Category Archives: Health Economics

“The Broken Promises of Profit-Driven Medicine”

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N Tomes. NEJM 2025; 393: 521-524. A Gilded Age for Patients? The Broken Promises of Profit-Driven Medicine

This article (one of several in a series) describes the development of the current corporate-centered health care system over the past 100 years and the drawbacks.

An excerpt:

Between the 1920s and the 1960s, the American medical profession adopted a new doctor-controlled business model of care delivery, dependent on continual investment in new drugs, technologies, and procedures. That model created the profit opportunities that enticed corporate stakeholders to invest in health care in the 1970s and 1980s. But as the corporate presence increased, physicians lost control of their business model; the “tail” of financialization began wagging the “dog” of medical practice. That shift coincided with corporate cooptation of the language of consumerism to justify these changes as in patients’ best interests. In the process, physicians and patients lost economic autonomy over health care choices…

Insurance plans let doctors and hospitals set prices, facilitating more investment in the capital-intensive technologies equated with higher-quality care. But that dynamic also created an upward spiral of costs…These problems led to a second transformative movement: the federal government’s entry into the health insurance business, with the creation of Medicare and Medicaid, which also let doctors and hospitals set prices. This… aimed to relieve Americans of the duty of financing the medical system themselves, bringing in third parties to help. Enrollees in the new plans got more coverage but only on the terms set by those parties; uninsured people had to manage on their own. Meanwhile, the cycle of rising costs continued unabated…

Medical entrepreneurs believed that applying market discipline to health care would produce the right combination of innovation, efficiency, and cost–benefit balance to ensure better care for patients while profiting investors…

While adopting some consumer-industry practices, corporate health care players strove to avoid others, such as direct price competition. Policy efforts to rein in costs stressed the need for price transparency: consumer–patients needed to “shop” more critically for the cheapest care. In this spirit, political conservatives promoted “consumer-driven” health care. But such schemes foundered on the reality that many insurance plans gave patients little flexibility to price-shop for care…

Many powerful health care industry stakeholders still believe allowing corporate interests freer rein will produce that “golden age for patients.” The health care economy’s fragility suggests otherwise…When they [hospitals] pivoted from profitable surgeries to unprofitable Covid care, they needed massive infusions of government funding to survive.  Similarly, recent shortages of essential but low-profit drugs, including chemotherapy agents and insulin, reveal the limits of the pharmaceutical industry’s profit-oriented approach to essential drug production…

No market solution has arisen for the most critical determinant of poor health and health care outcomes in the United States: extreme income inequality. Countless studies indicate that poverty is the most important health risk factor that Americans face…little profit can be made by preventing or treating poverty-induced illnesses.

U.S. health care needs a new business model…only more collective physician and patient action will help medicine find a more equitable, sustainable model…Many people will suffer if the system collapses completely, but perhaps a more sustainable health care system can be built from the rubble.

My take: This analysis of the U.S. healthcare system, like many others, is analogous to getting the license plate of the truck that ran you over. At this time, there is little prospect of stopping the truck.

Related blog posts:

Stone Mountain, Ga from the Cherokee Trail

Rising Scientific Fraud: Threats to Research Integrity Plus One

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Excerpts from NY Times Article:

“A team of researchers found evidence of shady organizations churning out fake or low-quality studies on an industrial scale. And their output is rising fast, threatening the integrity of many fields…“If these trends are not stopped, science is going to be destroyed,” said Luís A. Nunes Amaral, a data scientist at Northwestern University and an author of the study”

““Science relies on trusting what others did, so you do not have to repeat everything,” Dr. Amaral said….By the 2010s, journal editors and watchdog organizations were warning that this trust was under threat. They flagged a growing number of papers with fabricated data and doctored images. In the years that followed, the factors driving this increase grew more intense.”

“As more graduate students were trained in labs, the competition for a limited number of research jobs sharpened. High-profile papers became essential for success, not just for landing a job, but also for getting promotions and grants. Academic publishers have responded to the demand by opening thousands of new scientific journals every year…”

“Organizations known as paper mills are now turning scientific fraud into a lucrative business. Scientists eager to pad out their resumes can pay hundreds to thousands of dollars to be named as an author of a paper that they had nothing to do with…paper mills often use artificial intelligence to alter the text they lift from other papers…”

“The papers that Dr. Amaral and his colleagues could study came to light only because of the work of independent sleuths. To estimate how many paper mill papers have yet to be exposed, Dr. Amaral’s team created a statistical model that accurately predicted the rate at which suspicious papers surfaced. They estimate that the number of paper mill products may be 100 times greater than the ones they have identified…”

“In their new study, they calculated that the number of suspicious new papers appearing each year was doubling every 1.5 years. That’s far faster than the increase of scientific papers overall, which is doubling every 15 years.”

““We need to stop making it profitable to game the system.”

My take: This problem has preceded the widespread use of AI, although Al makes it harder to detect. Unfortunately, fake scientific reporting appears to be worsening.

Related article: Jessica Steier NY Times 8/19/25: The Playbook Used to ‘Prove’ Vaccines Cause Autism This article details very specifically how David Geier (now appointed by RFK Jr to evaluate vaccines and autism) and his father have produced multiple flawed studies regarding vaccine safety. This commentary takes a particularly deep dive into one of his articles on the preservative thimerosol. She shows that the authors likely used p-hacking to identify “atypical autism” since there was not a significant association with autism, compared different time cohorts (the control group was from a period with different diagnostic criteria/lower rates of autism), did not include confounders, and supported their arguments with “personal citing.”

Some excerpts:

There have been some 70 studies since Mr. Wakefield’s looking for any link between vaccines and autism. Of these, 26 have linked vaccines to autism in some way, and 43 found no connection between vaccines and autism.

A whopping two-thirds of studies that claimed to have found a link were written by  David and Mark Geier. These studies have been heavily criticized for using deceptive research techniques and flawed data.

Among the eight other studies that found a link, four were retracted for data manipulation, flawed methods or undisclosed conflicts of interest. Most of the authors have been involved in anti-vaccination campaigns and have had other papers retracted.

One such study that Mr. Kennedy referred to in his Senate confirmation hearing was published in a WordPress blog disguised as a journal and was funded by an anti-vaccine organization, among other problems.

Fortunately, independent scientists have conducted more than 40 high-quality studies since 1998 involving over 5.6 million people across seven countries. All found no connection between vaccines and autism. These studies were rigorously designed, were reviewed by independent peers and do not contain telltale signs of data manipulation, as the Geier studies do.

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Part of the Tower of London complex

Sterile Water is Unnecessary for Endoscopy

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From AGA Today (8/5/25): “Sterile Water is Unnecessary for Endoscopy”

GI and Hepatology News (8/4, Pass) reports a review suggests that “endoscopists can safely forgo sterile water in favor of tap, reducing both environmental and financial costs.” Researchers found that only two studies since 1975 “directly compared sterile and tap water use in endoscopy,” and “neither showed an increased risk of infection from tap water. In fact, some cultures from allegedly sterile water bottles grew pathogenic bacteria, while no patient complications were reported in either study.” Current guidelines “recommend sterile water for procedures involving mucosal penetration but acknowledge low-quality supporting evidence.” However, they pointed out that “these recommendations are based on outdated studies, some unrelated to GI endoscopy.” Furthermore, the “review estimates that the production and transportation of sterile water bottles contributes over 6,000 metric tons of emissions per year from US endoscopy units alone.” The review was published in Gastro Hep Advances.

Referenced article: D Agrawal, et al. Gastro Hep Advances, Volume 4, Issue 5, 100625. Ripple Effect: Safety, Cost, and Environmental Concerns of Using Sterile Water in Endoscopy

Environmental Costs:

“With a conservative estimate of using half of a 1-L sterile bottle for irrigation per endoscopy, 22 million yearly endoscopies in the US could result in an additional 6000 tons of eCO2.”

Economic Costs:

“A 1-L bottle of sterile water costs $3–$10. For an endoscopy unit performing 30 procedures daily and a conservative estimate of half a water bottle per case, the average monthly direct costs could be $1000–$3000”

Discussion:

“There is no direct supporting evidence for using sterile water during endoscopy…a Cochrane review show no difference in infection risk when using tap or sterile water to irrigate wounds…Similarly, there is no benefit in using sterile water for enteral feeds in immunosuppressed patients, and tap water enemas are routinely acceptable for colon cleansing before sigmoidoscopies in all patients, irrespective of immune status.

My take: Plastic water bottles in endoscopy centers contribute to health-care waste, climate change and increased costs.

Related blog post: Environmental Impact of Endoscopy

Sandy Springs, GA

Rising Prescription Drug Denials by Health Insurers

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S Kliff, NY Times, 7/18/25: Health Insurers Are Denying More Drug Claims, Data Shows

An excerpt:

Prescription drug denials by private insurers in the United States jumped 25 percent from 2016 to 2023, according to a new analysis of more than four billion claims… compiled for The New York Times by the medical data company Komodo Health, shows that denial rates rose from 18.3 percent to 22.9 percent….

Experts who have studied denials said the skyrocketing costs of popular new weight loss medications and greater automation of the claims process with artificial intelligence may have contributed to the rising rejection rates…

Prior authorization was responsible for about 10 percent of denied claims in the Komodo data. The analysis found that the most common reason for a drug claim to be rejected was that a refill had been requested “too soon,” before the patient was eligible for more medication…

Pricey new GLP-1 weight loss drugs like Ozempic, and other blockbuster medications, may have led insurers to increase restrictions on other drugs as they grappled with ways to offset those growing costs.

My take: Insurance companies and their pharmacy benefit managers are increasing their denials of medications. Presumably, much of this increase is driven by the pursuit of higher profits rather than the pursuit of better patient outcomes.

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Will You Be Able to Find a Caregiver When You Need One?

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PMG Santos et al. NEJM 2025; 393: 105-107. Who Will Care for America? Immigration Policy and the Coming Health Workforce Crisis

This article outlines the role of undocumented immigrants in our health care system with a focus on home health aides. Given the increase in the numbers of Americans older than 65 yrs, 56 million in 2020 and projected to be 80 million in 2030, current immigration policies will worsen the severe health care worker shortages.

An excerpt:

Immigrants are a vital part of the U.S. health care system: at least one in five U.S. health care workers is foreign-born, including 29% of physicians, 17% of nurses, and 24% of direct care workers…Data suggest that most (if not all) foreign-born physicians and nurses are naturalized U.S. citizens or lawfully permanent residents. In contrast, of the 37% of foreign-born direct care workers who are noncitizens, nearly half may be undocumented.4 This divergence is at least partly attributable to policies that streamline pathways to legal permanent residency or citizenship for some but not all immigrants…

As federal policies threaten to further destabilize the direct care workforce, nonimmigrants are unlikely to fill the resulting void. Direct care workers assist with household chores as well as bathing, dressing, and toileting — thereby enabling frail, older adults and those with disabilities to live safely at home….The physically demanding nature of direct care work, combined with low pay and high susceptibility to exploitation, makes these roles unattractive to U.S.-born and highly skilled foreign-born workers…

This is not the first time that immigrants have helped fill critical health care roles that were unattractive to U.S.-born workers…the Exchange Visitor Program in 1948, allowing Filipino nurses to obtain temporary work visas. Later, the Immigration and Nationality Act of 1965 allowed Filipino nurses to stay in the United States permanently…

Federal officials could effectuate immigration reform in a way that secures our borders while addressing labor shortages. Instead, current policies threaten to further shrink this essential workforce, maligning and driving out hard-working immigrants at the expense of an aging America…compromising care for older adults and the health care system at large…

The recent deportation of immigrant health care workers is our canary in the coal mine: policymakers must act swiftly, or risk endangering the health of us all.

My take: I doubt the consequences of mass deportation have been carefully considered amid the heated rhetoric. There is saying, often attributed to Otto von Bismarck: “Only a fool learns from his own mistakes. A wise man learns from the mistakes of others.” As such, it appears that we are destined to learn from mistakes rather than avoiding them.

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Seven Sisters Hike: Seaford to Eastbourne, UK

Unpacking Health Care Corporatization in the U.S.

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ECF Brown. NEJM 2025; 393; 1-3. Defining Health Care “Corporatization”

This blog has had many posts detailing the many flaws in the U.S. health care system. While the U.S. expends more per capita than any other country, our life expectancy is 4 years less than similar countries in Europe and Canada.

This article in the NEJM is the first of a series examining the ‘corporatization’ of health care and potential ways to improve health care delivery.

Excerpts:

The percentage of hospitals owned by companies controlling three or more hospitals increased from 11.6% in the 1980s to 56.1% today…and now nine megahospital chains own more than 50 hospitals each.

In the early 1980s, three quarters of U.S. physicians owned their practice, whereas in 2023 a similar proportion of physicians was employed by hospitals or corporate entities, including private equity funds.

Insurance conglomerates, such as UnitedHealthcare and CVS–Aetna, now control physicians, home care, pharmacies, and pharmacy benefit managers (PBMs). Horizontal hospital consolidation has been pursued for the promise of economies of scale and market power…

The term “corporatization” now refers to the general trend throughout the health care industry toward higher levels of integrated control by consolidated profit-seeking enterprises… First is the elevation of profit generation as the primary goal of the health care enterprise…the primary duty of the corporation is to maximize shareholder profits. Shareholder primacy subordinates the interests of other stakeholders, such as patients, the health care workforce, or the community…

Even nonprofit hospitals can become corporatized as they grow in size and organizational scale…powerful nonprofit health systems may come to prioritize revenue over patient and community welfare, evidenced by inflated prices, insurance network exclusions, medical debt–collection actions against patients, facility closures in low-income areas, and cuts to staffing levels and pay.

The second key element of corporatization is consolidation… Conglomerates’ market dominance, diversification across platforms, and change in locus of control insulate them from reputational or market discipline…

Corporatization has produced a system that is incredibly profitable for investors but increasingly unaffordable, inaccessible, and uncaring for everyone else — in other words, it has created a Gilded Age of medicine.5 …Corporate control over medical practices and the drive for profit have undermined many clinicians’ professionalism, autonomy, trust, and morale…

Traditional health policy interventions such as antitrust enforcement, tax subsidies and exemptions, prohibitions on the corporate practice of medicine, and payment reforms have not stopped the rise of the corporation in health care, owing to lax enforcement, political capture, and sophisticated regulatory workarounds…

Confronting corporatization may require a fundamental reorientation of the industrial organization of the health system… Future health policy efforts must confront the fundamental question of whom our health care system is meant to serve: corporate giants or the members of our society as a whole.

Related blog posts:

“How to Make America Healthy: the Real Problems — and Best Fixes”

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H Pearson, Nature, 6/24/25: Partly Open Access! How to make America healthy: the real problems — and best fixes

An excerpt:

Since taking over as the top US health official in February, Robert F. Kennedy Jr has overseen radical changes that have alarmed many public-health experts…His mission, he says, is to ‘Make America Healthy Again’. “We are the sickest nation in the world,” he said in March, “and we have the highest rate of chronic disease.” His diagnosis holds some truth, say public-health specialists and analysts. Relative to other similarly wealthy nations, the United States has the shortest life expectancy despite spending the most on health care…And researchers agree that high rates of chronic disease, including heart disease and obesity, are key contributors to Americans’ higher death rates, as Kennedy emphasizes.

But researchers say that Kennedy — widely known as RFK Jr — has mostly ignored other leading causes of death and ill health, including car accidents, drug overdoses and gun violence…

Life expectancy in the United States was closer to the average for its peers around 1980 and gradually improved, according to KFF’s analyses. The gains were driven partly by a drop in smoking and increased use of cholesterol-lowering drugs known as statins…

Overall, chronic conditions — heart disease, cancer, stroke and respiratory disease — take up four out of five spots on the country’s list of biggest killers…One of the biggest drivers of those deadly conditions is obesity, say researchers. As of 2022, about 42% of adults were considered obese in the United States, compared with 27% in the United Kingdom and 5.5% in Japan. Obesity increases the risks of developing diabetes, heart disease, cancer and many other conditions. “The US has, particularly around diet, obesity and overweight, adopted unhealthier lifestyles at a higher rate than our country peers,” Bollyky says…

The problems caused by chronic disease are compounded by poor health care. Compared with a group of similar high-income countries, the United States is the only one that lacks universal health-insurance coverage… Lack of health insurance, high costs and other barriers prevent people from getting diagnoses and treatment early on…

The other big contributors to lower life expectancy in the United States — and what really sets the country apart, researchers say — are high death rates from substance misuse, car accidents, suicide and homicide (see ‘Varied causes’). These tend to kill people of working age…All told, the death rates in working-age people mean that one 5-year-old out of every 20 — or roughly one in every school class — will die before the age of 45, according to Angus’s calculations. The comparable figure is one in 50 in the United Kingdom and one in 100 in Switzerland…

Health spending in the United States was about US$13,000 per person in 2023, according to a KFF analysis. That compares to an average of about $7,000 per person in similar large, well-off countries…

Boosting rather than cutting spending on disease prevention is “where the big gains are
to be made on population health” [Reginald Williams, a health-policy specialist at the Commonwealth Fund says his] first priority would be to expand health coverage. In the United States, around 8% of people lack health insurance, compared with around 1% or less in similar high-income countries. The second, he says, would be to invest more in primary care — the physicians and other health professionals who are the first port of call for patients, and who deal with disease prevention and management…

Tackling the high death rates from overdoses and guns, meanwhile, would involve
addressing entrenched social and political issues such as gun ownership, poverty,
unemployment and inequality.

My take: Despite big promises from politicians, there are no quick fixes for improving our national health. Improving health care access would help but this does not address deaths due to firearms, drug overdoses and to car accidents.

Related blog posts:

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“Proposed Medicaid Cuts Could Lead to Thousands of Preventable Deaths Annually” & Personal Message

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6/17/25 Healio, E Bascom: Proposed Medicaid cuts could lead to thousands of preventable deaths annually

An excerpt:

Congress passing the controversial One Big Beautiful Bill Act could leave millions without insurance and lead to at least 16,000 annual preventable deaths, according to research published in Annals of Internal Medicine…

Arthur L. Caplan, PhD, a professor and founding head of the division of medical ethics at NYU Grossman School of Medicine, told Healio that the authors’ “warnings about what will happen should the Big Beautiful Bill go through have to be taken very seriously.”

“I think the fallout in terms of impact on Medicaid populations … people losing coverage who would then lose access [to health care] is morally staggering and unacceptable,” he said. “We are taking some of the most vulnerable people in society … and cutting back what is often somewhat meager benefits to begin with…”

A brief recently published by the Robert Wood Johnson Foundation also examined the potential impact of Medicaid cuts. Researchers revealed that, if the bill passes, national health care spending would drop by $797 billion over the next 10 years… They found that physicians would see an $81 billion cut, but hospitals would see the biggest decline in spending, at $321 billion.

Cited Study: A Gafney et al. Annals of Internal Medicine 2025; https://doi.org/10.7326/ANNALS-25-00716 Open Access! Projected Effects of Proposed Cuts in Federal Medicaid Expenditures on Medicaid Enrollment, Uninsurance, Health Care, and Health

An excerpt:

Enactment of the House bill advanced in May would increase the number of uninsured persons by 7.6 million and the number of deaths by 16 642 annually, according to a mid-range estimate…These estimates may be conservative. They rely on CBO’s assumption that states would replace half of the federal funding shortfall…Medicaid cuts would likely also increase uncompensated care, stressing hospitals and safety-net clinics and causing spillover effects on other patients…

ACA boosted enrollment to more than 90 million. Today, despite its many shortcomings, Medicaid enjoys wide support from the electorate and serves as the foundation of the nation’s health care safety net. The cuts under consideration, intended to offset the cost of tax cuts that would predominantly benefit wealthier Americans, would strip care from millions and likely lead to thousands of medically preventable deaths.

My take: Yogi Berra is attributed with the saying, “It’s tough to make predictions, especially about the future.” While this is true, it is highly likely that huge cuts in Medicaid funding will result in huge numbers who lose health insurance with subsequent increases in mortality and other adverse outcomes.

Related article: M Mineiro and M Sanger-Katz, NY Times 6/19/25: ‘Little Lobbyists’ Urge Senators to Oppose Trump’s Bill Cutting Medicaid

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Personal Message:

Atlanta Botanical Gardens

How Putting America First is Undermining Health Outcomes Here and Globally

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CP Duggan, ZA Bhutta. NEJM 2025; DOI: 10.1056/NEJMp2503243. “Putting America First” — Undermining Health for Populations at Home and Abroad

This article initially lays out the historical context of U.S. involvement in global health dating back to aiding famine in Belgium (1917), WHO (1948), USAID (1961). Also, the CDC and NIH have played important roles following WWII. Subsequently, the commentary outlines the impact of dismantling U.S global health efforts. In the two related articles cited afterwards, it is clear that the cuts to foreign aid and other DOGE activities may result in millions of deaths and at the same time expand the federal deficit.

An excerpt:

In the initial months of the Trump administration, numerous executive orders have led to a chaotic dismantling of U.S. foreign-assistance and global health efforts. These orders have already had, and will continue to have, severe adverse effects on vulnerable populations globally. But they also have serious implications for people in the United States…

Often missing from these success stories are the financial and health-related benefits these programs have had in the United States….One of the earliest and most fundamental examples of reciprocal innovation was the discovery and implementation of oral rehydration therapy (ORT)…Widespread use of ORT has helped drive substantial reductions in childhood deaths from diarrhea and has led to a new standard of care for childhood diarrhea in high-income countries and to commercial products in the United States…

Perhaps no program epitomizes these dual advantages better than the President’s Emergency Plan for AIDS Relief (PEPFAR). Early in the HIV epidemic, the NIH promoted multinational scientific collaborations to identify the virus, develop effective treatments, and implement global prevention and treatment programs, which led to PEPFAR’s creation in 2003. PEPFAR has saved 26 million lives, and economic growth in countries with PEPFAR programs has benefited the United States and other trading partners…[and] have contributed enormously to current knowledge about HIV and AIDS.

Another essential initiative, the FIC — the NIH institute responsible for supporting research training and partnerships in global health — has …directly benefited health in the United States by advancing early cancer detection and the development of sickle cell disease therapies, point-of-care diagnostics for infectious diseases, and treatments for child malnutrition. More than three quarters of FIC grants involve a U.S. grantee or investigator, which further emphasizes the institute’s direct benefits to the U.S. economy…

Since U.S. foreign assistance accounts for about 1% of the federal budget, we are skeptical of cost-savings–based arguments for its elimination…

The Trump administration’s gutting of USAID and other foreign-assistance programs marks a break from decades of evidence-based practices that have improved lives throughout the world. In addition to pushing millions of people into poverty and leading to an estimated 160,000 or more avoidable child deaths each year,4 these reforms will undermine health and the economy in the United States…

Withdrawal from the WHO reduces the United States’ ability to influence reform and restructuring of the world’s global health coordinating body. The elimination of U.S. funding for Gavi, the Vaccine Alliance, also endangers the health of vulnerable populations internationally and in the United States…

Critical to the success of advocacy efforts will be evidence of the ways in which the withdrawal of foreign aid and global disengagement undermine health and economic well-being in the United States and threaten global health and economic security.

My take: By the time the extent of the damage is understood, it will be too late to fix what this administration has destroyed. The toll in terms of death and suffering both in the U.S. and abroad will be hard to justify and not further the aim of making ‘America First.’

Related articles:

  1. D Wallace-Wells, NY Times 5/8/25: The $200 Billion Gamble: Bill Gates’s Plan to Wind Down His Foundation “He is committing the foundation to 20 more years of generous aid, more than $200 billion in total, targeting health and human development…The news comes at a time that will seem to many as a perilous one, given the Trump administration’s recent assault on foreign aid and indeed on the idea of global generosity itself….The journal Nature suggested that an overall cessation of U.S. aid funding could result in roughly 25 million additional deaths over 15 years.”
  2. J Riedl, The Atlantic 5/8/25: The Actual Math Behind DOGE’s Cuts “As an effort to meaningfully reduce federal spending, however, DOGE remains wholly unserious…The DOGE website now claims $165 billion in savings. However, it still details only a fraction of the supposed cuts, and earlier accounting errors have given way to new ones…Even assuming that the website’s stated savings have become twice as accurate as they were in February, annual savings would reach perhaps $15 billion, or 0.2 percent of federal spending…Total federal outlays in February and March were $86 billion (or 7 percent) higher than the levels from the same months a year ago, when adjusted for timing shifts. This spending growth—approximately $500 billion at an annualized rate—continues to be driven by the three-quarters of federal spending allocated to Social Security, Medicare, Medicaid, defense, veterans’ benefits, and interest costs. These massive expenses have been untouched by DOGE’s focus on small but controversial targets such as DEI contracts and Politico subscriptions…The bad news is that the project seems quite likely to expand long-term budget deficits. Slashing IRS enforcement will embolden tax evasion and reduce revenues by hundreds of billions of dollars over the decade. Laying off Department of Education employees who ensure collection of student-loan repayments will increase the deficit. Illegally terminated federal employees are already being reinstated with full back pay, leaving the government with little to show for its trouble besides mounting legal fees…None of this is to say that DOGE has failed. Musk might not have followed through on his unfocused and evolving promises to eliminate payment errors, balance the entire budget, and implement regulatory reform. But he has successfully given the White House cover to purge and intimidate the civil service, helped Congress justify exorbitant tax cuts, rewarded MAGA voters with revenge against their perceived enemies, and granted himself the ability to access sensitive government data and possibly ensure his companies’ continued government contracts. Sure, annual budget deficits remain on track to double over the next decade. But if you thought DOGE was really about cutting costs, you were never in on the joke.”
View of the Chattahoochee River from Don While Memorial Park, Sandy Springs, Ga

Pharmaceutical Company Sponsoring Telehealth Visits –Is This a Good Idea?

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ECF Brown et al NEJM 2025; 392: 1148-51. Partnerships between Pharmaceutical and Telehealth Companies — Increasing Access or Driving Inappropriate Prescribing?

This recent commentary discusses the upsides and pitfall of online platforms launched by pharmaceutical companies that direct users to websites run by telehealth companies.

An excerpt:

Proponents highlight the potential for pharmaceutical–telehealth partnerships to facilitate access to prescriptions for some patients, such as those in rural areas…. Virtual consultations can be cheaper and less time-consuming for patients than in-person appointments. For stigmatized conditions such as obesity, patients may be more likely to seek care …

But partnerships between drug and telehealth companies have prompted concerns as well…about the risks these arrangements pose in terms of inappropriate prescribing, inadequate follow-up care, and unnecessary spending on brand-name medications.1 There is also concern that telehealth advertisements, including those on social media, may be misleading, since they sometimes lack disclosures of a product’s risks and contraindications.

The key law governing these relationships in the United States is the federal Anti-Kickback Statute (AKS). The AKS is intended to prevent and penalize the use of financial incentives for patient referrals or other arrangements that encourage clinicians to provide inappropriate or unnecessary health care, thereby increasing government expenditures…

Under the AKS, a pharmaceutical company cannot compensate a telehealth company or its affiliated clinicians on the basis of the number or monetary value of prescribed products. Nor may a telehealth company pay a pharmaceutical company for making patient referrals…

The OIG also noted several characteristics of telehealth arrangements that heighten the risk of an AKS violation. These characteristics include patient recruitment using targeted advertising (including on social media), insufficient patient evaluation or follow-up, and steering of patients toward specific treatments without adequate consideration of clinical appropriateness or alternatives…

More information about the nature of financial arrangements between pharmaceutical and telehealth companies should be reported. Such reporting could be mandated as part of an expansion of the Physician Payments Sunshine Act.

My take: There needs to be closer scrutiny of the relationship between pharmaceutical companies and affiliated telehealth companies. While the online telehealth partnershps improve access, the current set up is likely to promote inappropriate care.

Mai Khao Beach, Phuket