Excessive Medical Spending: Facing the Challenge PDF
Preview Excessive Medical Spending: Facing the Challenge
EXCE$$IVE MEDICAL $PENDING E EEXXCCEE$$$$IIVVEE X C facing the challenge E $ $ I This book exposes why healthcare costs have OTHER BOOKS OF V been rapidly increasing and includes a close RELATED INTEREST E MMEEDDIICCAALL examination of over-priced drugs. It contains a Physicians as Leaders M detailed explanation of how the drug industry Who, How and Why Now? E takes billions of dollars from society each year Mindi K. McKenna and Perry A. Pugno D I and proposes radical new ideas to reign in Medical Practice Management in the C excessive spending on medicine. 21st Century A the handbook $$PPEENNDDIINNGG L Marjorie A. Satinsky with Based on the latest research, its unique approach $ Randall T. Curnow Jr P takes into account the pharmaceutical industry, European Medicines Pricing and E healthcare policy and society to offer a wide- Reimbursement N ranging account. now and the future D Martina Garau and Jorge Mestre-Ferrandiz I N It is invaluable for all healthcare professionals, facing the challenge Suffering and Healing in America G especially managers, and doctors and nurses an American doctor’s view from outside with budgetary responsibilities. It will also Raymond Downing E d be useful for researchers, policy makers and Third World Health it e shapers, pharmaceutical company executives hostage to First World wealth d b and general readers with an interest in medical Théodore H. MacDonald y N Edited by expenditure. Communication Skills that Heal O R a practical approach to a new M NORMAN J. TEMPLE AND A ‘The more serious landmine in the road ahead is professionalism in medicine N Barry Bub J healthcare fi nance, which will be in full-blown . ANDREW THOMPSON T crisis sometime early in the next decade. That’s Home Visits EM a return to the classical role of the P why this book is timely. Until we learn to talk L physician E Foreword by Merrill Goozner openly and honestly about what constitutes A Alfred E. Stillman N good health, good healthcare, and the best and D The AIDS Pandemic A most cost-effective way of achieving both, we’ll N the collision of epidemiology with D never have an affordable healthcare system.’ R political correctness E W Merrill Goozner, in the Foreword James Chin T H O K27841 M 6000 Broken Sound Parkway, NW P Suite 300, Boca Raton, FL 33487 ISBN: 978-1-84619-168-8 S 711 Third Avenue 90000 O New York, NY 10017 N an informa business 2 Park Square, Milton Park Abingdon, Oxon OX14 4RN, UK 9 781846 191688 www.crcpress.com rad_Temple_1206.indd 1 3/1/07 10:27:39 am Excessive Medical Spending Facing the challenge TThhiiss ppaaggee iinntteennttiioonnaallllyy lleefftt bbllaannkk Excessive Medical Spending Facing the challenge Edited by Norman J. Temple AthabascaUniversity and Andrew Thompson UniversityofOregon(retired) CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2007 by Norman J. Temple and Andrew Thompson CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20160525 International Standard Book Number-13: 978-1-138-03068-8 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions of the publishers. The information or guidance contained in this book is intended for use by medical, scientific or health-care professionals and is provided strictly as a supple- ment to the medical or other professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to consult the relevant national drug formulary and the drug companies’ and device or material manufacturers’ printed instructions, and their websites, before administering or utilizing any of the drugs, devices or materials mentioned in this book. This book does not indicate whether a particular treatment is appropriate or suitable for a particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her own professional judgements, so as to advise and treat patients appropriately. The authors and publishers have also attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may rectify in any future reprint. Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. 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Visit the Taylor & Francis Web site at http://www.taylorandfrancis.com and the CRC Press Web site at http://www.crcpress.com ToMichaelandGillian –Norman Tomywife,Marie-Anne,forputtingupwithme –Andrew TThhiiss ppaaggee iinntteennttiioonnaallllyy lleefftt bbllaannkk Contents Foreword ix Authoraddresses xii Introduction xiv 1 Thecostofmedicalcare:howmuchistoomuch? 1 AndrewThompsonandNormanJ.Temple 2 Thenutsandboltsofmedicalresearch 9 NormanJ.TempleandAndrewThompson 3 Conflictofinterest:amajorprobleminmedicalresearch 20 JoyFraser 4 Drugregulation:twoparadigmsinconflict 36 JoelLexchin 5 Themarketingofdrugs:howdrugcompaniesmanipulatethe prescribinghabitsofdoctors 53 AudreyBalay-Karperien,NormanJ.Temple,andJoelLexchin 6 PricingpharmaceuticaldrugsintheUSA 63 DonaldW.Light 7 Potentialsavingsfromtherapeuticsubstitutionof10ofCanada’s mostdispensedprescriptiondrugs 80 AlanCasselsandJoelLexchin 8 Statins:isthenetbeingthrowntoowide? 93 AndrewThompsonandNormanJ.Temple 9 ModernWesternmedicine:lotsofbucks–where’sthebang? 101 NormanJ.TempleandJoyFraser 10 Genetics,genomicmedicine,andachievingbetterpopulationhealth: aflawedstrategy? 110 PatriciaA.BairdandNormanJ.Temple 11 Issuesinscreeningforcancer 112 LucBonneux 12 TheCanadianNationalBreastScreeningStudy:sciencemeets controversy 121 CorneliaJ.Baines 13 Screeningforbreastcancer:benefitsversuscosts 125 AndrewThompsonandNormanJ.Temple 14 ScreeningforcervicalcancerbyPaptests 131 AndrewThompsonandNormanJ.Temple viii Contents 15 Payingforwhatworks:theReferenceDrugProgramasamodel forrationalpolicy-making 139 AlanCasselsandNormanJ.Temple 16 Diseaseprevention:theneglectedalternative 152 NormanJ.Temple 17 Promotingthehealthofthemedicalprofession:environmentalism andcommercialisminmedicaleducation 166 IahnGonsenhauser,DannyGeorge,andPeterJ.Whitehouse 18 Aproposednewgrandstrategy:anintegratedhealthsystemfor the21stcentury 177 NormanJ.TempleandAndrewThompson Index 187 Foreword Everyindustrializedsocietyintheworldisagingrapidly.Withlifeexpectanciesat all-time highs and birth rates near all-time lows, the Baby Boom generation is closing in on retirement – a time when healthcare needs escalate rapidly – with relativelyfeweryoungpeoplearoundtopaythebills.Whilemostdiscussionsabout thefiscalproblemscausedbyagingsocietieshavefocusedonpensionsandincome security,themoreseriouslandmineintheroadaheadishealthcarefinance,which willbeinfull-blowncrisissometimeearlyinthenextdecade.That’swhythisbook, ExcessiveMedicalSpending:FacingtheChallenge,istimely.Untilwelearntotalkopenly andhonestlyaboutwhatconstitutesgoodhealth,goodhealthcare,andthebestand most cost-effective way of achieving both, we will never have an affordable healthcaresystem. The current practice of medicine, which is dominated by pharmaceutical and medicaldevicecompanies,hospitalchains,physicians’guilds,and,inthecaseofthe USA,largeinsurers,isdesignedtoavoidaskingsuchquestions.Evencountrieswith single-payer national healthcare systems have been stymied in their attempts to curbtheinfluenceofthespecialinterests.Theresultisthatinmostindustrialized countries healthcare spending is growing two or three times faster than the rest of the economy. The USA is leading the charge into healthcare bankruptcy by spendingnearly15%ofitsgrossdomesticproductonhealth,alevelnearly50% greaterthananyothernation.FormerlygreatindustrialpowerhouseslikeGeneral Motors and Ford are now threatened by economic collapse because of their escalatinghealthcarecosts. Sothetimehascometoasksomehardquestionsaboutwhatwearegettingfor our large and growing investment in health. Yes, we are living longer, but are medical interventions the reason? To an extent they are, but are they adding as muchtoourqualityoflifeastheyaretoitsduration?Aretheresomehealthcare interventions that are simply not worth the price? And are there better ways of addressingunderlyinghealthcareproblemsthatnotonlyextendlife,butdosoat lower cost and with better outcomes in terms of our ability to enjoy our extra monthsandyears? Inordertoanswersuchquestions,weneedanewlanguagefortalkingabouthow wespendourhealthcaredollars.Takeheartdisease,forexample.Thoughitremains aleadingkillerinvirtuallyeverywealthynation,deathratesfromcardiovascular diseasehavebeenedgingdowninrecentdecades.Whataccountsfortheimprove- ment? Can it be attributed to advances in diagnostics, drug therapy, and im- plantable devices such as stents and defibrillators? Or has it largely been due to publichealthcampaignstocombatsmoking,poordiets,andlackofexercise?And now that we are facing an alarming situation where some of those gains may be reversedbecauseoftheobesityepidemic,whatisthebeststrategyforpreserving andextendingourgainsagainstthisfeareddisease? As the studies here show, physicians seeking guidance for their treatment decisions will not get an objective review of the evidence when they go to the medicalliteratureorreadclinicalpracticeguidelines.Drugcompaniesanddevice
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