Public Health

Spiraling Prices for Cancer and Specialty Drugs

by Donald W. Light

Pharmaceutical companies sometimes charge so much for cancer drugs that even insured patients cannot afford their 20 percent co-payments—on what can be $100,000/year medicines. Sometimes, in order to pay for cancer drugs, patients stop taking other vital drugs, or cut back on food. This is a major concern for Hagop Kantarjian, Chief of Leukemia and full professor at the MD Anderson Cancer Center in Houston, Texas.

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Obamacare’s Unhealthy Relationship: A Cautionary Tale of Public-Private Partnerships

by Gregg Fields

The HealthCare.gov website isn’t exactly a government creation, but rather the product of partnerships with private contractors. In that sense, it’s a variation of an increasingly popular form of governance known as public-private partnerships, or PPPs. And it’s not working.

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Systematic Evidence of Less-Than-Truthful Commercial Free Speech That Harms Citizens

by Donald W. Light

In U.S. vs. Alfred Caronia, the U.S. Court of Appeals for the Second Circuit concluded that criminalizing the promotion of off-label uses of pharmaceuticals—that is, for purposes not approved by the Food and Drug Administration—amounted to an unconstitutional restriction on free speech. The court did not comment on evidence that Caronia had been untruthful in promoting a narcolepsy drug for the treatment of fibromyalgia and for patients under the age of 16. 

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Corrupting Practices Harm Patients

by Donald W. Light

In just a few months, the countervailing powers of academics, researchers, and the British medical profession have mounted the final campaign against the corrupting practices of hiding negative trial results that earned prominent attention recently in The New York Times.  Led by Peter Doshi and Ben Goldacre, the campaign includes formal endorsement by the British Medical Association, the Medical Research Council, and the editorial boards of three of the world’s leading medical journals. Thirty years of distorting medical knowledge and clinical guidelines seem to be ending; but imagine the difference if the AMA, the IOM and the NEJM joined them.

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Dispatch from Chile: The Ethics of Health Priority Setting, or Searching for True North Without a Compass

by Adriane Gelpi

Imagine that you are the Minister of Health for Chile, a middle-income country with a nearly universal health system. You face a predicament that pops up regularly. The Chilean health system provides a politically popular package of health interventions to meet the medical needs of its citizens. At the moment, 80 conditions are covered, leaving those suffering from other conditions without access to care for their serious medical needs. You would like to add another benefit to the existing package of services, but the Minister of Finance has given you a hard ceiling on the budget. You cannot add a service without subtracting another, a politically perilous move.... Read more about Dispatch from Chile: The Ethics of Health Priority Setting, or Searching for True North Without a Compass

Institutional Corruption: Linking and Learning from Regulatory Capture

by Donald W. Light

This is the third is a set of blogs devoted to strengthening the concept and theory of institutional corruption (IC). A previous blog urged that IC would be greatly strengthened by drawing on moral philosophy to establish a normative, external foundation for both defining when IC is occurring and for developing legitimate reforms for institutional integrity.

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Institutional Corruption and Countervailing Powers

by Donald W. Light

By its very nature, institutional corruption (IC) occurs in a force-field of countervailing powers. Corruption at the organizational or institutional levels inherently involves a larger constellation of stakeholders who participate in or are affected by the corruption being studied. Beyond them are other parties with other priorities who shape or are affected by different forms of corruption. These include public opinion and trust if its deterioration leads to organized responses. Doing research on how countervailing powers interact with the corruptors and shape either the forms of corruption or reforms for integrity to end it would strengthen IC studies.

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Physicians and the Pharmaceutical Industry: Where does this Story Begin?

by Kirsten Austad and Aaron Kesselheim

This blog post discusses the article "Changing Interactions Between Physician Trainees and the Pharmaceutical Industry” published in the February 27, 2013 electronic edition of the Journal of General Internal Medicine. The study was conducted by former Fellow in the Lab on Institutional Corruption Kirsten Austad, Lab affiliates Aaron Kesselheim M.D. J.D. and Eric Campbell Ph.D., and Jerry Avorn M.D. and other members of the Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women’s Hospital and Harvard Medical School.... Read more about Physicians and the Pharmaceutical Industry: Where does this Story Begin?