• ‘Medicare for All’ Isn’t Sounding So Crazy Anymore - The New York Times

    To be able to deliver on its promises, single payer would not only require trillions in new revenue through higher taxes, but also huge cost savings from slashing payments to drug companies, doctors and hospitals.

    #santé #Etats-Unis

  • Doctors raked in cash to push fentanyl as N.J. death rate exploded | @fil

    The most powerful opioid ever mass-marketed was designed to ease cancer patients into death.

    It’s ideal for that: the drug is fast acting, powerful enough to tame pain that other opioids can’t and comes in a variety of easy delivery methods — from patches to lollipops.

    But a dose the size of a grain of sand can kill you.

    Meet fentanyl. It’s heroin on steroids. It’s killing people in droves. And, in New Jersey, you can get it after having your tonsils removed.

    In fact, doctors who treat children’s colds and adult’s sore knees are prescribing it with alarming frequency, far more than oncologists easing end-of-life cancer pain.

    The surge is stoked by companies that shell out hundreds of thousands of dollars a year to doctors, wining and dining them in hopes of convincing them that their particular brand of fentanyl is the solution to all their patients’ pain problems.

    Evidently, it’s working.

    An NJ Advance Media analysis has found that eight medical specialties in New Jersey have filed more Medicare claims for fentanyl than those by oncologists. Family practitioners, for example, filed at least five times as many claims for fentanyl from 2013 to 2015 than did cancer doctors.

    “There are some powerful drivers of opioid prescriptions that have little to do with the presence of pain in the population,” said Dr. Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at Johns Hopkins University.

    The investigation also reveals:

    From 2013 to 2015, doctors in New Jersey were paid at least $1.67 million by pharmaceutical companies marketing various forms of fentanyl. In the same time period, fentanyl deaths in New Jersey increased from 42 in 2013 to 417 in 2015.
    Since late 2011, enough fentanyl has been dispensed to allow every person who has died of cancer in New Jersey to fill a prescription for the drug eight times.
    Doctors are being disciplined for improperly prescribing fentanyl, in several cases losing their licenses after their patients die while taking the drug.

  • Long-Term Opioid Use Could Depend on the Doctor Who First Prescribed It - The New York Times

    Over all, researchers estimated that out of every 48 patients who were sent home with a prescription, one would end up using opioids long-term, which researchers defined as at least 180 days of medication over a year. Chronic opioid use, particularly in older people, can contribute to spiraling problems: constipation, confusion, falls and addiction.

    But the risk of becoming that patient increased or decreased depending on the treating physician. Researchers found that doctors they identified as “high-intensity” prescribers sent one in four patients home with opioids. “Low-intensity” prescribers gave opioids to one in 14 patients. The patients who saw a high-intensity prescriber were 30 percent more likely to become long-term users, researchers said.

    The study did not seek to lay blame for the well-documented rise in opioid use by Medicare patients at the feet of emergency room doctors. Indeed, after patients receive an opioid prescription from the emergency room, they usually have subsequent prescriptions written by doctors outside the hospital, especially primary care physicians. The study’s authors alluded to “clinical inertia” — the belief among follow-up physicians that if the emergency room doctor’s prescription did the trick, they might as well refill it.

    But he also noted that there is a “structural disincentive” to offer alternatives to medication, such as acupuncture, massage therapy, physical therapy, because of poor insurance reimbursement.

    Les big pharma ne dirigent le monde qu’avec la comlicité des médecins. L’inconscience des effets sociaux et de long terme des prescriptions est véritablement une question à poser devant toute la société, pas seulement devant les corps médicaux spécialisés... et la prévention, le sport, les techniques alternatives prennent alors toute leur place dans l’arsenal médical.

    #santé_publique #crise_opiacés

  • Rien qu’un matin avec Trump sur WSWS ...

    1. Trump veut interdire aux Chinois l’accès à leurs îles (artificielles ou non) en Mer de Chine méridionale.

    Trump threats on South China Sea heighten risk of nuclear war - World Socialist Web Site

    Trump threats on South China Sea heighten risk of nuclear war
    25 January 2017

    Just days after taking office, the Trump administration has set course for a conflict with China over the South China Sea that threatens military clashes and war.

    President Donald Trump’s press secretary, Sean Spicer, on Tuesday backed up an earlier assertion by the administration’s nominee for secretary of state, former Exxon Mobil CEO Rex Tillerson, that Washington would bar Chinese access to islets being built up by Beijing in the South China Sea.

    –— --- ---

    2. Trump confirme la nomination d’une milliardaire au poste de ministre de l’éducation, opposée à l’école publique.

    Senate moves toward confirmation of billionaire opponent of public schools - World Socialist Web Site

    Senate moves toward confirmation of billionaire opponent of public schools
    By Isabelle Belanger
    25 January 2017

    The confirmation of Trump’s pick for education secretary, billionaire proponent of school privatization Betsy DeVos, is being rushed through despite blatant conflicts of interest and her ignorance of basic federal education laws. In a letter Monday, Tennessee Republican Senator Lamar Alexander, chairman of the Senate Committee on Health, Education, Labor & Pensions, rejected Democratic Party requests for a second hearing. The Republican-controlled Senate will vote on the confirmation January 31.

    –— --- ---

    3. Trump veut attaquer et détruire des fragile systèmes de santé.

    Trump nominee defends administration’s assault on health care - World Socialist Web Site

    Trump nominee defends administration’s assault on health care
    By Kate Randall
    25 January 2017

    In his final appearance before the Senate Finance Committee Tuesday, Rep. Tom Price (Republican of Georgia), Donald Trump’s nominee to head the Department of Health and Human Services (HHS), arrogantly dismissed questioning from committee Democrats about the new administration’s planned assault on Medicare, Medicaid and health care in general.

    –— --- ---

    4. Trump va relancer Keystone XL et Dakota Access pipelines et en même temps empêcher l’EPA (agence pour l’environnement) de surveiller et analyser les effets environnementaux de ces projets.

    Trump’s pro-corporate rampage of reaction
    Executive orders approve Dakota, Keystone pipelines
    By Patrick Martin
    25 January 2017

    President Donald Trump has ordered US government agencies to expedite approval of the Keystone XL and Dakota Access pipelines, running roughshod over opposition by environmentalists and Native American tribes.

    The Dakota Access Pipe Line (DAPL) has encountered impassioned opposition, with thousands gathering despite the deep freeze of the North Dakota winter to block completion of the 1,200-mile-long pipeline, which is to bring oil from the Bakken fields to refineries in the Midwest and South. The pipeline’s final link would cross the Missouri River just north of the Standing Rock Sioux reservation, threatening its water supply and tearing up land deemed sacred in tribal culture.

    #trump #misère #décadence

  • Does a Doctor’s Gender Affect Your Chance of Survival? - The New York Times

    What if your doctor’s gender could influence your chance of surviving a visit to the hospital?

    A big study of older patients hospitalized for common illnesses raises that provocative possibility — and also lots of questions. Patients who got most of their care from women doctors were more likely to leave the hospital alive than those treated by men.

    The differences were small — about 11 percent of patients treated mostly by women died within 30 days of entering the hospital, versus 11.5 percent of those treated by men. But the all-male research team estimated that there would be about 32,000 fewer deaths each year in the U.S. if male physicians performed at the same level as their female peers.

    The study didn’t probe why there might be these differences in survival. And Dr. Ashish Jha, the lead author, said the study doesn’t mean patients should avoid him and all other male physicians.

    But he said male doctors could take a cue from women doctors’ tendencies that might contribute to better care. According to other research, women doctors are more likely than men to follow treatment guidelines, provide preventive care more often and communicate more with patients.

  • Trump turns to conservative tacticians to run HHS and Medicare, Medicaid - The Washington Post

    President-elect Donald Trump’s choices for health secretary and administrator of the government’s largest health insurance programs have for years pursued a sharply conservative agenda that includes redefining Medicare, placing “personal responsibility” requirements on low-income recipients of Medicaid, and dismantling the Affordable Care Act.

    If adopted, this agenda could dramatically alter access to insurance and medical services for more than 100 million Americans covered through the two entitlement programs and the ACA.

    … et c’est le WaPo qui le dit…

  • Overdoses aux Etats-Unis : les pratiques douteuses du laboratoire Insys

    Alors que les décès suite à une overdose se banalisent aux Etats-Unis, le Wall Street Journal a publié cette semaine une enquête sur les pratiques peu scrupuleuses du laboratoire pharmaceutique Insys Therapeutics. Co-fondée par le milliardaire américano-indien John N. Kapoor, la société fait en sorte d’écouler toujours plus de boîtes de son produit phare : le #Subsys.

    Prescrit comme anti-douleur aux personnes atteintes d’un cancer, ce spray contient du #fentanyl, un opioïde 100 fois plus puissant que la morphine. Problème, entre 2000 et 2014, sur le demi-million d’Américains ayant succombé à une overdose, 60% des cas étaient dus à une prise d’opioïdes, selon le centre de prévention des maladies américains (CDC). Le chanteur Prince fait partie des victimes. La star est décédé d’une overdose de fentanyl.

    La situation sanitaire est édifiante et résulte des pratiques de laboratoires comme Insys.
    En compilant des données gouvernementales et judiciaires, ainsi qu’après plusieurs entretiens, le Wall Street Journal a découvert que des médecins liés au laboratoire sont responsables de l’énorme volume de prescriptions de Subsys. En effet, parmi les 20 médecins ayant le plus prescrit ce médicament à des patients couverts par le Medicare en 2014, plus de la moitié fait partie de ceux qui ont reçu le plus d’argent de la part d’Insys, au titre de consultant notamment, selon le journal américain.

    Certains ont déjà été rattrapés par la justice. En 2013, un neurologue du Michigan a rédigé des prescriptions de Subsys pour un coût de 6,4 millions de dollars au Medicare (l’assurance-santé américaine), faisant de lui le premier prescripteur du pays, avec un montant cinq fois plus élevé que le second. Ce même neurologue a reçu, de la part d’Insys, 90.000 dollars sur dix mois en nourriture, voyage et pour ses prestations lors de conférences. Le praticien a été arrêté en mai 2014 pour fraude au système de santé publique et distribution d’une substance contrôlée. Il a plaidé coupable ce mois de novembre, la sentence devrait être prononcée en février 2017.

    Ce praticien n’est pas un cas isolé.

  • Fentanyl Billionaire Comes Under Fire as Death Toll Mounts From Prescription Opioids - WSJ

    Before they were arrested last year, Alabama doctors John Couch and Xiulu Ruan were prized customers of Insys Therapeutics Inc., maker of a powerful and highly addictive type of synthetic opioid known as fentanyl.

    Drs. Couch and Ruan prescribed a combined $4.9 million of the painkiller, called Subsys, to Medicare patients in 2013 and 2014, among the most of any doctors in the U.S., federal data show.

    Insys, based in Chandler, Ariz., went to unusual lengths to keep these high-prescribing doctors happy. Insys Executive Chairman John N. Kapoor, the company’s billionaire co-founder, personally traveled to Mobile, Ala., to attend a business dinner with them, said people familiar with the matter. The doctors were also frequent speakers and consultants for Insys, which paid them $270,700 in combined fees over 21 months, according to government data.

    @fil #cadeau

  • Deep in Virginia’s craggy coal country, they saw Trump as their only hope - The Washington Post

    Behind the barber’s chair where Claude Rasnake diagnoses many of the world’s problems, he charted the to-do list of the Trump administration.

    Social Security, Medicare, the tax code — maybe Trump and a Republican Congress can finally get them fixed. Dismantle Obamacare and fix roads and bridges, too. But all that comes later, after the top priority.

    “The first thing I’d like him to do is fire that lady that runs the EPA,” Rasnake, 81, said, working the trimmer around a customer’s ear. The Environmental Protection Agency makes regulations that limit the use of coal, and here that kills jobs.

    #états-unis #trump

  • This could be the worrisome reason why new cancer patients are not using a lifesaving medicine - The Washington Post

    A Kaiser Family Foundation study of 2016 data found that the median out-of-pocket cost for #Gleevec was $8,503 per year under Medicare prescription-drug plans.

    (...) for people with private insurance, even a relatively modest co-pay can decrease adherence to a lifesaving cancer-drug regimen, so they hypothesized that the burden of cost-sharing under Medicare drug plans could explain why people who do not receive subsidies are slower to start the drug.

    #cancer #pharma #prix

  • La contre-révolution #Obamacare : six ans plus tard

    Comme le World Socialist Web Site l’expliquait déjà en 2009, la « réforme » du secteur de la santé communément appelée Obamacare érige un système qui permet aux compagnies d’#assurances, aux #entreprises et au gouvernement de réduire radicalement les prestations de# santé offertes aux familles et personnes à faibles revenus.

    Ceci a toujours été le but de la loi. La réduction des prestations et l’augmentation des coûts pour les familles travailleuses ne représentent pas les conséquences malheureuses d’un effort maladroit mais bien intentionné pour offrir à la population « un système presque universel de soins de santé de qualités », tel que le prétendait Obama lors de la création de la loi. Comme l’a admis récemment le New York Times, défenseur de longue date d’Obamacare, faisant référence au programme gouvernemental de santé minimal pour les pauvres, « [L]a vérité est qu’un plan typique Obamacare ressemble plutôt à Medicaid avec des franchises élevées. »

    Selon le « mandat » de l’ACA, quiconque se trouve sans assurance maladie procurée par l’employeur, et sans Medicare ou Medicaid, est obligé de contracter une assurance au privé, sous peine d’une #pénalité d’impôt considérable. Aujourd’hui, un nombre important de personnes peinent, si même elles y arrivent, à payer les primes exorbitantes exigées par les compagnies d’assurance privées pour leurs mauvais régimes, pendant que ceux qui en sont capables sont forcés de dépenser d’immenses sommes d’argent sans remboursement pour fournir des soins de santé limités à leurs familles.

    Les régimes les moins coûteux sont accompagnés de #franchises dépassant 5.000 $. Les réseaux rapetissent, ce qui force les membres à choisir parmi un éventail de plus en plus limité de médecins et d’hôpitaux. Des formulaires pour requête de médicaments barrent l’accès à des médicaments vitaux. Les assureurs demandent et reçoivent des augmentations de primes importantes pour leurs politiques d’assurances tout à fait inadéquates.

  • Bernie Sanders’ Democratic National Convention speech / Boing Boing
    La journée commence avec un type qui a du culot.

    Thank you. Good evening.

    It is an honor to be with you tonight and to be following in the footsteps of Elizabeth Warren, and to be here tonight to thank Michelle Obama for her incredible service to our country. She has made all of us proud.

    Let me begin by thanking the hundreds of thousands of Americans who actively participated in our campaign as volunteers. Thank you.

    Let me thank the 2 1/2 million Americans who helped fund our campaign with an unprecedented 8 million individual campaign contributions . Anyone know what that average contribution was? That’s right, $27. And let me thank the 13 million Americans who voted for the political revolution, giving us the 1,846 pledged delegates here tonight – 46 percent of the total.

    And delegates: Thank you for being here, and for all the work you’ve done. I look forward to your votes during the roll call on Tuesday night.

    And let me offer a special thanks to the people of my own state of Vermont who have sustained me and supported me as a mayor, congressman, senator and presidential candidate.

    And to my family – my wife Jane, four kids and seven grandchildren –thank you very much for your love and hard work on this campaign.

    I understand that many people here in this convention hall and around the country are disappointed about the final results of the nominating process. I think it’s fair to say that no one is more disappointed than I am. But to all of our supporters – here and around the country – I hope you take enormous pride in the historical accomplishments we have achieved.

    Together, my friends, we have begun a political revolution to transform America and that revolution – our revolution – continues. Election days come and go. But the struggle of the people to create a government which represents all of us and not just the 1 percent – a government based on the principles of economic, social, racial and environmental justice – that struggle continues. And I look forward to being part of that struggle with you.

    Let me be as clear as I can be. This election is not about, and has never been about, Hillary Clinton, or Donald Trump, or Bernie Sanders or any of the other candidates who sought the presidency. This election is not about political gossip. It’s not about polls. It’s not about campaign strategy. It’s not about fundraising. It’s not about all the things that the media spends so much time discussing.

    This election is about – and must be about – the needs of the American people and the kind of future we create for our children and grandchildren.

    This election is about ending the 40-year decline of our middle class the reality that 47 million men, women and children live in poverty. It is about understanding that if we do not transform our economy, our younger generation will likely have a lower standard of living then their parents.

    This election is about ending the grotesque level of income and wealth inequality that we currently experience, the worst it has been since 1928. It is not moral, not acceptable and not sustainable that the top one-tenth of one percent now own almost as much wealth as the bottom 90 percent, or that the top 1 percent in recent years has earned 85 percent of all new income. That is unacceptable. That must change.

    This election is about remembering where we were 7 1/2 years ago when President Obama came into office after eight years of Republican trickle-down economics.

    The Republicans want us to forget that as a result of the greed, recklessness and illegal behavior on Wall Street, our economy was in the worst economic downturn since the Great Depression. Some 800,000 people a month were losing their jobs. We were running up a record-breaking deficit of $1.4 trillion and the world’s financial system was on the verge of collapse.

    We have come a long way in the last 7 1/2 years, and I thank President Obama and Vice President Biden for their leadership in pulling us out of that terrible recession.

    Yes, we have made progress, but I think we can all agree that much, much more needs to be done.

    This election is about which candidate understands the real problems facing this country and has offered real solutions – not just bombast, not just fear-mongering, not just name-calling and divisiveness.

    We need leadership in this country which will improve the lives of working families, the children, the elderly, the sick and the poor. We need leadership which brings our people together and makes us stronger – not leadership which insults Latinos, Muslims, women, African-Americans and veterans – and divides us up.

    By these measures, any objective observer will conclude that – based on her ideas and her leadership – Hillary Clinton must become the next president of the United States. The choice is not even close.

    This election is about a single mom I saw in Nevada who, with tears in her eyes, told me that she was scared to death about the future because she and her young daughter were not making it on the $10.45 an hour she was earning. This election is about that woman and the millions of other workers in this country who are struggling to survive on totally inadequate wages.

    Hillary Clinton understands that if someone in this country works 40 hours a week, that person should not be living in poverty. She understands that we must raise the minimum wage to a living wage. And she is determined to create millions of new jobs by rebuilding our crumbling infrastructure – our roads, bridges, water systems and wastewater plants.

    But her opponent – Donald Trump – well, he has a very different point of view. He does not support raising the federal minimum wage of $7.25 an hour – a starvation wage. While Donald Trump believes in huge tax breaks for billionaires, he believes that states should actually have the right to lower the minimum wage below $7.25.

    Brothers and sisters, this election is about overturning Citizens United, one of the worst Supreme Court decisions in the history of our country. That decision allows the wealthiest people in America, like the billionaire Koch brothers, to spend hundreds of millions of dollars buying elections and, in the process, undermine American democracy.

    Hillary Clinton will nominate justices to the Supreme Court who are prepared to overturn Citizens United and end the movement toward oligarchy in this country. Her Supreme Court appointments will also defend a woman’s right to choose, workers’ rights, the rights of the LGBT community, the needs of minorities and immigrants and the government’s ability to protect our environment.

    If you don’t believe that this election is important, if you think you can sit it out, take a moment to think about the Supreme Court justices that Donald Trump would nominate and what that would mean to civil liberties, equal rights and the future of our country.

    This election is about the thousands of young people I have met all over this country who have left college deeply in debt, and tragically the many others who cannot afford to go to college. During the primary campaign, Secretary Clinton and I both focused on this issue but with somewhat different approaches. Recently, however, we have come together on a proposal that will revolutionize higher education in America. It will guarantee that the children of any family this country with an annual income of $125,000 a year or less – 83 percent of our population – will be able to go to a public college or university tuition free. That proposal also substantially reduces student debt.

    This election is about climate change, the greatest environmental crisis facing our planet, and the need to leave this world in a way that is healthy and habitable for our kids and future generations. Hillary Clinton is listening to the scientists who tell us that – unless we act boldly and transform our energy system in the very near future – there will be more drought, more floods, more acidification of the oceans, more rising sea levels. She understands that when we do that we can create hundreds of thousands of good-paying jobs.

    Donald Trump? Well, like most Republicans, he chooses to reject science. He believes that climate change is a “hoax,” no need to address it. Hillary Clinton understands that a president’s job is to worry about future generations, not the short-term profits of the fossil fuel industry.

    This campaign is about moving the United States toward universal health care and reducing the number of people who are uninsured or under-insured. Hillary Clinton wants to see that all Americans have the right to choose a public option in their health care exchange. She believes that anyone 55 years or older should be able to opt in to Medicare and she wants to see millions more Americans gain access to primary health care, dental care, mental health counseling and low-cost prescription drugs through a major expansion of community health centers.

    And What is Donald Trump’s position on health care? Well, no surprise there. Same old, same old Republican contempt for working families. He wants to abolish the Affordable Care Act, throw 20 million people off of the health insurance they currently have and cut Medicaid for lower-income Americans.

    Hillary Clinton also understands that millions of seniors, disabled vets and others are struggling with the outrageously high cost of prescription drugs and the fact that Americans pay the highest prices in the world for the medicine we use. She knows that Medicare must negotiate drug prices with the pharmaceutical industry and that drug companies should not be making billions in profits while one in five Americans are unable to afford the medicine they need. The greed of the drug companies must end.

    This election is about the leadership we need to pass comprehensive immigration reform and repair a broken criminal justice system. It’s about making sure that young people in this country are in good schools and at good jobs, not rotting in jail cells. Hillary Clinton understands that we have to invest in education and jobs for our young people, not more jails or incarceration.

    In these stressful times for our country, this election must be about bringing our people together, not dividing us up. While Donald Trump is busy insulting one group after another, Hillary Clinton understands that our diversity is one of our greatest strengths. Yes. We become stronger when black and white, Latino, Asian-American, Native American – when all of us – stand together. Yes. We become stronger when men and women, young and old, gay and straight, native born and immigrant fight together to create the kind of country we all know we can become.

    It is no secret that Hillary Clinton and I disagree on a number of issues. That’s what this campaign has been about. That’s what democracy is about. But I am happy to tell you that at the Democratic Platform Committee there was a significant coming together between the two campaigns and we produced, by far, the most progressive platform in the history of the Democratic Party. Among many, many other strong provisions, the Democratic Party now calls for breaking up the major financial institutions on Wall Street and the passage of a 21st Century Glass-Steagall Act. It also calls for strong opposition to job-killing free trade agreements like the Trans-Pacific Partnership.
    We have got to make sure that the #TPP doesn’t get passed by Cogress during a lame-duck session.

    Our job now is to see that platform implemented by a Democratic Senate, a Democratic House and a Hillary Clinton presidency – and I am going to do everything I can to make that happen.

    I have known Hillary Clinton for 25 years. I remember her as a great first lady who broke precedent in terms of the role that a first lady was supposed to play as she helped lead the fight for universal health care. I served with her in the United States Senate and know her as a fierce advocate for the rights of children, for the women, and for the disabled.

    Hillary Clinton will make an outstanding president and I am proud to stand with her tonight.

    Thank you all very much.

    #USA #politique

  • Democrats approved platform draft with Sanders’ imprint - The Washington Post

    Democrats approved a draft of the party platform early Saturday that includes steps to break up large Wall Street banks, advocates for a $15 an hour wage and urges the abolition of the death penalty, reflecting the influence of Bernie Sanders’ presidential campaign.

    Supporters of presumptive Democratic nominee Hillary Clinton defeated measures pushed by Sanders’ allies that would have promoted a Medicare-for-all single-payer health care system, a carbon tax to address climate change and impose a moratorium on hydraulic fracking.

    Ça risque quand même d’être un peu dur à avaler pour R. Kagan, clintonien néophyte. Heureusement, il y a des fondamentaux qui ne bougent pas (ou très peu, mais, bon, ils en ont parlé…)

    Deliberating late into the evening, the group considered the document’s language on the Israel-Palestinian conflict, an issue that has divided Democrats. The committee defeated an amendment led by Zogby that would have called for providing Palestinians with “an end to occupation and illegal settlements” and urged an international effort to rebuild Gaza.

    Zogby said Sanders had helped craft the language. The draft reflects Clinton’s views and advocates working toward a “two-state solution of the Israel-Palestinian conflict” that guarantees Israel’s security with recognized borders “and provides the Palestinians with independence, sovereignty, and dignity.

  • Free Lunches Pay off for Drug Companies, Study Shows - NBC News

    The research, published in the Journal of the American Medical Association’s JAMA Internal Medicine, reinforces earlier complaints that drug companies were buying loyalty by showering doctors with gifts, promotional items, lunches with often-attractive drug industry representatives and, most notoriously, paid vacations to luxury resorts that were ostensibly for advanced medical education.
    Dr. R. Adams Dudley of the University of California, San Francisco and colleagues looked at prescribing information for four popular drugs from nearly 280,000 Medicare physicians.

    They included the cholesterol-lowering drug rosuvastatin (brand-name Crestor), the blood pressure drugs nebivolol (brand-name Bystolic) and olmesartan medoxomil (Benicar) and the antidepressant desvenlafaxine (Pristiq).

    The doctors in the study had received some sort of benefit, nearly all meals, worth $20 or less in which the four drugs were discussed. Doctors frequently attend educational sessions at medical meetings or get briefings over meals from drug representatives.

    Those who got four or more meals relating to the four drugs prescribed Crestor nearly twice as often as doctors who didn’t get the free meals; Bystolic more than five times as often, Benicar more than four times as often and Pristig 3.4 times as often, the team found.

    Even one meal where the drug was discussed led to higher prescribing rates, the analysis showed.

    Furthermore, the relationship was dose dependent, with additional meals and costlier meals associated with greater increases in prescribing of the promoted drug,” Dudley’s team wrote.

    • Article en libre accès (extrait du résumé)

      JAMA Network | JAMA Internal Medicine | Pharmaceutical Industry–Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries

      Results  A total of 279 669 physicians received 63 524 payments associated with the 4 target drugs. Ninety-five percent of payments were meals, with a mean value of less than $20. Rosuvastatin represented 8.8% (SD, 9.9%) of statin prescriptions; nebivolol represented 3.3% (7.4%) of cardioselective β-blocker prescriptions; olmesartan represented 1.6% (3.9%) of ACE inhibitor and ARB prescriptions; and desvenlafaxine represented 0.6% (2.6%) of SSRI and SNRI prescriptions. Physicians who received a single meal promoting the drug of interest had higher rates of prescribing rosuvastatin over other statins (odds ratio [OR], 1.18; 95% CI, 1.17-1.18), nebivolol over other β-blockers (OR, 1.70; 95% CI, 1.69-1.72), olmesartan over other ACE inhibitors and ARBs (OR, 1.52; 95% CI, 1.51-1.53), and desvenlafaxine over other SSRIs and SNRIs (OR, 2.18; 95% CI, 2.13-2.23). Receipt of additional meals and receipt of meals costing more than $20 were associated with higher relative prescribing rates.

      Conclusions and Relevance  Receipt of industry-sponsored meals was associated with an increased rate of prescribing the brand-name medication that was being promoted. The findings represent an association, not a cause-and-effect relationship.
      Target Branded Drugs as a Percentage of All Filled Prescriptions in the Class in 2013, Across Days Receiving Target Drug–Sponsored Meals
      Predicted Probabilities for Prescribing the Target Drug as a Percentage of All Prescriptions in the Class, According to the Number and Cost of Sponsored Meals Received by Each Physician

    • Cher confrère, ça ne prouve nullement l’influence : les médecins qui savent que le pro-glandin est un bon médicament ont tout simplement moins de réticence à accepter des repas de la part de son fabricant ; que dirais-tu s’ils acceptaient à la place les repas du fabricant de génériques, qui marche tellement moins bien !?

  • How #Big_Pharma Uses Charity Programs to Cover for Drug Price Hikes

    PSI is a patient-assistance charitable organization, commonly known as a copay charity. It’s one of seven large charities (among many smaller ones) offering assistance to some of the 40 million Americans covered through the government-funded Medicare drug program. Those who meet income guidelines can get much or all of their out-of-pocket drug costs covered by a charity: a large initial copay for a prescription, another sum known as the coverage gap or the donut hole, and more-modest ongoing costs. It adds up fast. After Turing raised Daraprim’s price, some toxoplasmosis patients on #Medicare had initial out-of-pocket costs of as much as $3,000.

    That’s just a fraction of the total cost. Turing’s new price for an initial six-week course of Daraprim is $60,000 to $90,000. Who pays the difference? For Medicare patients, U.S. taxpayers shoulder the burden. Medicare doesn’t release complete data on what it pays pharmaceutical companies each year, but this much is clear: A million-dollar contribution from a pharmaceutical company to a copay charity can keep hundreds of patients from abandoning a newly pricey drug, enabling the donor to collect many millions from Medicare.

    #complicité #vicié #vicieux

  • Je vous écris de Huntsville, Alabama - SPARTACUS

    Mais contrairement à la Black Belt, la région de Huntsville est trépidante et bourdonnante grâce aux nouveaux emplois de l’industrie et du secteur de la défense. Remington projette de relocaliser à Huntsville une grande usine du nord de l’État de New York, en partie parce que la culture de l’Alabama est moins hostile au port d’arme et ne l’interdit pas. GE Aviation vient d’annoncer la création d’un projet très important, une usine high-tech de fabrication de produits en carbure de silicium pour l’industrie aérospatiale en plein essor de Huntsville. Même le port somnolent de Mobile, situé dans le golfe à l’extrémité sud de l’Etat, a décroché l’implantation de la très rentable usine de North American Airbus, la première de cette entreprise. Et les travailleurs d’United Auto Workers ont remporté une victoire rare, mais dont le Sud profond avait bien besoin, en organisant la Commercial Vehicle Company, petit fournisseur de pièces automobiles, à Piedmont.

    Cependant les finances de l’Etat d’Alabama sont en chute libre, en grande partie parce que le corps législatif, vraisemblablement le plus à droite du pays, refuse d’augmenter les #impôts des entreprises (2). Le dernier budget, menacé d’un déficit de 200 millions de dollars, aurait ruiné le programme Medicare de l’Etat ; en dépit d’un sursis pour l’année fiscale à venir grâce à un financement du même ordre, l’avenir à long terme du programme Medicare est encore incertain. Il est prévu de fermer les parcs de l’Etat et de réduire les services publics. La TVA de l’Alabama, qui s’élève à 9 cents par dollar, s’applique même à la nourriture, ce qui est une épreuve supplémentaire, même si elle n’est pas inattendue, abusivement imposée aux travailleurs et aux pauvres.

    La coupe budgétaire la plus tristement célèbre, celle qui a attiré l’attention au niveau national, a été le programme de fermetures échelonnées des bureaux de permis de conduire, programme qui, dès mars 2016, n’aurait laissé que quatre bureaux ouverts dans tout l’Etat (3). Cette décision a été très largement comprise comme un moyen de réduire la participation des Noirs aux élections, car – en Alabama, grâce à la loi qui oblige l’électeur à prouver son identité – les électeurs sont obligés de produire un document officiel, et un permis de conduire en cours de validité en est la forme la plus courante. On a moins remarqué qu’il était prévu de maintenir l’ouverture des magasins de vins et spiritueux non rentables agréés par l’Etat dans nombre de petits comtés ruraux, ce qui signifie qu’il serait plus facile d’acheter une bouteille de gnôle que de voter.

    #capitalisme #inégalités

  • Parents in trouble with the law - Pictures - CBS News
    Chez nous c’est la fin des vacances scolaires de pâques. Les parents recommencent à faire pression sur les cancres. En Floride aux États-Unis une maman est allée trop loin en obligeant sa fille à porter un t-shirt avec le graffiti ci-dessus. Sur le dos elle a adressé les mots suivants aux camarades de sa fille :

    “My eating French Fries and being a social butterfly is over because I know why my parents send me to school”

    Suite à la publication de son oeuvre la maman a subi une garde a vue prolongée pour abus de mineurs.

    Ces reportages sur les parents abusifs sont toujours tristes à pleurer. On y découvre la pauvreté extrème et le désespoir sans issue. Sous l’URL cité plus haut CBS News présente des histoires encore pires, comme celle des parents qui attachent leur fils de 17 ans avec des chaînes dans la cave et le nourrrissent à peine parce qu’il ne savent pas comment gérer le trouble bipolaire dont l’adolescent est victime.

    C’est dur pour les enfants de pauvres quand il n’y a ni moyens de transport en commun ni sécurité sociale.

    La rubrique manhunt nous plonge encore plus profondément dans l’abîme de la catastrophe humanitaire aux #USA.

    Woman stole $800 worth of toothbrushes from Pennsylvania CVS, cops say - CBS News

    Cops : Man angry about cleaning shoots fast-food worker

    Newborn girl found abandoned in Mesa, Arizona yard

    VIDEO : Suspects use rock to break into California pharmacy

    Police scratching heads over suspected serial Rogaine thief

    Cops : Inmate captured after swallowing pens, escaping hospital

    Police : Baby killed by shots likely aimed at alleged gang member dad

    Chinese fugitive accused of killing teen nephews to be extradited

    « Affluenza » teen and mom to be sent back to U.S.

    Couple terrorized in Ga. home invasion speak out

    Tuskegee airman, 93, carjacked and robbed in the same night

    Complaint : Wal-Mart kidnapper told victim she broke his heart

    Manhunt for Ohio teens accused in Pennsylvania armed robbery

    #éducation #école #USA #wtf

    • Comme d’habitude, j’ai l’impression que les médias oublient l’essentiel pour se concentrer sur le sensationnel, car dans l’article ils précisent que sa mère l’avait battue avant de l’envoyer à l’école, mais après ils disent que c’est pour le t-shirt qu’elle est condamnée.

    • @nicolasm bof, souvent les pères ne sont qu’un vecteur de la misère générale ...
      Dans notre univers il est à la société de remplir le vide matériel laissé par leur absence, pour les admirateurs de la vielle folle Ayn Rand et les adeptes de la théologie de la prospérité c’est à la mère de prouver si elle est digne de la prospérité.
      On est aux USA, ...

      Prosperity theology

      Recent U.S. history
      The Neo-Pentecostal movement has been characterized in part by an emphasis on prosperity theology, which gained greater acceptance within charismatic Christianity during the late 1990s. By 2006, three of the four largest congregations in the United States were teaching prosperity theology, and Joel Osteen has been credited with spreading it outside of the Pentecostal and Charismatic movement through his books, which have sold over 4 million copies. Bruce Wilkinson’s The Prayer of Jabez also sold millions of copies and invited readers to seek prosperity.

      International growth
      In the 2000s, churches teaching prosperity theology saw significant growth in the Third World. According to Philip Jenkins of Pennsylvania State University, poor citizens of impoverished countries often find the doctrine appealing because of their economic powerlessness and the doctrine’s emphasis on miracles. One region seeing explosive growth is Western Africa, particularly Nigeria. In the Philippines, the El Shaddai movement, part of the Catholic Charismatic Renewal, has spread prosperity theology outside Protestant Christianity. One South Korean prosperity church, Yoido Full Gospel Church, gained attention in the 1990s by claiming to be the world’s largest congregation.

      Ayn Rand

      In 1976, she retired from writing her newsletter and, despite her initial objections, allowed Evva Pryor, a social worker from her attorney’s office, to enroll her in Social Security and Medicare.
      Rand’s funeral was attended by some of her prominent followers, including Alan Greenspan.


      The essence of Objectivist ethics is summarized by the oath her Atlas Shrugged character John Galt adhered to: “I swear—by my life and my love of it—that I will never live for the sake of another man, nor ask another man to live for mine.”

      #argh !

    • @nicolasm Je vois. Puisqu’il est puni de passer un entretien d’embauche sous ces conditions, la pauvre serait mieux partie en laissant les gamins dans la voiture pendant qu’elle braque une banque ;-)

  • Big pharmacies are dismantling the industry that keeps US drug costs even sort-of under control

    The impetus was October’s announcement from Walgreens, the US’s second-largest chain of pharmacies, that it was buying Rite Aid, the third. Critics said that would create a drugstore duopoly with CVS, the market leader. They didn’t, however, look as hard at another effect of the deal, which likely will bring about the final collapse of the industry tasked with keeping prescription-drug costs under control.

    When a pharmacy owns a PBM, “it’s a sweetheart deal—the two entities no longer have an incentive to negotiate with each other.”

    Buried inside Rite Aid is a bundle of pharmacy benefit managers (PBMs). These are companies that handle the distribution of drugs for large employers, insurance companies, and government programs like Medicare. Walgreens says that acquiring Rite Aid’s PBMs would help it compete with arch-rival CVS, which controls a large and extremely profitable PBM called Caremark.
    But combining pharmacies and PBMs under one roof creates a conflict of interest. It can restrict patients’ access to certain prescription drugs, and can prevent independent drugstores from competing fairly for new customers.

    Worst of all, it could push up drug prices. When a pharmacy owns a PBM, explains Bob Zebroski, a professor at the St. Louis College of Pharmacy, “it’s a sweetheart deal—the two entities no longer have an incentive to negotiate with each other.”
    As the Federal Trade Commission (FTC) scrutinizes the Walgreens-Rite Aid deal, some experts believe the agency should consider more than just the potential effect on pharmacy retailing, and evaluate whether PBMs combined with pharmacies are good for patients. Indeed, there’s an opportunity here: The FTC could use the review to revisit its controversial 2007 decision that let CVS acquire Caremark. That was the deal that first undermined the ability of modern PBMs to drive a hard bargain with today’s giant drugstore chains.

    #Etats-Unis #big_pharma

  • Costs for Dementia Care Far Exceeding Other Diseases, Study Finds

    The study looked at patients on Medicare. The average total cost of care for a person with dementia over those five years was $287,038. For a patient who died of heart disease it was $175,136. For a cancer patient it was $173,383. Medicare paid almost the same amount for patients with each of those diseases — close to $100,000 — but dementia patients had many more expenses that were not covered.

    On average, the out-of-pocket cost for a patient with dementia was $61,522 — more than 80 percent higher than the cost for someone with heart disease or cancer. The reason is that dementia patients need caregivers to watch them, help with basic activities like eating, dressing and bathing, and provide constant supervision to make sure they do not wander off or harm themselves. None of those costs were covered by Medicare.

    #démence #coût #santé

  • Price & Value of #Cancer Drug | Memorial Sloan Kettering Cancer Center

    Cost of one month of treatment for an adult for each new cancer drug approved by the United States Food and Drug Administration, based on Medicare reimbursement rates and by year of drug approval.

    et un article du WSJ qui en parle (pas lu)

    #pharma #prix #santé

  • L’administration #Obama à nouveau accusée d’étouffer la liberté d’expression

    Les signataires dénoncent, entre autres barrières, l’impossibilité de parler à des experts sans être accompagnés de communicants officiels, et l’obligation de fournir préalablement à l’administration les questions d’une interview dont l’autorisation officielle « traîne pendant des jours ». Par ailleurs, 40 % des officiels bloqueraient certains journalistes sous prétexte qu’ils « n’apprécient pas » ce qu’ils écrivent, selon une étude menée en 2013.

    Parmi les organismes officiels les plus opaques, les auteurs de la lettre ouverte citent l’Agence de protection environnementale (EPA), les agences du Medicaid et du Medicare ou encore le département de la sécurité intérieure.

    « C’est comme un brouillard qu’on n’a pas vu venir et dont on ne peut se débarrasser aujourd’hui », analyse, très pessimiste, David Cuillier. « Les journalistes sont aussi coupables, en se contentant des informations relayées dans les conférences de #presse et les communiqués. L’effort doit venir de tous les côtés ». En cause, notamment, la fermeture de bureaux à Washington, qui aurait créé chez les médias une forme d’#autocensure, les empêchant d’enquêter davantage sur le gouvernement.

    #journalisme #censure #contrôle

  • Blame the Docs : Errors Cloud Medicare Payment Data

    Two doctors top the list of emergency medicine specialists in the Medicare doctor payment data released last week, with reimbursements over $1 million each.

    But it turns out both doctors are vascular surgeons who identified themselves as the wrong specialty. And it’s not just the “case of the mistaken specialties.” Other physicians report outdated data, missing records, and different addresses.

    Experts say the errors are manageable and mostly not Medicare’s fault.

    “I think it’s reliably accurate, whenever there’s an inaccuracy there’s always an explanation,” said Charles Ornstein, senior reporter for ProPublica, which produced the Dollars for Docs project based on similar Medicare data. “When they’re wrong, it’s often on doctors themselves or their practices in the way they do their billing. Doctors are notorious for not keeping their NPPES [National Plan and Provider Enumeration System] updated.”

    whenever there’s an inaccuracy there’s always an explanation
    Bienvenu dans le monde des données…

    On notera que le titre parle d’error là où l’expert parle d’inaccuracy.

  • Ouverture des #données de #Medicare : l’Open Data à l’américaine met les #médecins sous pression

    C’est historique. La base de données des paiements effectués par le système de #santé public américain Medicare – financé par les #contribuables – a été ouverte au public. Les conséquences ne font que commencer. On apprend notamment qu’un groupe de #docteurs a perçu plus de 3 millions de dollars chacun en 2012.

    L’un d’entre eux a même reçu 21 millions de dollars. C’est une des découvertes de l’Associated Press (AP) qui a analysé les données sur les médecins rendues publiques par l’administration Obama dans le cadre de la politique de communication sur le coût du système de santé.

    Un petit groupe de 344 médecins

    Ce petit groupe de médecins ainsi mis en exergue est composé de 344 praticiens parmi les 825 000 médecins ayant été payés par le système Medicare. Pour ce petit groupe, le total des #dépenses est de 1,5 milliard de dollars. Un médecin sur quatre dans ce groupe des plus payés – soit 87 – exercent en Floride. Il s’agit d’un état connu insiste l’AP pour son niveau de dépenses élevé auprès de Medicare et un haut niveau de #fraude.

    Toujours dans ce groupe, on trouve 151 ophtalmologues qui représentent à eux seuls 658 millions de dépenses. Quant aux spécialistes du cancer, ils pèsent pour 477 millions de dollars. L’AP avance une explication sur cette surreprésentation des ophtalmologues par leur usage d’un médicament, le Lucentis, très coûteux. Au global, 1% des médecins ont reçu 14% des 77 milliards de dollars de dépenses recensées. Le paiement médian s’est élevé à 30 265 $.

    Action en justice

    Si l’AP publie ces chiffres, c’est que jusqu’à ce mois d’Avril ces données étaient confidentielles. Les organisations de médecins étaient allées en justice pour en empêcher la divulgation, afin que l’on n’empiète pas sur la vie privée des médecins. Les employeurs, les assureurs, les groupes de consommateurs et la presse avaient demandé cette ouverture des données.

    Leurs arguments étaient que cela permettrait de guider les patients vers les médecins qui délivrent des soins de qualité à un prix correct. Un juge a finalement levé l’obstacle principal, et l’administration Obama a informé l’American Medical Association qu’elle allait ouvrir ces données. Et en Avril 2014, The Centers for Medicare and Medicaid Services a publié les données sur plus de 880 000 médecins et autres prestataires médicaux qui ont collectivement reçu 77 milliards de dollars du système Medicare en 2012. Les données sont nominatives et identifient les médecins.

    L’AP estime que l’analyse des données devrait permettre d’identifier les modèles de prise de décision des médecins par les chercheurs qui étudient ce qui amène au coût total de 2, 8 trillions de dollars annuels du système de santé.

    L’American Medical Association estime pour sa part que ces données, livrées telles quelles, hors contexte, vont faire plus de mal que de bien. Et qu’elles ne donneront pas d’indication sur la qualité des soins fournis par les médecins. De fait, de multiples raisons peuvent expliquer les coûts plus élevés de certains médecins par rapport à d’autres, telles que le coûts des équipements nécessaires, la taille des équipes aidant le médecin, l’âge moyen des patients, …. L’AP mise sur la divulgation de ces données pour améliorer la qualité des soins au fur et à mesure que les chercheurs apprendront à creuser dans ces données.

    Il pourrait être possible de connaître le nombre d’opérations menées par un chirurgien, et les recherches ont montré que pour de nombreuses procédures, il vaut mieux se faire opérer par un chirurgien qui les pratique fréquemment. Les données pourraient également aider à traquer les fraudes.


    “I’m concerned that people in the community will get the wrong idea of how these billings reflect doctors’ income,” said Welch, who ranked No. 8 in Medicare payments. “Instead of blaming us, they need to have a serious discussion with the drug companies about lowering the cost of these drugs. If they want us to stop taking care of patients, then tell us that — but don’t blame us for costs.”

    Cependant, et à plus d’un titre, cette dissociation entre #AMA et #big_pharma n’est pas toujours pertinente,

    Political Ties of Top Billers for Medicare

    MIAMI — Two Florida doctors who received the nation’s highest Medicare reimbursements in 2012 are both major contributors to Democratic Party causes, and they have turned to the political system in recent years to defend themselves against suspicions that they may have submitted fraudulent or excessive charges to the federal government.

    The pattern of large Medicare payments and six-figure political donations shows up among several of the doctors whose payment records were released for the first time this week by the Department of Health and Human Services. For years, the department refused to make the data public, and finally did so only after being sued by The Wall Street Journal.

    Topping the list is Dr. Salomon E. Melgen, 59, an ophthalmologist from North Palm Beach, Fla., who received $21 million in Medicare reimbursements in 2012 alone. The doctor billed a bulk of his reimbursements for Lucentis, a medication used to treat macular degeneration made by a company that pays generous rebates to its doctors

    Dr. Melgen’s firm donated more than $700,000 to Majority PAC, a super PAC run by former aides to the Senate majority leader, Harry Reid, Democrat of Nevada. The super PAC then spent $600,000 to help re-elect Senator Robert Menendez, Democrat of New Jersey, who is a close friend of Dr. Melgen’s. Last year, Mr. Menendez himself became a target of investigation after the senator intervened on behalf of Dr. Melgen with federal officials and took flights on his private jet.

    Another physician, Dr. Asad Qamar, an interventional cardiologist in Ocala, Fla., has sent at least $250,000 in donations over the last decade to the political campaigns of President Obama and other prominent Democrats; he has become the target of scrutiny related to cardiovascular treatment centers he runs in Central Florida.

    Dr. Qamar was paid more than $18 million in 2012, making him and Dr. Melgen by far the largest payment recipients nationwide, according to the data. A pathologist from New Jersey received the third largest Medicare reimbursement, $12.6 million.

    De la #corruption_légale à la #corruption_illégale #Etats-Unis

  • India’s Efforts to Aid Poor Worry Drug Makers

    American trade officials have voiced concerns about India’s treatment of drug patents, including its reasons for sometimes overriding them. President Obama discussed the issue this year with Prime Minister Manmohan Singh of India in the Oval Office, administration officials said.

    Executives in the international pharmaceutical industry, increasingly dependent on drug sales in emerging markets like India, China and Brazil, contend that India’s efforts to cancel patents threaten the global system for discovering cures (...) [*]


    For drug companies, the most worrisome aspect of India’s efforts to lower drug prices is that other countries are beginning to follow its lead. Both Indonesia and the Philippines recently adopted patent laws modeled on India’s, and legislators in Brazil and Colombia have proposed following suit.


    Even insured patients in the United States may wonder why they are making thousands of dollars in co-payments if these medicines cost far less in India. Treatment with Herceptin is even more expensive in the United States, so even Medicare patients must make thousands of dollars in co-pays.


    For the Obama administration, the fight over drug patents in the developing world is a minefield. The drug industry was a major contributor to Mr. Obama’s campaign and an early and crucial backer of his health care program. But Mr. Obama’s advisers hope to avoid the mistakes of the Clinton administration, which was harshly criticized by AIDS activists for its initial stand against providing generic antiretroviral drugs to Africa.

    [*] Sur cette affirmation, un article qui affirme le contraire (via Dean Baker)

    The initial eruption of small and large innovations leading to the creation of a new industry – from chemicals to cars, from radio and TV to personal computers and investment banking – is seldom, if ever, born out of patent protection and is, instead, the fruits of highly competitive-cooperative environments. It is only after the initial stages of explosive innovation and rampant growth end that mature industries turn toward the legal protection of patents, usually because their internal grow potential diminishes and the industry structure become concentrated.

    A closer look at the historical and international evidence suggests that while weak patent systems may mildly increase innovation with limited side-effects, strong patent systems retard innovation with many negative side-effects. Both theoretically and empirically, the political economy of government operated patent systems indicates that weak legislation will generally evolve into a strong protection and that the political demand for stronger patent protection comes from old and stagnant industries and firms, not from new and innovative ones. Hence the best solution is to abolish patents entirely through strong constitutional measures and to find other legislative instruments, less open to lobbying and rent-seeking, to foster innovation whenever there is clear evidence that laissez-faire under-supplies it.

    #santé #pharma #bigpharma #patentes #pauvres #lobby #medicare #états-unis #Inde