Leading by example: two stories

When health care institutions are charging outrageous prices, we need to stand up and say, "That's insane."

I was struck recently by two stories in the New York Times. The first, “Bishops Follow Pope’s Example: Opulence Is Out,” tells how bishop after bishop, either inspired by the Pope’s example or afraid of being shamed for not doing so, is moving out of his expensive, newly renovated residence and emulating Pope Francis’ emphasis on living simply. “Francis has very definitely sent out a signal, and the signal is that bishops should live like the people they pastor, and they shouldn’t be in palaces.”

I contrast this in my mind with the “do as I say, but not as I do” style of leadership shown by the US Congress on health care, where the message of “bending the cost curve on health care,” and limits on “Cadillac plans” was for everyone else. Congress’ own gold-plated plan remained in place, despite posturing to pretend that members of Congress were in the same boat as everyone else.

But when the leaders themselves don’t lead, sometimes individuals stand up to be counted.

One such example, buried in a much larger story about health care entitled, “Even Small Medical Advances Can Mean Big Jumps in Bills,” should have been front page news with this headline: “Health care heroism: patient refuses outrageously expensive treatment.” Here is the key passage from the article:

“In the United States, each patient with a chronic disease must make the cost-benefit analysis of each new high-priced treatment, weighing symptoms, disposable income and insurance coverage. They are often wrenching decisions….

“For Jeffrey Kivi, 51, a chemistry teacher at Stuyvesant High School in New York, it meant recently giving up an intravenous drug that, as an outpatient, he had had infused every six weeks for years to keep his psoriatic arthritis at bay. Before taking that drug, Remicade, Dr. Kivi was on high doses of steroids for debilitating joint pain that left him unable to walk at times.

“But when his last three-hour infusion at NYU Langone Medical Center’s outpatient clinic generated a bill of $133,000 — and his insurer paid $99,593 — Dr. Kivi was so outraged that he decided to risk switching to another drug that he could inject by himself at home. That is true even though his insurer did not require him to make up the difference.

“‘I cannot, in good conscience, continue to force my insurance company to pay $100,000 to NYU each time I get a Remicade infusion.’ Dr. Kivi, who was a drug company researcher for many years, wrote to the hospital. ‘That’s insane.’

“In a statement, Lisa Greiner, a spokeswoman for the medical center, said Dr. Kivi’s charge had been high relative to that of other patients because he had been prescribed a high dose of the drug.

“He had moved his care to NYU Langone to follow his longtime doctor, who had moved her practice from a nearby hospital where the same infusion had been billed at $19,000. The average price that hospitals paid for Dr. Kivi’s dose of Remicade late last year was about $1,200, according to Medicare data.”

Like Pope Francis, Jeffrey Kivi stood up and said, “This is wrong.” We need to celebrate people like him — and shame institutions like NYU, which charge such outrageous prices, so far out of line with industry norms, just because they can. The market power of large hospitals is turning out to be one of the key drivers of health care costs. But “with great power comes great responsibility.” Hospitals that overcharge the insurance system just because they can are increasingly turning out to be the villains of our health care system. They need to be shamed and pressured by their customers, just like the Catholic bishops have been shamed by their parishioners.

Fortunately, there is a movement toward increased transparency in health care costs, enabled in part by open data policies at the Center for Medicare Services, which is now releasing physician-level cost data. This is leading to an increasing number of services that make the system less opaque. But that only matters if people use the data.

Sites like clearhealthcosts.com let you compare prices for various medical procedures in your area. (Fred Trotter, author of the O’Reilly book Hacking Healthcare, has built another such system, the DocGraph.) These sites have been mainly targeted to those who are uninsured or who have high deductibles, but if we really want to drive down the cost of care, we need to use these tools whether insurance is paying the bill or not. When an institution is charging outrageous prices, we need to stand up, like Jeffrey Kivi did, and say, “That’s insane.”

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  • Yang Lin

    Tigecycline in vitro antibacterial activity against clinical strains

    Abstract: Objective evaluation of tigecycline ( tetracycline antibiotic ) in vitro antibacterial activity against clinical strains . Methods broth dilution method for tigecycline and other 14 kinds of drugs for nearly two years in the hospital clinical specimens of 400 bacteria were isolated MIC determined by WHONET5.4 statistical software . The results showed that MIC determination : tigecycline against methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus showed good antibacterial activity in vitro test has three vancomycin-resistant enterococci (VRE), on behalf of tigecycline and linezolid -sensitive display ;Daptomycin, against Gram- negative bacteria Escherichia coli and ESBL-producing Klebsiella spp MIC ∞ are 1trg · mL ~, behind or below meropenem ; present study for tigecycline against Acinetobacter baumannii

    The MIC. (2trg · mL a ) a minimum in all tests of antimicrobial drugs ; against Pseudomonas aeruginosa MIC ∞ value of 16p. g · mL ~.Tigecycline hydrochloride, Conclusion tigecycline against clinical pathogens have good broad-spectrum antimicrobial activity against Pseudomonas aeruginosa Yin poor antibacterial activity.

    Tigecycline (tigecycline) is a derivative of minocycline , is the first clinical application of new glycyl doxycycline antibiotics . Intravenous drug formulations, in 2005 the U.S. Food and Drug Administration (FDA) approval : tigecycline for the treatment of patients aged 18 and older infections caused by susceptible strains , indications include : complicated intra-abdominal infections ( such as complicated appendicitis ,Tigecycline mesylate, burns infections, intra-abdominal abscesses, deep soft tissue infections and infected ulcers ) and complicated skin and soft tissue infections. The drug can overcome the limitations of many two main resistance mechanisms of antimicrobial drug use : efflux pumps and ribosomal protection. 1 shows a lot of old literature : the drug can be used to treat multi-drug resistant , such as MRSA, VRE, producing extended-spectrum 13 -lactamase bacterial infections caused by Enterobacteriaceae .Ofloxacin
    To understand the in vitro antibacterial activity of the drug , the trial of the 2009 and 2010 clinical isolates from the Ministry of Health, Beijing Hospital, 400 clinical MIC common bacteria were measured to evaluate the in vitro antibacterial activity of the drug .

    Medchemexpress Can provide the above product,its website:http://www.medchemexpress.com