Would $2.3 Million Reach to the Moon and Back?

Every day I wake up to a plethora of headlines and editorials examining and opining on health care in this country. The other week there was a story about federal prosecutors levying a $2.3 billion fine on Pfizer Inc.(which makes Bextra, Lyrica, Lipitor and Viagra among many others) for several infractions, including promoting the off-label use of several drugs.

According to the Justice Department, that’s a big no-no.

Doctors can prescribe medication for off-label uses, but pharmaceutical companies may not market drugs for these off-label uses. Pfizer also got called out for providing physicians with perks like free golf and junkets to resorts.

I’m not sure how Pfizer is going to pay that fine, but I’m pretty sure they have enough money. Heck, the company just spent $68 million to acquire Wyeth, another huge pharmaceutical company. In any event, Pfizer is going to break the record when it pays up. The Justice Department says this is largest sum of money ever paid to the government for a fine and civil penalty.

All this got me to wondering: What does 2.3 billion look like in, say, stacks of $20 bills? If lined up end to end, would those $20 bills reach to the moon and back? Or would it take $5 bills to do that? Would they wrap around the earth a couple of times? How many mattresses could I stuff with $2.3 billion?

Certainly it’s enough to provide some health care for those in this country who don’t have it.

Fortunately, it looks like at least some of the penalty money will be used to do just that.

According to what I’ve read, about $331 million will go to states to help pay for Medicaid programs and some other things. (Only South Carolina declined this windfall.) Florida is going to use some of the money to reward people who report Medicaid fraud, and Illinois will use $11.3 million for its Medicaid program. New York will collect $66 million and California gets almost $35 million. Both states, according to wire reports, will use the money for Medicaid expenses.

Another chunk of money will go to five former Pfizer employees and a Pennsylvania physician who are going to split $102 million for blowing the whistle on the world’s largest drug manufacturer. One of the former employees didn’t mince words.

“The whole culture of Pfizer is driven by sales, and if you didn’t sell drugs illegally, you were not seen as a team player,” said John Kopchinski, who left the company in 2003 and will receive more than $50 million for his part in turning in the miscreants.

I confess: I’m conflicted about the contribution and role of pharmaceutical companies.

Many take big risks in developing drugs, and someone has to do that. Who else is going to slog through the immense barriers of time and money to bring forth new medicines that may or may not be effective? But are the high stakes tempting some companies to try to recoup and exceed their investments in other ways?

Maybe pharmaceutical research should be backed by the government and developed by universities who would be paid for the work, but whose goal was not to maximize profits at any cost.

In the meantime, perhaps if enough pharmaceutical companies continue down this path, and the government continues to get involved, we can finance health care for all the uninsured.

Disclaimer: The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of AMN Healthcare or its employees.

Sometimes Nurses Can’t Really Help; We Just Have to Hope

Today we are eight years out from Sept. 11, 2001.

In some ways, it’s been a short eight years since the tragedy that happened in New York City, Washington, D.C. and Somerset County, Pennsylvania; in other ways, it’s been a long eight years.

I still find it difficult to look at pictures from that day – the burning World Trade Center towers, the disbelief and fear in the faces of New Yorkers as they stare at those towers or run from the giant dust cloud that enveloped lower Manhattan; the smoke billowing from the Pentagon; and the charcoal crater left by Flight 93 after it crashed in the field near Shanksville, Pa.

I remember wondering that Tuesday morning how emergency crews – doctors, nurses, paramedics, firefighters and police officers – would handle the hundreds of seriously ill and injured that were bound to be rushed through their doors. As it turned out, there were very few seriously injured. Victims either escaped with non-life-threatening injuries or they died. I read that staffs in emergency rooms around New York City waited and waited. When no trauma victims arrived, they knew it was really bad.

Some nurses from around the country were compelled to go to New York City, without even knowing what might be there. Jerry Lucas RN, felt the call. After his 12-hour shift in an ER in New Albany, Ind., he drove for 12 hours to get to Ground Zero. In 2005, he recounted his story on a Web site for nurses:

“Like many other people, after the first plane hit the World Trade Center, I watched the television in horror as events unfolded. Then I called my boss and told her that I was going to New York to help out. I left home, drove for 12 hours and arrived at 2a.m. I could see a bright glow over the city. You could see smoke, but all I can remember is the glow of fire. When I got to Ground Zero it was like something out of a war movie. I worked side by side with the real heroes of the day -- the police, firefighters and the emergency medical services.

“The feeling of loss was indescribable. I worked throughout the night and all the following day. Words cannot describe what the situation was like.

“Once, when I walked out of Ground Zero, I met people wandering around with pictures of missing loved ones. I was asked if I could tell them anything. That is when I wept; how do you tell people about hell on Earth?”

Later that day – on Sept. 12 – Lucas drove home to meet some family obligations.

“I felt ashamed that I had not stayed longer and (given) more of my skills and time to help the rescue effort,” he continued. “I felt that, as a nurse, I should have given more to my country during a time of need.”

I’m sure Lucas’ frustration was shared by many nurses on Sept. 11, 2001, who could do little but watch as events unfolded. As helping professionals, we usually feel that there must be something we can do to “make it better.” We’ll never forget the events of that day. We’ll just hope that time can make living with these memories a little easier.

Sometimes Nurses Can’t Really Help; We Just Have to Hope

Today we are eight years out from Sept. 11, 2001.

In some ways, it’s been a short eight years since the tragedy that happened in New York City, Washington, D.C. and Somerset County, Pennsylvania; in other ways, it’s been a long eight years.

I still find it difficult to look at pictures from that day – the burning World Trade Center towers, the disbelief and fear in the faces of New Yorkers as they stare at those towers or run from the giant dust cloud that enveloped lower Manhattan; the smoke billowing from the Pentagon; and the charcoal crater left by Flight 93 after it crashed in the field near Shanksville, Pa.

I remember wondering that Tuesday morning how emergency crews – doctors, nurses, paramedics, firefighters and police officers – would handle the hundreds of seriously ill and injured that were bound to be rushed through their doors. As it turned out, there were very few seriously injured. Victims either escaped with non-life-threatening injuries or they died. I read that staffs in the emergency rooms around New York City waited and waited. When no trauma victims arrived, they knew it was really bad.

Some nurses from around the country were compelled to go to New York City, without even knowing what might be there. Jerry Lucas RN, felt the call. After his 12-hour shift in an ER in New Albany, Ind., he drove for 12 hours to get to Ground Zero. In 2005, he recounted his story on a Web site for nurses:

“Like many other people, after the first plane hit the World Trade Center, I watched the television in horror as events unfolded. Then I called my boss and told her that I was going to New York to help out. I left home, drove for 12 hours and arrived at 2 a.m. I could see a bright glow over the city. You could see smoke, but all I can remember is the glow of fire. When I got to Ground Zero it was like something out of a war movie. I worked side by side with the real heroes of the day -- the police, firefighters and the emergency medical services.

“The feeling of loss was indescribable. I worked throughout the night and all the following day. Words cannot describe what the situation was like.

“Once, when I walked out of Ground Zero, I met people wandering around with pictures of missing loved ones. I was asked if I could tell them anything. That is when I wept; how do you tell people about hell on Earth?”

Later that day – on Sept. 12 – Lucas drove home to meet some family obligations.

“I felt ashamed that I had not stayed longer and (given) more of my skills and time to help the rescue effort,” he continued. “I felt that, as a nurse, I should have given more to my country during a time of need.”

I’m sure Lucas’ frustration was shared by many nurses on Sept. 11, 2001, who could do little but watch helplessly as events unfolded. As helping professionals, we usually feel that there must be something we can do to “make it better.” We’ll never forget the events of that day. We’ll just hope that time that can make living with these memories a little easier.

Nursing Shortages: If Not Now, Soon

Believe me, I’m not an ageist.

I think anyone who can do the work and wants to should, but I have little pangs of concern and sympathy for folks in their 20s and all new graduates who are looking for employment and can’t find it.

There are reasons for fewer positions.

One, of course, is that companies are downsizing. Another is that the boomers (and those beyond age 63) are holding onto their jobs. Economic times are difficult and boomers may have lost healthy (or unhealthy) portions of their portfolios. They don’t have the money to retire. And some – well, they just enjoy their jobs and still have the energy and enthusiasm to continue working. (You know what they say: 60 is the new 40.)

In another time, these “oldsters” might be ready for gold watches and the condos in Florida, but it’s a new era.

The situation with nurses is no exception.

Many have remained on the job or returned to work at a time when they’d prefer to be home pursuing hobbies and playing with grandchildren because of economic circumstances beyond their control. Spouses have lost jobs and nurses have been called on to fill the income gap. (Your mother was right; nursing is a profession you can always fall back on.) Single older nurses – almost exclusively women – are looking at bleak retirement years unless they can feather the nest a bit more.

Those remaining on or returning to the workforce have helped curb the nursing shortage in some areas of the country – at least for awhile. In some places, there is a decreased need for nurses in the hospital. Because unemployment has risen, so has the number of uninsured. Without health care coverage, many have put elective surgeries on hold. This means a loss of income for hospitals and in some cases, these institutions have closed entire wings.

In California, the madatory nurse-to-patient ratio (legislation passed in 1999) has kept the need for nurses afloat. And if universal health insurance becomes a reality, that could boost the number people eligible for hospitalization. Lastly, it won’t be long before another reason to keep nurses employed kicks in nationwide: Boomers are aging, and as more and more live longer and longer, the demand for nurses will do nothing but rise.

I’m wondering from whence they’ll come.

Nursing schools presently are limited in the number of students they can accept - mostly because there are not enough instructors. This, I’m told by my nurse-instructor friends, is because teaching just doesn’t pay. It’s not uncommon for teachers to make half of what hospital nurses earn.

So whether there’s a current shortage or not of nurses where you live, just hang in there a bit. There clearly will be a demand in the not-too-distant future.