The Awful Dichotomy Between Health Care Politics and Policy

Amy Goldstein has an important article in today’s Washington Post detailing the place Don Berwick, the Medicare and Medicaid administrator, finds himself in.It is all but certain he will have to leave his post at year’s end, when his recess appointment expires, because the Senate will not confirm him for a lack of Republican support.Berwick is one of the most respected health care experts in the

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The Tragedy of Underfunded Mental Health Care

Today’s Managing Health Care Costs Indicator is 19,900 The NY Times on Friday had a deeply disturbing article on a murder that stunned the mental health community here in Massachusetts. A long-term schizophrenic man, off his medicine and spiraling into incoherence, killed a young female counselor who was the sole worker at a group home in a Boston suburb. His mother, who works at a Boston teaching hospital, was frantic with worry as her adult son, who had been arrested for assault multiple times, was becoming more psychotic. It was hard for her to get anyone’s attention. The counselor was the first in her family to get a college degree, and had just decided to go to nursing school. Now she’s dead – and her family had trouble scraping together the resources for a burial. The schizophrenic will be imprisoned for the rest of his life – which ironically could be the best chance for him to get appropriate medical care. Both...

How a Well-Intended FDA Policy on Colchicine is Harming Patients

The road to hell is paved with good intentions. The FDA has reaffirmed the truth of this aphorism with its policy about Colchicine. Here's the story: I recently spoke with a friend who has a family member suffering from Familial Mediterranean Fever (FMF), an auto-inflammatory disorder, most commonly seen in eastern Mediterranean populations. The condition is characterized by recurrent painful inflammation of the abdomen, chest and joints, accompanied by fever. FMF is associated with mutation of a gene on chromosome 16 involved with regulating Pyrin, a protein that is part of the inflammatory response. There is no specific test for the disease. Diagnosis is made on the basis of symptoms, family history, and ruling out other conditions. Since the 1960s, Colchicine, a plant extract first used for treatment of gout two thousand years ago, has been used for treating FMF. As an ancient treatment widely used prior to formation of the FDA, Colchicine did not require FDA approval as a new ...

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