Yearly, a well being care assume tank known 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 government who infamously raised the value of Daraprim, a lifesaving therapy for toxoplasmosis, from round $13 a capsule to $750. The media dubbed him “the pharma bro,” and he grew to become an emblem of brazen pharmaceutical greed.
On 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.
“Exhibiting all these tales collectively paints an image of a well being care system in determined want of transformation,” Saini mentioned on the occasion. “Not simply because the tales are surprising, however as a result of typically what they’re depicting, like Martin Shkreli’s notorious worth hike, is completely authorized.”
Dan Weissmann
@danweissmann
Host and producer of “An Arm and a Leg.” Beforehand, Dan was a employees reporter for Market and Chicago’s WBEZ. His work additionally seems on All Issues Thought-about, Market, the BBC, 99 % Invisible, and Reveal, from the Middle for Investigative Reporting.
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Transcript: The ‘Shkreli Awards’ — For Dysfunction and Profiteering in Well being Care
Be aware: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can comprise errors. Please use the transcript as a software 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 evening.
Dan: OK, I didn’t watch the Golden Globes this 12 months. However there may be an awards present that’s made mainly only for nerds like me.
Vikas Saini (awards ceremony): Whats up, everybody, and welcome to the eighth annual Shkreli Awards.
Dan: The Shkreli Awards! Named after the “pharma bro” Martin Shkreli. Bear in mind him?
He grew to become well-known — notorious — in 2015, when an organization he ran took over the making of an previous drug known as Daraprim. Outdated, previous. Launched in 1952, however it later grew to become used to stop a type of pneumonia that individuals with HIV can develop.
So Martin Shkreli jacked up the value — from thirteen-and-a-half {dollars} a capsule to seven hundred and fifty bucks. Rings a bell, proper? So, who provides out awards named after that man?
Reply: A well being care assume tank known as the Lown Institute. Considered one of their large current tasks was rating nonprofit hospitals by how a lot they do to “earn” their tax exemptions, for example, 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. The truth is, it’s additionally type of a celebration of nerds type of like me. Every of the terrible tales these awards spotlight was dug up and dropped at mild by … journalists.
Vikas Saini (awards ceremony): So this 12 months, the journalists behind these tales can 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. Sometime, I hope the reporting we do right here earns us considered one of these. The ceremony was held January 7. We’ll deliver you some highlights — I imply, is it a spotlight if you’re giving awards for the worst issues? Effectively, let’s simply say they have been a number of 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 costume it up a bit of bit, so it feels like different awards reveals, with an enormous crowd, and a stage …
Vikas Saini (awards ceremony): All proper, so. With out additional ado, let’s do the countdown. The 2024 Shkreli Awards. Brace yourselves. Right here we go.
Dan: That is An Arm and a Leg. A present about why well being care prices so freaking a lot, and what we will perhaps 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 probably the most enraging, terrifying, miserable elements of American life, and convey you one thing entertaining, empowering, and helpful.
The Shkreli Awards present is a countdown, beginning with quantity ten. They usually began with a doozy this 12 months.
Vikas Saini (awards ceremony):Quantity ten. Texas Medical College allegedly neglects to inform subsequent of kin earlier than promoting physique elements of the deceased.
Dan: NBC Information reported that the College of North Texas Well being Science Middle in Forth Price was getting unclaimed our bodies from the county coroner, after which chopping them up and promoting them — with out getting anyone’s consent.
Vikas Saini (awards ceremony): The middle’s enterprise equipped the physique elements to main for-profit ventures like Medtronic and Johnson Johnson. The investigation discovered repeated failures on the middle and on the county degree to contact members of the family who have been, in actual fact, comparatively simple to establish and attain.
Dan: As an illustration, NBC talked with the household of Carl Honey, a veteran who died homeless, however was entitled to a army burial. Right here’s what occurred as a substitute.
Vikas Saini (awards ceremony): Swedish medical gadget maker paid 341 {dollars} for Honey’s proper leg. A Pittsburgh medical training firm spent 900 {dollars} for his torso, and the U.S. Military paid 210 {dollars} for bones from his cranium. It simply sounds so macabre. It’s extra like a Halloween story.
Dan: When NBC Information advised the college what they’d discovered — and that they’d be publishing their findings — the medical college shut down this system and fired the individuals who had been operating it.
However as Vikas Saini mirrored after we talked, this most likely wasn’t a narrative about a number of rogue directors. It sounded to him extra like a very 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 realize, it’s just like the widget manufacturing facility and, you recognize, what number of vehicles did Tesla ship, and with that mentality, you set the tone.
When you set the tone, you may’t preserve monitor of what everyone’s doing. And the folks most likely thought they have been doing the appropriate factor. They’re attempting to herald some income.
Dan: In case your job is to herald income, assist make the numbers, then why would you hassle attempting to contact subsequent of kin and get consent earlier than promoting off anyone’s physique elements?
And this was a state medical college. As we’ll see, as you recognize, this theme — gotta make our numbers — runs by the entire awards ceremony and thru a lot of well being care.
Subsequent on the record was one other banger.
Vikas Saini (awards ceremony): Quantity 9, out of the mouths of babes, a style for tongue-tie chopping 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 of thicker, or shorter, and that’s known as a tongue tie. The New York Instances reported that lactation consultants have typically suggested new mothers to have tongue-tied infants snipped, to assist with nursing.
And the Instances reported that the process has exploded in reputation.
Vikas Saini (awards ceremony): Regardless of a scarcity of proof exhibiting effectiveness, child tongue tie chopping procedures are being touted as a remedy for the whole lot from breastfeeding difficulties to sleep apnea, scoliosis, and even constipation.
Dan: New York Instances reporters talked to 1 doc who mentioned he does this process 100 instances per week. At 900 {dollars} a pop.
Dentists additionally do plenty of these, and a medical-device maker named Biolase apparently was encouraging them to do extra. Right 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 gadget firm educated attendees on the process earlier than doing rounds of tequila pictures and margaritas.
I ought to add that, you recognize, they’d a 3rd annual Phrenectomy Fiesta, which was marketed as “nacho common dental assembly.”
Dan: Later, Vikas Saini advised me this story really stirred some deep reflection, that goes again to the Lown Institute’s origin story, and his personal.
The institute began because the Lown Cardiovascular Analysis Basis, based in 1973 by Dr. Bernard Lown, a heart specialist who advocated for non-invasive administration of coronary heart illness — and who grew to become 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 medical doctors and researchers wish to uncover new issues. However in our system, that need will get wrapped up within the medical business’s must 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 recognize, it form of snowballs.
Dan: Tongue-tie chopping appears to be like 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 folks within the approach, that’s not confined to this. This goes on in every single place.
Dan: We might dig up most likely a trove of tongue ties and tequila shots-like occasions.
Vikas Saini: Yeah, yeah, yeah. Gallbladders and gimlets.
Dan: Right 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 Well being Information. And on this case, the product is a drug.
Vikas Saini (awards ceremony): A drug firm pursues excessive dose of income regardless of threat to sufferers. That’s surprising. 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: However the firm additionally needed to check a decrease dose: 240 milligrams. Which seems to work nearly as properly, with loads fewer uncomfortable side effects.
Vikas Saini (awards ceremony): That must be excellent news for sufferers seeking to cut back the diarrhea, nausea, vomiting, and mouth sores that may happen.
Dan: One affected person advised KFF Well being Information, “After two months on that drug, I had misplaced 15 kilos, had sores in my mouth and down my throat, abdomen stuff. It was horrible.”
So yeah, a decrease dose feels like nice information.
However not for Amgen. KFF Well being Information reported that by promoting the upper dose, the corporate makes an additional 180 thousand {dollars} per 12 months, per affected person. In order that’s what they’re doing.
On the awards ceremony, Vikas Saini mentioned the story reveals weaknesses within the FDA approval course of. It’s lengthy and costly, however it’s not complete.
Vikas Saini (awards ceremony): There’s no manner of holistically taking a look at how a lot does this value? What are the uncomfortable side 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 permitted. You may cost a thousand bucks and we’ll determine it out later.”
Dan: Earlier than giving “last approval,” the FDA has requested Amgen for additional research, however in the meantime, the drug is available on the market, 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 perfect for sufferers. However do make cash. After which there’s a narrative from the New York Instances about of us promoting merchandise that … don’t appear to even exist.
Vikas Saini (awards ceremony): Right here’s a narrative that’s gonna piss folks off, maybe. In 2023, a large surge in Medicare billing for urinary catheters left sufferers shaking their heads. As much as 450,000 beneficiaries had payments for catheters submitted on their behalf.
Representing an 800 % improve over earlier years. Simply seven suppliers have been accountable for two billion {dollars} of those suspicious expenses.
Dan: That two billion {dollars}? The New York Instances story says that would 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 Instances regarded into these suppliers, the curiously named Fairly in Pink Boutique, they discovered no medical enterprise at its handle, and its cellphone quantity rang a random auto physique store.
Dan: The Instances discovered that Fairly In Pink had billed Medicare for greater than a quarter-billion {dollars}. I mentioned to Saini: This instance appears to point out, this type of fraud — perhaps you don’t even need to strive that onerous.
Vikas Saini: I feel it simply illustrates, you recognize, the greenback flows by healthcare are so large. A number of trillions of {dollars}. You realize, {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 must hit their numbers, we get high-priced medicine that might not be well worth the cash and physique elements offered off with out anyone’s consent. People getting procedures they might not want. Corporations billing for catheters nobody appears to have gotten.
And naturally the Shkreli Awards “honored” extra winners. Together with a health care provider 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 journey 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 Information discovered that their charity care coverage had been altered in 2023 to exclude most cancers therapy.
And as dangerous and ridiculous as all this sounds, nonetheless forward, we’ve acquired prime two honorees – properly, dis-honorees — and a few greater 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 Street Productions and KFF Well being Information — that’s a nonprofit newsroom masking well being points in America. KFF’s reporters do superb work — they’ve damaged a lot of Shkreli Award profitable tales. I’m honored to work with them.
The opposite private-equity story on this 12 months’s Shkreli Awards entails 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 value of Steward’s monetary 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 considered one of his yachts on the time. And acquired held in contempt.
It’s a hell of a narrative. But when I had gotten to vote for the highest spot, I might’ve gone with the corporate that grew to become the runner up.
Vikas Saini (awards ceremony): Quantity two, company healthcare behemoth workout routines 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 almost 90,000 physicians and buying affect throughout the breadth and depth of the healthcare business in america.
Dan: Ninety-thousand physicians. That’s greater than 3 times as many medical doctors as work for the VA.
In fact 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 loads about United on this present within the final couple of years.
And a workforce at STAT Information — that’s a information outlet masking well being, medication and science — they did a large sequence on United in 2024, documenting simply how large United has grown, and the way its tentacles work together.
As an illustration: UnitedHealth is the largest participant in Medicare Benefit — that’s the privatized model of Medicare. You’re in a United Healthcare Medicare Benefit plan, your in-network physician is prone to work for United HealthGroup.
STAT interviewed a few of these medical doctors, who mentioned they felt pressured to, one, spend much less time with sufferers. And two … properly, the second half wants a bit of setup: Once you run a Medicare Benefit plan, you get extra cash— 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 might earn that bonus for the insurance coverage plan.
Vikas Saini (awards ceremony): In keeping with STAT this tactic might have allowed the corporate to take tens of billions of {dollars} in extra funds from us, the taxpayers, over the previous decade. UnitedHealth faces a federal lawsuit for this habits, in addition to an ongoing antitrust investigation. And naturally, the corporate denies any wrongdoing.
Dan: After we talked, Vikas Saini mentioned: If he have been working for United, he would possibly pursue the identical sorts of methods. That’s the way you hit your numbers, preserve shareholders glad. It’s the logic of a lot of our healthcare system.
It was the logic of Martin Shkreli, the man who provides these awards their identify. Shkreli did ultimately spend seven years in jail. However not for jacking up the value of drugs.
Vikas Saini: Individuals 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 unique spin on his justification, which is he felt it was his responsibility to his shareholders to maximise what he might make.
Dan: By the identical logic, United owes its shareholders most return. Grows greater and larger. And different gamers — attempting to hit their numbers — they attempt to develop large enough to compete.
Vikas Saini: Now, perhaps sometime, you recognize, we’ll have three behemoths duking it out. However once more, the folks left holding the bag and all these healthcare Godzilla-versus-King-Kong fights, the folks 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: In the meantime, United has been within the information not too long ago, in an enormous manner. In December, the CEO of the insurance coverage division, Brian Thompson, was shot to loss of life in New York. You most likely heard about it.
Vikas Saini: I’d characterize my temper, or my response in response to that taking pictures to be considered one of alarm and urgency. The urgency is that we’ve been doing the Shkreli Awards for, you recognize, years, and years, and years. You realize, 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. As a result of we acquired large 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 will not be actual.
Dan: Vikas Saini sees this disaster as an extension of how our well being care system works. All people hitting their numbers. And he asks, “Yeah, however, 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 folks nonetheless assume is the best way ahead – I occur to disagree in lots of dimensions – however in response to 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 at all times fond of claiming that in most different companies, the you get extra environment friendly by doing the whole lot sooner. And he mentioned, 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: Which means, by taking time to essentially get to know sufferers.
Vikas Saini: The short instance is, if I do know somebody for 10 years and so they are available in Friday at 4:30 with a headache, I’ve one response. If I’ve by no means met this particular person in my life and so they are available in Friday at 4:30 with a headache, I’m extra prone to ship them for a CT scan or see a neurologist or regardless of the hell it’s.
Dan: As well as — and distinction — to the Shkreli Awards, the Lown Institute provides out a Bernard Lown Award for Social Accountability.
It honors a “younger clinician” — beneath the age of 45– who stands out for “daring management” in humanitarian work and standing up for justice.
If you recognize anyone who may very well be a match, the deadline to appoint them for the 2025 award is January 31.
Talking of deadlines, we had an enormous one on December 31: The tip of our year-end fundraising drive.
We have been racing to hit an enormous goal: Between the Institute for Nonprofit Information and some super-generous donors, there have been funds to match 30 thousand {dollars} in presents.
Did we make it?
You guess we did. Or ought to I say, YOU did. Thanks SO a lot. Due to your generosity and dedication, we’re beginning out 2025 super-strong.
Beginning with: We’re bringing again the First Assist Equipment publication, and making it WEEKLY. Beginning in February. I’m super-excited.
In the meantime, we’re beginning an especially cool partnership with KUOW, Seattle’s NPR information station. They’ll be serving to extra folks uncover this present– as a podcast.
(No instant plans for a broadcast model, however that is actually large. 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.)
In case 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 happy 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.
Until 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 Classes.
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 Well being Information. 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 Well being Information. He’s editorial liaison to this present.
And due to the Institute for Nonprofit Information for serving as our fiscal sponsor.
They permit us to simply accept tax-exempt donations. You may study extra about INN at
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Lastly, thanks to everyone who helps this present financially.
You may take part any time at arm and a leg present, dot com, slash: help.
And listed below are the names of simply a number of the individuals who pitched in earlier than the tip of 2024. Thanks this time to… [names redacted]
“An Arm and a Leg” is a co-production of KFF Well being Information and Public Street Productions.
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