Managing Healthcare Costs: health advocacy organizations

Today’s Managing Health Care Costs Indicator is $173 billion

Two courageous oncologists wrote in the May 26 New England Journal of Medicine (Free full text) that there were five changes in behavior and five changes in attitude that could lower overall health care costs. They cite a projection that the cost of oncology care in the US will be $173 billion in 2020, and state that continued increases are unsustainable.

The behavior changes (reworded by me):

Don’t do routine tests of cancer survivors looking for recurrence, except where there is evidence that this improves quality of life or survival
Give a single chemotherapy agent for most solid tumors –don’t use multiple agents except where there is good evidence to do so
Don’t give chemotherapy to patients who are so frail that they can’t walk
Don’t routinely use medicines to raise white blood cell counts. (This is for solid tumors – chemotherapy for leukemias and lymphomas does sometimes require these medications)
If patients fail three chemo regimens, limit further chemo to clinical trials.

The changes in attitudes (also reworded)

Recognize that costs are due to choices that oncologists make
Have realistic expectations
Pay more for cognitive services rather than chemo
Start palliative care earlier
Support comparative effectiveness research, and accept that there will be some limits on the care we can offer.

We’ve had over a generation of the “war on cancer,” and we’ve promised society that we can ‘cure’ cancer. The authors suggest that we should acknowledge that palliation is often the best goal, and we should avoid costs for treatment that has not been shown to be valuable.

This is rational – but could easily be misconstrued to be an endorsement of “death panels.” I think this is an important addition to the dialog on how to lower health care costs. We will clearly need to bring patient advocates along for this approach, and sometimes it’s hard to tell patient advocates from parties interested in maintaining high health care costs (and company revenues).

Today’s Managing Health Care Costs Indicator is $3,211,144

This month’s American Journal of Public Health has an article by researchers at Columbia University reviewing disclosure practices of health advocacy organizations.

In 2007, Eli Lilly gave grants totaling over $3.2 million to 161 health advocacy organizations across the country. Many of these do educational programs and advocacy which encourage use of medications, and Lilly’s donations parallel the clinical areas of the pharmaceutical company’s sales.

The biggest health advocacy organizations are household names, like American Lung Association, American Cancer Society, American Heart Association, and American Diabetes Association. Many health advocacy organizations have state and local chapters, so that Lilly ultimately donated to a total of 161 organizations, 40% of which acknowledged the donation on their website, in their annual report, or elsewhere. That number was a mere 20% for the 114 neuroscience health advocacy organizations, while it was 59% for endocrinology organizations and 67% for oncology.

The researchers looked at Eli Lilly’s 2007 calendar year disclosures because they were the first available, and they felt that there would be little sentinel effect from the disclosures.

Should we care? The amount of dollars here are small – it’s nothing like the huge influence that unnamed donors can have on political races since the Supreme Court’s Citizen’s United decision. When I looked at the Lilly registry for 2010, I couldn’t locate “astroturf” organizations that looked like their entire reason for existence was to promote (Lilly) medications.

I think this is another area where transparency is better than opacity, and I suspect that drug company sponsorships will be better disclosed going forward as a result of this research. The National Care Foundation, a league of health advocacy organizations, changed its policies prior to this article to encourage full reporting.