CT Center for Patient Safety Newsletter
September 8, 2009
In This Issue
Rexford Appointment
Medical Bankrupty
Pfizer gets a well deserved fine

Rexford appointed to the Connecticut State Board of Chiropractic Examiners.
And no one was more surprised than I.
In the required form, I was asked if I had engaged in anything controversial.   I wrote - not capping non economic damages, medical malpractice, hospital acquired infections, pharmaceutical company ties to health care providers, legislation requiring great Department of Public Health transparency and public accountability.
This will be a wonderful opportunity and education for all of us.  I will be attending a meeting of the Citizen Advocacy Center that was formed to assist  public members and the health professional oversight bodies on which they serve. The agenda for the conference focuses on the very issues we have raised such as implementing legislation through rulemaking, discipline issues, chemically dependent healthcare practioners - to name just a few of the presentations.

For the last few years we have increasingly focused on the opaque regulatory entities that  license health professionals as well as review public complaints.  Networking with the states that have "best practices" will be an invaluable tool for us in CT.

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Dear Members,
Connecticut's failure to deal with our biennial budget in June meant that legislators were reluctant to even think about policy initiaitves for next year.  There was a great deal of back and forth between the Senate, the House and the Governor's office during June, July and August.  CTCPS will be meeting with health leadership and our allies during the coming month and begin to focus on our strategy for the upcoming legislative session.  Clearly, at the national level, comprehensive health reform is becoming less likely so there will be plenty for us to do in our own state.  We will have time to look at whatever they do pass and figure out a way to create greater quality for the health care consumer in Connecticut.  Keep tuned. 
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The Bankruptcy Toll
Dr. David Himmelstein, an associate professor of medicine at Harvard Medical School, is a co-founder of Physicians for a National Health Program and co-author of studies finding that medical bills are a leading contributor to personal bankruptcies in the United States.  He spoke to Anne Underwood, a contriubtior to The New York Times.
Q.  How many medical bankruptcies are there annually in this country?
A.  Around 900,000 cases and each one affects about 2.7 people.  That makes roughtly 2.4 million people who will suffer from new medical bankruptcy filings in 2009 alone.
Q. A big goal of health care overhaul is to cover more people.  But does covering more people mean that medical banktuptcies will decline?
A.  No.  Of the medically bankrupt, three-quarters of that group had insurance at least when they first got sick.
Q.  Would any of the plans under discussion reduce the rate of medical bankruptcies?
A.  Only the single-payer plans. The others pretty clearly do little or nothing for medical bankruptcy. 
Bextra, Bextra!
This week, the Dept. of Justice announced that Pfizer will pay $2.3 billion in civil and criminal penalties for off-label marketing of four drugs.  The settlement, which alleges that off-label marketing tactics led to over-prescribing of Bextra, Lyrica, Geodon and Zyvox for unapproved indications, is the largest of its kind on record. The company plead guilty to misbranding Bextra, a pain medication pulled from the market in 2005, and along with returning funds to the Medicaid and Medicare programs, the settlement includes a corporate integrity agreement that, among other things, will require Pfizer to disclose payments made to doctors for honoraria and travel.

Such a corporate integrity agreement entered into as part of an earlier $1.4 billion settlement this year around the marketing of Zyprexa - has already yielded Eli Lilly's "faculty registry" - a fancy name for a list of what doctors the company paid, for what, and how much. The St. Petersburg Times looked at what local docs took home from Lilly in the first quarter of 2009, and topping the list of Tampa-area docs was Dr. Maria-Carmen Wilson, a neurologist at the University of South Florida who gave an average of two talks a week at about $2000 per talk - by May she'd hit Lilly's own $75,000/year per physician payment cap.

The Times reminded us of this striking industry calculus: "The drugmaker's payoff for each dollar paid to physicians: more than $12 in additional prescription sales