Monday, April 02, 2007

"The Ugliest Night I Have Ever Seen" - 60 Minutes on How the Medicare Drug Benefit Bill Was Passed

The legendary television news magazine, 60 Minutes, just did an expose of how the US Medicare Part D prescription drug benefit bill was passed. It is well-known that US drug prices have continued to increase since this bill, which prevented Medicare from negotiating the prices it paid on behalf of patients for drugs.

The vote for the bill came in the wee morning hours, in a process that a Republican congressman who opposed the bill described as "the ugliest night I have ever seen in 22 years."

It is worth reading the full transcript of the story, but what I found most striking were the number of relationships it cataloged between congresspeople, staffers, and other federal officials and the pharmaceutical industry. These included:
  • Bill Tauzin (Republican - Louisiana), who "steered it [the bill] through the house," within a few months "began discussions with the pharmaceutical industry to become its chief lobbyist in Washington." Tauzin had an "extremely rare" tumor removed, and was treated "with a new medicine, Avastatin, that had never been used on that form of cancer. The treatment was succesful , and as a result Tauzin felt he owed his life to the drug industry." [but apparently not to the surgeon - Ed] "After serving out his congressional term, he accepted a $2 million-a-year job ... as president of PhRMA - Pharmaceutical Research and Manufacturers of America."
  • Medicare Chief Actuary Richard Foster said he "was told to withold the new numbers" that gave an honest estimate of the cost of the new drug benefit, and said "the person who told him to withhold Congress from getting the revised estimates was Medicare boss Tom Sculley." But, "Sculley was the administration's lead negotiator on the prescription drug bill, and at the time was also negotiating a job for himself with a high-powered Washington law firm, where he became a lobbyist with the pharmaceutical industry."
  • Multiple former federal legislators helped lobby for the bill, including "former senators Dennis Deconcini (D-Arizona), and Steve Symms (R-Idaho), and former congressmen like Tom Downey (D-New York), Vic Fazio (D-California), Bill Paxon (R-New York), and former house Minority Leader Robert Michel (R-Illinois)."
  • "John McManus, the staff director of the Ways and Means subcommittee on Health. Within a few months, he left Congress and started his own lobbying firm. Among his new clients was PhRMA, Pfizer, Eli Lilly and Merck. "
  • "Linda Fishman, from the majority side of the Finance Committee, left to become a lobbyist with the drug manufacturer Amgen. "
  • "Pat Morrisey, chief of staff of the Energy and Commerce Committee, took a job lobbying for drug companies Novartis and Hoffman-La Roche. "
  • "Jeremy Allen went to Johnson and Johnson. "
  • "Kathleen Weldon went to lobby for Biogen, a Bio-tech company. "
  • "Jim Barnette left to lobby for Hoffman-La Roche. "

One Republican congressman who opposed the bill commented thus about Billy Tauzin's new job, "I mean, when you're pushing so hard for a bill that's controversial and you have to keep the machine open for three hours to get the one vote necessary to pass it, and then, within a matter of months you go to work for the industry that's gonna benefit from it, it does cause you some concern."

Well, if nothing else, this case shows that it is not only physicians and medical academics who have issues with conflicts of interest involving the pharmaceutical and biotechnology industries.

It also suggests that simplistic arguments between advocates of private insurance and single-payer government financed insurance, each claiming that their approach would solve all our health care problems, completely miss the point.

What would help to solve our problems is to get rid of the conflicts that interest that affect health care policy, not just academics and policy experts paid on the side by commercial health care firms, but legislators and legislative staff working to impress their eventual commercial employers, when they are supposed to be representing the public.

See also the post on PharmaGossip, and the post on PharmaLot.


Anonymous said...

The report notes that: "In all, at least 15 congressional staffers, congressmen and federal officials left to go to work for the pharmaceutical industry, whose profits were increased by several billion dollars."

What struck me in watching the interview with Bill Tauzin was his complete sales persona, and like a person in that position, when pressed he ultimately challenged Steve Kroft to produce hard evidence of a conflict of interest.

This is set against the backdrop of declining revenues for all of the major networks. The drug ads we have all been subject to have been revenue enhancers. I am sure that implied in the challenge was the undercurrent that if CBS, or any other network, challenged PhRMA he would use his clout to reduce advertising on the offending network.

Let's hope all news organizations have the courage to continue to report on the conflicts this issue raises.

Steve Lucas

Dr. BK said...

I am respectfully responding to

"What would help to solve our problems is to get rid of the conflicts that interest that affect health care policy, not just academics and policy experts paid on the side by commercial health care firms, but legislators and legislative staff working to impress their eventual commercial employers, when they are supposed to be representing the public."

No disagreement here. I totally agree.

However, one only has to go to Canada to see the difference it makes to remove PHARMA from the mix. Although far from perfect, and certainly PHARMA driven to some extent, in general the POPULOUS of B.C. is anti-PHARMA as a first line treatment. Behavioral treatments are most always implemented first. Drug prices are reasonable.

In the US, it is overly idealistic to expect a system, whose research funding is almost entirely either NIMH, NIH, Insurance company, or PHARMA funded to produce academics scientists who have NO conflict of interest.

Who doesn't want an RO1 to have the desired results in order to keep together their research team? Most teams in all the studies described in these blogs are made up of research assistants, nurses, statisticians, secretaries, program assistants and project managers who barely earn a working living, and work their butts off in the name of science.

I get so depressed over how many idealistic students we lose each year because they instantly see thru the BASIC conflict that is INHERENT in our current funding pressures.

In most Medical Schools, faculty HAVE NO TENURE. That means, in order TO DO RESEARCH they HAVE TO HAVE FUNDING FROM OUTSIDE SOURCES. Until society decides to change this funding - science tautology, nothing will change.

I am so sorry to be so pessimistic, but ethics alone is not going to make any changes in this situation, or in the situations that lead to all the abuses you bloggers are so wonderful to report.

Thanks for allowing this comment.


Anonymous said...

And this is surprising? In a derivation of one of the most profound statements of all time "It is what it is", but could be changed to the actual quote.. "I am what I am", indeed the health care industry has become the greatest example of an unethical industry in this country. I believe we beat the Military Industrial Complex hands down.

This is how health care (HC) corporations control the government dollars and the big HC players ensure their continued success. Whether pharma, Medicare HMOs, supply companies, device manufacturers, they all spend millions of dollars to be sure they get even more millions of dollars. Their lobbying ROIs are much higher than any media campaign.

It occurs at the Federal level but lets not forget the States. The large corporations buy the right to make money. I have seen contracts awarded and renewed outside of normal contracting procedures based on the efforts of a politician who was influenced by a lobbyist or corporation that provided him or her with large sums of money.

One other noteworthy point is people going the other direction... for example the current head of FL Medicaid was a former Board member of a prominent HMO with large operations and contracts in and with the State of Florida (he resigned the day before he announced his acceptance of the position). Of course the Governor chose a former head of the Medicaid Bureau for his search committee who also happened to sit on the same Board. Do you think that HMO might have a bit of a leg up in any future business with the State?????

Dr. BK said...

You are correct. We do have State contracts too. The big HMO here provides THE SAMPLES FOR STUDY but RARELY funds any of the research that I was talking about. MET and the big insurance companies actually fund studies...

The HMO lobby our state hard for the contracts of its workers. I think that each State government that comes into office, tries to stack the deck with their own people... That is logical.

What bothers me, is that if you look at the DISCLOSURES from most psychiatric research, it is funded most entirely by NIMH and PHARMA.


Cheers :) BK