Recent news and commentary of note on US and global issues related to health and well-being:
Archive for the ‘Ethics’ Category
Posted in Access to Medicines, Advocacy, Assistance, Children's Health, Economics of Health Care, Environmental Health, Ethics, Global Health, Health Care Marketing, Health Disparities, Health Insurance, Health Literacy, Healthcare Inequalities, Language Access, Recession, State of Washington, Workers' rights on 18 May 2011 | Leave a Comment »
On tonight’s evening news, King 5 TV, our local CBS affiliated carried a story about a Microsoft worker who lost his job after being diagnosed with leukemia. Duncan Sutherland came forward after after seeing another report the night before about Ken Knightley, a Microsoft worker who is now being denied paid leave to undergo treatment for a brain tumor. Knightley told reporters that he was informed that his request for paid leave under the company’s short-term disability plan, was denied because at Microsoft links disability pay to performance reviews. When Knightley’s severe symptoms had caused him to miss work for medical care, he had been unable to fulfill some project deadlines. He then received a negative performance review, despite his excellent track record and promotions during his 11-year tenure with the company. His future uncertain, he now also may lose his home if he needs to go out on long-term disability, for which there is a 6-month waiting period. Sutherland shared that his own experience was similar, and King 5 reports that they have been contacted by other former Microsoft employees who shared similar experiences. Microsoft has declined to speak to the media, stating it cannot discuss personnel matters.
Listening to these stories was a déjà vu experience for me on an issue that still doesn’t seem to be going away. Fifteen years ago this month I was laid off from my job at a large private child & family service agency after being diagnosed with lymphoma. During several weeks of diagnostic tests, I’d re-arranged my work schedule in collaboration with my co-workers and supervisor. One of the administrators had asked me what kind of accommodations I needed, and I indicated my need for a flexible schedule. I took off 5 days for the first cycle of chemotherapy in order to rest up for returning to work. When I came back the following Monday, I was called into a meeting where I was told that my job had been eliminated , effective that week. I was not offered an exit interview, not given information on how to sign up for COBRA, nor advised that I was eligible to receive benefits from the disability plan I’d been paying into over the years. I was not allowed to either use or cash out my several months-worth of accrued sick and vacation leave, and I later learned that an request by my co-workers to donate sick leave to me had been denied by the agency.
I pursued legal action and had to endure a mediation session where the employer lied , claiming that they had no idea that I was sick and that the department that I worked in was being shut down and my job was simply the first one to be eliminated. The employer further claimed that this was part of a secret business plan that employees had not been told about, as we had been given a written document describing the expansion of the department. Although my attorney felt my case was strong, the Bush-era EEOC issued a negative ruling, saying that they could not second guess a business plan. At this point, my condition was worsening and the attorney urged me to settle , to avoid a protracted and expensive case. Later I learned that there had been agency employees at other sites who also had been laid off when they got sick. A memo was evidently later circulated expressing regrets that some situations may not have been been handled appropriately, and instructing supervisors on how to avoid future untoward situations.
Over the years I have met and heard of others here in western Washington who suffered similar treatment, including Seattle journalist Jeanne Sather who was fired in 2000 by OnHealth who had hired her specifically to write a column about her experiences of living with breast cancer. When a recurrence forced Jeanne to alter her work schedule, OnHealth let her go.
And even for those whose jobs are in workplaces required to comply with the Americans with Disabilities Act, the law is not much protection when employers use every artifice to get around the requirements, especially in at-will employment states like ours. Workers who even have sick leave that may become a source of contention are in a better position than most, as some 38% of US workers have no sick leave at all, according to data compiled from federal government sources by the Economic Policy Institute. The study found the ranks of haves and have-nots correlate along economic lines with only 19% of low-wage workers (mostly service workers) having paid sick days, compared with 86% of high-wage workers. While there is no federal or state mandate for paid sick leave, there is no excuse for the behavior of thriving mega-corporations like Microsoft who have chosen to offer employees benefits and then manipulate them in ways that harm their workers. These cases illustrate once again too what’s wrong with a system that links health insurance with employment.
For locals interested in this issue , the Seattle Coalition for a Healthy Workforce will be holding a town hall meeting on the evening of May 11 to discuss the needs of some 190,000 Seattle workers who have no paid sick days.
A friend recently shared this personal story with me, in the hopes that it will inspire people to demand price controls on drugs, as well as an end to the Rx profiteering by insurance companies. This is a story about a commonly-prescribed generic drug, levothyroxine, used for hypothyroidism and other thyroid conditions. The fact that this is a common and generic drug is significant. Since it is a widely used drug, the following story gives perspectives on the scope and amount of profit being made on just this one medicine. And in turn, this small story can help increase understanding of the magnitude of the Rx pricing problem.
Now for the story. My friend recently retired from nursing at not quite age 65, and had been paying costly COBRA premiums until she could enroll in Medicare. The hospital where she had worked offered a comprehensive plan through one of the big insurers in Washington state, including a $7 co-pay for drugs on the plan’s formulary. Levothyroxine was one of these.
After retirement, my friend planned an extended out-of-area trip, so she wanted to purchase a full 3-month supply of her medicine to take with her. She had coverage via COBRA for October, but could not get benefits from Medicare Part D until her Medicare activation date the following month. So she planned to pay the $7 co-pay for her medicine for October, plus the out-of-pocket price for the supply for the next 2 months. She had checked the Rx price look-up feature of the insurance company’s website, and learned that the retail price of levothyroxine was listed as $24-$28 for a 30-day supply. My friend then took her script for 90 days of levothyroxine to be filled at the community pharmacy she had always used, and got a big surprise.
This time, the surprise wasn’t the sticker shock we have come to expect all too frequently, but just the opposite, and equally problematic. The pharmacy told her that while she was welcome to apply her co-pay to 30-days worth of the medicine, they could sell her the entire 90-days worth for a total of $10!!!!!
While this was good for her pocketbook, she was astounded to think about how much this basic generic drug had been marked up to benefit the insurance company and the manufacturer who set the price reported to the insurer. While the pharmacy was undoubtedly making a modest return on this Rx, it was presumably not out to gouge its customers, quite remarkable these days. And this is not even a one of the costly drugs, even at the retail price listed by the insurer. When one figures how many scripts are written for levothyroxine across the country each month, the dollar amounts are staggering.
The lesson to individual consumers is that while we must continue to push for price controls on Rx drugs, we also need to shop around for prices, even if insured. And it’s good to remember that even for those with Rx insurance coverage, there is no requirement that an Rx benefit be used, if a better cash price is found. It can be difficult to check medicine prices, but well worth the time spent doing research over the phone and via the Internet. Plus there are resources for some states and communities that offer Rx price-comparison tools that include commercial pharmacies. For example. folks in Illinois can check prices for drugs and medical procedures, on Leslies List, an independent website created by primary care physician Leslie Ramirez, to help improve access to care. In my state, there is a price-checker tool for drugs on the formulary of the Washington Prescription Drug Program. BTW, all WA state residents can request a free WPDP card to use at participating pharmacies. I have found in some cases, the WPDP price for certain medicines is less than the co-pay charged by my insurance company. It pays to compare prices between big box stores, supermarket pharmacies, and community pharmacies. The “$4 generics” that have been so widely promoted may not always be the best deal, nor actually sold at that price. Another resource for helpful tips on shopping for drugs and their prices is Consumer Reports.
The first international “Selling Sickness” Conference held October 7-8 in Amsterdam drew some 200 participants from around the globe to discuss the issues and trends in marketing of prescription drugs. While most attendees were from Europe, all regions of the world were represented at the event. Slide shows of the presentations, along with a list of attendees, may be viewed on the conference website.
Many of conference presentations focused on the phenomena and techniques of promotion of “disease mongering”: use of pharma promotions to depict normal life issues as diseases and to encourage consumers to visit doctors to seek prescriptions to treat these disorders. My poster displayed at the conference focused on a different facet of inappropriate drug promotion, the equally problematic practice of misleading promotion of a very useful new drug for genuine and deadly diseases. The poster Glivec in Global Perspective, covers highlights of the worldwide promotions for the breakthrough cancer drug Glivec, done for a different purpose. Since Glivec is quite effective for most patients for whom it is indicated, its manufacturer Novartis has used promotions to aim to secure both its excessive global price and monopoly patent status for the drug.
Novartis, a relatively new company on the scene, formed from the merger of Ciba-Geigy and Sandoz in 1996, has invested heavily in patient relationship marketing to further its goals. Influencing patient groups by all the well-known techniques used to woo doctors to prescribe certain medicines–along with patient-specific types of outreach–has been used to induce enthusiastic lobbying for Glivec, and ostensibly to keep patients from recognizing and protesting the real cause behind access problems for this drug, its exorbitant price. Novartis has not hesitated to approach cancer groups, and to help create new ones, through emotional manipulation of the genuine despair linked to the diseases and the experiences of patients with health systems. Yet most patients continue to seem to be unaware of what is really going on, showing the power of the promotions. This poster was created as an educational resource on drug promotion as a critical public health issue. While no health system, insurer, government, or individual has unlimited resources, the vast majority of patient groups lobbying for access to Glivec, along with other costly drugs, act as if cost were irrelevant. Unless things change, access to this and other important medicines is only going to get worse. Those of us with both personal and professional experience in this realm can play an important role in spreading the sunshine on this vital topic. Supporting information and references were too lengthy to include in the poster, so have been organized as a separate document.
Posted in Consumer Protection, Economics of Health Care, Ethics, Global Health, Health Care Marketing, Health Disparities, Healthcare Inequalities, Language Access, Language Services on 26 September 2010 | 3 Comments »
Many important conferences are scheduled from September to the end of the year. Last week I was fortunate to be able to attend the second annual meeting of the Consortium of Universities for Global Health at the University of Washington here in Seattle. I’ll report on that later.
Some other notable conferences, including those in which I am involved in running and/presenting, are:
International “Selling Sickness” Conference in Amsterdam, October 7-8, sponsored by the Dutch Ministry of Health and Health Care Inspectorate, Gezonde Scepsis, Healthy Skepticism International, and the World Health Organization, Regional Office for Europe.
While I won’t get to be there in person, my poster will be there and also posted here on the blog .
Summit VI of the Washington State Coalition for Language Access (WASCLA) will take place in Seattle on October 15-16. Run entirely by volunteers, including yours truly, I’m on the team organizing the conference and also a presenter for a plenary session on Community Advocacy & Engagement. And FYI to those interested in attending: early bird registration rates have been extended to October 1.
The Diversity Rx 7th National Conference on Quality Health Care for Culturally Diverse Populations will be held in Baltimore on October 18-21. Sadly I’ll be missing this top-notch biannual event.
Heading into November, the Washington State Pharmacy Association will hold its annual meeting in Vancouver, WA on the 5th and 6th, where together with pharmacist and attorney colleagues from WASCLA, we’ll be speaking on Language Access at the Pharmacy.