Healthy Policy

Johns Hopkins reverses on comestics line

Yesterday I wrote about the revelation that Johns Hopkins will be partnering with Sephora to develop a "Johns Hopkins tested" cosmetics line.  Apparently I wasn't the only one uncomfortable with this announcement, as Hopkins retreated from the partnership today (again, via Health Care Renewal):

After the relationship was publicized and criticized, the Baltimore Sun reported that Johns Hopkins quickly decided to revise it. Johns Hopkins will no longer receive stock or a seat on the board of directors of the cosmetics company. Hopkins asked that company marketers "withdraw all references to JHM (Johns Hopkins Medicine) except for certain limited information - on product packages and in previously printed promotional material - that disclose JHM's consulting role," although so far the Sephora web-site's page for Klinger Advanced Aesthetics Cosmedicine has not been modified (as of April 10, 2006).

I'm with Roy Poses; Hopkins' retraction is a good move. 

Time for some reevaluating

Via Health Care Renewal, Johns Hopkins is starting a new venture:

The Baltimore Sun and the Wall Street Journal reported (the latter available here via the Pittsburg Post-Gazette) the latest venture by the revered Johns Hopkins University. They are collaborating with a cosmetic company whose products will be labeled as produced "in consultation with Johns Hopkins Medicine."

The Cosmedicine "premium skin-care line," per the Journal, will be sold by Sephora, a unit of LVMH Moet Hennesy Louis Vuitton, and manufactured by Klinger Advanced Aesthetics, a unit of TrueYou.com Inc. According to Dr Edward Miller, Chief Executive of Johns Hopkins Medicine and Dean of the School of Medicine (and also on the board of directors of Bradmer Pharmaceuticals, a Canadian biotechnology company), "We have been pretty clear about our role. We are reporting on the scientific validity of studies done by outside testing agencies." But, according to the Journal, "Johns Hopkins will also work with Klinger to develop clinical 'best practices for the company's chain of spa-clinics." Their offerings include "'light medical' services, such as Botox and Restylane shots...."

The Cosmedicine web-page proclaims,  "Cosmedicine, the only skincare line tested for performance and safety in clinical studies designed and analyzed in consultation with Johns Hopkins Medicine, a world leader in healthcare, education, and research."

For those of you outside Sephora's 13-25 y.o. female target audience, it's a large expensive cosmetics chain that's quite popular.  Mostly they carry a bunch of sparkly eye shadows and lipsticks, but apparently they're moving on to "age-defying" cosmetics. 

But I'm quite troubled that Johns Hopkins, a world renowed academic institution (and arguably the best med school in the U.S.), a top-notch treatment center (anyone remember ABC's "Hopkins 24/7" series from about six years ago?), is partnering with Sephora, aka the home for all things sparkly and cosmetic-y for young women. 

Should there be a differentiation between the institutions that perfect life-saving techniques and disease management with those who perfect cosmetic treatments? 

Aren't those different goals?

More than that; it's not just the testing and "approving" of cosmetic products, it's the promoting and profit sharing.  What's the logical extension of this?  Johns Hopkins approved medical devices? 

Exactly what price transparency isn't going to do

From the opening paragraph of this WaPo article:

Hospital bills are about to become less mysterious. Within a few weeks, the Bush administration plans to publish the prices Medicare pays for common medical procedures, a move that advocates for the poor say will pressure hospitals to give uninsured patients the discounts provided to people with insurance.

I hate to get all nit-picky on this, but I have to.

First of all, this is not going to make hospital bills less mysterious AT ALL.  There will still be five million billing codes, five million acronyms and foreign phrases, and lists and lists of things patients are charged for.  No, this has nothing to do with simplifying bills.

What it does do is list the price Medicare pays for certain procedures. 

But I'd like to see just exactly how, especially in the light of Medicare Part D, this listing is going to "give uninsured patients the discounts provided to people with insurance."

Really though, in the interest of fairness, let's look at how hospitals work with insurance companies.  The insurance company agrees to cover services at a given hospital, and the hospital agrees to charge discounted prices because of the guarantee of patients. 

What happens when an individual comes to the hospital?  They have no contract with the hospital.  If they're uninsured, they have no guarantee (nor can they make one) that they will return to the hospital for further business.  And lastly, if they're poor and uneducated, they have no access to these price lists, have never heard of these price lists, and certainly have no clue how to use price lists to leverage their payment.

That being said, Medicare, with its huge bargaining power, should have control over how much it pays for services, and use that as general tool to influence more uniform pricing.  Price transparency is generally a good thing, and something that we could certainly use more of.

But let's not be naive about what price transparency will accomplish. 

Hospital Challenges

Hospital Impact has an interesting take on the top five challenges identified as major threats to U.S. hospitals.  I'll leave the commentary up to Tony, with the exception of a point on medical malpractice.  Tony writes:

The average malpractice settlement more than tripled from $95,000 in 1986 to $320,000 in 2002. (can't argue with this one either, though we have to remember that inflation alone would bring the $95k to ~$180k. and on the whole, what % of a hospital's budget is dedicated to malpractice insurance/risk management processes?)

Standard inflation adds a certain amount, but the vast majority of the increase you're seeing there is technology.   Lifesaving advances are much much more expensive than they were in 1986, especially when you factor in scanning and imaging devices.  If you need extensive surgery or medical care due to medical injury, that care is simply much more expensive now than it was twenty years ago.