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American v. Brazilian Healthcare, a Continuing Series

by Mike Kimel

American v. Brazilian Healthcare, a Continuing Series

I spoke to my sister on Skype last night. She’s been in Natal, in Northeastern Brazil, for the past few months. Last week, she noticed a couple small warts growing on her leg. So she wandered down to a government run hospital and and had them removed. The hospital was low on supplies, and the doctor asked her to contribute a box of Q-tips (since Q-tips would be needed in the procedure). The total cost of the whole thing: 12 reais, or about $6.60 American, plus a box of Q-tips.

This isn’t the first time I’ve had a post that dealt with my sister and the Brazilian health care system. A few years ago I wrote about the time she had emergency open heart surgery in Brazil, and how it compared very favorably with her experience with (planned) open heart surgery in the US.

Now, on the subject of the US, my wife also has an interesting healthcare story to relate. She got a letter from Aetna, her insurance provider, indicating they didn’t know why they were being asked to pay for services when she doesn’t have health insurance through them. Interestingly enough, money is withdrawn from our bank account each month to pay for her health insurance, and a call to Aetna indicated that she did, in fact, have health insurance. A number of phone calls back and forth between my wife, Aetna, and her doctor resolved the issue (I think) – the doctor is being paid, etc. But it isn’t the first time this has happened, and it serves to follow up our family’s earlier experience with health insurance. All told, I would estimate my wife and I have spent about 40 hours – that would be a workweek – dealing with health insurance since July.

Brazil is a poor country, and I don’t think anyone has ever suggested that the Brazilian health system is the best in the world. On the other hand, we often hear precisely that about the American system from certain circles, despite the astounding cost (which doesn’t seem to include the waste of time dealing with the paperwork or fighting with health insurance companies) and ho-hum outcomes. I’m starting to think a lot of Americans are absolutely insane. Lord knows it would explain a lot.

Prostate Cancer Advance, and Europeans Free Riding on American Research

by Mike Kimel

There’s a story going around in the news about a new prostate cancer drug. Here’s press release:

A life-extending new drug to treat patients with advanced prostate cancer, developed by The Institute of Cancer Research (ICR) and The Royal Marsden Hospital, has received its UK license.

Abiraterone acetate, marketed by Janssen under the trade name ZYTIGA®, has been shown in clinical trials to prolong survival for men with advanced prostate cancer. An estimated 10,500 men in the UK have advanced prostate cancer that has become resistant to standard hormone treatments.

The once-daily pill officially launches in the UK today after the European Commission earlier this month approved it for the treatment of metastatic prostate cancer. Abiraterone acetate was licensed for use in combination with the steroids prednisone or prednisolone, by men whose disease has developed resistance to conventional hormone therapies and docetaxel-based chemotherapy.

Abiraterone acetate is a new type of treatment for prostate cancer that works by blocking the synthesis of testosterone in all tissues including the tumour itself, not just the testes. This testosterone would otherwise continue to fuel prostate cancer growth and spread. Abiraterone was discovered at the ICR in what is now the Cancer Research UK Cancer Therapeutics Unit and further developed at the ICR and The Royal Marsden.*

The ICR’s Chief Executive Professor Alan Ashworth says: “This drug was discovered in the UK at The Institute of Cancer Research. Its launch is the culmination of immense hard work and dedication by scientists and clinicians here and around the world. To have reached the point where thousands of prostate cancer patients will be able to benefit from this life-extending treatment is hugely rewarding.”

Royal Marsden Chief Executive Cally Palmer says: “The development of abiraterone by The Royal Marsden and the ICR highlights the national importance of funding pioneering cancer research. We are delighted our patients at The Royal Marsden have been among the first to benefit from the very latest in drug development.”

Another quote:

Results of a major international Phase III trial of almost 2,000 men jointly led by Professor Johann de Bono from the ICR and The Royal Marsden showed that patients given abiraterone acetate lived on average 15.8 months compared to 11.2 months for men taking a placebo. Pain also eased for a higher proportion of patients taking abiraterone, while side effects were easily manageable and reversible.

From the footnotes:

Cancer Research Technology assigned abiraterone acetate to BTG International Ltd, who in turn licensed it to Cougar Biotechnology Inc., now a member of the Janssen Pharmaceutical Companies.

Now, I’m not that familiar with British entitites, but as I understand it, a publicly funded university and its research hospital developed a new wonder-drug using grants from the public, a charity, and a formerly government owned but now private company. Commercialization rights eventually ended up with Janssen, a company owned by Johnson & Johnson.

How long will it be before Zytiga gets trotted out as an example of the European healthcare system free-riding on American research and who will be the first pundit to make that argument?

The Best Health Care System in the World

For the record, both my daughters were vaccinated today, under government supervision at no cost to us, in a procedure that took less than 10 minutes—including getting a five-year-old to take her coat off and, post shot, put it on again.

Via Felix Salmon’s Twitter feed, without further comment.

(cross-posted from Skippy the Bush Kangaroo)

Five Myths about health care


5 myths about health care round the world by By T.R. Reid, Commentary, Washington Post (hat tip Mark Thoma)

…I’ve traveled the world … to see how other developed democracies provide health care. Instead of dismissing these models as “socialist,” we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:

1. It’s all socialized medicine out there. Not so. … In some ways, health care is less “socialized” overseas than in the United States. Almost all Americans sign up for government insurance (Medicare) at age 65. In Germany, Switzerland and the Netherlands, seniors stick with private insurance plans for life. Meanwhile, the U.S. Department of Veterans Affairs is one of the planet’s purest examples of government-run health care….
(the rest of the article is below the fold)

2. Overseas, care is rationed through limited choices or long lines. Generally, no. Germans can sign up for any of the nation’s 200 private health insurance plans — a broader choice than any American has. … The Swiss, too, can choose any insurance plan in the country.

In France and Japan, you … can go to any doctor, any hospital, any traditional healer. There are no U.S.-style limits such as “in-network” lists of doctors or “pre-authorization” for surgery. You pick any doctor, you get treatment — and insurance has to pay. …

As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But … many nations — Germany, Britain, Austria — outperform the United States on measures such as waiting times for appointments and for elective surgeries. In Japan, waiting times are so short that most patients don’t bother to make an appointment. …

3. Foreign health-care systems are inefficient, bloated bureaucracies. Much less so than here. …

4. Cost controls stifle innovation. False. The United States is home to groundbreaking medical research, but so are other countries… Any American who’s had a hip or knee replacement is standing on French innovation. … Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs. Overseas, strict cost controls actually drive innovation. …

5. Health insurance has to be cruel. Not really. American health insurance companies routinely reject applicants with a “preexisting condition”… They employ armies of adjusters to deny claims. If a customer … faces big medical bills, the insurer’s “rescission department” digs through the records looking for grounds to cancel the policy… Foreign health insurance companies, in contrast, must accept all applicants, and they can’t cancel as long as you pay your premiums. …

In many ways, foreign health-care models are not really “foreign” to America, because our … system uses elements of all of them. For Native Americans or veterans, we’re Britain: The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we’re Germany: Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we’re Canada: Everyone pays premiums for an insurance plan run by the government, and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we’re Burundi or Burma: In the world’s poor nations, sick people pay out of pocket for medical care…

This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance; we’ve blended them all into a costly, confusing bureaucratic mess.

Which, in turn, punctures the most persistent myth of all: that America has “the finest health care” in the world. We don’t. In terms of results, almost all advanced countries have better national health statistics than the United States… In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.

Given our remarkable medical assets — the best-educated doctors and nurses, the most advanced hospitals, world-class research — the United States … should be the best in the world. To get there, though, we have to be willing to learn some lessons about health-care … from the other industrialized democracies.

There are, of course, groups that have a strong interest in perpetuating these myths as part of their attempt to block health care reform.