False advertising

The concern over consumer protection is growing with new health technologies. This is not new, you may think. However the lawsuit by FTC against Genelink for misleading claims is the first case in a genetics testing company. Genelink said that they analyzed your DNA and afterwards send back nutritional supplements customized to your personal genome. The regimen, the company promised, was good for diabetes, heart disease, arthritis, insomnia and other ailments.On request by FTC, they were unable to confirm such promises.
Since you may find a similar test on the corner of the street, once again my question is: where is the regulator?

PS. Some months ago, was the FDA who asked 23and me to stop selling its genetics test kit.

PS. On DTC genetic tests, a good article.

An ongoing tug-of-war

Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs

Consolidation of private healthcare providers is an increasing trend nowadays. The exact implications for competition and choice are usually unknown. It is worth having a look at other markets. This article in HA explains the impact for the US context:

Prior research shows that private hospital prices vary considerably both within and across markets, even after differences in patient populations and services provided are accounted for. The wide variations in price and the high prices at some hospitals reflect an ongoing tug-of-war between increasingly consolidated buyers (health plans) and increasingly consolidated sellers (hospitals and hospital systems).

Given the intense and growing pressure to rein in the growth in private health insurance premiums, the continuation of current trends appears to be unsustainable. It remains to be seen whether or not health plans will somehow regain the upper hand. If they do not, more radical approaches—such as state-based rate setting or restrictions on contracting arrangements between hospitals and health plans—may gain traction.

PS. HA Blog, a comment.

PS. On limiting bisphenol in food.

PS. Health expenditures NEJM Graphic 

PS.Health Policy Basics: Health Insurance Marketplaces

PS. Are Human Genes Patentable? 

PS. Regulating 23andMe to Death Won’t Stop the New Age of Genetic Testing

Who is the owner?

While reading a recent op-ed on hospitals in a National Health System, suddenly I asked myself: but who is the owner?. The article was reflecting a new view on hierarchy and management of public organizations and was advocating for new cooperative models, horizontal schemes where professionals fit better than a pure civil servant. It may sound good, although it raises a certain fuzzy landscape. Who has the decision rights in a cooperative scheme? Who is the residual claimant?. Just check The Economist for a recent case and remember the potential implications if we translate such model in health care.
There are two sides of the coin: management and governance. Managers and owners have their specific roles. When somebody wants to play both, conflicts of interest arise. It's obvious. Unfortunately in public organizations, such considerations are too often forgotten. Public organizations require better governance designs, stronger and clearer, representing the preferences of the final owner: the citizen.

TMT syndrome

What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology?

Each day every newspaper wants to convince us over a new technology. In biosciences, journalists enjoy talking about "opening doors" to new cures, and rarely anybody checks afterwards if this anouncement is really in place and provides its expected outcomes. Most of what we see in the media regarding these anouncements are free adverts.
The promise of information technologies in health care is another example. Its application is crucial for success, it is available, but it takes a long, long time to be applied. The disapointing impact of IT on health care has been the last year's article most read in Health Affairs . It is not by chance. We live in a society with a "too much technology" -TMT- syndrome. Organizations can't digest it without internal change in management and governance. Why not create some organizational conditions for success?

Thrasymachus

Wikipedia dixit:

Thrasymachus was a citizen of Chalcedon, on the Bosphorus. His career appears to have been spent as a sophist at Athens, although the exact nature of his work and thought is unclear. He is credited with an increase in the rhythmic character of Greek oratory, especially the use of the paeonic rhythm in prose, and a greater appeal to the emotions through gesture.

Quote from Plato's Thrasymachus in Republic I

338c: Ἄκουε δή, ἦ δ᾽ ὅς. φημὶ γὰρ ἐγὼ εἶναι τὸ δίκαιον οὐκ ἄλλο τι ἢ τὸ τοῦ κρείττονος συμφέρον..[1] (“Listen—I say that justice is nothing other than the advantage of the stronger.”)

This forceful statement is dated from 426 BCE more or less. I'm just quoting it after 25 centuries.

Yesterday at Auditori. Jordi Savall and Le Concert des Nations. Impressive.

Pharma news

The growth in the number of pharmaceutical prescriptions per capita in 2013 has fallen by 6,9%, unit price 1,8% less, and total expenditure minus 8,6%, completing a 4 years cycle of negative deelopment. This means that 80% of the decrease is due to the number of prescriptions.
It seems that physicians are increasing the quality of prescription following a specific policy. This is good news. However, more assessment is needed.

PS. Recent statement at Davos Conference:
"Europe's light at the end of the tunnel looks more and more like an oncoming train"

Where is the regulator?

Understanding the Economic Value of Molecular Diagnostic Tests: Case Studies and Lessons Learned

Maybe we have just arrived at the expected moment, when the cost of one whole genome sequencing is below $1000. (mapping up to 25.000 genes). At the same time, one test for 21 genes may cost you $4.500. This is our crazy world. In the first case you will only know your genome, in the second there will be a probability of success from a certain therapy.
There's only one question: Does anybody know any information about the reliability of such probabilities beyond the firm that is selling the test?. Where is the regulator?
After reading a recent article on the value of molecular diagnostic tests, I'm convinced that we still remain in an uncertain world in need of transparency. Given such uncertainty, better keep calm until the regulator confirms the clinical utility and cost-effectiveness of molecular diagnostic tests.

Parov Stelar Band - Jimmy's Gang (Unplugged in Moscow)

PS. You may avoid watching "The wolf of Wall Street" if you read this article.