The website that cried wolf: World Net Daily and death panels

Today, the far right website, World Net Daily, is accusing the President of using the Food & Drug Administration drug approval process as a way to ration health care via “death panels.”  As evidence for the claim, this front page story by Greg Koprowski states that “new drug approvals declined dramatically last year” citing a drop in such drug approvals from 25 in 2009 to 21 in 2010.

Although website claims the article is “breaking news,” the other evidence offered is a quote from a July 27, 2010 letter to FDA official Dr. Richard Pazdur from Senator David Vitter (R-LA) writing in support of the anti-cancer drug Avastin.  The FDA recently made a recommendation to remove the breast cancer indication from the Avastin drug label. In the letter, Senator Vitter worries that the approval process may signal the beginning of treatment rationing.

I spoke with Sandy Walsh at the FDA who called the claim that the FDA was using cost as a measure of approval “absurd.” She also noted that recent approvals are in line with past years.  As a review of FDA data demonstrates, she is correct.  For perspective, here are numbers of new medicines approved by the FDA from 2000 to the 2010 estimate.

2010 – 21 (estimated)

2009 – 25

2008 – 24

2007 – 18

2006 – 22

2005 – 20

2004 – 36

2003 – 21

2002 – 17

2001 – 24

2000 – 27

Mr. Koprowski called the drop from 25 new drugs in 2009 to a “mere 21 new drugs in 2010” a dramatic decline. Not at all. An examination of the approvals over time tells a different story. Clearly, Obama’s FDA is keeping pace with the record of the Bush administration.

Regarding Avastin, the maker of the cancer fighting drug is appealing the decision but it is simply wrong to assume that the FDA decision was based on cost considerations. The FDA panel that voted 12-to-1 to recommended the action consisted of physicians and patient advocates. FDA spokesperson Erica Jefferson told me that “no political appointees were involved in the decision-making” adding that “most of the reviewers have been with the agency close to 15 years.” Moreover, the decision was endorsed by the National Breast Cancer Coalition, which said about the action, “We applaud the FDA for responding to the scientific evidence in the face of significant political and public pressure.”

By reading WND, one would never know the rest of the story. Selective reporting is just one reason to question crying wolves at WND. Enter the Medicare death panel scare.

In late December, World Net Daily published an article that said the Obama Administration was slipping death panels back into Medicare via a regulation defining patient-physician discussions of advance directive planning. Yesterday, the Obama administration rescinded that rule, in part because of the misinformation campaign waged by social conservatives.

Judie Brown of the American Life League was quoted as saying:

Nothing good can come of this,” said Judie Brown, the president of American Life League. “This will affect everybody’s parents and grandparents and preborn babies, and it will not affect anybody for the good.

She added ominously:

Congress must step up to cancel the regulation, Brown added. “If not, a death certificate is written for an awful lot of elderly people.”

Ratcheting up the rhetoric, Liberty Counsel’s Mat Staver told WND that the Medicare regulation was not just a death panel, but a “super death panel,” saying

When you have the government mandating this end-of-life counseling, they’re conscripting doctors to do end-of-life counseling on a massive scale. It will be the equivalent of a super death panel. Elderly patients will get confused and will end up signing documents without having a clue what they’re signing, and they will sign away care they might really want.

As I noted in a previous post, claims that the just rescinded Medicare regulation required doctors to persuade senior citizens to refuse care are just false. The new regulation was an extension of a definition of advance care planning which remains a part of the initial Medicare visit, a provision that was added by Congress in 2008. That bill was passed via override of a President Bush veto. The veto however, had nothing to do with end-of-life counseling, but rather concerns over cost. As far as I can find via search engines, there was no outcry from conservatives then over the end-of-life provision. No one cried death panels then.

As an administration official told me yesterday, Medicare does not prescribe any conversation between patients and physicians about end-of-life issues. Patients are free to use pro-life resources and advance directives to plan their end-of-life care. The only reason the definition was included was to alert physicians that these conversations are important. There is neither a separate reimbursement for advanced care planning now nor would there have been if the rule, rescinded yesterday, would have remained viable.

In the case of the advance care planning regulation, the scare tactics worked. The Obama administration backed off of a reasonable definition of advanced care planning, a practice that pro-life groups actually recommend to their constituents. However, hysteria and spin won out over good policy. In the case of FDA approvals, it is clear that there is no trend specific to this administration. At what point, do readers realize that those crying death panels are crying wolf?

Administration reverses course on end-of-life care planning regulation

UPDATE: I just spoke with an Obama Administration official who said the new proposed rule would be published at 4:15pm today in the Federal Register. This will allow for comment. He also confirmed to me that the advance care planning provision remains in the initial Welcome to Medicare visit with a physician. That provision was included by via statute during the Bush Administration in 2008. In other words, all of the bluster from social conservatives is a bit late. The Administration official indicated that the rule had been removed in order to give the public opportunity to indicate their views on the issue. He noted the misrepresentation of the issue and the Administration did not want the political process to jeopardize the existing benefits.

….

Annual voluntary advance care planning, we hardly knew ya.

Last week, I defended a new Medicare regulation which would have added advance end-of-life care planning to the definition of what could take place during the new Annual Wellness Visits authorized by the Affordable Care Act (ACA), otherwise known as ObamaCare. Some conservatives demonized this rule as the return of “death panels” in an effort to frighten voters. I don’t know whether or not the public was frightened, but according to the New York Times, these false characterizations scared the administration so much that the rule is being deleted.

And this is sad because this is case where spin and misinformation won out over fact and good sense. The truth is the Medicare regulation did not create a new reimbursable benefit and did not bring back “death panels.” The regulation added one voluntary component to the annual wellness visit – a discussion of the patients’ wishes if they become unable to express themselves during illness or injury. Physicians were not going to be paid separately for this conversation; they will still do the annual wellness visit and focus on many other issues of prevention and health maintenance. And here is the kicker, physicians can still bring up advance care planning if they want to.

Social conservatives who ranted about government involvement in end-of-life decision either had not read the regulation or were  intentionally  misleading people. 

But now the administration without attribution has shifted course and it is quite unclear why. 

Since yesterday morning, I have been seeking answers from the HHS press office and will comment more  as I get more information.

Here is an AP piece on the matter…

Slain Pakistani Governor had received death threats

As is being widely reported, the governor of Pakistan’s Punjab province, Salman Taseer, was assasinated earlier today by his own security guard. The guard apparently heeded the fatwa issued by Islamic extremists who were angry about Taseer’s advocacy for Asia Bibi, a Christian mother of five who was recently sentenced to death for allegedly insulting Islam. Taseer had petitioned the government for her pardon.

Over the past several weeks, I have had contact with Raza Anjum, a city Councillor from the UK, who is in Pakistan trying to win freedom for Asia Bibi. Just hours after the shooting, Anjum (on left below) issued a statement describing a meeting he had with Governor Taseer less than a week ago.  In that meeting, Taseer (on the right in the picture below) said that a fatwa had been issued on him due to his support for Asia Bibi and his opposition to the nation’s blasphemy laws.         

Anjum said that Taseer spoke strongly against religious extremism, saying that  “one needs to be determined and brave in standing up for human rights,” adding that “the extremists aim to install fear in the minds of the people.” According to Anjum, Taseer said he was “prepared to stand up to them to help bring about a progressive and peaceful Pakistan.”

That peaceful Pakistan now seems elusive. 

On New Year’s Eve, thousands went on strike warning of violence if the government amended the blasphemy laws or freed Asia Bibi. On Sunday, the second largest political party in Pakistan pulled out of the coalition goverment citing corruption and economic differences.   

About the tragedy, Anjum said, “The assassination of Salman Taseer is a huge blow to all those who are working for an enlightened and progressive Pakistan. His death has left the country in shock at a time when it faces an imminent political crisis.”

On Taseer’s Twitter page, an associate posted “R.I.P. Lion of the Punjab Salmaan Taseer (31 May 1944-04 Jan 2011)” According to Mr. Anjum, the Pakistan People’s Party said it would observe two weeks of mourning over Taseer’s death. Prime Minister Syed Yusuf Raza Gilani “strongly condemned” the incident, according to CNN.

Here is a Wall Street Journal news report that fills in additional information:

Governor of Pakistan’s Punjab province killed by his own security guard

This is a shocking and ominous development in Pakistan. Increasing calls from outside Pakistan for reform of blasphemy laws and the release of Asia Bibi has been met with a rise in violence from far right Islamic forces.

Islamabad, Pakistan (CNN) — The governor of Pakistan’s Punjab province, Salman Taseer, was assassinated by his own security guard Tuesday, according to Interior Minister Rehman Malik, apparently because he spoke out against the country’s controversial blasphemy law.

The security guard was arrested, Malik said. The shooting occurred at Islamabad’s Kohsar Market, which is frequented by foreigners.

Taseer went into the market to make some purchases, and he was shot by his guard as he left, said Naeem Iqbal, spokesman for Islamabad police. He was taken to a hospital, where he died, apparently from blood loss.

Malik told Pakistan’s GEO TV that Taseer was assassinated because he spoke out against Pakistan’s blasphemy law.

A spotlight was put on the law in November when a Christian woman, Asia Bibi of Punjab province, was sentenced to death for blasphemy. A court found the 45-year-old woman guilty of defiling the name of the Prophet Mohammed during a 2009 argument with fellow Muslim field workers.

When I spoke recently with Raza Anjum, UK city official now in Pakistan trying to win the release of Asia Bibi, he told me that Taseer was a fair man who saw the injustice being done in the name of Islam. He spoke out in her favor and worked to get a fair hearing for her case. For that reason, he was under constant threat.

Pakistan is no stranger to such violence but the issues surrounding the blasphemy laws appear to be giving extremists a rallying cry for opposition to moderate elements. The government recently demonstrated weakness by backing away from a bill that would reform the blasphemy laws. It shows no signs of an effective response to the far right.

I will be adding updates and information as I get it. Here is an interview with Taseer about why he took up Asia Bibi’s cause. Note his confidence in the ruling party. This was before the party began to capitulate to extremists.

Who not to vote for in 2012

Bryan Fischer is doing people like me an enormous favor. He is handicapping the 2012 GOP field and will apparently in his next column tell us who he thinks would a great GOP candidate for President. Knowing what I know thus far, this should be a pretty good sign of not to vote for in 2012.

First, he claims evangelicals are key to the next election. This could be true if they voted as a group. However, as Fischer points out, 2008 saw erosion in this demographic with seven million evangelicals preferring Obama over McCain. Two years from now, a case could made that evangelicals will continue to fragment with moderates and social justice evangelicals going one way and social conservatives another.  Fischer’s prescription seems to be an inspiring candidate that is even more socially conservative than McCain.  I doubt evangelicals who were attracted to Obama in 2008 (and to be clear, I was not one of them) will rally around someone who is farther to the right than McCain.

Fischer then rules out Mitt Romney, Sarah Palin, Mike Huckabee and Newt Gingrich for various reasons, some of which are on target, some of which are questionable. For instance, for the same reasons Fischer rejects Mitt Romney, I suspect the party as a whole might make him the nominee. He will almost certainly look reasonable and mainstream next to the far right candidate preferred by Fischer.  

He promises to reveal who he thinks the GOP should select soon. I suspect it will be Mike Pence or Jim Demint. I know it won’t be Mitch Daniels (someone I believe is a compelling figure). In any case, the revelation will likely help my process of elimination.