece in the New York Times this week about overtreatment of older adults, paid for by Medicare.  Some highlights (or lowlights)

  • 40% of colonoscopies are administered to people over age 75 (screening guidelines suggest not screening after 75, and certainly not screening after age 85).  Paid for by Medicare.
  • Kyphoplasty and Vertebroplasty, shown in two terrific randomized trials to be no better than sham procedures, are still funded by Medicare, to a tune of $1 BILLION/year.  
  • Cardiac stents are no more effective than medication management or lifestyle changes in preventing heart attacks or death.  Medicare cost: $1.4 BILLION/year.
  • 1/5th of implantable cardiac defibrillators were placed without meeting guidelines for placement.  Cost: $50,000 to $100,000 per device!

My favorite quote from Dr. Redberg:

Another factor is the shocking chasm between Medicare coverage and clinical evidence. Our medical culture is such that if the choice is between doing a test and not doing one, it is considered better care to do the test.

2.  Pro-publica has been doing some terrific reporting recently.  I previously postedon their terrific expose of the Heart Rhythm Society’s shameless and absurdly lucrative relationship with the makers of implantable cardiac defibrillators (usually paid for by Medicare, as above).  This week Pro-publica exposeda frankly disgusting relationship between the Society of Hospital Medicine and the drug company Sanofi-Aventis.

Here’s the brief story:

  • Lovenox is a blood thinner commonly used in hospitalized patients to treat blood clots.  It’s made by Sanofi.
  • Sanofi has an interest in keeping cheaper generic versions of Lovenox off the market.
  • Sanofi paid the Society of Hospital Medicine more than 2.3 million between 2007 and 2010
  • Sanofi asked the Society of Hospital Medicine to write a letter to the FDA
  • The CEO of the Society of Hospital Medicine said in an email that although the society had never written a letter like that to the FDA…”That being said when something is important to any of our partners (like Sanofi) that we have a long term relationship with we want to give any issue that is important to our partner careful consideration.”
  • The Society of Hospital Medicine wrote the (unprecedented) letter to the FDA, and another letter to the Wall Street Journal, cautioning against introduction of generic lovenox.
  • Keeping generic drugs like Lovenox off the market costs Medicare (and thus taxpayers) billions of dollars per year.

This “pay for delay” profits the drug companies at the expense of taxpayers and patients.  It’s yet another example of how drug and device money given to professional societies is tainted.

It’s sick, really.  The Society of Hospital Medicine should issue an apology, and return the money from Sanofi.

And transparency is not enough.  Professional societies should not be allowed to take money from drug and device manufacturers.  Period.  It leads to too much abuse, erosion of public trust, and overtreatment that harms patients, particularly older adults.  And industry profits often come at the expense of Medicare, paid for by you.

Your tax dollars, going to waste.  Tea party, anyone?

by: Alex Smith

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