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NIH Commissioned Study Results on Race, Ethinicity and NIH Research Awards.

August 19, 2011 Leave a comment

Findings of a US National Institutes of Health (NIH) commissioned study to investigate gaps in NIH grant success rates among various racial and ethnic groups have been published in the Aug 19 issue of Science.  The study reported that even after controlling for education, institution, and other factors that influence the likelihood of success, black investigators were still 10 percentage points less likely than white investigators to receive a new research project grant.

Dr. Lawrence Collins, Director of the NIH, and Lawrence Tabak, NIH Principal Deputy Director, have pledged to remedy that with a thorough investigation of ways to improve the peer review process, encourage greater diversity on review boards, increase technical assistance to applicants in grant preparation, and support innovative ways to increase local mentoring of junior faculty.    As they say in their commentary “Troubling data such as these require substantive action. Compelling evidence supports the view that diversification of the research workforce is an imperative for our nation’s continued success”. They call upon every institution and scientist supported by NIH to join in reinvigorating efforts to diversify the nation’s current and future biomedical research workforce.

The study can be downloaded  here

Lawrence Tabak and Francis Collins Commentary on the study can be downloaded here.

News article about the study can be downloaded here

Peer review under review

August 16, 2011 1 comment

Two interesting reports were mentioned on  DocuTicker today concerning the use of peer review in scientific publications:  Peer review in scientific publications by the U.K. House of Commons Science and Technology Committee; and Alternatives to peer review in research funding by the Rand Corporation.

A detailed examination of the current peer-review system was conducted this year by the UK Science and Technology Committee,  examining its effectiveness, and  touching on issues of impact, publication ethics and research integrity.  Among its recommendations the report advocated for a development of standards and training for all editors and, particularly, for early-career researchers in peer review, acknowledging that the system depends on the integrity and competence of the people involved, and the degree of editorial oversight and the quality assurance of the peer review system itself.  The committee felt strongly that research data should be fully disclosed and, especially in the case of publicly funded research, made publicly available, to ensure reliability, testing, and reproducibility. Citing the importance of post-publication peer review and commentary, the use of new media and social networking tools was seen as an “enormous opportunity for experimentation” as a supplement to pre-publication peer-review. As well  post-publication review was recognized as an important vehicle in ensuring wide and expedient transmission of interesting research,  facilitation of rapid review by the global audience, and  in alerting the community to ”potential deficiencies and problems with published work”.

The Rand Europe Report, Alternatives to Peer Review in Research Project Funding  acknowledged that while peer review is considered the gold standard for reviewing research proposals, it is not always the best methodology for every research funding process.  The discussion of a set of established approaches that offer alternatives to traditional peer review are presented to inspire thinking among research funders to apply based on their situation and mission.

Another report on generic drug pricing in Canada

Further to my last posting on the complexity of generic drug pricing in Canada, I point to a new report, commissioned by the Health Council of Canada with the view to shedding light on generic drug pricing issues, to pr0mote transparency and to encourage public discussion.  This discussion paper is written by SECOR Consulting, and is entitled: Generic Drug Pricing and Access in Canada: What are the implications?.

As it says in the Foreword:

Prescription drugs account for an increasing proportion of Canada’s growing health care system with rising costs that governments in this country are seeking ways to restrain. The greater use of generic drugs, for which Canadians pay some of the highest prices in the world, accounts for a significant portion of these rising costs. The Health Council of Canada commissioned this independent discussion paper to provide Canadians with some further insight into the generic drug sector and potential options to reduce generic drug prices. Prescription drugs account for an increasing proportion of Canada’s growing health caresystem with rising costs that governments in this country are seeking ways to restrain.The greater use of generic drugs, for which Canadians pay some of the highest pricesin the world, accounts for a significant portion of these rising costs.The Health Council of Canada commissioned this independent discussion paper toprovide Canadians with some further insight into the generic drug sector and potential options to reduce generic drug prices.

Categories: Canada, Drugs, Report

How will Ontario’s new rules for generic drug costs affect us?

Effective July 1, 2010, the Ontario government has fixed the price of generic medicines at 25% of the price of the equivalent brand name drug.  In addition, approximately $800 million a year currently paid by generic drug companies to pharmacies in rebates will be banned.

Per Ontario’s Health Minister Deb Matthews, this will bring cost savings to taxpayers who support the provincial drug plan for seniors and social assistance and those who buy their drugs directly or get them from a work benefits plan. Pharmacists don’t agree.  They say the rebates fund important patient services and without them patients will bear the cost in the form of higher service fees and there will have to be cutbacks in service. This is confusing. Why are rebates covering pharmacy costs?

A 2007 Canadian Generic Drug Sector Study by the Competition Bureau showed that pharmaceutical costs comprised $19 billion — the 2nd largest component of health care spending. Generic drugs play an important role in helping curb these costs as patents on branded drugs begin to expire.  So why target generic drug prices as a form of cost-cutting?

In  Canada’s Drug Price Paradox, the Fraser Institute’s annual study of generic drug prices, the 100 most commonly prescribed brand name and generic drugs sold in Canada are compared to an identical group sold in the United States.  According to the most recent analysis, the generic drug prices in Canada were, on average, 112% higher than US prices in 2007. This was attributed to the fact that in Canada provincial policies restrict and distort competitive market forces that would naturally regulate drug pricing, like the Ontario Drug Benefit Plan (ODB) that directly reimburses pharmacies instead of consumers.  How?

As explained in a Fraser Forum article, Ontario’s generic drug pricing debacle, the ODB accounts for 45% of total prescription drug costs in the province. ODB recipients must pay a small flat fee surcharge to a pharmacy when they have a prescription filled, and that, apparently, is all. The pharmacy dispenses the drug and is reimbursed by the government for the full cost of the drug provided, plus a mark-up and dispensing fee. This reimbursement scheme insulates consumers from the proportional cost of the drugs they use, encouraging overuse and reducing incentives for comparative shopping. The current reimbursement system also allows generic drug makers to offer price rebates to retailers in exchange for a monopoly on sales. Furthermore, the ODB reimburses pharmacies for generic drugs at a fixed percentage of the cost of the original brand-name drug.  With the fixed percentage reimbursement, retail pharmacies have no incentive to compete on prices to win sales, so the rebates pharmacies receive are not passed on in the form of savings to consumers.

In a recent paper: Generic drug pricing in Canada: components of the value-chain Aidan Hollis, from the Department of Economics at the University of Calgary, offers a useful way to frame the problem of fair pricing for generic drugs by relating them to the core components of cost: litigation, production, and pharmacy services.  The paper proposes that each component of this value chain be paid for separately:

  • Litigation: As generic firms must address all patents for a branded product remaining on the Health Canada Patent Register before they can enter the market, the costs of litigation can be substantial.  Hollis advocates using a royalty to reward successful litigation that benefits payers, so that generic drug producers have an incentive to introduce the cheaper drugs into the market.
  • Production: The design of pricing policy, rather than being fixed at an arbitrary percentage of a brand price, should be flexible to accommodate the costs of production which can vary according to circumstances. The paper advocates encouragement of a competitive market framework to pay for production.
  • Pharmacy services: Unlike drug manufacturers, Hollis believes that pharmacies are in a position to exercise considerable market power, despite their apparent competitive position. Pharmacies also possess very strong market power as buyers. Thus Hollis feels that price regulation can be justified, and advocates a transparent, independent regulatory process to set dispensing fees for pharmacies.

As Ontario struggles to contain the costs of health care, it seems that arbitrary price controls are not the answer.  The system needs a overhaul.

Making American Health Care More Efficient

May 12, 2010 2 comments

The United States spent 17.3% of GDP on health in 2009, but ranks on 49th on life expectancy worldwide, patients receive the correct treatment just 55% of the time, and significant variability exists in the quality of care delivered. The contentious Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act, signed into US law on March 23, 2010 and March 30, 2010 respectively, were historic events paving the way to changing the US health care system to make it more equitable, efficient and effective. The challenge lies in bringing about the change needed.

A 21st Century Roadmap for Advancing America’s Health: The Path From Peril to Progress, the 2nd report by the Commission on U.S. Federal Leadership in Health and Medicine, was published this week. Drawing on recommendations from working groups representing key areas in which progress is needed, the Commission put forth a comprehensive strategy:

• Re-engineer America’s health care system: Invest in health technology ($19 billion has already been committed to investment in health information technology with the American Recovery and Reinvestment Act) to maximize value and minimize waste; lower costs by adopting new value-based payment methods, promoting team-based medicine, strengthening primary care and conducting comparative effectiveness and health systems research.

• Advance public health: Focus on public health, prevention of illness, and encouragement of healthy lifestyles: more than 75% of health care costs in the US result from chronic diseases, many of which are preventable.

• Promote global health and health diplomacy: Increase federal investments in global health, as global health has humanitarian, economic and national security implications. Currently federal investments in global health account for less than 1% of the US budget.

• Strengthen US medical and public health research:  Increase the funding base for scientific research in biomedical and public health research, as it is “the foundation for all health and medical interventions, the cornerstone of health care reform efforts, and an engine of economic and societal progress.”

The Commission acknowledged that improvement in health needs much more than investments in health technology, access to care, measures to contain costs or health insurance coverage for all citizens – that commitment to change is needed at every level: from government & policy-makers, to health care and public health workers, to individual citizens. Whether the new legislation, increased investments, and new technology will achieve the goal of advancing America’a health depends greatly on how that change is managed. Developments so far are promising….

EHR Impact Study Findings: Interoperability, long-term strategic focus, good management essential to realize eventual benefit from investment

Findings from the recently released EHR Impact study: The Socio-Economic Impact of Interoperable Electronic Health Record (EHR) and Eprescribing Systems in Europe and Beyond, show that EHRs and ePrescribing are not quick wins, but they are sustainable wins. An important finding was that interoperability is a prime driver of benefits from EHR and ePrescribing systems, as benefits rely on access to information regardless of place and time. Local, closed ICT systems lacking interoperability would not release these substantial gains. Extremely important to success of such investments, also, is the skill and expertise of executives and managers in managing organisational change and resource redeployment.

The study comprised nine quantitative and two qualitative independent evaluations of selected case studies (listed below). Two perspectives were applied: the socio-economic, and a narrower, financial one within the socio-economic to enable estimation of the long-term impacts of interoperable EHR and eprescribing systems. Calculations involved some 1300 time series variables and about 600 estimates and assumptions that do not change over time.

Cost levels depend on the scope of the EHR and ePrescribing solution, the range of healthcare levels affected, the type of health system, and the economic environment of the investment. Per estimates, it can take at least four and, more typically, up to nine years before initiatives produce their first positive annual socio-economic returns, and six to eleven years to realise a cumulative net benefit. A key finding of the study was that benefits from EHR and ePrescribing investments come under very broad, diverse categories, but are very individual and specific to the respective context of an investment.

In the sub-analysis of financial impacts, study findings show extensive reliance on executives’ and managers’ skill and expertise in organisational change and resource redeployment to realise financial returns. However, engagement must be continuous, not just consultative: both management and professionals need to constructively address issues that arise regarding positions, propositions, concerns and requirements on an ongoing basis. Achievement of specific goals requires a consistent, continuous investment in people as well as technology over a long time period.

Perhaps not surprising, the report finds there is no single, theoretically right strategy for implementing interoperable EHRs and ePrescribing systems. It is advisable that decisions to invest in EHR and ePrescribing systems devise and adopt strategies that fit their local or regional setting and are designed to succeed by meeting clearly identified, measurable needs.

By taking the socio-economic perspective, it was estimated that initiatives can achieve returns of close to 200% on their total investment, and an average of about 80% over some nine years. Financial gains can be up to 60% of the total socio-economic benefits, with an average of some 13%.  Financial outlay can be between 20% and 85% of the total socio-economic cost of investment, and an average of about 50%. The match of extra cash for the initiative and extra cash generated is usually a negative bottom line, with exceptions proving the rule. When opportunities to redeploy resources liberated by efficiency gains are included, the financial gains increase to an average 60% of total benefits, exceeding the extra cash invested.

The case studies upon which this evaluation is based are:

  • The Emergency Care Summary of NHS Scotland, UK
  • The Computerised Patient Record System at the University Hospitals of the Canton of Geneva, Switzerland
  • The Hospital Information System at the National Heart Hospital Sofia, Bulgaria
  • The regional EHR and ePrescribing system Diraya in Andalucía, Spain
  • The regional ePrescribing system Receta XXI in Andalucía, Spain
  • The regional integrated EHR and ePrescribing across Kronoberg County, Sweden
  • The Kolín-Čáslav health data and exchange network, Czech Republic
  • Dossier Patient Partagé Réparti (DPPR) – Shared and Distributed Patient Record platform in the Rhône-Alpes Region, France
  • The regional Healthcare Information System in Lombardy, Italy
  • A nation-wide health information network in Israel – qualitative report
  • Evanston Hospital, Northwestern Healthcare, USA – qualitative report

The study was commissioned by the European Union DG Information Society and Media.

New EU report on (ICT) Use and the Elderly: ICT can benefit seniors; though interest is high, usage is low.

March 11, 2010 1 comment

The elderly can benefit considerably from new developments in ICT.  Given the aging demographic and the increasing demands on healthcare systems, ICT holds considerable promise for monitoring, educating, and implementing preventative measures to promote health. Interest in ICT is high, yet usage continues to be low among seniors.  There are many reasons for this including cost, education  or training required for use, lack o f awareness of the therapeutic or other properties of technology, and inadequate design of a technology in addressing special needs like visual and functional abilities.  If you are interested in this topic, the final report of a major study funded by the European Commission Information Society and Media:  Senior Watch 2: Assessment of the Senior Market for ICT Progress and Developments is worth a look.