Him and every other Wall Street asshole. They blamed everyone but themselves:
Tell me again about how you won’t vote for the Democratic nominee?
Artificial intelligence is on the rise in newer cars to improve vehicle safety. For instance, vehicle blind spot detection was once a revolutionary concept, aiding in safer lane changes, merges, and turns because an automated warning system could tell a driver that a large object, such as another vehicle, was in their blind spot.
As technology has advanced, the types of safety features have improved as well. Now, it is not uncommon to find cars that have “lane assist” that will physically self-correct the vehicle’s lane positioning if the driver fails to maintain lane control. Another new safety technology that is currently being tested has been designed to decrease pedestrian-related crashes and fatalities through the use of a pedestrian detection sensor.
“Enhanced safety technology can be a wonderful thing, making driving safer for other cars as well as pedestrians,” said personal injury attorney Gregory J. Bubalo of Becker Law Office. “However, drivers cannot become complacent and rely fully on safety technology to ensure safe driving.”
Sensors that detect pedestrians and deploy an emergency braking system have the potential to significantly reduce pedestrian-related crashes, especially with the development of semi-autonomous or fully self-driving cars. On average, pedestrian deaths account for 16% of traffic-related deaths per year and results in the loss of approximately 6,000 pedestrian lives. Additionally, three-quarters of pedestrian deaths occur at night, when visibility is lower. Thus, creating a safety system that can reduce these numbers and make the streets safer for pedestrians would be a significant advancement for vehicle and traffic safety.
However, this pedestrian detection technology can only decrease pedestrian accidents when it works. AAA released new research that shows these sensors do not work consistently, and that they were ineffective at night. AAA’s testing further revealed that in simulated real-world scenarios, this technology failed, and the vehicle crashed into the pedestrian almost every single time. This particular technology may not be ready yet, but it certainly has the potential to significantly reduce pedestrian fatalities.
Regardless of how advanced safety technology becomes in vehicles, the driver of that vehicle is ultimately responsible for driving safely and avoiding safety hazards or causing accidents. Even if a car is equipped with advanced safety features, the driver is likely to be ultimately responsible for any injury or damage that vehicle causes.
The financial interactions include payments for delivering promotional talks, consulting and receiving sponsored meals and travel.
The 50 drugs in our analysis include many popular and expensive ones. Thirty-eight of the drugs have yearly costs exceeding $1,000 per patient, and many topped the list that are most costly for the Medicare Part D drug program.
Take Linzess, a drug to treat irritable bowel syndrome and severe constipation. From 2014 to 2018, the drug’s makers, Allergan and Ironwood, spent nearly $29 million on payments to doctors related to Linzess, mostly for meals and promotional speaking fees.
ProPublica’s analysis found that doctors who received payments related to Linzess in 2016 wrote 45% more prescriptions for the drug, on average, than doctors who received no payments.
Those findings were repeated for drug after drug. In 2016, doctors who received payments related to Myrbetriq, which treats overactive bladder, wrote 64% more prescriptions for the drug than those who did not. For Restasis, used to treat chronic dry eye, doctors who received payments wrote 141% more prescriptions. The pattern holds true for 46 of the 50 drugs.
On average, across all drugs, providers who received payments specifically tied to a drug prescribed it 58% more than providers who did not receive payments.
Other research, including our own, has found a correlation between payments and overall prescribing. This new analysis expands upon past work by looking individually at a variety of popular drugs. “What clearly jumps out is how consistent the association is across drugs,” said Aaron Mitchell, a medical oncologist at Memorial Sloan Kettering Cancer Center who has studied pharmaceutical payments for oncology drugs.
Our analysis looked at the relationship in two ways: whether those who received payments prescribed more of a drug, as well as whether those who prescribed a drug received higher payments than those who did not. We found that, on average, physicians who prescribed a drug received higher payments related to the drug that same year than those who didn’t prescribe it. For Linzess, the value of payments was more than four times higher for providers who prescribed the drug than among those who did not. For Myrbetriq, it was three times higher, and for Restasis, it was twice as much. (Read our methodology for more about the analysis.)
Holly Campbell, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, an industry trade group, said it stands to reason that doctors who have interactions with a company about a drug may prescribe more of it “because they have more information about the appropriate uses for the products.”
Through spokespeople, Allergan (maker of Linzess as well as Alphagan P, Bystolic, Combigan, Lumigan, Namenda and Restasis), Janssen (maker of Invega, Invokana, Xarelto and Zytiga) and Novo Nordisk (maker of Levemir, Novolog and Victoza) described their interactions with physicians as important for sharing medical information.
Novo Nordisk added that prescribing data is not used to target physicians for speaking or other promotional interactions. Eli Lilly said in a statement that meals can take place in many contexts, including in doctors’ offices, at speaker events and at conferences, but didn’t answer other questions. GlaxoSmithKline, Ironwood, Astellas and Purdue declined to comment.
For some drugs that are household names, it was more common for prescribers to receive a payment than not to. More than half of doctors who prescribed Breo, an expensive asthma drug, to Medicare patients received payments involving the drug in 2016. This was also true for Invokana and Victoza, both of which are diabetes medications. For Linzess, nearly half of doctors who prescribed the drug had interactions with its maker.
More than one in five doctors who prescribed OxyContin under Medicare in 2016 had a promotional interaction with the drug’s manufacturer, Purdue Pharma. The company did not respond to a request for comment.
“If there are physicians out there that deny that there is a relationship, they are starting to look more and more like climate deniers in the face of the growing evidence,” said Aaron Kesselheim, a professor of medicine at Harvard Medical School and an expert in pharmaceutical costs and regulation. “The association is consistent across the different types of payments. It’s also consistent across numerous drug specialties and drug types, across multiple different fields of medicine. And for small and large payments. It’s a remarkably durable effect. No specialty is immune from this phenomenon.”
Huey Nguyen, a gastroenterologist in southern Indiana, increased his prescribing of Linzess in recent years. From 2013 to 2015, Nguyen’s Medicare patients had fewer than 60 claims per year for Linzess. In 2016 and 2017, that jumped to over 110 claims per year.
Over that time, Nguyen was a promotional speaker for Linzess. Allergan paid him $1,000 in 2013, over $4,000 in both 2016 and 2017, and $2,000 in 2018 to speak about the drug.
Though Linzess has been on the market since 2012, Ironwood and Allergan made a big push to promote the drug in 2016 and 2017. Spending on doctors reached $10 million in 2016 and nearly $8 million the following year, up from under $4 million in both 2014 and 2015.
In total, Nguyen has earned $25,000 from 2014 to 2018 related to six drugs from four pharmaceutical companies, excluding meals. In 2018, he was paid by two companies to promote competing drugs that treat irritable bowel syndrome.
ProPublica’s analysis did not set out to examine, nor did it resolve, whether industry payments change doctors’ behavior, or if patients receive inferior care from doctors who receive payments. Many factors can influence doctors’ prescribing choices. Some patients, for instance, have conditions for which only brand-name treatments are available or for which other drugs have failed.
Nguyen said promotional speaking educates doctors about how a drug works, whether insurance covers it and when not to prescribe it.
“It’s a way for the primary care physicians to have access to a gastroenterologist where they can ask one-on-one questions,” Nguyen said. “I’m more educated towards the drug, because I have to be trained to speak on it, so I’m more comfortable prescribing it.”
Experts are skeptical that interactions between companies and doctors benefit patients. “If there really were innovations and real benefits that were accruing to patients for a new treatment, it shouldn’t take so much spending by the company to get the word out,” said Stacie B. Dusetzina, associate professor of health policy at Vanderbilt University Medical Center, who advised ProPublica on the design of its analysis. “I wonder if promotion is really to try to push products that have a much less substantial benefit because they’re not gaining the market share naturally.”
Nguyen said he takes many things into account when prescribing a drug, including its approved uses, cost and side effects. “In my day-to-day practice, my patients still come first,” Nguyen said. He said the speaking engagements do not influence his prescribing, “at least not consciously. Unconsciously, I don’t know.” He sees the public disclosure of industry payments to doctors as a way to help patients be active participants in their care.
Nguyen said he works with companies for the extra compensation but acknowledged that “it’s perfectly reasonable for people to question my motives.”
ProPublica’s analysis matched doctors’ prescribing in Medicare’s prescription drug program to the industry payments doctors received. Drug and medical device companies are required to report these payments annually through the federal Open Payments program, and they are made public on a government website. More than 600,000 doctors receive payments annually. (Companies also report research payments and ownership interests, but these were excluded from our analysis.)
Some providers were paid thousands of dollars, often for promotional speaking. But the typical doctor took in much less. Most only received meals, typically worth less than $100 per year.
In 2016, ProPublica found a relationship between the total dollar value of a doctor’s interactions with drug and device companies and the overall percentage of brand-name drugs he or she prescribed.
Other research has found correlations between industry interactions and prescribing for certain classes of drugs, includingopioids, urology drugs, oncologytreatments, inflammatory bowel disease treatments and heartburn medication. In one study, brand-name prescribing for certain classes of drugs was associated with receiving as little as a single pharmaceutical industry sponsored meal. A study of prostate cancer treatments did not find evidence of a connection.
Brand-name drugs are more expensive than generic options, both for patients and for Medicare. A recent report from the Department of Health and Human Services found that Medicare Part D and its beneficiaries could have saved almost $3 billion by switching from brand-name drugs to generics.
Linzess is an expensive drug, costing Medicare and patients an average of about $1,500 annually. A common alternative is the laxative Miralax, available over the counter as generic polyethylene glycol, which costs less than $200 annually if taken every day. Nguyen said he recommends Miralax to many patients, but that wouldn’t show up in Medicare’s data because Medicare doesn’t cover over-the-counter drugs. He said he often prescribes Linzess to patients who have tried Miralax and not seen the symptom relief they hoped for.
For brand-name drugs that have good generic alternatives, “every time a doctor prescribes one of these brand-name medications, it’s extra money transferred from the Medicare program to the manufacturer,” said Michael Barnett, assistant professor of health policy at Harvard T. H. Chan School of Public Health. “Medicare spending is out of control. And drug costs are one of the major reasons.”
Drug cost can have major consequences, not just for Medicare balance sheets but also for patients’ well-being. “The newest, latest drug is often not any better than the old drugs” that treat the same condition, Mitchell said. “But the new drugs are always more expensive. That really hurts patients’ pocketbooks. You’ve got physicians prescribing more expensive drugs and patients who aren’t taking them as a result. A generic medicine that’s cheaper that a patient does take is a whole lot more effective than an on-brand, expensive medicine that they don’t take.”
Upon hearing of an accident that involved a self-driving car, many people assume that the autonomous vehicle, or at least its manufacturer, is at fault for the crash. However, that does not seem to be the case. Axios has conducted a study between 2014 and 2018 in which they reviewed crash data from the California Department of Motor Vehicles. The results showed that, in fact, it is likely the humans inside the car that are at fault for an accident. That study showed that people were at fault for 81 of the 88 accidents studied that involved autonomous vehicles. It is unlikely that the numbers are any different in other states.
The study also found that when drivers are in control of the vehicle, the cars are much more likely to get into an accident than they are when the cars are in autonomous mode. In all accidents studied, only one of 62 occurred while the vehicle was in autonomous mode. The study also concluded that another driver likely caused this crash. When a person was in control of the vehicle, these vehicles caused 6 of 26 accidents.
“Human error will always occur on the roads as long as people are behind the wheel,” says personal injury attorney Jacob Kimball of Springs Law Group. “People always need to pay attention to their surroundings, follow all traffic laws, and focus on the road in front of them in order to prevent an accident from occurring. These rules are important no matter the type of vehicle drivers are operating or if they are in control of their car.”
In an odd turn in the report, however, it was also found that drivers are not always the only ones responsible for accidents. In three of the accidents, people outside of the vehicle were also at fault. Individuals would hit or climb on top of the cars, although it was not clear why. So, even if there is a future world in which all vehicles are replaced by autonomous cars, there still may be many accidents that involve these cars due to human error.
On June 29, 2019, Abbot issued a recall of their Ellipse Implantable Cardioverter Defibrillators (ICDs) due to an issue with faulty wiring. The ICDs are similar to Pacemakers. They detect rapid heartbeats and when they occur, send a small electric shock to the heart. This shock returns the heartbeat to its normal rhythm. Without these devices, cardiac patients could suffer from a heart attack or stroke, two conditions that could be fatal. However, those consequences could result when the devices are faulty, too.
The issue with the ICDs identified in the latest recall is that some of the wiring was not properly insulated. That left some wires exposed, which would result in the device not working properly. When the wires are exposed, the ICD cannot send the shocks to the heart that return the rhythm back to normal. Unfortunately, there is no way to determine whether a device is faulty or not before it is implanted in a patient.
“This type of defect in a medical device is disastrous for patients,” said product liability lawyer Ryan McKeen of Connecticut Trial Firm. “When patients rely on a product to save their life, and that product is defective, it provides a sense of false security. These defects also have tragic results, and there are only more recalls occurring every year.”
That is a fact. In both 2017 and 2018, there were 32 device recalls each year. This year that number has increased by one, as currently there have been 33 device recalls. However, the year is not over yet, and there could be even more by the time New Year’s Eve rolls around.
Of the 108 devices that were recalled in this latest announcement, 31 were implanted in patients in the United States. Abbott has stated that it has not received any reports of patients being harmed in the United States due to the devices. The company also said that most of the defective devices issued have been replaced, or are about to be replaced. Unfortunately, when it comes to these devices that are supposed to be life-saving, not everyone is always so lucky.