Consumer and health advocacy groups in New York are criticizing a yet-to-be-made public plan to create a medical malpractice indemnity pool which would cover medical expenses for injured patients.

Although no plan to create the pool has been announced, the coalition of groups – which includes the New York Public Interest Research Group, the Center for Medical Consumers and the Center for Justice and Democracy – has nevertheless sent letters to Gov. David Paterson decrying the rumored plan, which they say is a poor fix for the state’s health care troubles.
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Patients given freebies spend nearly 40 percent more on meds, study says

Leaving the doctor’s office with a bagful of free drug samples may seem like a good way to save money, not to mention an inconvenient trip to the pharmacy.

But people banking on the freebies need to think again, according to a new study that shows patients who get samples end up with significantly higher out-of-pocket costs than those who don’t.

On average, patients who got free prescription samples spent nearly 40 percent more for medication during the six months they received samples, and nearly 20 percent more in the six months afterward, than those who didn’t, according to University of Chicago researchers.

“The notion that people have is that if you receive samples, it helps with out-of-pocket costs because you don’t have to go out and buy the drugs,” said Anirban Basu, one of the study authors and an assistant professor of medicine at the University of Chicago.

“What we found, actually, was that their out-of-pocket expenditures increased. Most surprising was that those out-of-pocket expenditures continued even after the samples stopped.”

The study, published this week in the journal Medical Care, renews debate about the role of more than $18 billion in free pharmaceutical samples distributed each year, which drug industry representatives have described as a cost-saving safety net for the poor.

“This builds on a growing body of literature that shows that samples are not aimed to help the uninsured and the poor, but to increase the sales of the branded drugs,” said Dr. William Shrank, an instructor at Harvard Medical School, who has studied the issue.

The study comes on the heels of a January report that showed free samples are more likely to go to insured and wealthy patients than to the needy.

Drugmakers dispute critics
But the Pharmaceutical Research and Manufacturers of America, a trade group representing most drugmakers, disputed those views. Free samples allow doctors to try new medicines and to implement them immediately in people of all income levels — including patients who lack prescription drug coverage, Ken Johnson, a PhRMA senior vice president, said in a statement.

Looking at samples in isolation “misses the point,” Johnson said. “Contrary to statements made by critics, American’s physicians prescribe medicines based on a wide range of factors, not simply receipt of free prescription drug samples,” he wrote.

Two out of every three drugs prescribed is generic, not branded, and drugmakers have offered struggling patients a range of options besides samples for receiving medication, Johnson added.

In the Chicago study, patients who never received free samples spent an estimated $178 out-of-pocket on prescription drugs over six months. By comparison, patients given free samples spent about $166 of their own money during the six months before they got the samples — but then $244 during the six months they received the samples and $212 in the six months after that, researchers found.
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Does the medical system try to prevent you from “bothering” your doctor?

That’s a question Sacramento physician Dr. Faith Fitzgerald mulled recently as she attempted to notify another physician about a health crisis involving one of his patients. She chronicles her futile effort to phone a fellow doctor in an essay that appeared in last months’ Annals of Internal Medicine.

The patient was a secretary at the University of California, Davis, where Dr. Fitzgerald works. The woman staggered into her office with a headache and feeling faint. She ended up in the intensive care unit of a nearby hospital, and Dr. Fitzgerald called the woman’s regular physician to let him know what had happened.

But instead of speaking to her colleague, she was blocked by a medical culture seemingly designed to prevent anybody from actually contacting a doctor while at work. Dr. Fitzgerald first ended up in an automated phone system. When she finally reached a live human, she was put on hold more than once, transferred to another operator for a futile attempt at paging the doctor, then sent back to the original operator before eventually being hung up on.
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Nevada Gov. Jim Gibbons is asking for the resignations of three doctors on the state’s Board of Medical Examiners because they’ve said they have conflicts of interest involving the now-closed endoscopy center at the vortex of a Hepatitis C outbreak in the state.

nevada_state_seal.pngThe medical board is investigating physician involvement in the scare, set off by the Endoscopy Center of Southern Nevada, to which a half-dozen cases of acute hepatitis C were linked after it re-used syringes and then drew medicine for multiple patients from the same vials, according to local press.

The Las-Vegas Review Journal, which is reporting the governor’s decision this morning, doesn’t specify the conflicts of the three doctors. But the paper says the governor’s announcement came the same day the newspaper reported that one of the doctors, the board’s president, had not initially disclosed that he is a longtime friend and business associate of the endoscopy center’s owner. All three of the doctors on Friday recused themselves from taking actions dealing with friends or business associates tied to the scare, the newspaper reports.
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Doctors are concerned that they will face massive medical malpractice actions brought by families of the more than 40,000 smokers who die each year because their doctors refuse to follow clear but simple federal guidelines for treating patients who smoke, reports the Philadelphia Bulletin.

Indeed, the Patients and Physicians Alliance has protested vigorously, claiming that juries could easily rule against doctors when their testimony is contradicted by that of the patient or patient’s family over whether the physician adequately warned the patient about the risks of smoking and offered effective treatment to help him quit.

The warning by the Bulletin that “Litigation By Smokers Would Worsen Tort Predicament” was triggered by a concern that state health commissioners would join the New York City Health Department in reminding doctors of their professional responsibilities to effectively treat smokers, saying that “because physician intervention can be so effective, failure to provide optimal counseling and treatment is failure to meet the standard of care – and could be considered malpractice.”

In a letter to state health commissioners, Action on Smoking and Health (ASH) reminded them of NYC’s warning, and of a major article in a medical journal suggesting that bringing smoker law suits against physicians — similar to the earlier smoker law suits against tobacco companies — could be an effective way to save lives. This is based in turn upon a recent study that at least 42,000 lives could be saved annually if physicians would only follow the clear and simple federal guidelines for treating smokers.

ASH’s letter argued: “Since physician malpractice kills over 40,000 smokers annually – more than motor vehicle or product liability accidents – it should not be surprising if antismoking lawyers, as well as those in private practice working on contingency fees, find physicians who deliberately flout federal guidelines to be a major target of litigation.”
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