Illustrating One Aspect of Big Pharma’s Grip on Medical Practice — Physicians Writing Prescriptions for Brand Name Statins, Instead of Generic Statins — This Reportedly Costs America $5.8 Billion per Year

03 October 2011

Guess who’s subsidizing this bit of scientifically-unjustified corporate profit-seeking

A recent cross-database survey of medical records tried to estimate what the most costly deviations from recommended primary care medical practices cost the nation.

Prescribing brand name (costly) statins in place of generic (cheaper) statins took the top spot, with $5.8 billion wasted per year:

The practice activity associated with the highest cost was the prescribing of brand instead of generic statins, resulting in excess expenditures of $5.8 billion per year (95% CI, $4.3-$7.3 billion).

Approximately 86% of the costs associated with the "Top 5" lists were from the use of brand name instead of generic statins.

Although generic drug substitutions may appear to be a "low hanging fruit" for drug savings, numerous efforts have already been made by the US states (generic substitution laws), payers (tiered formularies), and health care providers (generic drug detailing) to achieve this goal.

In this light, our data suggest that considerably more work is needed to reduce the costs associated with brand name statin use.

Statins are used to manage cholesterol levels.

The pharmaceutical industry has managed to persuade (con) our entire medical culture into thinking that these drugs are so wondrously effective that almost the entire population should be taking them.

That is so, despite the fact that there is (to date) no evidence that taking statins reduces all-cause mortality. You can read about aspects of this here and here.

Note

In other words, not only is it questionable that people should be on expensive new statins (as opposed to old cheap ones), one can reasonably ask whether so many people should be taking statins at all.

That is, unless we want people to pick which particular disease they’re going to die of at the same time in the future. And we’re willing to pay billions of dollars to encourage those choices.

That seems an odd way to constrain medical spending.

On the other hand, our culture seems to be caught in a mindset in which it thinks that reducing the impact of one disease is going to miraculously extend people’s individual longevity. Medical protocol-initiating committees can justify their recommendations based on this socially accepted (but probably dubious) logic.

“How did the researchers come up with these numbers?”

Unlike public health information commonly available in Europe and Canada, the United States does not keep track of very much, when it comes to medical practice and its costs.

That explains (in part) why it has been so difficult to make intelligent guesses as to which medical procedures and practices are most efficient, when it comes to keeping people healthy at reasonable cost.

Therefore, the research team in the above-quoted statin cost study had to make educated guesses as to what is actually going on in American primary care, using very probably highly flawed data sets.

The study’s authors looked at information taken from the 2009 National Ambulatory Medical Care Survey and the 2009 National Hospital Ambulatory Medical Care Survey. These data sets cover, respectively, medical visits to doctors in (a) private practice and (b) non-federally funded hospital outpatient units.

The team’s cost analysis combined information taken from the 2011 Medicare physician fee and Medicare clinical lab fee schedules. Prescription drug costs of drugs were estimated from Drugstore.com and retail pharmacies.

Obvious difficulties with the data sets in question

The word “survey” in the title of each database should clue thoughtful readers into the fact that neither is likely to be particularly accurate — especially when one considers how busy the people being surveyed are.

If you want to see why I am skeptical of the Surveys’ accuracy, go to applicable page at the Centers for Disease Control and Prevention’s Ambulatory Health Care Data webpage. It is here — “Questionnaires, Datasets, and Related Documentation.”

Only the most dedicated of my readers is going to wade through the subheadings listed on that page. But, if you do, you will quickly see that truth is an improbable result.

For example, take a look at the CDC’s explanation of how it collects the data it needs for the National Ambulatory Medical Care Survey — here.

I’ll be surprised if you get past one or two paragraphs on that page without asking yourself, “And they think this is going to work?”

Putting it bluntly, the gremlins of professional busyness and “behind-covering” almost certainly skew the information collected away from truth.

But this stuff is the best we’ve got.

Inadequate information in (and about) the economy’s medical sector is unlikely to change

Why? Unprincipled profit-seeking and an almost complete lack of accountability in the medical industry.

It is in virtually no profit-seeker’s interest to find out that much or most of what “it” does is unwarranted by science or facts. That’s true from the medico-corporate complex right down through all but the most dedicated and conscientious of practitioners.

For even highly motivated science-based doctors, taking care of patients and insurance-billing are so time-consuming, that they have virtually no time left over to do anything else.

And for their part, patients generally don’t care about costs and information. Unless they’re footing most of the bill. And even then, most of us are too ignorant to know what the medical science actually says.

Insurance companies only pretend to care about excessive medical costs. But, in so far as they are successfully collecting overages of money from subscribers, most of them don’t actually constrain costs, either. Insurance companies’ main goal is to keep a big gap between what they take in and pay out. That’s different than wanting to make medicine itself a fact-based and efficient discipline.

In sum, the medico-corporate complex is one of the most reliably high-paying and often profitable sectors of the American economy for the overwhelming majority of its contributing cogs.

Ain’t no one in power gonna mess with that.

At least not until taxpayers and small businesses in the United States finally decide that enough is enough.

PeteFree.com

Illustrating One Aspect of Big Pharma’s Grip on Medical Practice — Physicians Writing Prescriptions for Brand Name Statins, Instead of Generic Statins — This Reportedly Costs America $5.8 Billion per Year