Rethinking the Value of Medical Services

by Brian Klepper and David KibbeOne of American politics’ most disingenuous conceits is that health care must cost what we currently pay. Another is that the only way to make it cost less is to deny care. It has been in industry executives’ financial interests to perpetuate these myths, but most will acknowledge privately that the way we value and pay for medical services is a deep root of

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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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