Dan Weissmann
Every 12 months, a well being care suppose tank referred to as the Lown Institute ranks the ten worst examples of “profiteering and dysfunction” in well being care and “honors” the winners.
The “Shkreli Awards” are a type of Oscars for probably the most outrageous examples of greed, fraud, and common brokenness in American well being care.
The awards are named after Martin Shkreli, a former pharmaceutical govt who infamously raised the value of Daraprim, a lifesaving remedy for toxoplasmosis, from round $13 a tablet to $750. The media dubbed him “the pharma bro,” and he turned an emblem of brazen pharmaceutical greed.
In this episode of “An Arm and a Leg,” you’ll hear highlights from this 12 months’s ceremony and reflections from the Lown Institute’s president, Vikas Saini.
“Showing all these stories together paints a picture of a health care system in desperate need of transformation,” Saini stated on the occasion. “Not just because the stories are shocking, but because often what they’re depicting, like Martin Shkreli’s infamous price hike, is perfectly legal.”
Dan Weissmann
Host and producer of “An Arm and a Leg.” Previously, Dan was a employees reporter for Marketplace and Chicago’s WBEZ. His work additionally seems on All Things Considered, Marketplace, the BBC, 99 Percent Invisible, and Reveal, from the Center for Investigative Reporting.
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Transcript: The ‘Shkreli Awards’ — For Dysfunction and Profiteering in Health Care
Note: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can include errors. Please use the transcript as a instrument however verify the corresponding audio earlier than quoting the podcast.
Dan: Hey there. So, awards season has already began …
Nikki Glaser, Golden Globes host: Good night! And welcome to the 82nd Golden Globes, Ozempic’s largest night time.
Dan: OK, I didn’t watch the Golden Globes this 12 months. But there’s an awards present that’s made mainly only for nerds like me.
Vikas Saini (awards ceremony): Hello, everybody, and welcome to the eighth annual Shkreli Awards.
Dan: The Shkreli Awards! Named after the “pharma bro” Martin Shkreli. Remember him?
He turned well-known — notorious — in 2015, when an organization he ran took over the making of an previous drug referred to as Daraprim. Old, previous. Introduced in 1952, but it surely later turned used to forestall a type of pneumonia that individuals with HIV can develop.
So Martin Shkreli jacked up the value — from thirteen-and-a-half {dollars} a tablet to seven hundred and fifty bucks. Rings a bell, proper? So, who offers out awards named after that man?
Answer: A well being care suppose tank referred to as the Lown Institute. One of their massive latest tasks was rating nonprofit hospitals by how a lot they do to “earn” their tax exemptions, as an illustration, by giving out charity care. The institute’s president, Dr. Vikas Saini, hosts the awards ceremony.
Vikas Saini (awards ceremony): So if that is your first time on the Shkreli Awards, that is our prime 10 record of probably the most egregious examples of profiteering or dysfunction in well being care.
Dan: I’m telling you: that is an awards present for nerds identical to me. In truth, it’s additionally type of a celebration of nerds type of like me. Each of the terrible tales these awards spotlight was dug up and dropped at gentle by … journalists.
Vikas Saini (awards ceremony): So this 12 months, the journalists behind these tales will likely be receiving a Shkreli Reporting Award. And I’ve one in my hand right here.
Dan: It’s a bobble head: White man in a black swimsuit — Clark Kent with out the glasses – and it’s in a show field that claims 2024 Shkreli Award. Someday, I hope the reporting we do right here earns us certainly one of these. The ceremony was held January 7. We’ll carry you some highlights — I imply, is it a spotlight whenever you’re giving awards for the worst issues? Well, let’s simply say they have been among the most entertaining tales.
And we’ve acquired some reflections from a dialog I had with Dr. Saini the following day. The ceremony itself wasn’t fancy — only a Zoom presentation — however we’re gonna gown it up a bit bit, so it feels like different awards exhibits, with an enormous crowd, and a stage …
Vikas Saini (awards ceremony): All proper, so. Without additional ado, let’s do the countdown. The 2024 Shkreli Awards. Brace yourselves. Here we go.
Dan: This is An Arm and a Leg. A present about why well being care prices so freaking a lot, and what we are able to possibly do about it. I’m Dan Weissmann. I’m a reporter, and I like a problem. So the job we’ve chosen on this present is to take one of the crucial enraging, terrifying, miserable elements of American life, and produce you one thing entertaining, empowering, and helpful.
The Shkreli Awards present is a countdown, beginning with quantity ten. And they began with a doozy this 12 months.
Vikas Saini (awards ceremony):Number ten. Texas Medical School allegedly neglects to inform subsequent of kin earlier than promoting physique elements of the deceased.
Dan: NBC News reported that the University of North Texas Health Science Center in Forth Worth was getting unclaimed our bodies from the county coroner, after which reducing them up and promoting them — with out getting anyone’s consent.
Vikas Saini (awards ceremony): The heart’s enterprise equipped the physique elements to main for-profit ventures like Medtronic and Johnson Johnson. The investigation discovered repeated failures on the heart and on the county stage to contact members of the family who have been, in actual fact, comparatively straightforward to establish and attain.
Dan: For occasion, NBC talked with the household of Carl Honey, a veteran who died homeless, however was entitled to a army burial. Here’s what occurred as an alternative.
Vikas Saini (awards ceremony): Swedish medical system maker paid 341 {dollars} for Honey’s proper leg. A Pittsburgh medical training firm spent 900 {dollars} for his torso, and the U.S. Army paid 210 {dollars} for bones from his cranium. It simply sounds so macabre. It’s extra like a Halloween story.
Dan: When NBC News advised the college what they’d discovered — and that they’d be publishing their findings — the medical faculty shut down this system and fired the individuals who had been working it.
But as Vikas Saini mirrored after we talked, this in all probability wasn’t a narrative about a number of rogue directors. It sounded to him extra like a extremely grisly instance of how well being care establishments get run.
Vikas Saini: They set a tone on the prime, that’s, we acquired to make our numbers. We acquired to make our backside line. You know, it’s just like the widget manufacturing unit and, you already know, what number of vehicles did Tesla ship, and with that mentality, you set the tone.
Once you set the tone, you possibly can’t maintain monitor of what everyone’s doing. And the individuals in all probability thought they have been doing the correct factor. They’re making an attempt to usher in some income.
Dan: If your job is to usher in income, assist make the numbers, then why would you hassle making an attempt to contact subsequent of kin and get consent earlier than promoting off any person’s physique elements?
And this was a state medical faculty. As we’ll see, as you already know, this theme — gotta make our numbers — runs via the entire awards ceremony and thru a lot of well being care.
Next on the record was one other banger.
Vikas Saini (awards ceremony): Number 9, out of the mouths of babes, a style for tongue-tie reducing intensifies.
Dan: I’d by no means heard of this, however: In some infants the little little bit of tissue that connects the tongue to the ground of the mouth is a bit thicker, or shorter, and that’s referred to as a tongue tie. The New York Times reported that lactation consultants have generally suggested new mothers to have tongue-tied infants snipped, to assist with nursing.
And the Times reported that the process has exploded in recognition.
Vikas Saini (awards ceremony): Despite an absence of proof displaying effectiveness, child tongue tie reducing procedures are being touted as a treatment for the whole lot from breastfeeding difficulties to sleep apnea, scoliosis, and even constipation.
Dan: New York Times reporters talked to at least one doc who stated he does this process 100 occasions every week. At 900 {dollars} a pop.
Dentists additionally do numerous these, and a medical-device maker named Biolase apparently was encouraging them to do extra. Here’s Dr. Saini from the awards ceremony once more.
Vikas Saini (awards ceremony): At an April 2024 occasion for pediatric dentists billed as tequila and tongue ties, representatives for the laser system firm educated attendees on the process earlier than doing rounds of tequila pictures and margaritas.
I ought to add that, you already know, that they had a 3rd annual Phrenectomy Fiesta, which was marketed as “nacho average dental meeting.”
Dan: Later, Vikas Saini advised me this story truly stirred some deep reflection, that goes again to the Lown Institute’s origin story, and his personal.
The institute began because the Lown Cardiovascular Research Foundation, based in 1973 by Dr. Bernard Lown, a heart specialist who advocated for non-invasive administration of coronary heart illness — and who turned Saini’s mentor.
Vikas Saini: Dr. Lown’s motto was we do as a lot as attainable for the affected person and as little as attainable to the affected person.
Dan: Saini appreciates how docs and researchers need to uncover new issues. But in our system, that want will get wrapped up within the medical business’s have to make the numbers — discover new merchandise to promote — like procedures.
Vikas Saini: These procedures take off, particularly if there’s a necessity or a believable facsimile of a necessity on this case. And as soon as they take off, you already know, it kind of snowballs.
Dan: Tongue-tie reducing seems to be to him like an particularly wild model of the product-development aspect of issues. And an occasion like tequila and tongue ties simply strikes him as a pure extension.
Vikas Saini: This concept that the producers practice individuals within the approach, that’s not confined to this. This goes on all over.
Dan: We may dig up in all probability a trove of tongue ties and tequila shots-like occasions.
Vikas Saini: Yeah, yeah, yeah. Gallbladders and gimlets.
Dan: Here’s one other instance of a product in the hunt for a market. This story was dug up by Arthur Allen, a reporter with our buddies at KFF Health News. And on this case, the product is a drug.
Vikas Saini (awards ceremony): A drug firm pursues excessive dose of earnings regardless of threat to sufferers. That’s stunning. Amgen’s lung most cancers drug, Lumakras … How do they make these names? Lumakras? There’s Ludacris. Lumakras… was granted accelerated FDA approval in 2021 at a day by day dose of 960 milligrams.
Dan: But the corporate additionally needed to take a look at a decrease dose: 240 milligrams. Which seems to work nearly as properly, with quite a bit fewer unwanted effects.
Vikas Saini (awards ceremony): That must be excellent news for sufferers trying to cut back the diarrhea, nausea, vomiting, and mouth sores that may happen.
Dan: One affected person advised KFF Health News, “After two months on that drug, I had lost 15 pounds, had sores in my mouth and down my throat, stomach stuff. It was horrible.”
So yeah, a decrease dose feels like nice information.
But not for Amgen. KFF Health News reported that by promoting the upper dose, the corporate makes an additional 180 thousand {dollars} per 12 months, per affected person. So that’s what they’re doing.
At the awards ceremony, Vikas Saini stated the story exhibits weaknesses within the FDA approval course of. It’s lengthy and costly, but it surely’s not complete.
Vikas Saini (awards ceremony): There’s no method of holistically how a lot does this price? What are the unwanted effects? What are the trade-offs? And what’s the energy of the proof? We want completely different mechanisms and strategies than simply saying, “Hey, you’re approved. You can charge a thousand bucks and we’ll figure it out later.”
Dan: Before giving “final approval,” the FDA has requested Amgen for further research, however in the meantime, the drug is in the marketplace, and the “FDA-approved” dose on the label is … the upper one.
So, we’ve heard about procedures and medicines getting pushed which will… not be the most effective for sufferers. But do generate profits. And then there’s a narrative from the New York Times about of us promoting merchandise that … don’t appear to even exist.
Vikas Saini (awards ceremony): Here’s a narrative that’s gonna piss individuals off, maybe. In 2023, an enormous surge in Medicare billing for urinary catheters left sufferers shaking their heads. Up to 450,000 beneficiaries had payments for catheters submitted on their behalf.
Representing an 800 % enhance over earlier years. Just seven suppliers have been chargeable for two billion {dollars} of those suspicious expenses.
Dan: That two billion {dollars}? The New York Times story says that might quantity to a fifth of all Medicare spending on medical provides for that 12 months. That’s simply seven “suppliers.”
Vikas Saini (awards ceremony): When the New York Times regarded into these suppliers, the curiously named Pretty in Pink Boutique, they discovered no medical enterprise at its handle, and its telephone quantity rang a random auto physique store.
Dan: The Times discovered that Pretty In Pink had billed Medicare for greater than a quarter-billion {dollars}. I stated to Saini: This instance appears to indicate, this type of fraud — possibly you don’t even need to attempt that onerous.
Vikas Saini: I feel it simply illustrates, you already know, the greenback flows via healthcare are so huge. Multiple trillions of {dollars}. You know, {that a} billion right here, a billion there, it’s not even actual cash but.
Dan: So, with trillions of {dollars} transferring round, and a LOT of people that have to hit their numbers, we get high-priced medicine that is probably not definitely worth the cash and physique elements bought off with out anyone’s consent. Folks getting procedures they might not want. Companies billing for catheters nobody appears to have gotten.
And after all the Shkreli Awards “honored” extra winners. Including a physician accused of giving sufferers medicine they didn’t want — and which killed them.
There was an insurance coverage firm that denied a declare for an air-ambulance experience for a child — leaving the household on the hook for greater than 97 thousand {dollars}. [That’s another one reported by our pals at KFF Health News, with NPR this time.]
And there have been two tales about hospitals beholden to personal fairness buyers. One has been accused of denying care to most cancers sufferers and demanding fee upfront.
The hospital denies that allegation, however NBC News discovered that their charity care coverage had been altered in 2023 to exclude most cancers remedy.
And as dangerous and ridiculous as all this sounds, nonetheless forward, we’ve acquired prime two honorees – properly, dis-honorees — and a few larger ideas from Vikas Saini about what all of it means. That’s proper after this.
An Arm and a Leg is a co-production of Public Road Productions and KFF Health News — that’s a nonprofit newsroom protecting well being points in America. KFF’s reporters do wonderful work — they’ve damaged a lot of Shkreli Award successful tales. I’m honored to work with them.
The different private-equity story on this 12 months’s Shkreli Awards includes a sequence of hospitals, Steward Healthcare, that ended up bankrupt. The Boston Globe revealed a heartbreaking story with the headline, “They died in hallways. In line. Alone. Their deaths are the human cost of Steward’s financial neglect.”
The Shkreli Awards gave their primary spot to Steward’s CEO — properly, now he’s the previous CEO: Ralph de la Torre, who reportedly made a quarter-billion {dollars} over the 4 years main as much as the chapter.
They illustrated the story with a photograph of an empty chair with a reputation card for de la Torre — in a Congressional listening to room. He skipped the listening to — he was reportedly on certainly one of his yachts on the time. And acquired held in contempt.
It’s a hell of a narrative. But if I had gotten to vote for the highest spot, I’d’ve gone with the corporate that turned the runner up.
Vikas Saini (awards ceremony): Number two, company healthcare behemoth workouts crushing energy. So what began out as a small Minnesota well being insurer is now the fourth largest enterprise within the nation by income, controlling practically 90,000 physicians and buying affect throughout the breadth and depth of the healthcare business within the United States.
Dan: Ninety-thousand physicians. That’s greater than thrice as many docs as work for the VA.
Of course that firm is UnitedHealth Group. Which additionally operates the nation’s largest insurance coverage firm, United HealthCare. And a BUNCH of different well being care companies. We’ve talked quite a bit about United on this present within the final couple of years.
And a staff at STAT News — that’s a information outlet protecting well being, medication and science — they did an enormous collection on United in 2024, documenting simply how massive United has grown, and the way its tentacles work together.
For occasion: UnitedHealth is the largest participant in Medicare Advantage — that’s the privatized model of Medicare. You’re in a United Healthcare Medicare Advantage plan, your in-network physician is more likely to work for United HealthGroup.
STAT interviewed a few of these docs, who stated they felt pressured to, one, spend much less time with sufferers. And two … properly, the second half wants a bit setup: When you run a Medicare Advantage plan, you get more money— a bonus — for insuring sufferers who’re much less wholesome.
So the second factor these docs advised STAT was: They felt pressured to make use of aggressive medical-coding ways to make their sufferers look as unhealthy as attainable. Which may earn that bonus for the insurance coverage plan.
Vikas Saini (awards ceremony): According to STAT this tactic might have allowed the corporate to take tens of billions of {dollars} in further funds from us, the taxpayers, over the previous decade. UnitedHealth faces a federal lawsuit for this conduct, in addition to an ongoing antitrust investigation. And after all, the corporate denies any wrongdoing.
Dan: When we talked, Vikas Saini stated: If he have been working for United, he may pursue the identical sorts of methods. That’s the way you hit your numbers, maintain shareholders completely happy. It’s the logic of a lot of our healthcare system.
It was the logic of Martin Shkreli, the man who offers these awards their identify. Shkreli did finally spend seven years in jail. But not for jacking up the value of medication.
Vikas Saini: People say he went to jail and so they hyperlink it to the pharma pricing factor, however he didn’t go to jail for that. He went to jail for this different factor, securities fraud. So it might be, elevating the value that a lot was completely authorized, after which that places a distinct spin on his justification, which is he felt it was his obligation to his shareholders to maximise what he may make.
Dan: By the identical logic, United owes its shareholders most return. Grows larger and larger. And different gamers — making an attempt to hit their numbers — they attempt to develop large enough to compete.
Vikas Saini: Now, possibly sometime, you already know, we’ll have three behemoths duking it out. But once more, the individuals left holding the bag and all these healthcare Godzilla-versus-King-Kong fights, the individuals left holding the bag are sufferers, communities, smaller hospitals, rural hospitals, and most of us, actually.
Dan: When Godzilla and King Kong combat, they stomp on everyone.
Vikas Saini: Yeah, precisely.
Dan: Meanwhile, United has been within the information not too long ago, in an enormous method. In December, the CEO of the insurance coverage division, Brian Thompson, was shot to demise in New York. You in all probability heard about it.
Vikas Saini: I’d characterize my temper, or my response in response to that capturing to be certainly one of alarm and urgency. The urgency is that we’ve been doing the Shkreli Awards for, you already know, years, and years, and years. You know, the type of anger and the type of simmering resentments, they’ve been there for some time. And that’s what I’m alarmed about. Because we acquired massive issues. If nothing else, it’s a flare being shot as much as say there’s a disaster and to name it something lower than a disaster isn’t actual.
Dan: Vikas Saini sees this disaster as an extension of how our well being care system works. Everybody hitting their numbers. And he asks, “Yeah, but, numbers of what?”
Vikas Saini: If we’re going to deal with well being care as a commodity and we’re going to have the magic of {the marketplace} remedy all these issues, which some individuals nonetheless suppose is the best way ahead – I occur to disagree in lots of dimensions – however in accordance with the logic of {the marketplace}, what’s the product off the meeting line? If the product is well being care exercise, well being care procedures, then now we have the system now we have, however what if the product have been well being? What if the product have been wellness?
Dan: We don’t measure for that. He thinks once more about his mentor, Bernard Lown.
Vikas Saini: He was all the time fond of claiming that in most different companies, the you get extra environment friendly by doing the whole lot sooner. And he stated, in well being care, not less than within the physician affected person relationship, you get extra environment friendly by doing the whole lot slower.
Dan: Meaning, by taking time to essentially get to know sufferers.
Vikas Saini: The fast instance is, if I do know somebody for 10 years and so they are available Friday at 4:30 with a headache, I’ve one response. If I’ve by no means met this individual in my life and so they are available Friday at 4:30 with a headache, I’m extra more likely to ship them for a CT scan or see a neurologist or regardless of the hell it’s.
Dan: In addition — and distinction — to the Shkreli Awards, the Lown Institute offers out a Bernard Lown Award for Social Responsibility.
It honors a “young clinician” — underneath the age of 45– who stands out for “bold leadership” in humanitarian work and standing up for justice.
If you already know any person who might be a match, the deadline to appoint them for the 2025 award is January 31.
Speaking of deadlines, we had an enormous one on December 31: The finish of our year-end fundraising drive.
We have been racing to hit an enormous goal: Between the Institute for Nonprofit News and some super-generous donors, there have been funds to match 30 thousand {dollars} in items.
Did we make it?
You wager we did. Or ought to I say, YOU did. Thank you SO a lot. Because of your generosity and dedication, we’re beginning out 2025 super-strong.
Starting with: We’re bringing again the First Aid Kit e-newsletter, and making it WEEKLY. Starting in February. I’m super-excited.
Meanwhile, we’re beginning an especially cool partnership with KUOW, Seattle’s NPR information station. They’ll be serving to extra individuals uncover this present– as a podcast.
(No fast plans for a broadcast model, however that is actually massive. In simply within the first few days, we’re seeing a lot of new of us listening to An Arm and a Leg — and we’re actually simply getting began.)
If you’re one of many of us who’s found this present with assist from KUOW and the NPR community, welcome aboard! I’m so glad you’re right here.
We’ll be again with a brand new episode in a number of weeks, and in the meantime, be at liberty to dig round within the hundred-and-some episodes we’ve revealed within the final six years. I feel they’re all fairly good.
Catch you quickly.
Till then, deal with your self.
This episode of An Arm and a Leg was produced by me, Dan Weissmann, with
assist from Emily Pisacreta and Claire Davenport — and edited by Ellen Weiss.
Adam Raymonda is our audio wizard.
Our music is by Dave Weiner and Blue Dot Sessions.
Bea Bosco is our consulting director of operations.
Lynne Johnson is our operations supervisor.
An Arm and a Leg is produced in partnership with KFF Health News. That’s a
nationwide newsroom producing in-depth journalism about well being points in
America and a core program at KFF, an unbiased supply of well being coverage
analysis, polling, and journalism.
Zach Dyer is senior audio producer at KFF Health News. He’s editorial liaison to this present.
And because of the Institute for Nonprofit News for serving as our fiscal sponsor.
They permit us to just accept tax-exempt donations. You can be taught extra about INN at
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Finally, thanks to everyone who helps this present financially.
You can take part any time at arm and a leg present, dot com, slash: help.
And listed below are the names of simply among the individuals who pitched in earlier than the tip of 2024. Thanks this time to… [names redacted]
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