Articles by JCS

Price in Not Right

Part 4

Word count: 2643

This Price is Not Right

“Don't just follow the money, follow the lies.”

Carl Bernstein, Watergate journalist speaking at the previous White House Correspondent Dinner

Many people recall the daytime television game show with Bob Barker, The Price is Right, where contestants guess the cost of merchandise. If they guess right, they win; but most contestants lost, just as most patients also lose in the medical game, considering medical bills are the leading cause of bankruptcy in the US.

Just as the appointment of Alabama US Senator Jefferson Beauregard Sessions, III, as Attorney General was a very bad omen for civil rights advocates, the selection of Dr. Tom Price as the new Secretary at HHS certainly doesn’t bode well for chiropractors or for healthcare reform in general.

As an orthopedist, not only does Sec. Price have a conflict of interest against chiropractors, he is being investigated for allegedly trading stocks of health-related companies while working on legislation affecting the firms.[1]

The Wrong Price

Unfortunately, the price of healthcare is never right, which explains why There is just too much money and too few ethics to allow fair competition in spine care—the largest expense in medicine—and follow the new guidelines endorsing nondrug, nonsurgical care first.

Despite the call for healthcare reform to reduce costs and improve outcomes, in the fee-for-service American healthcare system Dr. Price and his orthopedic colleagues like the status quo just the way it is, thank you very much, with high costs and a virtual medical monopoly. The American medical system avoids any semblance of a free market to let chiropractors compete on a level playing field.

Don’t expect any progress in healthcare matters from Dr. Price, a red-neck alt-right legislator from Georgia, who has maintained strong conservative positions on healthcare policy. Price is on record of supporting the dismantling of Medicare and Medicaid, opposing abortion rights and medicinal/recreational pot; he opposes regulations on tobacco and he belongs to a small, fringe, ultra-conservative and conspiracy-laden group called the Association of American Physicians and Surgeons.

Dr. Arnold Milstein from Stanford’s Clinical Excellence Research Center also mentioned in the Washington Monthly that Dr. Price is not an innovator in healthcare:

“The Affordable Care Act created the Center for Medicare & Medicaid Innovation, which supports new models of care delivery. But Tom Price, the new health and human services secretary, has made no secret of his disdain for the CMMI and any effort to reform fee-for-service payment.”

Dr. Price is Not Right for Chiropractors

Nor should we expect Dr. Price to acknowledge the recent string of positive events for the chiropractic profession and fully implement chiro care to reduce costs for “low-value” services such as back surgery, to slow the opioid crisis, and offset the poor outcomes and disability from spine surgery.

A good example of an upcoming fight with Dr. Price will occur after the May 18, 2017, Statement for the Record Submitted by the American Chiropractic Association to the U.S. House Committee on Ways and Means, Subcommittee on Health “Hearing on the Current Status of the Medicare Program, Payment Systems, and Extenders”:

In closing, at a time when the need to reform health care delivery is so critical, beneficiaries must have access to all effective, efficient, justified and coordinated treatment options. Given the prevalence of acute and chronic musculoskeletal conditions in today’s society, Congress should embrace the opportunity to reform federal government health care policy and encourage the use of -- and provide access to – chiropractic care and other conservative, non-drug, non-surgical treatment options. Integration of these services will allow for the delivery of high quality care with strong patient outcomes, increased program efficiency, contribute to an overall reduction in Medicare spending and ensure the solvency of Medicare.

The ACA’s call for expanding the role of nondrug chiropractic care is a logical suggestion considering the recent guidelines such as the American College of Physicians and JAMA endorse SMT for the pandemic of low back pain and opioid abuse, but don’t expect Dr. Price to share the ACA’s wishes to expand and intrude into the orthopedists’ lucrative field.

Attorney/journalist Steven Brill in his TIME cover article, “Bitter Pill: Why Medical Bills Are Killing Us,” discusses how badly the medical system is broken and spoke of the lack of free enterprise in healthcare in a lengthy 36-page exposé:

"It’s about facing the reality that our largest consumer product by far—one-fifth of our economy—does not operate in a free market…We’ve created a secure, prosperous island in an economy that is suffering under the weight of the riches those on the island extract. And we’ve allowed those on the island and their lobbyists and allies to control the debate…”

Indeed, now their biggest ally is Sec. Tom Price, guardian of the preposterous medical island. Considering  the median salary for the 75th percentile of orthopedic surgeons is around $555,789 and he highest annual salary for spine surgeons is about $710,055 per year, if he were to enforce the ACP and JAMA guidelines promoting conservative care as the front-line treatments, his colleagues would be livid—there is no room on their prosperous island for second-class providers such as chiropractors.

The Price is Too High

Sec. Price also knows not to bite the hands that feed him. Health professionals alone contributed $474,070 in 2016 to his Campaign Committee and Leadership PAC combined and Pharmaceuticals/Health Products contributed another $166,400. Donors included Abbot Laboratories, Pfizer, and Zimmer Biomet PACs.

Total contributions to Rep. Price reached nearly $2.4 million. Price, first elected to Congress from Georgia in 2004, is ranked as the 50th richest member of Congress by the Capitol Hill publication Roll Call. 2 Now as Secretary of Health & Human Services, Tom Price ranks 8th in the Trump’s cabinet with an estimated net worth of $14,063,132 in 2016.

According to, total contributions for health issues were $515,482,528 in 2016. The total contributions by health professionals to federal candidates and parties amounted to $84,849,148 ($133,620 per congressman) for the election cycle ending in 2016.

The AMA alone contributed $19,410,000 in 2016 ($36,728 per congressman). In comparison, the American Chiropractic Association 2016 PAC contributions to federal candidates (39% to Democrats, 61% to Republicans) was $157,250 ($245 per congressman).

And we wonder why we get short shrift on Capitol Hill (which should be renamed Capital Hill)?

As I experienced personally with my US Rep. Austin Scott whose father is an orthopedist, this medical mafia family has stronger ties than does the law when it comes to healthcare and implementing chiropractic into TRICARE and federal workers’ comp programs.

Dirty Price

Dr. Price came under scrutiny for insider-trading during his confirmation hearings for investments he made while serving in Congress. The Georgia lawmaker traded hundreds of thousands of dollars worth of shares in health-related companies, even as he voted on and sponsored legislation affecting the industry.

  • In December, the Wall Street Journal reported  Price traded more than $300,000 worth of shares in health companies over a recent four-year period, while taking actions that could have affected those companies. Price, an orthopedic surgeon, chaired the powerful House Budget Committee and sat on the Ways and Means Committee’s health panel.
  • A second transaction that drew scrutiny was a 2016 purchase of between $1,001 and $15,000 in shares of medical device manufacturer Zimmer Biomet. CNN reported that days after Price bought the stock, he introduced legislation to delay a regulation that would have hurt Zimmer Biomet.
  • In a third case reported by Time magazine, Price invested thousands of dollars in six pharmaceutical companies before leading a legislative and public relations effort that eventually killed proposed regulations that would have harmed those companies.

Rep. Louise Slaughter, (D-NY), who sponsored the STOCK Act, wrote in January to the SEC asking that the agency investigate Price’s stock trades. “The fact that these trades were made and in many cases timed to achieve significant earnings or avoid losses would lead a reasonable person to question whether the transactions were triggered by insider knowledge.”

“You’re Fired, Too!”

The investigation into Price’s trades by federal attorney Preet Bharara in the U.S. Attorney’s Office for the Southern District of New York was underway at the time of his sudden dismissal. As we witnessed when former FBI Director James Comey was fired when his investigation into Mike Flynn’s and President Trump’s ties with Russia got too close, the same thing happened with Bharara’s investigation of Dr. Price.

According to an article in ProPublica, Bharara was one of 46 U.S. attorneys asked to resign after Trump took office. Although standard for new presidents to replace officials with their own appointees, Bharara’s firing came as a surprise because the president had met with Trump who asked if he would remain in his post, and Bharara said he agreed to stay on.

When the Trump administration instead asked for Bharara’s resignation, the prosecutor refused, and he said he was then fired, just like James Comey. Apparently any investigation into the Trump administration or cabinet members results in sudden dismissal.

Sec. Price’s stock portfolio includes investments in pharmaceutical, medical device, and health insurance companies, the heart of the industries he would be overseeing as secretary. Obviously there is an appearance of many conflicts of interest.

An HHS ethics official lists 43 companies from which Price pledged to divest his interest within 90 days of his confirmation, including Aetna, Amgen, Eli Lilly, and Pfizer.

Sale Price

The most curious conflict occurred when a tiny Australian biotech firm Innate Immunotherapeutics needed to raise money last summer, it offered a sweetheart deal to “sophisticated U.S. investors.”

According to an article in ProPublica, “Tom Price Bought Drug Stocks. Then He Pushed Pharma’s Agenda in Australia,” before he was named Trump’s health secretary, Price took a congressional trip to Australia and pressed officials to extend protections for drug companies in an international trade agreement.

 Innate Immunotherapeutics sold nearly $1 million in discounted shares to two American congressmen sitting on House committees with the potential power to advance the company’s interests—Rep. Tom Price (D-GA) and Rep. Chris Collins (R-NY).

They paid 18 cents a share for a stake in a company that was rapidly escalating in value, rising to more than 90 cents as the company promoted an aggressive plan to sell to a major pharmaceutical company.

However, this bounty was short-lived when the bottom fell out.

Innate Immunotherapeutics’s lead drug, an investigational treatment for multiple sclerosis, failed in a 93-patient trial, demonstrating no benefit over placebo.1 The company’s drug, MIS416, failed on every measure of efficacy in the clinical trial. Innate’s share price promptly fell by more than 90 percent to 4 cents a share.

Dr. Price sold shares in Innate Immunotherapeutics in February for $320,000, or some $225,000 more than his $94,000 investment, getting out before the stock collapsed, according to disclosure reports in The Wall Street Journal.
Coincidence or collusion?

This begs the appearance of insider-trading: did Price have knowledge of the disapproval of this drug before the bottom fell out or was it a case of good luck? Go figure.

However, Rep. Collins suffered a paper loss of $22 million with 17% of Innate's shares. Apparently Rep. Price didn’t share his insider information with Collins.

Rep. Rosa DeLauro (D-Conn) has called on Price to eliminate any potential conflicts of interest by divesting and putting his assets in a blind trust.

“I hope that Dr. Price will hold himself to a higher ethical standard than his new boss,” DeLauro said. “Mr. Price must set his business dealings aside and work for the American people, not the pharmaceutical industry.”

Price Disruption

Another conflict of interest concerns Dr. Price’s resistance to policy designed to eliminate unnecessary procedures and exorbitant costs.

Dr. Price has made no secret of his disdain to reform the expensive fee-for-service payments that lead to unnecessary procedures, and at the top of this list are medical spine care treatments. In 2014, Medicare spent anywhere from $2.4 billion to $6.5 billion on these types of services, which are known as "low-value care."

The Affordable Care Act (ACA) and the Medicare and CHIP Reauthorization Act (MACRA) provided the Centers for Medicare & Medicaid Services (CMS) and the newly created Center for Medicare and Medicaid Innovation (CMMI) tremendous authority to implement studies examining the biggest offenders of low-value care that comprises one-third of healthcare spending.

Of course, at the top of this list are back surgeries.

 “Reducing the use of such services cannot only help curb health care costs, but it can also protect patients from the potentially harmful effects associated with them,” according to John Mafi, MD.

The “Innovation Center” was established by Section 3021 of the Affordable Care Act. The Innovation Center is tasked with testing innovative health care payment and service delivery models with the potential to improve the quality of care and reduce Medicare, Medicaid, and CHIP expenditures. 

Several members of the Medicare Payment Advisory Commission (MedPAC) said Medicare should work harder on ferreting out the services it shouldn't be paying for because they either don't help patients or actually do them harm.

"Well-established guidelines for routine back pain stress conservative management, including use of nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen and physical therapy," wrote Dr. John Mafi.[2]

Despite these guidelines, researchers found that doctors were doing much the opposite and with Sec. Price at the helm, this opposition will remain entrenched.

Nationally, back and neck problems are responsible for more than 10% of all visits to primary care physicians and account for $86 billion in healthcare spending every year. According to study authors, spending on these conditions has increased more rapidly than overall health expenditures from 1997 to 2005.

“This form of surgery in workers’ compensation subjects appears to be a gamble at best,” according to the editors of The BACKLETTER. In another workers’ compensation study from Kentucky by Leah Carreon, MD, et al., only 19 percent of patients had a clinically significant improvement in disability after fusion surgery. “Surgeons should be cautious in discussing the effectiveness of lumbar fusion for patients on workers’ compensation,” said Carreon.[3]

Dr. Steven Atlas, MD, shared his thoughts with the editors of The BACKLETTER:

In my experience, patients don’t want spinal fusion when they’re given good information—that is why I favor a shared decision-making approach. Others would argue that we should stop doing this expensive procedure until we show that it provides a benefit. But that is not how we do things at present in the United States. But if we don’t see rates of spinal fusion dropping—then maybe it would be time to simply say no.[4]

Not only are most spine surgeries unnecessary, and costly, they are also disabling for many. A study in Surgical Neurology by E. Berger showed that 71 percent of patients with a single surgery and 95 percent of lumbar fusion patients who had multiple surgeries never returned to work.[5] 

Medicare spending on imaging for nonspecific low-back pain amounted to $232 million in 2014 and spinal injections for low-back pain alone accounted for $1.26 billion.[6]

"With healthcare costs soaring, improvements in the management of back pain represent an area of potential cost savings for the healthcare system while also improving the quality of care," the authors concluded.

Price Boycott

As you can imagine, there’s grave doubt Sec. Price as an orthopedist will place any emphasis on this effort to reduce low-value treatments considering the bulk of medical spine care—imaging, narcotic painkillers, epidural steroid injections, and spine surgery—are the main sources of income for the medical spine industry.

Clearly there are many low-value procedures that need to be reduced or eliminated, but as long as spine treatments enrich orthopedists on their prosperous island, and his investments in the medical industrial complex funnel him money, there is no way healthcare reform will happen as long as Sec. Price is in charge.

Indeed, drain the swamp!

[2] Back pain: Doctors increasingly ignore clinical guidelines, by Monte Morin, LA Times, July 29, 2013

[3] “Dismal Results for Spinal Fusion Among Patients with Workers’ Compensation Claims,” THE BACKLETTER 25/11 (November 2010):121 p. 127.

[4] “Fusion Surgery for Injured Workers: An Opportunity for Shared Decision-Making?” THE BACKLETTER 25/11 (November 2010):129.

[5] E Berger, Later Postoperative Results in 1000 Work Related Lumbar Spine Conditions,” Surgical  Neurology 54/2  (August 2000):101-106.

[6] Medicare Urged to Look Harder at Value of Services Provided by Joyce Frieden, News Editor, MedPage Today April 07, 2017


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