The chairmen of 13 clinical departments at Boston’s Beth Israel Deaconess Medical Center agreed last week to donate $350,000 to help reduce the need for staff layoffs.
 
“This was a really easy decision,” Mary Ann Stevenson told the Boston Globe.

The Radiation Oncology chair added, “most of us have been longtime campaigners for the hospital. Most of us feel really strongly about where we work.”

And they’ve appealed to their physician colleagues and reports who are affiliated with the hospital to follow suit.

“We invite you to consider making as generous a contribution as possible,” the chiefs penned in a letter to 1,100 staff physicians that was obtained by the Globe. Donated funds “will support job preservation among the hospital staff (so) they can continue to provide great service to our patients.”

Beth Israel Deaconess is affiliated with Harvard Medical School. It announced last month that it faced a $20 million operating loss for the fiscal year, and planned to enact cost-reducing moves including RIFs as a consequence.

After that announcement, hospital CEO cum blogger extraordinaire Paul Levy began working with employees on money saving, job preserving ideas.

That let BIDMC reduce the number of layoffs from 600 to 150.

The ideas included a temporary halt in funding employees’ 401(k) and 403(b) retirement plans, suspending a planned 3% salary increase for certain employees, eliminating the annual employee barbecue and ending hospital reimbursement for staff cell phones.

In addition, Levy has cut his own pay by 10%, and that of his executive staff by 5%.

Hospitals across the country have seen patient volumes drop as the Great Economic Crisis prompts people to defer elective procedures. Inpatient volume at BIDMC is off 1% this year.

In the decade since the FDA began permitting Big Pharma to market drugs directly to consumers, the ads have become ubiquitous on TV and radio and in print media.

The industry spends $5 billion per year on DTC and no one argues the ads move mountains. For example, ads for the highly effective cholesterol-lowering statins have increased their utilization and almost certainly saved lives as a result.

But it’s galled more than a few folks that DTC ads have been equally effective promoting lifestyle drugs that line Big Pharma’s pockets without doing much to improve overall population health.

Rep. Bart Stupak (D-Mich.) for example, never did warm to the DTC concept. In May, he called out Pfizer for Lipitor ads featuring Robert Jarvik, the well-known inventor of the artificial heart because Jarvik is not a practicing physician.

So Big Pharma knew what to expect from Stupak when PhRMA, its trade group announced last week it was tightening its own guidelines governing DTC practices.

The new “voluntary guiding principles” include halting the practice of using actors to role-play physicians on DTC ads, requiring that celebrities cease claiming they use drugs unless they actually do, and ceasing the promotion of drugs for indications not approved by the FDA.

The guidelines also limit ads with adult-oriented DTC content (that would be Viagra and congeners) to programs that normally draw adult audiences.

Stupak offered lukewarm praise and quickly added that the guidelines don’t go far enough.

He wants Big Pharma to wait 2 years after drugs are marketed before releasing ads DTC to assure all drug effects are fully understood.  He also wants the FDA’s toll-free number to appear on DTC ads to facilitate reporting of side effects.

Industry spokespeople indicated they’d be happy to review the issue in a few years if critics remained unsatisfied. There’s no chance the issue remains quiet that long.

In 1960, 13% of US adults were obese. Now it’s 31% and it’s looking like obesity might surpass cigarette smoking as the numero uno preventable cause of premature death.

How can we get people to get serious about losing weight?

Kevin Volpp and colleagues at the University of Pennsylvania thought why not try financial incentives and you know what? They worked like a charm.

The scientists randomized 57 obese healthy male volunteers aged 30-70 years to either of 2 incentive programs or a control group. The goal was to lose 16 pounds in 16 weeks.

In both incentive schemes, participants had to pay to play and could only win if they met weight loss targets during the study. The first involved a cash lottery. In the second, players doubled their money straight-up if they met the targets.

In both schemes, the payout came out to about the same, $300 per qualifying player. The control group received educational materials and monthly weigh-ins.

At the end of 16 weeks, only 10% of the controls achieved the weight loss target. Fully half those in each incentive group made it and the difference was significant.  The findings were not impacted by age, income or initial BMI.

At 7 months, scientists found that the weight of control group participants had returned to pre-study values. Weight of participants in the incentive groups was significantly below baseline levels, although they had packed on some pounds since the study ended.  

And almost no one in the incentive groups was lost to follow-up!

Scientists will want to study the long-term benefits of incentive programs, determine whether the findings can be generalized to women and assess program cost-effectiveness but yea, we know how get their attention all right!

After reporting a 28% decrease in Q3 net income, pharmaceutical giant Merck & Co. announced it will cut 7,200 jobs over the next 3 years. This amounts to 12% of its workforce and it comes on top of 10,400 job cuts the company has made during the last 3 years.

Merck said workforce reductions will coincide with the shuttering of research facilities in Seattle, Italy and Japan. Executive positions will be reduced by 25%. 40% of the reductions will involve US-based employees.

CEO Richard Clark indicated the moves were part of the company’s plans to reengineer its R & D, manufacturing and sales processes. “New business models have to be put in place for our industry to survive,” he told the Wall Street Journal.

Merck’s Q3 sales dropped 2% to $5.9 billion. The company attributed the fall to decreased revenue from three key drugs: Gardasil, a cervical cancer vaccine, Vytorin, a cholesterol-lowering drug whose effectiveness has been questioned, and Fosamax a bone mineralization drug that faces generic competition in the US. Merck also cited the economic downturn as a cause of its troubles. The Great Economic Crisis of 2008 has triggered a nearly unprecedented drop in US health care consumption.

Merck did report sales growth for its diabetes drugs, Januvia and Janumet. Sales of the former increased 250% to $379 million. Sales of the latter increased 500% to $101 million.

Eli Lilly and Company has announced it is nearing a settlement with the US Attorney’s Office regarding unsavory marketing and promotional practices for Zyprexa, its antipsychotic blockbuster. As a consequence, Lilly will take a $1.4 billion charge, or $1.29 per share in Q3 2008.

Lilly stands accused of promoting the drug for psychotic symptoms in the setting of dementia even though the FDA did not approve the drug for this purpose.

As part of the settlement, Lilly announced it will incorporate a compliance program to assure its marketing and promotional practices comply with all laws and regulations.

“We now have a heightened sense of responsibility to all our stakeholders to intensify efforts to resolve these issues,” said Robert A. Armitage, Lilly’s general counsel.

Lilly’s move is an attempt to preempt a long, complex legal battle. Medicaid Fraud Control Units in 30 states had begun coordinating with the US Court while pursuing their own investigations of the matter.

Since its introduction in 1996, Zyprexa has been prescribed for 26 million people around the world. Q2 sales exceeded $1.1 billion, nearly a third of Lilly’s total revenue. Zyprexa sales dropped in 2008 as competitive drugs entered the market and concerns about weight gain and diabetes risk have surfaced.

Last month Pizaazz reported that Zyprexa is also commonly used off-label for psychosis in children, although its efficacy has been questioned and serious side effects have been reported in this group.

Four stent makers and 4 drug companies have agreed to fund a $100 million study to determine how long vigorous but risky anti-platelet therapy should be continued in patients who receive stents following balloon angioplasty.

Anti-platelet therapy with aspirin and Plavix helps prevent blood clot formation around the stent (pictured), an event which can be serious, even fatal. The downside of anti-platelet therapy is an increased risk of bleeding and stroke. 

In patients receiving stents, physicians typically prescribe aggressive anti-platelet therapy for about one year, but many patients have developed clots after that time. The study will randomize patients to receive one year versus 2 ½ years of aggressive anti-platelet therapy.

The global market for stents, particularly the more profitable drug-eluting variety, has diminished to about $5 billion per year primarily due to concerns about blood clots and bleeding from anti-platelet therapy.

Four of the study’s funding companies are stent-makers: Johnson & Johnson, Boston Scientific Corp. Abbott Laboratories, Inc. and Medtronic, Inc.

The other four are drug companies. They include Sanofi-Aventis and Bristol-Meyers Squibb, which co-market Plavix, and Eli Lilly & Co. and Daiichi Sankyo, which co-developed prasugrel, a Plavix competitor that is edging toward FDA approval.

Plavix by the way, is the world’s second largest selling drug with $5.9 billion in annual sales. It has patent protection until November, 2011. It is anticipated that the current study will take 4 years to complete.

Physicians know the dangers of smoking, but they don’t have time to counsel patients. Toll free tobacco quit lines are a proven, cost-effective alternative, but physicians rarely refer patients to such services.

A study published in this week’s Archives of Internal Medicine has shown that paying physicians to refer cigarette-smoking patients to quit lines increases their referral rates by 250%.

The study was a randomized trial of a program offering physicians $5,000 for 50 referrals to a quit line vs. usual care (no pay for performance). Only patients who intended to quit within 30 days were eligible for referral. Physicians in the incentive program referred 11.4% of eligible smokers while those in the usual care cohort referred 4.2%.

The marginal cost per quit line enrollee was $300, a pittance given that in the US, tobacco use causes 440,000 premature deaths and $75 billion in extra medical costs per year.

The study’s authors commented that health plan collaboration was essential to program success. It streamlined referrals and allowed physicians to refer patients regardless of their insurer. Thus physicians could target all smokers rather than just those from certain health plans.

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According to results published last week by comScore, purplepill.com, the AstraZeneca-sponsored web site for its heartburn drug Nexium was the busiest of all company-sponsored web sites in Q2 2008, with more than 1 million unique visitors.

Here are the top five sites by number of unique visitors (in millions), and the percent change from Q2 2007:

Nexium (heartburn):  1,021, +55%
Actos (diabetes):  855, +2,399%
Ambien CR (insomnia):  756, -61%
Gardasil (HPV vaccine):  722, -21%
Lexapro (anxiety, depression):  549, +3%

“AstraZeneca has aggressively marketed Nexium this year, running approximately twice as much online display advertising in Q2 as either of its major competitors, Prevacid and Aciphex,” said comScore’s John Mangano. “This additional marketing muscle appears to have helped generate strong site visitation, a very important marketing step in the competitive pharmaceutical industry.”

comScore also credited marketing campaigns for the surge in volume on the web site for Actos, Takeda’s diabetes drug, although safety concerns about a competing drug, Avandia, probably played a role as well.

Sanofi-Aventis’ Ambien CR site lost significant volume in the past year, as the regular version of the drug faced generic competition for the first time.

Gardasil, Merck’s HPV vaccine was approved by the FDA in Q2 2006. Merck is not publicizing the vaccine as aggressively as it was a year ago, but the site still makes the top five.

When both houses of Congress approved bills last week requiring insurers to provide mental health benefits equivalent to those for physical illness, advocates who had worked 10 years to enact such legislation lauded it as a major step forward.

But the House and Senate versions differed, and the legislative session was coming to a close. It wasn’t clear Congress would act quickly enough to have something on the President’s desk before adjournment.

Subsequently the credit markets froze, the House turned Paulson’s 3 page scheme into a 240 treatise before voting it down, and the markets dropped like a stone.

The Senate had to clean up the mess, and thanks to a handful of clear headed, dedicated people  who seized the moment, the Senate’s version of the mental health bill became part of the bailout legislation (see page 310 out of 451) that it passed on Wednesday.

Now it’s on to the House. 

Terrific work right there by people who know how to get things done in Washington. There are some who will point to enactment of this mental health legislation as the crowning achievement of their careers. These people are, of course, “all in” on the bailout.  We wish them luck!

Ever since surgical resident workweeks started getting shaved (it’s now 80 hours), there has been debate about how the change impacts quality in teaching hospitals. Proponents of the shorter workweek believe less fatigued residents make less errors. Skeptics fear that frequent shift changes increase the risk of errors in information transfer.

To date, studies of the matter have failed to silence the debate one way or the other.

The same can be said of the latest study of laporoscopic cholecystectomy in the era of the 80 hour workweek. The problem isn’t its finding that quality improved after the workweek became shorter, but that it’s not possible to attribute the improvement to residents sleeping more.

Using a retrospective trial design, the investigators compared complication rates at their hospital before and after the change to an 80 hour workweek. After accounting for age, gender and presence of acute cholecystitis, they found that the incidence of bile duct injury and total complications was lower after the rule change.

But why?  It may be that rested residents make all the difference. But it also could be that attending physician supervisors got more involved for whatever reason, or that the manpower alteration caused risky patients (where complications are most likely) to get procedures other than laporoscopic cholecystectomy.

A frequently used toll-free help line for Medicare beneficiaries either gives out inaccurate information or no information at all, according to a report presented to the Senate Aging Committee.

The service in question is 1-800-Medicare. It is supposed to help beneficiaries find their way through the complex federal health insurance program.

Recently, Sen. Gordon Smith (D-Ore) had his staff place 500 test calls to the help line. Staff members found that the information they received was inadequate 90% of the time.  Callers to the toll free number are also plagued by wait times up to an hour and frequent dropped calls, according to the report.

1-800-Medicare will receive 30 million calls this year. It has been in operation for 10 years. Volume ramped up substantially in 2003 when Medicare’s Part D prescription drug plan went into effect.

CMS acting administrator Kerry Weems said Medicare will improve performance of the toll free service by upgrading training and improving the call center’s data bases. A senior officer at Vangent Inc., the contractor that operates the 1-800-Medicare call centers, pointed out that 85% of callers were actually satisfied with the program. He added that most real world callers had simpler issues than the ones posed by Smith’s staff.