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#Post#: 2336--------------------------------------------------
Rosenthal, AMERICAN SICKNESS: HOW HEALTHCARE BECAME BIG BUSINESS
AND HOW YOU CAN TAKE IT BACK
DIR By: agate
Date: January 6, 2019, 2:05 am
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Elisabeth Rosenthal, AN AMERICAN SICKNESS: HOW HEALTHCARE BECAME
BIG BUSINESS AND HOW YOU CAN TAKE IT BACK (2017)
This is what I posted on my book reviews blog:
This is a timely and important book. The author, who was a
practicing physician for about 8 years before becoming the
science and health reporter for the New York Times, seems to
know her topic thoroughly. She paints an alarming picture of
the US healthcare system, with hospitals and medical providers
and drug companies all helping themselves to considerable sums
of money thanks to cleverness in manipulating insurance company
and Medicare policies. It adds up to a catastrophically broken
system, with patients being harmed and often impoverished by it.
She gives detailed descriptions of inventive forms of "strategic
billing" used by doctors and hospitals who have devised ways of
using the elaborate coding system to generate a far higher price
tag for services and items that they should have.
She has no use for direct-to-consumer drug advertising, which is
now inundating the US media.
Then there are "surrogate endpoints." According to the National
Cancer Institute Website, a surrogate endpoint is:
In clinical trials, an indicator or sign used in place of
another to tell if a treatment works. Surrogate endpoints
include a shrinking tumor or lower biomarker levels. They may be
used instead of stronger indicators, such as longer survival or
improved quality of life, because the results of the trial can
be measured sooner. The use of surrogate endpoints in clinical
trials may allow earlier approval of new drugs to treat serious
or life-threatening diseases, such as cancer. Surrogate
endpoints are not always true indicators or signs of how well a
treatment works.
Rosenthal has this to say about them:
An in-depth data investigation by the Milwaukee Journal Sentinel
and MedPage Today in 2014 revealed that, thanks to surrogate
endpoints, 74% of cancer drugs approved by the FDA during the
previous decade ultimately did not extend life by even a single
day.
She discusses "accelerated approval measures"--the easiest way
to get drug products onto the market. In this way companies can
more easily market drugs and biologics that have no real proven
value, she says.
She strongly favors obliging hospitals to make their
chargemasters clearly available to all patients so that they can
find out what they can expect to be charged for everything that
is done during their hospital stays, and she would like to see
hospitals guarantee that all doctors who treat you are in your
insurance network--to avoid the very unwelcome surprise of a
bill that is astonishingly higher than anticipated just because
the doctor who examined or treated you was out-of-network.
She maintains that the skills of pharmacists in the US are very
underused and points out that in Europe drugs are classified
into three groups: over-the-counter, prescription, and
pharmacist-dispensed. Using pharmacists' training and knowledge
by enabling them to dispense drugs without doctors'
prescriptions would ease the burden on doctors and provide
patients with readier access to many well-established drugs.
The book includes three useful appendices, with links to
Websites where more information can be found.
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