Health care costs too much. Everyone agrees. But no one seems to know what to do about it.

If Obamacare survives Supreme Court review and takes effect in 2014, it will go a long way toward reducing the number of people without insurance. But it leaves the problem of rising costs relatively untouched. 

Obama’s plan is modeled on the Massachusetts law signed by then Governor Mitt Romney in 2006. When the state implemented that plan, it led the country in attacking the problem of uninsurance.

Massachusetts stands on the verge of leading again, this time in addressing high costs. Similar bills were introduced last week in each house of the state legislature to limit annual spending increases. Both would implement an aggressive new approach that is yet to be tested anywhere else.

by Daniel R. Hoffman, Ph.D.

The perfect storm into which pharma has navigated itself means that the most constructive observations ought to point out potentially fruitful, new directions for the industry. That has been the main emphasis from this quarter in 2012, but sometimes the week brings news so astonishing that gentle encouragement must step aside. So it was with the news that Abbott Labs agreed to pay $1.6 billion in fines and admit its guilt for marketing its anti-seizure medication, Depakote, to nursing homes for unapproved uses.

The penalties levied on Abbott, depending on how they're calculated, were the second or third highest in pharma history, yet taking into account the audacity of violations and the vulnerability of affected patients, the company got off lightly. The matter was not limited to an over-ambitious sales district or a brand team that paid speakers to spin fables for physicians at dinner meetings. Instead the company organized and trained a special sales force to sell Depakote for treating aggression and agitation in elderly dementia patients confined to nursing homes. For six years, starting in 2001, Abbott also promoted Depakote as an adjunct to antipsychotic drugs for treating schizophrenia, despite the fact that their own studies failed to show any benefit from adding the second drug.

As flagrant and deliberate as these Depakote violations were, they were not Abbott's first foray into illegal behavior. In 2001 a joint venture of Abbott and Takeda paid an $875 million fine for conspiring with physicians to bill Medicare for samples of a prostate cancer medication that Abbott gave the doctors for free. Two years later, Abbott paid another $600 million fine because its nutritional products sales people helped hospital and long-term care facilities pull a similar scam on health insurers. Abbott sold the providers liquid meal products at discount prices and then corroborated reimbursement requests the institutions submitted to insurers for the full price.

Does your doctor telephone prescriptions over a cell phone? We asked pharmacists if they had ever experienced a “case of bad cellular” when receiving telephone orders via cell phones. Over 40 percent responded that they did and all clearly felt that the opportunity for a medication error exists.

Here’s what we learned. Physicians made cellular calls most frequently after office hours, on weekends, while in cars, at home or at social events. Often they seemed to be in a hurry to return to their previous activity and may not have given the prescribing task their full attention. Poor transmission clarity and failed connections requiring callbacks were cited as frequent problems.

Factors such as make and model of the phone, wireless carrier, calling area transmission, handset vs. speakerphone use, and general background noise from the road, home or social events all posed threats to accurate transmission of prescription information. This is especially true if a message is left on the pharmacy voice mail. If follow-up calls were needed for clarification, the pharmacist often did not have the physician’s cell phone number. Also, since physicians often did not have access to the patient’s medical records, they could not answer questions about allergies, weight, or other medications. Likewise, the medications prescribed were less likely to be documented in the patient’s record, since it was not available. That could obviously cause problems later on, due to the missing medical information.

Most pharmacists reported difficulty recognizing the physician’s voice on the phone and verifying their identity. Some reported that it was especially difficult when the consumer initiated the call to the physician while at the pharmacy counter. In many cases pharmacists will ask the prescriber to call the pharmacy back using an office phone line. For obvious reasons, many pharmacists will not accept certain prescriptions at all via a cell phone call that is initiated by a patient at the counter.

A year ago, Inquirer Sports Editor John Quinn, overweight and feeling it, would never have dreamed he would be competing in the Broad Street Run on May 6. In this final blog entry, he shares the experience of running the race. Check out all of our Broad Street Run coverage at www.philly.com/broadstreetrun.

You go to the gym every day, with a goal in mind. Run Broad Street.

It was the fear of the unknown that motivated you and scared the hell out of you, too, as the day approached.

Then comes the fateful Sunday morning. You get to the parking lot early, you take the SEPTA express, you check your gear, you go to the bathroom.

Beth Wallace, a dietition at Children's Hospital of Philadelphia, chronicled the journey of her and her motley group of roomates as they battled to beat each other in the Broad Street Run. In this final installment, she talks about an unexpected turn during the race. Check out all of our Broad Street Run coverage at www.philly.com/broadstreetrun.

Let me set the stage for you ...

At 8:20, Soup and I said goodbye and good luck to Joe and J.P., and made our way into the orange corral. Soup looked at me, and said, “I like that quote that says, ‘leave your doubts at the starting line.’” I smiled and agreed, but today, I had no doubts in my mind. 

I worked, I was ready, and I was going to come home to Manayunk with pride. The guys would have to tell their friends they had been beaten by a girl. This girl. 

Beth Wallace, a dietition at Children's Hospital of Philadelphia, is chronicling the journey of her and her motley group of roomates as they battle to beat each other in the Broad Street Run. In this fifth installment, she sets provides advice for the fans. Check out all of our Broad Street Run coverage at www.philly.com/broadstreetrun.

If Philly is known for anything, it’s cheesesteaks, Rocky, and  serious sports fans. As the biggest race in Philadelphia is right around the corner, I would be remiss not to acknowledge one very important piece of the experience: the fans.

So I hand the podium over to Bridget; my dear friend, running companion, and captain of my cheer squad, for her tips on:

How to be a Broad Street Run Super Fan

A year ago, Inquirer Sports Editor John Quinn, overweight and feeling it, would never have dreamed he would be competing in the Broad Street Run on May 6. Yet, here he is, and the race is looming. In this fifth blog entry, he talks about getting the bib. Check out all of our Broad Street Run coverage at www.philly.com/broadstreetrun.

The first leg of the Broad Street Run came Friday morning around 11 a.m. when I joined the line at Lincoln Financial Field in an attempt to get my race bib.

The drizzle/fog was burning off and the heat started to rise as I meandered up the concrete hallways toward the mysterious final destination.

Everyone took the wait in stride. Years on the Schuylkill can do that to you.

Beth Wallace, a dietition at Children's Hospital of Philadelphia, is chronicling the journey of her and her motley group of roomates as they battle to beat each other in the Broad Street Run. In this fourth installment, she sets the scene for race day. Check out all of our Broad Street Run coverage at www.philly.com/broadstreetrun.

We may be entering the orange corral as a group of three, not four, on Sunday.

Last Saturday, J.P. and a few friends planned to meet at Lloyd Hall for a final run around the loop before retiring their legs for the race day. Like an annoying little sister, I invited myself along to the join them for the 8.5 miles.  “I will drive,” I said to ensure my position in the plans. J.P. politely faked his enthusiasm for my crashing the party, and we met the group at 8 a.m. sharp.

It was the perfect day for a run — a cool, dewy spring morning with just the right amount of sun for warmth. We started with a steady, easy pace, and the first few miles were over in no time. Every now and then someone would take their headphones off to pretend that they were interested in something that I was talking about, but they mostly just nodded and smiled. It didn’t matter; I just enjoyed the chance to talk to someone other than my Australian Shepherd on a run.