Your Weekly Update of News and Reviews
September 16, 2018
Consumer Health Digest is a free weekly e-mail newsletter edited by William M. London, Ed.D., M.P.H., with help from Stephen Barrett, M.D. It summarizes scientific reports; legislative developments; enforcement actions; news reports; Web site evaluations; recommended and nonrecommended books; and other information relevant to consumer protection and consumer decision-making. Its primary focus is on health, but occasionally it includes non-health scams and practical tips.
“Bioidentical hormone” prescriber disciplined. Prudence Hall, M.D. who operates The Hall Center in Santa Monica, California, has been placed on probation by the Medical Board of California. In 2017, the board accused her of unprofessional conduct, negligence, and inadequate record-keeping in her management of two patient identified as “L.H.” and “M.S.” The accusation stated:
- Both patients were treated unnecessarily for various supposed hormonal problems even though they had normal tests or no relevant tests before the treatment was started.
- In her initial assessment, Hall concluded that L.H. (a) was perimenopausal (despite having regular periods), (b) had abnormally low levels of thyroid hormone, adrenal hormone, and vitamin D3 (without performing any appropriate laboratory tests), and (c) had several other hormonal difficulties (despite having had normal laboratory tests for these hormones). During the same visit, Hall prescribed six hormones plus vitamin D, iodine, and lemon drops.
- During the next three years, Hall charged L.H. more than $7,000 for the unnecessary hormones.
- During the second and third years, Hall was “grossly negligent” in failing to properly investigate uterine bleeding, reported by L.H., which turned out to be due to cancer of the uterus.
- Hall diagnosed M.S. with hypothyroidism (low thyroid) even though she had normal laboratory test values and no relevant symptoms.
- Hall acted negligently by “diagnosing M.S. with perimenopause despite no objective evidence of such condition and then treated that incorrect diagnosis in a manner that stood to gain financially.”
- Hall’s notes for both patients were “incomplete, illegible and wholly lacking in required information.”
In 2018, Hall signed a consent order under which was placed on probation for four years and required to complete (a) a comprehensive clinical competence assessment program, (b) a specified course in ethics, and (c) at least 40 hours of additional continuing education “aimed at correcting any areas of deficient practice or knowledge.” She must also engage a board-approved specialist to monitor her practice or engage in a board-approved professional enhancement program that includes chart reviews and periodic assessments. The board also barred her from supervising physician assistants or advanced practice nurses or representing herself as a specialist in obstetrics, gynecology, or “hormone therapy.”
Hall has received testimonials from celebrity patients such as model Cindy Crawford and actress-author Suzanne Somers and has promoted bioidentical hormone therapy on the Oprah Winfrey Network. [Ostrov BF. Doctor to the stars disciplined over use of controversial menopause therapy. Kaiser Health News. Sept 12, 2018]
Crowdfunding campaigns for dubious cancer treatments investigated. A year-long investigation by the Good Thinking Society, a charity that promotes scientific thinking, has revealed that since 2012:
- Cancer patients in the UK have raised at least ₤8 million through 540 appeals on the crowdfunding sites GoFundMe and JustGiving to pursue costly unproven and disproven cancer treatments, mostly offered at overseas clinics in Germany, Mexico, and the U.S.
- 223 of the appeals received positive coverage in the local or national media.
- More than 140 of the patients who made appeals have subsequently died. [Marsh. BMJ publishes Good Thinking’s cancer fundraising investigation. Good Thinking. Sept 12, 2018]
Clinics that attract crowdfunded patients have been criticized for their lack of transparency and communication about costs, courses of treatments, and expected treatment outcomes. Newspaper and television reports about people with cancer seeking crowdfunding rarely reveal that (a) donations support dubious treatments and (b) many publicized success stories have a tragic ending. [Newman M. Is cancer fundraising fueling quackery? BMJ 362:k3829, Sept 12, 2018]
Interactive graphic spotlights prescription drug overpayments. The University of Southern California’s Schaeffer Center for Health Policy and Economics has released an interactive graphic and a 2-minute videothat show how, for hundreds of commonly prescribed drugs, insurance co-payments exceed the retail price of the drug. [Hedt S. Gersema S. Who wins when a prescription copy exceeds the drug price? Leonard D. Schaeffer Center for Health Policy & Economics, July 18, 2018] The information is derived from the researchers’ study that appeared in the Journal of the American Medical Association and a corresponding Center white paper in March. The study was based on national data collected by the Centers for Medicare and Medicaid Services. The key findings include:
- Overpayments were frequently made for antibiotics, statins, anti-hypertensives, sleep aids, anti-inflammatories, and cough and cold medications.
- The co-payment exceeds the cost to the insurer in 23% of claims in 2013.
- 28% of generic drug claims and 6% of branded drug claims involved overpayments.
- The average overpayment for generic drug claims was $7.32 while the average overpayment for branded drug claims was $13.46.
In an overpayment situation (also known as a co-pay clawback), patients pay their share of the cost—the copay set by their pharmacy-benefit manager (PBM) and insurance plan. Days or weeks later, the PBM firm takes back a portion of the copay from the pharmacy after the PBM determines what it will actually pay for the drug. The extra amount does not go to the consumer but is kept by the PBM. In such cases, patients would be better off paying for the drug out-of-pocket instead of using their insurance. [Appleby J. Better off paying cash. Kaiser Health News, June 24, 2016] One of the Schaeffer Center researchers no longer believes that pharmacy-benefit managers play a valuable role in restraining drug prices. He wants federal regulators to be empowered to restore order. [Joyce G. An economist’s change of heart: It’s time to regulate the prescription-drug middlemen. MarketWatch, Aug 20, 2018]
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