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Scammers Alive And Well In The Health Blogosphere

March 28th, 2009 by Dr. Val Jones in Quackery Exposed
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On January 28th I exposed the tactics of a certain unscrupulous company called Wellsphere. In a nutshell, they lured unsuspecting bloggers to join their network with a series of flattering emails from their Chief Medical Officer, Geoff Rutledge, M.D., Ph.D. The emails suggest that by being featured at Wellsphere, the bloggers would receive higher visibility and more traffic to their blogs. In reality, when the bloggers signed up to join, they unwittingly gave Wellsphere the right to take all of their blogs’ content, aggregate it on Wellsphere and then SELL it to Health Central (without compensating the bloggers a penny). The bloggers whom I spoke with did not notice any increase in their traffic – in fact, since their entire RSS feed was featured at Wellsphere, readers had no incentive to click back to their blogs.

Beyond the shady blog-scraping practices, Wellsphere encouraged bloggers to answer medical questions (regardless of their qualifications to do so) on their site. Health Central’s tagline, by the way, is “trusted, reliable, and up to date health information.” In return, they were offered a “Maven” badge which suggested that they had special authority to do so. One blogger pointed out how unsafe this was:

I’m supposed to be a “Health Maven” in the “General Medicine” group … and I got my qualifications from …. a Cracker Jacks box? Wellsphere made it appear as if I was someone knowledgeable in General Medicine, and no one was checking in to make sure I wasn’t killing someone with bad advice! Dude! In fact, most of the questions which were sent in weren’t being answered at all, or they were being answered by numbos like me. Answers from real medical professionals were meager. Imagine if the readers took Wellsphere seriously, and actually trusted our replies!!!

When I first posted the story, about 60 commenters relayed horror stories of how misled they were by Wellsphere, and how their content was not removed from the site in a timely manner when they asked to cease participation. Twitter lit up with more disgruntlement. I figured that Health Central would have issued an apology to the bloggers who felt betrayed, but instead Chris Schroeder, CEO
of Health Central, had this to say,

“Most bloggers are happy about Wellsphere.”

In an early announcement to the media about the acquisition of Wellsphere, Mr. Schroeder revealed that the blogger content would allow Health Central “to more effectively monetize their advertising” because bloggers tend to come back regularly to the site, thus increasing advertising page views.

The Plot Thickens

So after doing my part to make bloggers aware of what was happening – and let them decide if they’d like to remain members of Wellsphere – I decided to move on. However, yesterday a member of Better Health was sent a flattering email from Dr. Geoff Rutledge inviting her to join Wellsphere. This same blogger had received similar emails over a year ago, had joined Wellsphere, figured out that there was NO value proposition for her or her blog, and requested that her content be removed.  Now many months later she receives this email:

I am astonished that these emails are still being sent, and the bold faced lie at the beginning (“Several months ago I discovered your blog…”) is truly disturbing.

I personally feel that these emails are now bordering on harassment, and that something needs to be done to protect bloggers from continued contact with Wellsphere.

As a point of interest, I NEVER joined Wellsphere, yet here is a screen shot from their website, featuring blog posts about me, my headshot, and my YouTube videos of recent TV interviews where I was a guest.

What do you think should be done next?

The Friday Funny: Animal Allergies

March 27th, 2009 by Dr. Val Jones in Friday Funny
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Cash-Only Physician Practices Could Save You A Bundle

March 26th, 2009 by Dr. Val Jones in Expert Interviews, Opinion
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When most people think of “cash-only” medical practices, plastic surgery and dermatology procedures are top of mind. But there is a small contingent of primary care physicians who offer low-cost “pay-as-you-go” services. Yearly physicals, well-child visits, screening tests, vaccinations, and chronic disease management are all part of comprehensive primary care options available. And this costs the average patient only $300 a year.

It is estimated that 75% of Americans require an average of 3.5 office visits per year to receive all the medical care they need. If the average office visit is 15-20 minutes in length, then that averages out to 1 hour of a physician’s time each year. How much should that cost? Dr. Alan Dappen (founder of Doctokr Family Medicine, a cash-only primary care practice in Vienna, Virginia) says, “$300.” But insurance premiums are often closer to $300 per month for these Americans, and that doesn’t include co-pays for provider visits.

So why aren’t people buying high deductible insurance plans, saving thousands on premiums per year, and flocking to cash-only primary care practices?  Dr. Dappen says it’s a simple matter of mindset – “People have been conditioned to believe that if they pay their insurance premiums, then healthcare is ‘free.’ In reality, their employers are taking out $3600 or more per year from their paychecks for this ‘free’ care. But since employees don’t see that money, they don’t miss it as much.”

A high deductible health insurance plan (where insurance doesn’t kick in until you’ve paid at least $3000 out of pocket in a given year) costs about $110/month for the generally healthy 75% of Americans (you can check rates at eHealthInsurance.com). That’s a savings of at least $2280/year for those who switch from a regular deductible plan to a high deductible plan.

What are the odds that the average, reasonably healthy American will outspend $2280/year? I asked Alan Dappen how many of his 1500 patients spent more than $2000 on his services per year. The answer? Three.

“Most Americans who buy-in to low deductible plans pay a lot more in premiums than they’ll ever use. They’re essentially betting against the casino, and we all know who wins on those bets.”

So I asked Alan Dappen if “the casino” was making most of its money on the “healthy” 75% of its enrollees to subsidize the cost of the sick 25%.

“Sure they are. And I suppose if enough people saw the light and switched to high deductible plans with cash-only physicians, it might force change in the health insurance industry.  Perhaps the government would use our taxes to help subsidize the sicker patients.

The bottom line is that at this very moment, 75% of Americans could be saving thousands of dollars per year on their healthcare costs – and have their very own cash-only primary care physician available to them 24-7 by phone, email, home visit, or office visit. The cash-only doc can afford to offer these conveniences because they are paid by the hour to do whatever the patient needs done, without forcing the relationship to conform to insurance billing codes. In fact, the physician saves a bundle on coding and billing fees – and can pass that on to the patients.”

I wondered about the outrageous costs of laboratory fees and radiology charges for people who don’t qualify for the insurance company negotiated rate. Dappen explained:

“My practice has negotiated similar rates with local labs and radiology groups. Screening tests and x-rays are very reasonable.”

I asked Dr. Dappen who uses his services.

“I see both ends of the spectrum. The high-powered executives who don’t have the time to wait in a doctor’s office and enjoy the convenience of handling things with me via phone or house call. For them, time is money, and by losing half a day or more traveling to a doctor’s office and waiting for their 15 minute slot, they might lose $5000 in billable work time. On the other end I see patients with no insurance or high deductible plans. They enjoy the same conveniences, and end up paying an average of $300/year for their healthcare. This is high quality care that they can afford.”

I guess the only thing preventing this model of healthcare from taking off is the courage of individuals to try something new. I myself have switched to a cash-only practice with a high deductible health insurance plan, and have saved myself thousands a year in the process. I love the convenience of knowing that my doctor has all my records in his EMR, I have his cell phone number, and he can renew my prescriptions with a simple email request. I can’t imagine why more people aren’t doing this.

Alan Dappen says, “They just have to wake up out of the Matrix.”

**For more in-depth coverage of the rising trend in cash-only practices, check out MedPage Today’s special report.**

What’s Big Pharma’s Position On Healthcare Reform?

March 25th, 2009 by Dr. Val Jones in Expert Interviews, Health Policy
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Today I participated in a conference call with Billy Tauzin, CEO of PhRMA (the Pharmaceutical Research and Manufacturers of America). The goal of the call was to let bloggers know about PhRMA’s position on healthcare reform. I counted at least 12 bloggers on the call, and I was the only physician. It pains me to see how few physicians participate in reform discussions and I’d like to get more of us involved.

The salient points, as I understood them, were:

1.    PhRMA would like all Americans to have health insurance. They believe that Medicare Part D is a model health insurance program. They do not support a single payer system because it would likely attempt to cut costs by rationing care and denying options to patients. They don’t believe that insurance coverage mandates are a good idea unless the insurance is subsidized to the point of being affordable for all. They favor the current public (Medicare and Medicaid for the elderly, poor, or disabled) private blend of insurance, with roughly 50% of the population in each category.
2.    PhRMA would like to support “precision medicine” where treatments are tailored more effectively to the individual. Mr. Tauzin suggested that some FDA-approved drugs are only effective for 30% of the patients in a given disease class. He’d like to see more research devoted to figuring out why that is, and supports comparative clinical effectiveness research insofar as it furthers this agenda.
3.    PhRMA wants to preserve the unique features of the American healthcare system – to maintain our leadership in biomedical research and new drug development, and to protect the sacred shared decision-making between physicians and patients (to shield it from government intervention).
4.    PhRMA wants to support IT infrastructure that would track patient medication compliance and let physicians know when/if they fill their prescriptions.

Now, the business case for all four of these positions is clear – the pharmaceutical industry benefits from having everyone able to afford medications (i.e. universal coverage), personalized medicine would reward the development of new and innovative drugs and establish a consumer base for many different treatments, protecting the doctor-patient relationship allows for off-label use of medications and a broader array of similar drugs, and IT infrastructure would help to increase drug purchase and compliance with treatment regimens, thus increasing overall sales.

However, the truth is that PhRMA’s positions on healthcare reform – beneficial as they are to themselves – also happen to be beneficial to patients. Increasing the number of insured improves access to medical care, personalized medicine could create more effective treatments with fewer failure rates and side effects, shared-decision making empowers patients to make the right decisions for their circumstances (with their physician’s guidance), and IT solutions that facilitate medication adherence, tracking, and reminder systems could improve patient health outcomes and keep them out of the hospital.

So, in a way pharmaceutical companies, advocacy groups, and physicians are fairly well aligned on many aspects of healthcare reform. Now if certain members of Big Pharma would please give up on those “me-too” drugs, stop creating more expensive medicines by simply combining two perfectly good ones into a new pill, stop hiding negative research studies, and refrain from aggressive direct-to-consumer marketing tactics, we might all really be on the same page.

***

Interesting factoids from call:

• Medicines only account for 10% of total healthcare costs (unchanged from the 1960s), but they “feel” like a larger cost driver because health insurance doesn’t cover their cost as completely as they do hospital fees.
• There are about 750 new cancer drugs in the research pipeline.
• Half of all prescriptions remain unfilled.
• Physicians provide 30 billion dollars a year in free care.
• The United States conducts 70% of the world’s research in biomedicines.

Please check out Billy Tauzin’s amazing story of triumph over cancer.

Extraordinary Physicians Honored For Advances In Medicine

March 24th, 2009 by Dr. Val Jones in News
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I attended the fourth annual Castle Connolly National Physician of the Year Awards last night in New York City. It was truly moving to hear the incredible stories of triumph of each honoree – from military surgery (Dr. Judd Moul), to curing head and neck cancer (Dr. Carol Bradford), to expanding palliative care services for people not expecting a cure (Dr. Diane Meier) – each awardee embodied the very best character and principles one can hope for in a physician.

But perhaps most moving of all was the story of lifetime achievement award-winner, Dr. Emil Freireich. Dr. Freireich was born to Hungarian immigrants, his father died when Emil was 2 years old, his mother worked in a sewing factory to provide for his needs growing up. Through sheer grit and determination, Emil managed to get himself to college and then medical school. He began his career in 1955 at the National Cancer Institute (and has been working at MD Anderson Cancer Center since 1965) where he was provided a challenge: to cure childhood leukemia. Here is what Dr. Freireich had to say about how things have advanced in the field of leukemia in his lifetime:

In 1955 when I began my career at the National Cancer Institute, children diagnosed with leukemia usually lived for about 8 weeks. They had about a 1% chance of surviving a year – and they had a median age of 5 years old at diagnosis.

The worst thing about leukemia was not the short life expectancy, but the way the children died. You see, leukemia destroys blood platelets (the part of the blood that allows it to clot), and produces its own anti-coagulant. So every child with leukemia died of massive hemorrhaging. As a doctor in 1955, when I entered the leukemia ward, all I saw was blood. The children were bleeding in their urine, stool, lungs, and even from their eyes. They would cough to breathe and spew blood as high as the ceilings. The wards were red with death.

But now, thanks to years of research and the development of combination chemotherapy, leukemia is not a death sentence. In most cases it can be cured, and in all cases we can stop the bleeding.

The most rewarding part of my career has been treating young children with leukemia, and watching these same children grow up to become physicians who treat other children with leukemia. I have passed the torch on to them, and I believe that they will one day find the cure for other cancers too. I believe we will get there soon.

I had the chance to interview Dr. Freireich for this blog last year. You may read more here. Congratulations to all the awardees of the event – carry the torch high for us docs, we need more stories of hope like yours… and thanks to Castle Connolly for such an inspirational evening.