He wanted to do good, but could not. The system would not allow him.
Another model of transparency at work:
Hospital care is nearly 1/3 of overall spend on healthcare in America. At a recent @SenFinance hearing Dr G. Keith Smith, founder of the @SurgeryCenterOK testified that his surgery center “recently performed a tonsillectomy on a child for $3,875 after the family had been quoted $72,000 by a Dallas-area hospital. [The OSC’s] prices are generally half of what Medicare pays hospitals, and less than Medicaid payments to hospitals for the same procedure.”
How does the OSC do it? With publicly posted, transparent prices and without conventional insurance. When employers steer their employees in the direction of the OSC, they save tens of thousands of dollars by flying their employees to Oklahoma and paying directly for the procedures performed there.
@RogerMarshallMD (R-KS) and @Hickenlooper (D-CO) intro the Patients Deserve Price Tags Act. I brought up this bill at the onset of our discussion with @cherrigregg and @Avi_WA . The bill requires hospitals, surgery centers, imaging centers, and labs to report their negotiated rates and cash prices publicly. More than that, the bill would prohibit third-party insurers from concealing from insured employers the prices they are paying. Transparency for employers would be a huge boon to the 60% of Americans under 65 who have insurance provided through employers. The bill would also require that patients receive an itemized bill for services rendered.
We clearly need this fix, because the Executive order we have alone on Price Transparency is not enough. Per @PtRightsAdvoc only 21% of hospitals are fully compliant. What are they hiding? Maybe the fact that they are able to provide care for less.
Here is the whole hearing https://www.aging.senate.gov/hearings/modernizing-health-care-how-shoppable-services-improve-outcomes-and-lower-costs
There is so much inside baseball happening within these FDA trials that creates a ripe environment for distortion, allegations of ideology and politics, or other ad hominem attacks. Moreover , those suffering from untreatable chronic disease can easily be co-opted to advocate for companies developing treatments that could have promise but haven’t passed a reasonable bar for efficacy and safety. Someone or some organization has to stand in the breach and demand this standard. Whither critical appraisal?
x.com/i/article/203031182839…
R to @anish_koka: substack.com/@anishkokamd/no…
Better things to do than spend Saturday morning writing this, but important since there aren't enough actual journalists who can do their job. (link in reply)
The Prasad - FDA timeline
This is an incredible effort. It is many fold better than anything you could read in a top medical journal.
Not just for cardiologists either. A good read for economists as well.
Caveat Emptor, Caveat Lector.
Wrapping gossamer-thin evidence in an aura of AI might be a successful reimbursement strategy, but it does not make it authoritative or convincing!
@drjohnm @venkmurthy @anish_koka
👇🏻
💯
No FDA is better than this FDA.
At least return it to its pre Kefauver amendment days where its main focus was safety, not efficacy.
Everyone is not clear. And biotech world has created their own rules on what qualifies as working.
Best part is you get to pay for it.
Another must read on coronary CT from @anish_koka
The great debate on CT Plaque Volume Measurement - I took the opposing side in a live debate at an excellent local Indian Restaurant (Sura Bistro).
Thanks to @RogueRad for organizing.
My opponents side was unfortunately not recorded (I do summarize some of his points)
x.com/i/article/203009521099…
DOJ is targeting a doctor who treated over 100,000 patients during the pandemic with monoclonal antibodies.
@RonElfenbeinmd is now facing 50 years in prison over a bogus coding dispute.
@AGPamBondi should dismiss!
Another warrior for the truth sighted.
Ryan fin twit has some thoughts
Only looking out for greater good I’m sure.
Nah. I’ve seen enough.
Medicare should negotiate with drug companies the way they negotiate with doctors.
Just let them know what an appropriate price is.
Couldn’t sum it up better myself.
Yup. The public should wake up.
Medicare should have a global budget for pharma spend and set prices.. just like they do for physicians.
I see no other path given the current rigged system - the Ds and Rs that will push back —> all pharma funded.
lol. Why were they called? Who decided ? There is no way VP makes that decision given coverage by many of these outlets.
The origin story of this news cycle is uniqure CEO running to media after a rejection.
But you knew that. Again, all bad faith actors here.
What you’re seeing playing out by science media has little to do with actual science or how it’s supposed to be done.
These are friends of the Biden administration, political actors masquerading as journalists hell bent on proving how dysfunctional the FDA is with their former friends no longer in charge.
This campaign was set in motion the moment Marks/Fauci et. al. were forced out.
This is revenge.
I agree that randomized clinical trials, not comparisons to historical controls, needed for vast majority of approvals. I can only imagine how hard this could be for patients w/ terrible illnesses & their families, but truly helping such patients requires knowing what works.
Unless Marty colors within the lines the stat news reporters draw from now on, he’s out as well.
Prediction: Even if he does what they say and approves everything the Peter Marks FDA wanted, they wont stop until they claim his scalp as well.
My favorite illustration of the problems with propensity-score matching comes from Facebook
Their researchers had to use a massive set of 3,719 covariates to come close to matching the estimate produced by an experiment they ran
'Yeah, PSM works, just get 3,719 covariates, bro'
New Unreported Truths, about the FDA’s Catch-22…
Nothing to see here, folks! Move along. Thanks for posting, Anish. GKS
Who could have predicated that NPs who lobbied for independent practice without oversight to serve Rural and primary care shortages are mostly working in Med Spas, Addiction/Psych, Cardiology😳 with no supervision in FL.
Why CT-FFR Doesn't Work And Why Its Reference Standard Is Suspect Too
https://x.com/i/status/2029893569444524406 via @anish_koka
Finally someone entered boldly into this field.
MUST BE RED with open mind and will to challenge mainstream narrative.
Free , no paywall, so you know exactly who the FDA staffer is that’s speaking on condition of anonymity.
Sorry, not good faith.
Questionable tech, but hospital admins see a great marketing opportunity
Excellent! MUST READ read for anyone providing cardiac care to patients.
The visual is a Rube Goldberg machine - “an intentionally over-engineered contraption designed to perform a simple task in a comically complex, chain-reaction manner.”
R to @anish_koka: 14/14: Right question: Does acting on CT-FFR improve outcomes? No idea, and given issues discussed, doubtful a well done trial would be positive.
Until a positive trial on hard endpoints, it's a business model dressed up as diagnostic test.
R to @anish_koka: 12/14: Bottom line: CT-FFR is sophisticated but oversold. Rests on flawed assumptions, questionable reference standard, modest accuracy. No outcomes trial showing patient benefit. In stable CAD, revasc itself lacks mortality benefit (ORBITA/ISCHEMIA).
R to @anish_koka: 13/14: Good cardiologists use it as one data point, but push is to defer to the number. Reimbursement rewards more testing/procedures. Patients may demand fixes for "bad" numbers.
R to @anish_koka: 11/14: Incentives: Positive CT-FFR (often wrong) → cath → fees/stents. Belief cultivated via guidelines/pubs, but structure favors revenue over evidence.