It’s a daunting task, but the ailing beast that is the US healthcare system must be brought to heel. Its feverish appetite for dollars needs to be curbed while getting the brute to recognize everyone in society is entitled to attention.

Science won’t feature extensively in discussions over the coming weeks, but it is central to effectively rehabilitate the monster. So in this month’s Opinion articles, we offer two sets of recommendations on science to the warriors of Congress who are crusading for just reform.

In the first, Dennis Cotter and colleagues from the non-profit Medical Technology & Practice Patterns Institute (MTPPI), illustrate vividly one of the struggles: the battle with mindless consumption. They describe in "Striking the right balance" the unnecessary, possibly harmful, and inordinately expensive over prescription of Epogen, a synthetic form of erythropoietin that regulates red blood cell production.

While Epogen is highly effective in managing the debilitating effects of anemia in patients with chronic renal failure, alleviating the need for regular blood transfusions, Cotter and colleagues describe how it is being administered in high doses to large numbers of patients who arguably receive no clinical benefit, and at great cost. The system has built-in reinforcements of this bad practice so that by 2005, 99% of all hemodialysis patients received Epogen instead of just the target 16%. To Cotter et al. the solution is clear: healthcare decision-making must take cognizance of scientific evidence.

One way is through comparison of the effectiveness of different treatments for illness. The economic stimulus bill fittingly allocated $1.1 billion to this, despite efforts from industry to thwart it.

Incidentally, the other Opinion writer is Sean Harper, Chief Medical Officer of Amgen—the company that makes Epogen. (Cotter and colleagues do not apportion blame to Amgen in their article.)

Harper endorses the need for reform of the healthcare system, but cautions against losing one of its great strengths: the support for innovation. He’s right, of course: If the motivation to develop new medicines (a/k/a a competitive financial return for drug developers) isn’t retained, the flow of new treatments might cease. And new medicines are desperately needed—for cancer patients, those with neurodegenerative diseases, psychiatric diseases, and many others. Only the pharma and biotech industry can provide them, and they are businesses.

Consequently, healthcare reformers must tread a fine line, seeking to make substantial savings without stymieing innovation. There’s a complex set of issues to consider: For biologics like Epogen (which has enjoyed 20 years without competition) drugmakers would like 12 to 14 years of sales free of generic competitors, and may be offered seven years. How great an impact will this have on long-term R&D investment?

R&D intensity, defined as expenditure on research and development as a percentage of a company’s sales, runs at 10–20% for pharma, depending on the parameters used. My first reaction was that this didn’t sound too impressive, what else do they do with the money? But it is around five times the average R&D intensity for non-pharma companies, and is likely to be hard hit if profits start to slide.

The pharma industry is currently lavishing $1.4 million per day on lobbying efforts to influence the healthcare reform process—this shows where a small portion of the company’s money goes, and just how high the stakes are. (See our Community post titled "Big Pharma = Big Lobby" for an in-depth discussion of this issue.)

When all is said and done on legislation, one massive headache will remain. The sheer cost of drug discovery—$2bn to develop a new therapy—is, quite simply, unsustainable. Reduce it by, say, 50 percent, and cut the timeline in half too, from 10 to five years, and the picture would be a whole lot brighter. One step in the right direction, adaptive clinical trials, is discussed in the Biobusiness section on page 55. We need more.

Those who must reform health care find themselves, to paraphrase the philosopher Marshall Berman, “in an environment that promises (us) adventure, power, joy, growth, transformation of ourselves and the world—and, at the same time, that threatens to destroy everything we have, everything we know, everything we are”.

I wish them every success. And urge them to stay close to the science.

rgallagher@the-scientist.com

Thanks Dov. They will also end up and stay in the brains and hearts of people who share the same concerns. I will definitely go to those specific references. Yes, I know that going from the concepts to the praxis is not easy but is worth trying.

Dov, I know that you are a biochemist. I checked on you. I enjoy your way of thinking. Thanks again.

Technology Culture Modification

Hi, Rafaela.

Embarassing to thus correspond by "comments"...

1) I have in my PC circa 250 brief currently relevant "essays" posted in 2008-9. At my age (84) I reckon they will soon end up in Earth's biosphere energy matrix together with myself...That's life...

2) I simply do not have time to go back to what I already wrote. my attempts to "blog" them failed as I refuse to pay for posting them anywhere. Try searches like

- Dov Henis on The 20th century technology culture
- Dov Henis on the role of science in the present economic collapse
- Dov Henis on the AAAS and on the science establishment

3) Obviously "practical ways to approach a real rational cultural modification" is not a matter of Obama-style grand national PR politics, but a long arduous ground breaking undertaking that requires comprehension of the present sad state of Western culture and definition of desirable modification tasks-targets. It should be started somehow, the sooner the better, rather than wait for worse circumstances in the next phase of the present economy-culture collapse, when the coming generation(s) will have to bear the costs of our present "investments"...


Suggesting, with best regards,

Dov

Hello Dov,

Thanks for the comments. Would you mind elaborating a little bit more on practical ways to approach a real rational cultural modification ?.

It seems that language and economics are critical parts of cultural development, what role they ought to have in that cultural modification you are proposing ?.

Perhaps you have already written about this. If so, please direct me there.

Thanks again for your insights

Obama Healthcare System Prospects


The US healthcare system is hurting,
but (more money for) research can come to its rescue...???

Delusions delusions delusions...

From: "Prsdnt Obama Should Consider An Overdue Introspection"
LINK

"Money printing will not cure the technology culture greed cancer", and

"And still further: Prsdnt Obama has been elected to office by and within the 20th century technology culture society, a society that still resists internalizing, accepting, admitting its cultural collapse.

Society not only has not yet internalized its cultural collapse, but is persistently striving against basic rationalism, scientism, to re-invigorate the terminally ill technology culture, its values and its economy."

Upgrading the healthcare system is but one component of modifying the present technology culture. Surviving the cultural collapse requires a real rational cultural modification. Verbiage, and money too, will not rescue anything. They only offer brief temporary apparent respites.


Suggesting,

Dov Henis

Pharmaceutical companies could save by ending those obnoxious T.V. ads. More money for R & D. I have lost all respect for the drug companies.