EP260: The Latest Shkreli Awards for the Worst Examples of Profiteering and Dysfunction in the Health Care Industry, With Shannon Brownlee and Vikas Saini, MD, of the Lown Institute

The Shkreli Awards are published each year by the Lown Institute. This is a much-anticipated top 10 list of the worst examples of profiteering and dysfunction in the health care industry. The list is named for Martin Shkreli, that price-hiking “pharma bro” I’m sure you’ve heard about because he is so easy to vehemently dislike. The Lown Institute, in case you have not heard of them, is a nonpartisan think tank advocating for a just and caring health system.

In this health care podcast, I speak with Shannon Brownlee, who is a senior VP at the Lown Institute, and Vikas Saini, MD, president and CEO over there. And we talk about this year’s Shkreli Award winners. There are 10 winners, and we talk about most of them in this show. But just so no one feels left out, there were three that we didn’t really get to, so let me mention them here.

#8 Thirty-five people, including nine doctors, charged with fraud for billing Medicare $2.1 billion (that’s billion with a B) for unnecessary and expensive cancer DNA tests. The doctors enticed seniors and disabled patients to have genetic testing done, and then they received kickbacks from telemedicine companies and genetic testing labs. (Editorializing a little bit here, besides the $2.1 billion that taxpayers needed to front for these guys, also now I’m sure insurance carriers are putting prior auths in place before people can get time-sensitive oncology DNA tests, for example. Thanks, guys, for making that a thing.)

#6 Pediatric cardiologists at the University of North Carolina Medical Center were alarmed by the high mortality rate of pediatric heart surgery patients at the Center. When the cardiologists expressed their concerns, they were told by administrators that if they stopped referring children to the surgery program, they could lose their jobs.

#5 The Sackler family, the owners of Purdue Pharma. New court documents showed that Dr. Richard Sackler encouraged atrocious marketing techniques of OxyContin, including diverting blame for opioid abuse onto addiction victims.

So now, let’s talk about the other seven winners.

You can learn more by connecting with Dr. Saini (@DrVikasSaini) and Shannon (@ShannonBrownlee) on Twitter.

Vikas Saini, MD, is president of the Lown Institute. He is a clinical cardiologist trained by Dr. Bernard Lown at Harvard, where he has taught and done research. He has also been an entrepreneur as scientific cofounder of Aspect Medical Systems, the pioneer in noninvasive consciousness monitoring in the operating room with the BIS device. He was in private practice in cardiology for over 15 years on Cape Cod, where he also founded a primary care physician network participating in global payment contracts.

Dr. Saini is board certified in cardiovascular disease, internal medicine, and nuclear cardiology. He has served on the faculty of Harvard Medical School and the Harvard School of Public Health, where he initiated the first course focused on policy translation for cardiovascular disease prevention.

In April 2012, Dr. Saini convened the Avoiding Avoidable Care Conference with the noted author Shannon Brownlee. This was the first major academic conference focused on the problem of overuse of health care services. Dr. Saini led the international writing group of the Right Care series of papers commissioned by The Lancet and published in January 2017. With Ms. Brownlee, he is a convener of the Right Care Alliance, a grassroots network of physicians, nurses, patient activists, and community leaders dedicated to creating public demand for care that is safe, effective, affordable, and just.

Dr. Saini has spoken and presented research about avoiding unnecessary care at professional meetings around the world and has been quoted in numerous print media and on radio and television.

Shannon Brownlee is senior vice president of the Lown Institute. She and Lown Institute President Dr. Vikas Saini are cofounders of the Right Care Alliance, a network of activist patients, clinicians, and community leaders devoted to organizing a broad-based movement for a radically better health care system. Before joining the Lown Institute, Brownlee served as acting director of the health policy program at the New America Foundation. As a senior fellow at New America, she published the groundbreaking book, Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, which was named the best economics book of 2007 by the New York Times.

She was a senior writer at US News and World Report and Discover Magazine and is the recipient of numerous awards, including a Congressional Commendation, and was named one of “four writers who changed the world” by the World Congress of Science Journalists. Her stories and essays have appeared in such publications as The Atlantic, New York Times Magazine, The Washington Post, Times of London, Time, New Republic, Los Angeles Times, BMJ, The Lancet, and Health Affairs. Brownlee is a nationally recognized speaker, has been featured in several documentary films, and has appeared on such broadcast outlets as ABC World News, Good Morning America, Fox News, NPR, and The Diane Rehm Show and is quoted regularly in the press. She is the author of several peer-reviewed articles in medical journals and has served on numerous scientific panels, working groups, and roundtables. From 2014-2016, she was an editor of the “Less is More” section of JAMA Internal Medicine and was a lecturer from 2011-2014 at the Dartmouth Institute for Health Policy and Clinical Practice.

She is currently a member of the boards of the Robert Graham Center of the American Academy of Family Practice and Families USA and is a visiting scientist at the Harvard T.H. Chan School of Public Health. Brownlee holds a master’s degree in marine science from the University of California, Santa Cruz.

03:21 What the Shkreli Awards are.
05:17 What the Shkreli Awards are meant to do by spotlighting these areas of health care.
07:24 The categories that the Shkreli Awards winners fall into.
08:56 Balancing the business side with the mission side of health care organizations.
09:33 The correlation between the decline in trust and hospital rankings on the Shkreli Awards list.
12:30 The constraints of the current system and how these affect the behavior of nonprofit hospitals.
13:27 Why making nonprofits for-profit isn’t the answer.
16:43 Where private equity plays into profiteering and dysfunction in health care.
19:54 The opioid “kingpins” and the oncology organization that made the Shkreli list.
21:43 “Fraud is fraud; that’s just illegal.”
26:27 “Fraud is just … a fact of life … the biggest problem [is] bad behavior that’s perfectly legal and everybody thinks is okay.”
27:10 Shannon and Dr. Saini’s advice for organizations looking to avoid getting on the Shkreli list.
27:25 “We need real transparency around hospital behavior.”
29:24 “You can’t legislate the heart.”
29:31 You can see the list at lowninstitute.org/shkreli-2019.
29:46 What the Lown Institute is and what they do.

You can learn more by connecting with Dr. Saini (@DrVikasSaini) and Shannon (@ShannonBrownlee) on Twitter.