Conrad Theodore Seitz

The eye drug Lucentis, which costs thousands of dollars a dose and is no better than a drug made by the same company that costs $50, has some interesting correlations with abnormal donations by a top prescribing ophthalmologist to the Democratic Party.

The New York Times reported on the top billers to Medicare with a special reference to a Dr. Melgen, who was the top recipient of Medicare reimbursements in 2012:

“Topping the list is Dr. Salomon E. Melgen, 59, an ophthalmologist from North Palm Beach, Fla., who received $21 million in Medicare reimbursements in 2012 alone. The doctor billed a bulk of his reimbursements for Lucentis, a medication used to treat macular degeneration made by a company that pays generous rebates to its doctors.”

And this:

“Dr. Melgen’s firm donated more than $700,000 to Majority PAC, a super PAC run by former aides to the Senate majority leader, Harry Reid, Democrat of Nevada. The super PAC then spent $600,000 to help re-elect Senator Robert Menendez, Democrat of New Jersey, who is a close friend of Dr. Melgen’s. Last year, Mr. Menendez himself became a target of investigation after the senator intervened on behalf of Dr. Melgen with federal officials and took flights on his private jet.”

The second highest recipient of Medicare reimbursements was an interventional cardiologist who performed cardiac procedures in his clinic that were usually done in a hospital; he received $18 million in 2012 and donated $250,000 to the Democratic party over the last ten years.

The third highest recipient was a pathologist from New Jersey who received over $12 million in 2012.

For some reason, Florida is the preferred habitation of some of the country’s highest paid physicians; in fraud cases recently settled, for example:

“Just last month, two Florida medical clinic owners were sentenced on charges of Medicare fraud, both in cases involving more than $20 million in fraudulent payments. In addition, the Halifax Hospital Medical Center in Daytona Beach, Fla., agreed to pay the government $85 million to resolve allegations that it had billed Medicare for care based on referrals from doctors who had a financial relationship with the institution, a forbidden practice.”

Florida is also the preferred place to live for rich fugitives from Latin America, particularly the Isaias family of Ecuador:

In another case of fairly obvious pay for play donations, this family won special treatment from the State Department after making a number of donations each in the tens of thousands of dollars.  One member of the family, Estefania Isaias, had been banned from the US after fraudulently obtaining visas for her maids to stay in the US.  After donating over a hundred thousand dollars to the Democratic Party, she was allowed to return to the US.  The family’s patriarchs, Roberto and William Isaias, were accused of looting a bank they owned in Ecuador and fleeing to the US to live off the profits.  Ecuador has requested extradition without success.  They were sentenced in absentia to 8 years in prison in 2012; Ecuador claims that the fraud cost their country $400 million.

Senator Robert Menendez, Democrat of New Jersey, ran a campaign for more than a year to help Ms. Isaias.  In an email dated May 15, 2012, Mr. Menendez’ office sent Ms. Isaias the good news that her ban from the US had been dropped.  On May 14, Ms. Isaias’ mother gave $40,000 to the Obama Victory Fund.  Ms. Isaias has a sister, Maria, who was also banned from the US for the same reason.  Her case is apparently under review and Mr. Menendez’ letter to the US Citizen and Immigration office has triggered an inquiry by the Homeland Security Investigations.

Homeland Security is still trying to have the Isaias brothers extradited to Ecuador.  The family has some support on Capitol Hill because the Ecuadorean government is considered leftist and the president is especially disliked by right wing congressmen.  Nonetheless, the political contribution angle has raised concerns, partly because the New Jersey congressman can’t consider Ms. Isaias a constituent.  Congressmen are well known and accepted for helping their constituents with government problems, but Ms. Isaias is not in the category usually helped.

The company that sponsored Ms. Isaias’ visa application is run by an Obama fund raiser; this company, Balsera Communications, would have to continue to employ her for the three years that her visa runs.  The company has a website that lists twelve employees with biographies but doesn’t mention Ms. Isaias, and Mr. Balsera refused to answer any questions about Ms. Isaias from the newspaper.  The company has close ties to the Administration, and the paper commented:

“David A. Duckenfield, a partner at the company who is now on leave for a position as deputy assistant secretary of public affairs at the State Department, said Ms. Isaías worked for the firm but declined to comment further.”

In an interview obtained elsewhere earlier this year, Roberto Isaias said his family’s political donations were targeted towards politicians who support “human rights and freedom of speech in Latin America.”

Do not be fooled by  the fact that these instances of corruption can be laid to Democratic politicians.  If the Executive Department of the US government had been under the control of Republicans, these donations would have gone to Republican entities.  These examples show that the US political system is hopelessly corrupt because donations to the major political parties can be used to buy influence and specific favors; political help is available only to wealthy citizens (and aliens), not to the ordinary American.

We have harped on high medical costs in the US again and again, and the New York Times has provided reams of documentation for this shameful situation.  A December 15 article, part of a series, concentrates on the cost of echocardiograms.

An example is the cost that a recent patient was charged at a community hospital: $5,500.  For the same test, arguably more advanced, at a university hospital, with a cardiologist supervising, he was charged $1,400.  Medicare pays roughly $400 for the test at a hospital, so the reimbursement was the same.  By contrast, Medicare only pays $93 for an echocardiogram performed at an outpatient clinic.  A patient usually pays $80 towards the fee under Medicare.  The number of echocardiograms ordered has almost doubled in the last ten years.

In the rest of the developed world, prices are significantly lower.  Japan, which lays claim to development of the echo technology, charges are $50 to $88.  Germany pays $115.

To illustrate the results of this cost structure, Japan spends about 9.6% of its GDP on healthcare, or $4000, while the US spends 17%, or over $9000.  The life expectancy at birth in Japan is considerably longer than that in the US.

The companies in the US that make ultrasound scanners refuse to publicly disclose their prices.  Medical prices in the US also include much larger proportions of administrative costs, including people who make decisions as to whether doctors will be allowed to order tests in the first place.  These administrative costs are much higher for private insurance companies than for Medicare, contradicting the “common knowledge” that government costs are higher than private costs.

In other developed countries, costs are controlled by government bodies, which allow “reasonable” profits by providers and manufacturers and keep close track of utilization.  In the US, charges by providers and manufacturers are not controlled at all.  Only reimbursements by Medicare and Medicaid are controlled by government bodies.

This results in a wide range of prices, with the uninsured patients paying enormously more than privately insured patients, who pay vastly more than Medicare patients, who pay more than Medicaid patients.  As a result, half of doctors in the US don’t even accept Medicaid patients at all; those who do, find that Medicaid patients make up half of their practices.

The NYT article can be found at: http://www.nytimes.com/2014/12/16/health/the-odd-math-of-medical-tests-one-echocardiogram-two-prices-both-high.html

“Socrates” of the New York Times commentariat wrote this interesting comment yesterday:

Dick Cheney doesn’t have all the key behavioral characteristics that define sociopathy and psychopathy, but he has the most important ones:

(The DSM – Diagnostic and Statistical Manual of Mental Disorders – published by the American Psychiatric Association prefers the term ‘antisocial personality disorder’ to psychopath and sociopath)

Superficial charm and good intelligence

Absence of nervousness or neurotic manifestations

Untruthfulness and insincerity

Lack of remorse and shame

Inadequately motivated antisocial behavior

Poor judgment and failure to learn by experience

Pathologic egocentricity and incapacity for love

General poverty in major affective reactions

Specific loss of insight

Unresponsiveness in general interpersonal relations

Dick Cheney’s rigid and remorseless certainty of the impeachable ‘success’ of the Iraq debacle and the CIA torture debacle – among many other Bush-Cheney debacles – cement him as one of the preeminent sociopaths in American history.

Mark Fallon wrote a piece in Politico called “Dick Cheney was Lying.”

I’m sure you’ve never heard of Mark Fallon, so this is how he was described in the Politico piece: “Mark Fallon served as an interrogator for more than 30 years, including as a Naval Criminal Investigative Service special agent and within the Department of Homeland Security, as the assistant director for training of the Federal Law Enforcement Training Center.”

Here’s a quote from his piece that explains why torture doesn’t work: “Yes, torture makes people talk—but what they say is often untrue. Seeking to stop the pain, people subjected to torture tend to say what they believe their interrogators want to hear.”

What DOES work, and sometimes amazingly well, is to befriend the detainee and offer him positive reinforcement for just talking, about anything that you want to talk about. The shock and relief of being treated well loosens the tongue and makes the detainee want to be helpful, rather than making him try to guess what you want to hear so the pain will stop.

Here’s a link to his piece: http://www.politico.com/magazine/story/2014/12/torture-report-dick-cheney-110306.html#.VItoLTHF98E

And here’s a quote that I’ve seen several times in the last few days:

“Should any American soldier be so base and infamous as to injure any [prisoner]. . . I do most earnestly enjoin you to bring him to such severe and exemplary punishment as the enormity of the crime may require. Should it extend to death itself, it will not be disproportional to its guilt at such a time and in such a cause… for by such conduct they bring shame, disgrace and ruin to themselves and their country.” – George Washington, charge to the Northern Expeditionary Force, Sept. 14, 1775…

The irony about the Senate report on torture (a 500 page summary of a 6,000 page document, heavily redacted by the CIA itself) is that so many other things, probably even more horrifying, will never be revealed.

Even the innocent prisoners (and at least a quarter of them were completely innocent) got precious little relief if they survived the brutal interrogations and months of solitary confinement.  One innocent man, who was literally sold to the CIA for a bounty, died after five days of unrelenting torture.  Another such prisoner, when it was discovered after five months of torture that he had nothing to do with terrorism, was dropped off on a lonely road in a Central European country where he didn’t speak the language.  He was left to walk home alone, with no resources, and finally made it back to a family that had long thought he was dead.  Some innocent prisoners are still under confinement at Guantanamo Bay.

Warning to all Americans: our government is doing things that are clearly unethical, brutal, and frankly evil, and we will never find out who did these things or who approved them.  Is there any wonder that foreigners hate us?

See also the photo of the Notch, a close-up view of the land beyond the labyrinth in Sheep Mesa.

Avastin is a full-length monoclonal antibody, that is, it has both antigen binding sites the same as an antibody produced within the body.  Lucentis turns out to be a half-length monoclonal antibody, that is, it is half as big and only has one antigen binding site.  Both compounds are produced by Genentech.

Avastin has been used experimentally since 2005 for treating wet macular degeneration, and it really does work.  It does not work for its approved indication, which is adjunctive therapy in advanced metastatic cancers.  It is supplied in 100 and 400 mg vials.  To prepare an intraocular dose, one must withdraw 1.25 or 2.5 from this vial into a sterile syringe.  The contents are then injected into the vitreal humor of the eye.

Lucentis is approved for wet macular degeneration, and is distributed by the company in single-dose vials.

The major difference between these two drugs is that a vial of Avastin can be broken up into over fifty individual doses, which cuts the price down to $50 a shot.  Lucentis, on the other hand, is vastly more expensive.

The worst part about this situation is that Avastin is approved for an indication where it does no good because the patient is usually too far gone, and costs big money for those full vials that are injected intravenously.  The situation where it actually works requires the physician or a compounding pharmacy to withdraw the required amount into a syringe, making many doses from one vial and cutting the cost exponentially.

At the same time, the company produces and has had approved by the FDA a drug which is virtually identical, and testing has shown to be in reality identical in efficacy, which is conveniently supplied in individual doses for a cost even greater than that of a full vial of the Avastin it mirrors.

Thus, we have full clarity of purpose: to charge a really huge amount for a drug that works and is FDA approved, and hope to get it paid for by the patient or insurance company.  Eventually some one pays the demanded price because it really works and the alternative is eventual blindness.  The purpose is to make the largest amount of money possible.