Are You To Blame For The High Cost Of Health Care?

doctors drugs lawyers.jpgIf you listen to Republican legislators tell it, medical malpractice lawyers are to blame for the high cost of health care. Frivolous medical malpractice lawsuits drive up doctors’ medical malpractice premiums and force them to practice “defensive medicine” – ordering more tests and examinations than are actually necessary to treat the patient. All of this translates into you paying much more than you should for your health care.
We’ve dealt with those claims before on this blog and found them lacking.
So now there’s a new explanation for the high cost of health care and it’s probably not one you’re going to like. The new theory is: You’re to blame. Yes, you. Stop looking around at everyone else.
As economist/blogger Tyler Cowen explains, a new journal article shows that since 1997, when the FDA relaxed its rules on direct-to-consumer advertising (DTCA), the cost of prescription drugs has gone up threefold. Prior to 1997, broadcast advertising by pharmaceutical companies was much more heavily regulated by the FDA. The 1997 changes meant drug companies were able to spend comparatively more money directing advertisements at the consumer (you), rather than targeting your doctor (the person who writes out the prescription).
This research is really surprising because it flies in the face of a very famous free market economics journal article showing that, when advertising bans on optometry services were abandoned, the price of eyeglasses fell dramatically. Advertising gave consumers access to information that they hadn’t had before, so they were able to shop around for the best prices and eyeglass frames and lenses.
How do we reconcile the famous study of eyeglass prices with the new research suggesting pharmaceutical advertising is driving up the prices of pharmaceuticals? There are many explanations, but it seems “informational asymmetry” is involved. When a consumer is buying eyeglasses, she can tell that she needs them (she can tell that her vision is poor or has declined) and she knows what kind of results the eyeglasses produce (she can see them plain as day). So, in short, she and the eyeglass seller possess a roughly equal amount of information.
Pharmaceutical pills are a little more complex. Most problems have a vague set of symptoms. You can’t really tell if your symptoms are serious enough to need the pills. But you see the advertisement and want the magic pill. And you go to your doctor and pressure him to give it to you.
And we wind up with the cost of prescription drugs tripling in a little over a decade.
Needless to say, I like this theory better than the “medical malpractice lawyers are the root of all evil” theory.

Why You Should Pay Attention To Drug And Product Warning Labels

Warning labels on drugs and other products are often mocked for the extreme caution they recommend and for their obviousness. In fact, there’s a whole host of websites dedicated to mocking warning labels, including the website “Dumb Warning Labels.” (My favorite: “Warning: Product will be hot after heating.”)
One warning that I’ve heard mocked quite a few times is the warning you hear at the end of certain prescription drug commercials that a side effect of the drug may be an increased risk of problem gambling. Ads for the drugs Mirapex and Requip (a medication for restless leg syndrome and Parkinson’s) carry this warning, as seen here:

The ad, and its litany of warnings, probably seems silly, just another vestige of an overly litigious society. People may watch and doubt whether there’s any sort of connection between the drug and gambling and suspect this warning is premised entirely upon some scientist’s conjecture that such drugs may cause such behavior.
But, as I was reminded this week, while reading “How We Decide,” a book on neuroscience, drug and product warning labels are there for our own benefit. Drugs like Requip are called “dopamine agonists” – they activate dopamine receptors in your brain even when your dopamine levels are low.
For many people these drugs are a miracle. For example, Parkinson’s disease is a disorder of the dopamine system that involves the irreversible death of dopamine neurons in the part of the brain that controls bodily movement. A Parkinson’s patient taking a dopamine agonist can see dramatic improvement in his control of his bodily movement because the agonist gets more horsepower out of the few surviving dopamine neurons.
One side effect of this is that the patient’s amped-up dopamine neurons make him more attracted to the “dopamine highs” he gets from gambling. Lehrer, the Rhodes Scholar author of “How We Decide,” tells the story of Ann Klinestiver, a fifty-one year old English teacher who was diagnosed with Parkinson’s and prescribed Requip. Klinestiver, who had never previously gambled, and who had religious objections to gambling, suddenly became a problem gambler. After a year of playing slot machines, Ann had lost more than $250,000 – wiping out her retirement savings.
Klinstiver’s story is not unique. As Lehrer informs us, medical research suggests that as many of 13 percent of patients taking dopamine agonists develop severe gambling compulsions.
So the next time you come across a product warning label or a prescription drug label reciting a litany of possible side effects, ones that seem like a barrage of nonsense, take heed. The labels may actually be there for your benefit.

Journal Article Reveals Undisclosed Conflicts Of Interest In Avandia Studies

Professor Alberto Bernabe’s Torts blog has a good round-up of the recent coverage of a British Medical Journal article revealing undisclosed financial ties between researchers who discounted a link between the diabetes drug and heart attacks and the drug’s maker, GlaxoSmithKline.
In 2007, the FDA issued a warning that Avandia may elevate a patient’s risks for a heart attack. Since that time, more than 200 scholarly articles have been published. In about 90 of those articles, the authors had a financial interest in Avandia. However, one-quarter of the time when authors had a financial conflict of interest, they did not disclose the conflict.
And in fourteen percent of the articles, the authors stated that they had no conflict of interest, when in fact, the authors of this new article say they did.
The authors of this new British Medical Journal say that the number of Avandia researchers who disclosed their conflicts of interest was “unexpectedly low.” They also found that 94 percent of researchers who had positive opinions of Avandia received industry funding.

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Plaintiff Loses In First Seroquel Trial To Go To Jury Verdict

It’s been reported that the first Seroquel trial to go to jury verdict anywhere in the country has resulted in a loss for the plaintiff, with jurors voting 7-1 on Wednesday that AstraZeneca, Seroquel’s manufacturer, adequately warned the plaintiff’s doctors about Seroquel’s putting the plaintiff at an elevated risk for diabetes.
Seroquel is a pharmaceutical most often used to treat patients for bipolar disorder, schizophrenia or other mental illnesses, but is frequently also prescribed as a sedative and as a treatment for restless leg syndrome. Seroquel is AstraZeneca’s second-biggest selling drug.
A number of people prescribed Seroquel have filed lawsuits against AstraZeneca, claiming that the drug maker failed to warn adequately that the drug can lead to diabetes and pancreatitis.
The Seroquel lawsuits filed in federal court have all been consolidated into a single class action, however, individual lawsuits have proceeded in various state courts. This Seroquel defense action was one such case; it was filed on behalf of a single plaintiff in New Jersey.
It should be noted that verdict does not mean that the jury found that Seroquel does not cause diabetes. What the jury was simply supposed to consider was the question of whether AstraZeneca, Seroquel’s makers, adequately warned the patient’s doctors of the risks in the materials they provided the doctors.
In October of 2009, AstraZeneca settled two whistleblower lawsuits about Seroquel for $520 million and agreed to enter into a “Corporate Integrity” agreement with the United States Department of Justice. The allegations raised by the company’s internal whistleblower concern clinical trials of Seroquel but are otherwise confidential. Should the details of these cases also become public, we will report on that. In the meantime, we will keep you posted as these Seroquel cases reach jury verdict in other states.

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