This month’s episode of “News You Can Use” on HealthcareNOWRadio features news from the month of September 2024
News You Can Use with your Hosts Dr Craig Joseph and Dr Nick van Terheyden
The show that gives you a quick insight into the latest news, twists, turns and debacles going on in healthcare with my friend and co-host Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners and myself, where every diagnosis comes with a side of humor. We hope you stay curious, stay engaged, and keep seeking the truth in healthcare in a world that thrives on information.
Buckle up as we dive into the ER of excitement, the ICU of irrationality, and the waiting room of wacky wisdom in this months show that features a review of:
- The mysterious big-pharma bus
- Eli Lily new mafia look
- Epic being sued by Particle Health
- Claims denials disproportionate impact
- Commonwealth Fund Report
- Cyber security and fun with code names
Pharma on Wheels: More Questions Than Answers
This week we explore the origins and implications of a mysterious “Big Pharma” bus. The bus, emblazoned with messages opposing the pharmaceutical industry, has been touring in secrecy, leaving many wondering who is behind it. While the bus’s backers remain unclear, and Dr Nick’s investigation to trace the campaign’s website registration was a dead-end lead. We wonder what kind of impact it will have but recognize it has successfully sparked a conversation about the role of big pharmaceutical companies in U.S. healthcare.
We moved to the larger debates surrounding the cost of pharmaceuticals in the U.S., particularly in comparison to other countries and the recent Senate showdown on Ozempic, which costs significantly more in the U.S. than in countries like Canada or Germany. While we both recognize the need for profit, pharmaceutical companies defending these high prices citing the need to recoup extensive research costs still fail to explain these differences. While leaders and critics all present valid points, the issue remains complicated, with numerous players such as pharmacy benefit managers (PBMs) influencing drug prices.
We discuss the recent legal battles, including Eli Lilly’s actions against compounded versions of GLP-1 drugs where they sent letters asking patients to reveal where they sourced compounded versions of the drug, raising concerns about patient privacy and the erosion of further erosion of trust. And we close with a dive into the Cybersecurity alert for healthcare, still top of the list, and the humorous names for the various Ransomware groups as compared to World War Two double agents.
We hope you enjoy our take on the latest news and developments in healthcare and want to help you keep untangling the web of information, dodging the sensational pitfalls, and emerging victorious, albeit a little dizzy, on the other side. In the end, the stories we uncover, and the discussions we ignite, all shape the narrative of our shared future. We want to hear from you especially if you have topics covered or questions you’d like answered. You can reach out directly via the contact form on my website, or send a message on LinkedIn to Craig or me.
Until next week keep solving healthcare’s mysteries before they become your emergencies
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
Listen along on HealthcareNowRadio or on SoundCloud
Raw Transcript
Nick van Terheyden
first off, this week, we’re going to look at the mysterious Big Pharma bus. What is the big pharma bus? You asked Craig,
Craig Joseph
I was wondering, and where do I do I buy tickets? How does this work?
Nick van Terheyden
Yeah, we’re not sure where it’s going to but we are wondering where it came from. So this particular piece of news came out of stat, which essentially had a piece talking about this big farmer bus that seems to be touring around, essentially opposing, I think, the big pharma world. And they asked the question, who’s behind this? What’s the story, and Where’s this coming from? Because there’s no details about it. It says, bust Big Pharma, Farmer reform, or America’s for farmer reform. There appears to be a whole website that is associated with this particular group called bustbigfarmer.com and I was certainly curious. I wondered if stat had done any investigation, and thought, well, let’s go see if we could find who was behind it. So I looked up the registrar only recently been registered for that particular domain, the administrative contract contact was listed as an individual by the name of Aaron sagas, who’s listed in Brooklyn, New York. Unfortunately, that name not sufficiently unique to find an individual. It did come with a contact number, and I thought I was onto something as I went searching and trying to zero in and I think that’s where that name, Aaron sagas came from. Was from that particular contact number, because GoDaddy had screened out all of the contact details which you can pay to have done. And ultimately, I think this number used to belong to Aaron, but was transferred and is now owned by GoDaddy, and some of the reverse lookups hadn’t actually caught up, so that proved to be a dead end. Do you have any ideas, Craig,
Craig Joseph
well, my first idea is we should have you say the words GoDaddy as much as possible on this show, because I think our ratings are going to go way up with you, with you, speaking like that, I had not heard about this. I hadn’t, hadn’t read the article in stat, and I had not gone to that, to that website. It’s, it’s interesting, you know, I mean, there’s always a there’s the push and pull of of folks with regard to pharma in in the US, which I completely understand, Americans pay a lot more than our than other citizens, citizens of other industrialized Countries. Certainly we pay a lot more. The argument from the industry side is, well, you get a lot more too. And all of this research, you know, we spend. We Pharma. Pharmaceutical companies spend lots and lots of money on research that mostly doesn’t work out, and only a small percentage of our research works out. So we need to spend we need to make up that that loss, which is a reasonable statement. So I think both, yeah, I see both sides. I don’t I don’t know where this came from, and I’m not sure how effective putting a bus on the road with big signs is, although I suspect it’s focused in Washington, DC, because that’s where the people who make the laws are. Hmm, yeah, I’m not sure if they’re getting their money’s worth, but we’re talking about it. So I guess so. I guess so.
Nick van Terheyden
Well, I mean, at a minimum, I’d want to know who was on the bus and, you know, maybe who’s driving it, because that might actually give i. I The whole concept of trying to hide your identity, you know, I know you’ve got to be really good at this stuff, because ultimately, there’s always a connection to be found, although, you know, I’m not sufficiently skilled enough in the deep dive and maybe not enough time to sort of go after this. But I am curious. I think it’s interesting. It was concurrent with the Senate hearings on, you know, some of the GLP one agonists that just talked about those very issues, you know. So I think what I saw in the reports was, you know, the high prices that we pay in the US for the same drug, ozempic in this particular instance. And this was, you know, addressed to the CEO of that company, almost $1,000 in the US. But in Canada, it’s 150 522 in Denmark, and $59 in Germany. I come on. This just, I, I’m, with you. I think there’s, you know, some balance in here, but everything that I read about that says that we’ve been paying over the top for as long as this industry has existed, perhaps, and all because, why? Because the money’s here or something. I’m not, I’m not really sure, but
Craig Joseph
go where the money is. And another thing that’s, you know, it’s complicated, right? We haven’t talked about PBMs, and so there’s lots of, lots of fingers that can be pointed. The manufacturer says, well, that’s not what we’re charging for. And you know, the fact that you’re paying $1,000 a month, well, that’s not that’s been marked up by the middleman. That was
Nick van Terheyden
exactly what the CEO said to the Senate. He was, of course, my fault, blaming the pharmacy. Yeah, well,
Craig Joseph
but the problem is, all of these industry groups have valid points, right? That’s the problem. Dr, Nick, in my opinion, you can’t discount any of them as being ridiculous, because they can. I just
Nick van Terheyden
say, I’m going to turn that around and say they, they all have valid points. Is also, they all have their fingers in the pie.
Craig Joseph
They’re all trying to maximize shareholder value, right? So that’s, which is,
Nick van Terheyden
you know, appropriate for a public company, right? It’s,
Craig Joseph
it’s, it’s absolutely true, yeah, if it were, if there were an easy, if they were an easy solution, I think I would have already been, you’d be saving No, I’d be made president, and I’d be enacting these solutions.
Nick van Terheyden
Oh, God forbid. Yeah, no, you
Craig Joseph
don’t want Joseph. No, no, that would be bad. It would be bad. I’m putting that out there. Well,
Nick van Terheyden
so, you know, connected to this was the Eli Lilly news that I just, I’m sorry, just left me shaking my head. They here, they are strong arming their patients into revealing the source of their compounded GLP one. So maybe for the benefit of those that don’t understand, if you can’t get the drug in the form, and you know this applies to pediatrics a lot, I think you’d know this, right? So if you can’t get the drug, and it’s not formulated officially, it can be compounded and as appropriately so, especially in neonates and some of the smaller ones, because you’ve got to get that appropriate dosage, and it’s much, much smaller. And I think that’s the go around that folks have been using for these GLP one drugs and compound pharmacies have been springing up all over the place, and now they want to go after it, and they sent out notices to all the patients saying, Tell us who sent this to you, right? Yeah,
Craig Joseph
it’s, it’s confusing to me. So compounding pharmacies have always been around. They’re, relatively speaking, kind of like mom and pop shops. Is I like to think of them. They’re small. I wouldn’t call them factories. They can just be in the back of a regular pharmacy where they can, they can concoct and make formulations of drugs that are not commercially available. And the problem that we’re having now for some of these GLP ones is that there’s not enough of them. They can’t make them fast enough, right? Which makes it now allowable in the US for others to take these copyrighted trademark. What’s the right word? I don’t know. It’s probably neither are one of those. But normally you can’t just copy someone else’s, you know, medication, and start making it, but you can if there’s not enough of it. And this is odd. So this was one of the pharmacy one of the pharmaceutical companies somehow got a list of patients who had gotten copies of the medications from compounding pharmacies and said, hey, we’d like to have access to your medical records so that we can compare the quality the outcomes that you’ve had essentially, to the outcomes of. Patients who’ve had the real medicine, which is the real medicine, the best medicine, the real medicine, aka the medicine that we we formulated. It’s an interesting, certainly, it’s an interesting from a research standpoint. I think that would be interesting. They again, Lily makes an argument that, hey, these compounding pharmacies are not under the same strict supervision that we are. That’s accurate, and may not have the exact same it may not have the highest level of quality control like we do, that’s also accurate, but it does seem it’s a it’s it’s an odd it’s an odd thing to do, I’ll grant you that, and I’m not sure how many people are going to respond well to such an I’m looking at the email now. I’m sorry at the letter, snail mail, letter on a piece of paper, yeah, I don’t, I don’t, I don’t. I know I would not respond well to that, and would probably not grant access to my medical records to a pharmaceutical company that actually, that, actually, I’m not even dealing with, right? Because I didn’t get my meds from them.
Nick van Terheyden
It doesn’t exactly paint you in a good corner, you know, given the low level of trust I think that we see in the marketplace, right? It’s, it is? It’s a shaking my head kind of challenge. I think maybe somebody needs to rethink that.
Craig Joseph
They’re not stepping back, really, according to this article, like, yeah, this says the CEO of Lilly is not backing away from the fight. I I get it. I get it. They’re, they’re, they’re going to be advertising the fact that, Hey, you want the real stuff, because we have hot, better quality, which may or may not be the case, that it’s really unknowable at this point. But I, you know you can’t, if you’re not making it fast enough and people want it, then that’s what happens when you start to make it, when they can up their production, and and, and there’s a supply is ample, then all of a sudden, this all stops. It’s not a problem anymore, right? Because then you compounding pharmacies are not allowed to do what they’re doing, right? So, yeah, it’s a it’s a wonder. Maybe
Nick van Terheyden
they’ll be like the Sonos CEO, CEO who is sitting on some pretty challenging customer experience and has actually had to pull back on the hey, we’re releasing a whole new version of our software that has just really upset users. I’ll be clear, me included, but I was, I’m still and, you know, sadly for them, I’m reminded about it every morning because the alarm that I set the night before the upgrade occurred still shows up on my iPhone and I can’t get rid
Craig Joseph
of it. Yikes. Yeah,
Nick van Terheyden
all right, so moving on. We’re still with the legal world and some of the challenges, epic, largest, well, certainly one of the largest, I think EHRs, is being sued by particle health. And there’s certainly been lots of commentary. What are your thoughts?
Craig Joseph
Well, full disclosure, I used to work for epic, so put that out there. Epic has been sued by many, many groups before, mostly, I think patent trolls and and they have a very aggressive response. And they are, you know, Epic is the one of the one of the largest electronic health record vendors, probably, definitely in the United States, probably in the world, one of the top, and they don’t back down from legal fights because it costs money or time, right? And so I’m not, I’m not confident that particle health and their law firm fully appreciate the history epic was founded in 1979 they it doesn’t matter if it’s cheaper to settle, they will never settle, or at least have never, in the past, settled if they think that they’re the right so that’s a so You know, what are they being sued for? They’re they’re essentially being sued for for particle health is asserting that they’re trying to that Epic is trying to shut them out of the payer space. So by payers, we mean the insurance companies here in the United States and an epic has produced some software that makes it easier for payers to get access to the medical records of their clients. Insurance. I’m not sure what the right term is, which they have the right to do, but typically it’s a it’s very difficult, you know? So when you have insurance, you’ve given the right to your insurance company to be able. Who do what they to get access to your medical records, to check for quality, to make sure that the physicians and hospitals who are billing them are actually doing what they say they’re doing, and and that sort of thing, making sure the documentation is accurate represents what really happened. And so to make that easier, people want that, and people are paying epic for that, at least insurance companies are, and particle health is a potentially a competitor in that space. That’s what they see themselves as, and think that Epic is stifling them to try to decrease competition. I think that’s a 30,000 foot summary of of their argument, again, complicated. I don’t think it’s obvious on one side or the other, right, but I, but I do think that whenever third parties like law firms expect a business to react in the way a business typically would react, yeah, right there they’re, they’re gonna, they’re gonna hit a freight train in Yeah,
Nick van Terheyden
I think that’s exactly right. And you know, what’s it? The piece that I found interesting in all of this was the selection of the law firm who had been described as the top for the last three years. Top, and I forgive me if I get precisely, but essentially, you know, highly regarded, highly successful, however you sort of determine, and you know, present that. And I think what I’m curious about is what the deal is, you know, are they paying for this, or is it on, you know, some kind of retainer basis where, hey, if we win, we’ll, you know, which all presents, and anyway, it’s certainly going to be a story worth watching, right? Much
Craig Joseph
like the first, first story we talked about with the bus Big Pharma bus tour. You know, you’re the most interesting aspect of it is, wait, who’s, who’s bankrolling this? Yeah, I think this might ultimately be the most interesting aspect of this part of health is a small company. They can’t afford this, for sure, I think the chance of success is is low enough that I I’m not sure the law firm would want to take that, that risk, right of, hey, if we lose, and this is going to be years and years and years. If we lose we get nothing, and we’ve lost millions and 10s of millions of dollars. So that’s a great question. Dr Nick, who is bankrolling this law, this lawsuit? I That will be an interesting question to answer.
Nick van Terheyden
Well, another one that we’ll watch carefully. So moving on Social Determinants of Health and insurance claim denials, I’m just going to say, not shockingly, but nice article in JAMA that came out that reviewed denials for preventative care on one and a half million patients who were covered by their employers or the marketplace and the denial rate, as they described it, was brutally disparate. For the lower income patients, they were 43% more likely to get a denial than the higher income patients who I suspect maybe tell me if I’m wrong here probably need that preventative care less, or at least the coverage for it. Not that they don’t need the preventative care, but you know, could potentially cover it if it’s not. And even you know, a change by race. And I’m just going to say, given all the stuff that we’ve seen over the course of many years, going back now, it’s almost duh. I’m afraid, yes,
Craig Joseph
yeah, you know, I’m looking at the article in JAMA now, and what we’re talking about is are things like colorectal screening, cholesterol screening mammograms,
Nick van Terheyden
and, by the way, we’re coming to this, but the Commonwealth Fund, that’s the only thing in cheerful Commonwealth Fund report where the US is actually good, yeah,
Craig Joseph
and Paying for some of these things, diabetes screenings, right, those kinds of things. And you know, there the it is. It is curious. Why these would be denied more frequently. You would expect the denial rates to be the same, no matter how much money you made,
Nick van Terheyden
it should be right, right?
Craig Joseph
Or what your race was, or how much education you have,
Nick van Terheyden
and it raises a question in my mind, I gotta be honest, how I mean assuming that that’s part of the equation is that contributing? God, let’s hope not. But if not, how is that actually? Actually translating into the reality that we’re seeing here. What is, I mean, I’m just, I’m, you know, scientifically fascinated, as well as a port in this, because I’d love to understand why that’s the case, and where is the bleed out that’s allowing this to take place. Because somewhere it’s happening. And it may not even be deliberate. It may just be a sort of, you know this, what do we call it? The inbuilt or inherent bias that’s sort of in the data, is that what it’s just, it’s
Craig Joseph
fascinating. I mean, if you look through the article, they have some suggestions as to they’re not suggestions, but possibilities. And, yeah, I don’t, I can’t imagine any payer checking this out. You know, wanting this to happen, right? Right? Yeah,
Nick van Terheyden
no, exactly. So I think somebody’s money downstream, right? Well,
Craig Joseph
no, but I’m saying, like, no payers. Like, listen, if they only have a high school education, we’re gonna deny them. Let’s make sure to, let’s make sure to ask that question. You know, I they that hope that’s like, almost unthinkable. So I’m, you know, quoting here, patients may sort into insurance plans with fewer administrative resources or higher propensity. Yeah, selling errors, yeah, no. Patients may visit different healthcare organizations with different billing practices. So, you know, if you live in a poorer part of town, you’re going to a healthcare system or a hospital with fewer resources, so they don’t know how to follow the rules, so they get dinged by the insurance company that one could imagine that that’s an answer to your question,
Nick van Terheyden
yep. All right. So briefly, the Commonwealth Fund report that gets published every year, reviews, healthcare systems, once again, the US is depressingly, depressingly poor performance. And not even, I mean, you can look at the line, and everybody’s on this sort of line of, you know, various countries, but then radically falls in terms of so many measures. And ironically, the one area where the US actually performed best or better or however, was in the screening programs that we have that actually do a pretty good job. But as I said, cheerful Commonwealth Fund report, my, oh, my, yeah,
Craig Joseph
I like some of their key findings. The top three countries are Australia, the Netherlands and the United Kingdom. I’ve never heard of that. Oh, hello. I’ve never heard of that last one. Yeah,
Nick van Terheyden
I’m going to say that the folks in the NHS, whilst they’re passionately supporters of the UK healthcare system, it’s been struggling significantly. So it’s not brilliant everywhere, just to be clear, but it is pretty good. And, you know, I just saw something just recently locally where, you know, somebody lost, it was a physician lost employment as a result of cancer and cancer treatment, and then, because they lost their employment, they lost access to the healthcare insurance that they were paying through their job, even with, you know, and it all sort of it. It rolls down the hill. It’s terrible, yeah, all right. Um, last topic, and you know, for me, this was just a bit of fun, but no surprise here, healthcare is targeted again, as usual, for ransomware. But in the report from it was bleeping computer. It was all the names, and all I could think of was World War Two. And you know, some of the movies and, you know, books that I’ve read on that whole space, it was these code names that they all had. So, you know, the group names of these ransomware, vanilla Tempest, Vice society, Hello Kitty, five hands. Like, where the heart they coming up with these things are they going to the double cross system? Where, I gotta say, you know, I actually want my code name. I feel like I need to get a code name that’s beyond my sort of usual, you know, Dragon Man, or maybe I should be cobweb. These are all real names from World War Two, of the double agents and stuff. Carrot. Celery was another. Who the hell was celery? What were they doing? Why were they called celery?
Craig Joseph
Your code name is GoDaddy.
Nick van Terheyden
Go Daddy. Okay,
Craig Joseph
that’s your code name. I’m
Nick van Terheyden
going to come up with one for you. I’m just saying, that’s fair. I’m
Craig Joseph
waiting. I’m ready.
Nick van Terheyden
I’m going to say, we’re going to call you, let’s mullet. Yes, perfect. Oh, there it is.
Craig Joseph
Hurts, that hurts.
Nick van Terheyden
We actually know who mullet was in the code name. He was a Britain born in Belgium, apparently. Or you could be teapot, that would be all right. Actually, I
Craig Joseph
like that more. I like that more, not the German part necessarily. I’m not pro or anti.
Nick van Terheyden
Oh, here it is. Weasel. There it is, weasel
Craig Joseph
the one. All right, oh, dr, Nick, I was trying to give you a good one, and now you’re just hurting me. And I feel like our listeners are, they’re gonna turn against you now, because I’m a sympathetic figure, and you’re, oh yeah, you’re attacking me here. Yes,
Nick van Terheyden
you keep telling yourself that we find ourselves at the end of another episode exploring Healthcare’s mysteries before they become your emergencies. Until next time, I’m Dr Nick
Craig Joseph
and I’m Dr Craig.
