Saturday, August 04, 2018

What is the worth of a Human life ? $50, $5 million or 30 million

 While I am working in  a community health clinic in a small west texas town,  
I come across patients who cannot buy their insulin because they cannot afford the $5 for which it is being sold under the 340b program
and the millions of dollars awarded by juries all over the USA and how much money do personal injury lawyers are actually making on these people

This is just in USA forget about others in places like Syria ,Sudan and Somalia

As of 2011, the Environmental Protection Agency set the value of a human life at $9.1 million. Meanwhile, the Food and Drug Administration put it at $7.9 million — and the Department of Transportation figure was around $6 million.Jul 21, 2012

Most recently, the law firm in 2018 obtained a $30 million settlement with AT&T and other companies for a worker who suffered catastrophic injuries in a nearly 50-foot fall from an improperly designed and maintained cell tower. (Read article)  
In an earlier case, Kline & Specter won a $46.5 million jury verdict against a security company for the families of two women employees who were shot to death by a fired worker at the Kraft Foods plant in Northeast Philadelphia. The award was for compensatory and punitive damages. (See the Brown/Wilson Case)
In 2014, Shanin Specter and David Williams settled a wrongful death case involving a worker at a Philadelphia-area refinery for $10 million

And in the prior year, Kline & Specter obtained one of the largest settlements for an undocumented worker in negotiating a $5 million award for a man crushed to death by a collapsing excavation site. (Arana)
Workplace injuries range from broken limbs to those involving more severe brain injuries and spinal cord injuries, even death. Among Kline & Specter's legal victories for working men and women are several with spectacular settlements or jury verdicts. They are:
  • A lawsuit in which the firm won a $36.4 million settlement for a worker killed in an explosion at a Delaware oil refinery (see Davis/Motiva) The settlement, announced in September 2003, is considered the largest for a single-victim fatality ever reported in the United States.
  • Two months later, in a case that spanned seven years and several appeals, an Allegheny County jury handed down a verdict of nearly $7.9 million for a Pittsburgh worker seriously injured in a fall from a forklift. (Drum)
  • On Jan. 21, 2004, a jury in Luzerne County handed down a $19.1 million verdict for a woman who was struck and seriously injured by a van as she worked on a roadside construction job. (McManamon).
  • In September 2008, Tom Kline won a $5.5 million jury verdict for the family of an 18-year-old man who was fatally shot while working as a parking lot attendant at Hahnemann University Hospital. The hospital had failed to improve safety and security after an armed robbery at the same booth only 12 days earlier. (Palmer)
In 2007, the firm won an $8 million settlement for a worker killed when he fell into a high-temperature pulping pit at a Manayunk paper mill. The case involved a lengthy dispute over which corporations were responsible. (Green.)
The firm also won two major cases for ironworkers. In November 2006, a jury awarded $3 million to a Philadelphia ironworker who sustained neck and shoulder injuries in a fall down a stairwell after temporary lighting failed at a construction site. (See McCormick 1 | 2) In December 2006, Kline & Specter negotiated a $1.7 million settlement for a Lehigh County ironworker severely injured in a fall at a cold storage facility. (Broadbent.)
In an earlier case, the family of a man crushed to death in a crane accident settled a suit against the manufacturer, seller and installer of the crane's control system. The settlement, reached in November 2002, was for $4.4 million. (Yankosky).
A workplace injury case was among one of Kline & Specter’s first victories as the firm secured settlements totaling $1.25 million in 1995 for Demetrius Atwood, a Philadelphia hotel employee injured by a malfunctioning elevator.



In theory, a year of human life is priceless. In reality, it's worth $50,000.

That's the international standard most private and government-run health insurance plans worldwide use to determine whether to cover a new medical procedure. More simply, insurance companies calculate that to make a treatment worth its cost, it must guarantee one year of "quality life" for $50,000 or less. New research, however, would argue that that figure is far too low.

Stanford economists have demonstrated that the average value of a year of quality human life is actually closer to about $129,000. To get to that number, Stefanos Zenios and his colleagues at Stanford Graduate School of Business used kidney dialysis as a benchmark. Every year dialysis saves the lives of hundreds of thousands of Americans who would otherwise die of renal failure while waiting for an organ transplant. It is also the one procedure that Medicare has covered unconditionally since 1972 despite rapid and sometimes expensive innovations in its administration. To tally the cost-effectiveness of such innovations Zenios and his colleagues ran a computer analysis of more than half a million patients who underwent dialysis, adding up costs and comparing that data to treatment outcomes. Considering both inflation and new technologies in dialysis, they arrived at $129,000 as a more appropriate threshold for deciding coverage. "That means that if Medicare paid an additional $129,000 to treat a group of patients, on average, group members would get one more quality-adjusted life year," Zenios says. Based on patient surveys, one "quality of life" year is defined as about two years of life on dialysis.

Zenios's conclusions arrive amidst mounting debate over whether Medicare, the U.S. government health plan for seniors, ought to use cost-effectiveness analysis in determining coverage of procedures. Nearly all other industrial nations — including Canada, Britain and the Netherlands — ration health care based on cost-effectiveness and the $50,000 threshold. Medicare, on the other hand, decides whether to pay for new technology based on whether a treatment is "medically necessary and appropriate." But as health care expenses rise and entitlement programs grow fiscally strapped — at least one part of Medicare is now expected to be bankrupt by 2019 — more and more academics have called for this approach to be reconsidered, and for cost to become a factor. Such a move would mean that "if the incremental cost of a new technology was more than the threshold," Zenios says, "then the recommendation would be that Medicare not cover that new technology."

Assigning a dollar figure to Medicare patients' lives may sound crass, but such valuations are routine in Americans' daily lives. Take, for example, the $500,000 death benefit the government pays families when a soldier is killed in Iraq or Afghanistan. Or the cost calculations that for-profit health insurers make to determine how much coverage they'll give customers. In fact, at least some Americans seem at ease with allowing money to play a prominent role in health care decisions. In a 2007 survey of New Yorkers, 75% of participants felt "somewhat" to "very" comfortable with allowing cost to inform Medicare treatment decisions, once they understood how the system worked. "Americans understand and are prepared to engage the issues that arise when setting priorities and limits for their public programs," Marthe Gold, the City University of New York Medical School professor who conducted the study, wrote with colleagues this past fall in the journal Health Affairs.

The Stanford researchers caution that if Medicare fully adopted a cost-benefit analysis model, too many patients could be denied life-saving treatment. They return to the example of dialysis patients. Their study showed that for the sickest patients, the average cost of an additional quality-of-life year was much higher — $488,000. "It is difficult to justify the burden and expense of dialysis when persons have other serious health conditions such as, for example, advanced dementia or cancer," says co-author Glenn Chertow, a nephrology professor at the Stanford School of Medicine. "In these settings, dialysis is unlikely to provide any meaningful benefit." But with organs including kidneys for transplant so scarce, is it justifiable to deny these patients a chance to live through dialysis? It is a question, Zenios says, everyone should approach with trepidation. "What is the true value of a human life? That's what we're asking people," he adds. "I wouldn't pretend to know."

"Medical prostitutes " Doctors who are also lawyers

The law firm, with more than 40 attorneys, five of whom are also highly skilled doctors, has unparalleled expertise and unsurpassed success in medical malpractice litigation. 
 Kline & Specter has had the most medical malpractice verdicts and settlements of any Pennsylvania firm. No law firm in the United States has as many M.D.-J.Ds.


A Philadelphia Common Pleas jury Tuesday awarded $2.5 million in damages to an Alabama man with autism who took the anti-psychotic drug Risperdal as a teen and grew size 46DD breasts, according to Thomas Kline, the man’s attorney.
“The testimony of his mother before the jury is he would smash them on a table,” he says. “And that when he gets out of the shower he covers himself in a towel before he looks at himself in a mirror.”
so his mother, Benita Pledger did not hear of the internet?  did not think she could get a second opinion?

and  what kind of 
“pediatric neurologist,”
Does not know about Hyperprolactinemia and antipsychotic medication?

"Johnson & Johnson declined to allow anyone to speak on the record about any of the Risperdal litigation or investigations, but as company Vice President for Media Relations Ernie Knewitz put it, "In our opinion, significant ambiguity exists about what is or is not permissible regarding the communication of truthful and non-misleading scientific information about FDA-approved pharmaceutical products. Like doctors, patients, and others in the industry, we share an interest in greater regulatory clarity on the rules for appropriate promotion and scientific exchange, and we are working through industry groups to bring clarity and consistency to the rules that apply to those communications.”"

Wow such Honesty



massaging data to conceal potentially damaging test results. Profits first Patients last.

 Profits first Patients last.

The Cutting edge or the bleeding edge ? Is new always better?

Do not prescribe newly introduced drugs unless they offer significant therapeutic advantages, are cost-effective, and are affordable. 

Drug companies routinely mislead doctors and the public about the safety and effectiveness of their drugs to increase sales. The cost in terms of bad health outcomes and avoidable deaths runs into the tens of billions of dollars every year.
 Scientific curiosity which was the driving  force of  new discoveries was maintained by a number of individuals some rich some poor just for the heck of it. 
We don’t need patent monopolies to support research.


The Bleeding Edge

2018 ‧ Documentary ‧ 1h 39m

Bayer lashed out at Netflix documentary “The Bleeding Edge,” with the pharmaceutical giant saying it presents an inaccurate picture of its Essure birth-control implant device.
The film from Oscar-nominated documentary filmmakers Kirby Dick and Amy Ziering (“The Invisible War,” “The Hunting Ground”) investigates the $400 billion medical-device industry, “examining lax regulations, corporate cover-ups, and profit-driven incentives that put patients at risk daily,” according to a Netflix description.
Bayer, in a statement issued Friday, said the film “presents an inaccurate and misleading picture of Essure by relying almost entirely on anecdotes, cherry-picking information to fit a predetermined conclusion, ignoring the full body of scientific evidence that supports the [FDA’s] determination that Essure’s benefits outweigh its risks and disregarding the appropriate warnings that accompany the device.”


Then tell me why you have discontinued "Essure" sale all over the world and at last from the USA?
In 1999, Johnson & Johnson had signed a contract with a company called Excerpta Medica. Its specialty was medical marketing. Its sub-specialty was producing ghostwritten, data-filled studies on the efficacy and safety of a client’s drugs, finding the right academic scholars to be listed as the authors and then placing the articles in prestigious academic journals.
Excerpta’s and Johnson & Johnson’s partnership with academics and the journals that publish them was not unusual. Over the last 20 years, research into the effects of specific drugs has become almost exclusively funded by drug companies that have an interest in the results. The government, through agencies such as the National Institutes of Health, sponsors generic research related to various diseases, but beyond that initial stage, most of the work is paid for by the pharmaceutical or biomedical industries.
In a detailed presentation to Johnson & Johnson, Excerpta outlined one of its key selling points: “Ensuring Vast Opinion Leader Access.”
“No other medical education company has the tremendous access to top opinion leaders that Excerpta Medica does … ” Excerpta promised. “Our parent company, Reed Elsevier, is the largest supplier of medical information in the world, publishing over 700 medical journals in almost every conceivable therapeutic area. Each journal has an editorial board composed of renown specialists throughout the world who are available to us as consultants, advisory board members, speakers, and in other capacities. We provide this significant access to all of our clients.” (The Excerpta connection to the giant Europe-based publisher would be severed in 2010, when it was sold to a unit of the giant advertising agency Omnicom.)
Now, in 2000, Excerpta began working on a plan to place dozens of Risperdal articles in medical journals. “Awareness articles” and “original reports,” of which a total of 39 were planned, would cost $22,000 each in fees, plus fees for the “authors.” Shorter pieces would be $9,000 each.

What happened in Indian Pharma sector ? why a poor man can't buy medicines?


Pharmaceutical policy in India is perceived as an industrial policy rather than health policy. The formulation of pharmaceutical policy, therefore, has traditionally been the responsibility of the Department of Petrochemicals in the central Ministry of Chemicals and Fertilizers, with only limited input being provided by the Ministry of Health and the Bureau of Industrial Costs and Prices (BICP) of the Ministry of Industry.

govt-may-bring-in-new-curbs-on-drug-prices-this-month

https://timesofindia.indiatimes.com/business/india-business/govt-may-bring-in-new-curbs-on-drug-prices-this-month/articleshow/64432770.cms

the strategies and policy instruments used by the Indian government to achieve these objectives have changed radically in each of three phases: 1947-1969, 1970-1990 and 1991-present. The period between 1947 to 1969 was characterized by minimal government regulations, during which the multinational corporations (MNCs) dominated the sector. The second period, between 1970 and 1990 was a period of intense government regulatory oversight, with the MNCs being a particular target of the regulation. A number of public corporations also sprang up during this time. The 1990s, on the other hand, were a period that witnessed a substantial relaxation of government controls over the pharmaceutical industry

In the 1994-95 NDP, the functions of the Ministries involved in the pharmaceutical sector were redefined. Price controls were significantly scaled back. MNCs were provided substantial concessions in equity ownership, in the production and licensing of drugs, in drug imports and exports, and in the profit margins that firms could retain. A product patents-based intellectual property (IPR) regime (instead of a process patent regime) was also promulgated, which will come into force in 2006, as a direct outcome of India's signing the Trade Related Aspects of Intellectual Property Rights (TRIPS) agreement. However, no new health-oriented measures to promote the availability, affordability, quality, and rational use of drugs were outlined in the new drug policy. Very significantly, an initial proposal to set up an independent National Drug Control Agency to monitor and control pharmaceutical quality assurance was ultimately given up. Nor did the new drug policy outline any strategies to improve compliance with existing laws and regulations, of which there are many.

In India, the pharmaceutical sector is affected by a complex variety of laws and policy instruments. Not all of these regulations, however, form part of the National Drug Policies (NDPs) that have been promulgated from time to time by the Ministry of Petroleum and Chemicals. In addition to the national drug policies, the Drug Price Control Orders (DPCOs), the National Industrial Policies, the Foreign Exchange Regulation Act (FERA), and the Indian Patents Act (IPA) also have an impact on the pharmaceutical industry.

Thankfully the penetration of third party payers  in Indian health industry 




Impact on Prices The prices of drugs in India have increased since the promulgation of the 1994-95 policy, although the price increases are not as extreme as portrayed in several academic and media reports in India (e.g. Rane, 1993, Bidwai, 1995). A detailed study by an independent market research group in India showed that, in a 12-month post-DPCO (1995) period, the index of pharmaceutical prices (Base: 100 in January, 1995) had gone up to 102.6 for formulations under price control, to 106.3 for decontrolled formulations, and 104.6 for all formulations (ORG, 1996). In other words, there had been a 4.6% increase in drug prices in the 12 months following the announcement of the 1995 DPCO, compared to an increase in the Consumer Price Index (CPI) of 9.8% for the same period. The study also showed that the index of prices on products that had moved from the controlled to the decontrolled category under the DPCO was 110.7 (i.e., a 10.7% increase). Of the 6495 products surveyed by ORG, 32% showed an increase in price, with 7.6% showing an increase in excess of 25%. 15% of the surveyed products registered a decrease in price, and the price of 53% of the products remained unchanged (ORG, 1996). Impact on Profitability The profitability of the MNCs in India has improved significantly, since the announcement of the 1994-95 drug policy. An annual survey of its member-companies by the organization of multinational drug companies in India (OPPI), which is based on the Annual Reports published by these firms, showed that the profitability of these companies 16 had increased substantially between 1993-94 and 1994-95. A summary of the profitability figures from these companies, between 1990-91 and 1994-95, are shown in Table 10. Table 10: Profitability of OPPI Member-Companies 1990-91 1991-92 1992-93 1993-94 1994-95 Total Profit Before Tax (PBT) as % of Total Net 5.1 5.3 5.2 7.8 9.9 Sales__ _ _ _ _ __ _ _ _ _ PBT on Total Pharmaceutical Sales (domestic + exports) as % of Total Net Sales of 3.3 2.6 2.9 5.2 6.3 D rugs__ _ _ _ __ _ _ _ _ _ _ _ _ _ PBT on Domestic Pharmaceutical Sales as % of 2.0 1.0 2.6 4.4 6.1 Domestic Net Sales of Drugs Source: OPPI, Annual Report, 1995-96. Table 11 shows the trends in profits before taxes, as a share of total sales, for several major pharmaceutical companies (both domestic and multinational) in India for the Table 11: Trends in Profits as a % of Sales for Major Pharmaceutical_Companies Year/Company 95 96 7 8 Cipla 17% 17% 28% 27% Dr Reddy's Laboratories Ltd. 24% 28% 20% 21% E Merck India Ltd. 19% 18% 18% 18% Glaxo Ltd. 14% 15% 15% 16% Hoecht Marion Roussel Ltd. 14% 14% 15% 14% IPCA Laboratories Ltd. 15% 14% 14% 14% Knoll Pharmaceuticals Ltd. 14% 17% 18% 19% Kopran Ltd. 18% 19% 20% 17% Lupin Labs Ltd. 12% 16% 12% 14% Nicholas Piramal India Ltd. 30% 30% 23% 19% arke Davis India Ltd. 12% 16% 14% 13% Pfizer Ltd. 11% 15% 15% 13% Ranbaxy Laboratories Ltd. 27% 26% 5% 24% Rhone Poulenc India Ltd. 7% 22% 24% 14% SmithKline Beecham Pharmaceuticals Ltd. 14% 14% 21% 13% Sun Pharmaceuticals Industries Ltd. 27% 36% 32% 24% Wockhardt Ltd. 38% 32% 27% 21% Source: Compiled from data provided in the Probity Sector Report: Pharmaceuticals, 1999 period 1995 to 1998. The figures show that the Indian domestic companies had a higher profit to sales ratio compared to the multinational firms.However, the multinational companies are better off compared to the domestic firms in terms of profit as a percentage of capital deployed. The difference between the two groups of companies probably reflects the differences in levels of efficiency, the use of technology, and the portfolio of products (Table 12). 17 Table 12: Trends in Profit as a % of Capital for Major Pharmaceutical Companies Year/Company 95 96 97 98 Cipla 25% 20% 42% 36% Dr Reddy's Laboratories Ltd. 19% 19% 14% 17% E Merck India Ltd. 37% 38% 36% 41% Glaxo Ltd. 45% 37% 35% 36% Hoechst Marion Roussel Ltd. 20% 22% 24% 25% IPCA Laboratories Ltd. 22% 17% 18% 17% Knoll Pharmaceuticals Ltd. 50% 64% 48% 42% Kopran Ltd. 16% 18% 18% 16% Lupin Labs Ltd. 9% 14% 12% 13% Nicholas Piramal India Ltd. 17% 17% 23% 15% Parke Davis India Ltd. 45% 67% 32% 24% Pfizer Ltd. 33% 47% 26% 36% Ranbaxy Laboratories Ltd. 18% 18% 17% 18% Rhone Poulenc India Ltd. 8% 28% 29% 17% SmithKline Beecham Pharmaceuticals Ltd. 34% 36% 43% 35% Sun Pharmaceuticals Industries Ltd. 21% 27% 29% 23% Wockhardt Ltd. 13% 13% 12% 10% Source: Compiled from data provided in the Probity Sector Report: Pharmaceuticals, 1999. Note: Indicator calculated as the ratio of profit (before Interest, depreciation and tax) divided by total capital deployed. The variation between the two tables can be possibly explained by the fact that the multinationals are presently dependent on their high volume low margin drugs (several of their older drugs are covered under DPCO). They are not making large investments (hence their capital deployed is low) and are waiting for 2005 to get in a big way. The Indian manufacturers, on the other hand, are consolidating their positions and developing their all-round capabilities in order to be able to compete with the global industry when WTO rules come into force

Reasons for Rejection of Drugs Source: Compiled from data provided by the Andhra Pradesh Drug Controllers Office, Hyderabad

Source: Compiled from data provided by the Andhra Pradesh Drug Controllers Office, Hyderabad
Reasons for Rejection of Drugs 
the content of drug is less than specified 
26%
fails the test for sterility
25%
fails the test for disintegration 
10%
does not have the drug on testing 
9%
presence of fungus 
8%
fails the test for assay 
4%
fails the test for uniformity of weight 
3%
presence of particulate matter 
2%
Fails the test for acidity /alkalinity 
2%

non compliance with IP[USP requirements 
1%
fails the test for hardness 
1%
presence of undesirable substances 
1%
presence of suspended particles 
1%
Fails the test for dispersion
1%
Content of drug in excess Of specifications 
 1%
Total 
 100

Friday, August 03, 2018

Stupid EHR and imbecile DSS(Decision support system)


Stupid EHR and imbecile DSS(Decision support system)

When you use Microsoft Excel and want to add some formulae one of the warnings is not to use any formula which has a circular logic then it may freeze or crash your computer.

I hate these stupid EHR  systems  I have  to use 
one of the  worst is Intergy which has come up with gems like this 


Promethazine Hypotension the use of Promethazine  Hypotension. HCI Oral Tablet 25 MG should be used with extreme caution in since Anaphylaxis (which is a proxy medical condition based on the use of  Promethazine HCI Oral Tablet 25 MG) is more specific form Of the same precaution may apply


Dr.Hariharan Ramamurthy .M.D.oward County Community Clinic, Big Spring, TX, USA

IRSI /Quality Healthcare and longevity