July 21st, 2011 by DrWes in Opinion, Research
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To ensure rational and responsible dissemination of this new
technology (transcatheter aortic valve replacement [TAVR]), government,
industry and medicine will need to work in harmony.”
– David R. Holmes, Jr., MD, FACC
President, American College of Cardiology
Today, Edwards Lifesciences’ will request pre-market approval of its SAPIEN Transcatheter Heart Valve from the FDA’s Circulatory Systems Devices Panel of the Medical Devices Advisory Committee. And for the first time, the groundwork for our complicated new era of health care rationing will be exposed.
To win an expensive technology on behalf of patients these days, there will have to be “harmony” between doctors and their professional organizations and government regulators. If not, patients lose.
At issue is a transformative technology – another milestone forwarding medical innovation on behalf of some of our oldest and sickest patients: those with critical aortic stenosis who are too sick to undergo open heart surgery. Aortic stenosis tends to be a disease of the elderly that carries at least a 2-year 50% mortality when accompanied by a weakened heart muscle. Yet thanks to the wonders of careful engineering and some daring researchers that paired their expertise and lessons learned from a variety of disciples (cardiothoracic and peripheral vascular surgery, cardiology, and even cardiac electrophysiology), technigues and technology have combined to offer a percutaneous option for aortic valve replacement.
Everyone involved in this research (and even those who have watched from afar) knows this therapy works. Most believe in the long run, it will prove to be a safer option than open heart surgery in these patients.
But that’s about where the harmony ends. Read more »
*This blog post was originally published at Dr. Wes*
July 20th, 2011 by BobDoherty in Health Policy, Opinion
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Joe Scarborough reminds us that the divisions in American government are hardly new, paraphrasing Benjamin Franklin’s observation that “When you assemble a number of men, to have the advantage of their joint wisdom, you inevitably assemble . . . all their prejudices, their passions, their errors of opinion, their local interests, and their selfish views. From such an assembly can a perfect production be expected?” (This comes from a September 17, 1787 speech by Mr. Franklin to urge ratification of the U.S. Constitution, read on his behalf because he was too ill to deliver it in person. The Constitution was ratified the same day.)
I suppose we should be encouraged that Congress’s prejudices, passions, errors of opinion, local interests and selfish views are as American as apple pie, and the Republic has somehow survived nonetheless. Still, I find it deeply troubling that today’s politicians can’t find their way to agree on the debt ceiling.
No one should expect a “perfect production” to come out of this Congress and this administration, given how far apart they are on the need for tax increases and entitlement reforms. But they need to agree to something, and they need to do it soon.
I will leave it to others, who know a lot more about global economics than me, to explain what likely will happen to the economy if the debt ceiling isn’t increased by August 2. Let’s talk about the impact on health care, something I know quite a bit about—and why physicians especially should be concerned: Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
July 20th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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President Obama, where is your promise about transparency and accountability in Obamacare?
A major problem in the healthcare system is the lack of transparency and accountability. It has been unchecked for a very long time.
Both primary and secondary stakeholders act in their self-interest. These stakeholders have had ample opportunity to be non-transparent and non-accountable. All the stakeholders have abused the healthcare system.
I hit a nerve with my last blog “Patients And Physicians Must Control Costs”. Multiple readers responded with the usual comments:
“Patients are not smart enough to handle their own healthcare dollars.”
“Your basic idea makes sense, but in reality I doubt that a patient knows enough to make intelligent medical/financial decisions, because there are too many unknowns and variables.”
“Physicians over use the fee for service system in order to make more money.”
“If a physician tells a patient that there is only a 1/10,000 chance that an MRI will yield something useful, if the patient doesn’t have to pay for it, the patient wants the MRI.
Patients (consumers) must be taught and motivated to manage their own healthcare dollars. Patients’ choice Read more »
*This blog post was originally published at Repairing the Healthcare System*
July 17th, 2011 by Michael Kirsch, M.D. in Health Policy, Opinion
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Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity…The poor have more sickness, but they get less medical care. People who live in rural areas do not get the same amount or quality of medical attention as those who live in our cities.
The above quote wasn’t taken from an Obama administration policy proposal. These words are from a 1945 speech by President Harry Truman. It is astonishing that over 60 years later, the health care crisis is not only still with us, but is slowly smothering us. How many years of oxygen do we have left until health care in America is entirely asphyxiated? Each year, the challenges deepen and multiply, which pushes necessary solutions and reform further out of reach. The financial costs of simply maintaining the current system are sailing beyond the stratosphere. The ‘reform’ strategies in my adult lifetime have been to promise, procrastinate and pray, methods which provide politicians with short term gains at our long term expense.
As I write this, Read more »
*This blog post was originally published at MD Whistleblower*
July 16th, 2011 by Michael Sevilla, M.D. in Health Policy, Opinion
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Every day in the news, you hear about the United States federal budget and the potential political complications if something is done or if nothing is done. And every day in the news you hear about possible cuts in Medicare. What you don’t know is that some cuts in Medicare can significantly impact the training of future Family Physicians. What do I mean by this? Well, did you know that residency programs are paid Medicare funds (called Graduate Medical Education funds) going to hospitals? Check out this great article about how residency programs are funded.
So, let’s play this out with its potential complications for Family Medicine. If GME funds are cut as they are proposed, then many hospitals with only one residency program (usually a Family Medicine program), may be forced to close the program – thereby decreasing the number of Family Physicians being trained. In those hospitals with multispecialty programs (like large university hospitals), cuts in GME funding would force hospitals to cut their Family Medicine residency slots in favor of more specialty residency slots, which are more lucrative for hospitals. Again, this would decrease the number of Family Physicians being trained.
With GME funding being cut, there are two other disturbing possibilities that may happen. First, Read more »
*This blog post was originally published at Family Medicine Rocks Blog - Mike Sevilla, MD*
