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garden-of-everything · 7 years ago

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ABIM: Gastroenterology

ABIM syllabus can be found here Let me know if you find any errors Sources: UWorld, MKSAP 16/17, Rizk Review Course, Louisville Lectures, Knowmedge (free version)

Esophageal disease

Gastroesophageal reflux: - Dx/Tx: PPI --> endoscopy --> ambulatory esophageal pH monitoring with PPI - Endoscopy first if: >50yo (white male), alarm symptoms (weight loss/dysphagia), symptoms >5 years *young patient without alarm signs: test for H.pylori (urea breath test, stool Ag, serum Ab (useless to test for eradication)) and treat empirically WITHOUT endoscopy Barrett’s esophagus: EGD Q3-5 years; if high grade dysplasia --> esophagectomy Esophageal carcinoma: progressive solid to liquid dysphagia Esophageal dysphagia --> endoscopy vs. Oropharyngeal dysphagia (i.e., CVA, Parkinson’s, Zenker’s, MG, ALS) --> videofluoroscopy > barium swallow *Esophageal diverticula (Zenker’s) --> videofluoroscopy Achalasia: liquid +/- solid dysphagia; associated with Chaga’s disease - Dx: barium esophagram “bird’s beak” --> manometry --> endoscopy - Tx: LES surgery / pneumatic dilation > CCB / Nitrate / Botox Medication-induced esophageal disorder: KCl, tetracyclines, bisphosphonates, iron, NSAIDs Esophageal strictures or webs: solid food dysphagia; associated with iron deficiency anemia Gastroesophageal varices: - PPx: non-selective BB (Propranolol/Nadolol) > ligation - Tx: octreotide + ligation +/- if bleeding/SBP, protein<1: FQ > TIPS/shunt Infectious esophagitis: - Candida esophagitis: Tx empirically with Fluconazole/Itraconazole --> fail?: endoscopy - HSV esophagitis: Tx with acyclovir/famciclovir --> fail?: IV foscarnet - CMV esophagitis: Tx foscarnet / ganciclovir *Viruses rarely cause oropharyngeal ulcers Mallory-Weiss syndrome: heavy EtOH + wretching/weight lifting/bulimia; Dx: endoscopy Eosinophilic esophagitis: young adult with extreme dysphagia and food impaction - Dx: esophageal Bx - Tx: steroids

Stomach or duodenal disease

Helicobacter pylori infection: - Dx: upper endoscopy + bx of ulcer and + (1) histologic assessment of H.pylori or (2) rapid urease test - Tx: PPI and 2 abx x2 weeks (Clarithromycin + (1)Amoxicillin or (2)Metronidazole) --> if fail: different Abx (i.e., tetracycline) + bismuth Peptic ulcer disease: gastric ulcers need bx, but duodenal ulcers don’t unless they’re refractory to treatment or suspicious looking Stomach cancer: Sister-Mary-Joseph nodule at umbilicus; CEA is positive and nonspecific for everything in the abdomen Non-ulcer dyspepsia: usually due to NSAIDs, Abx, Bisphosphonates, KCl; if alarm signs --> endoscopy Disorders of gastric emptying / gastroparesis: - Dx: endoscopy --> NM solid-phase gastric emptying (NOT KUB) - acute Tx: erythromycin; chronic Tx: metoclopramide Gastric outlet obstruction: - nausea/vomiting, early satiety - PEx: “succussion splash” (roll patient back and forth and hear sloshing sound in stomach) - Tx: PPI + NG tube Mentrier’s disease: associated with gastric cancer - protein-losing enteropathy c/o epigastric pain, N/V, edema - associated with CMV, H.pylori - increased TGFalpha, huge gastric folds, significantly decreased protein/decreased albumin - Dx: endoscopy with bx - Tx: Cetuximab

Small intestine disease

Celiac disease: - Dx: small bowel biopsy OR dermatitis herpetiformis (pruritic papulovesicular rash on extensors) - associated with small bowel lymphoma, osteomalacia, iron deficiency/microcytic anemia, malabsorption (Vits ADEK)/increased PT, elevated AST Bacterial overgrowth syndrome: - diarrhea in the setting of previous abdominal surgery / small bowel diverticulosis, systemic sclerosis, Diabetes - Dx: hydrogen breath test - Tx: empiric antibiotics Short bowel syndrome: - if <100cm resection --> Tx: cholestyramine - if >200cm: nutritional supplementation Whipple’s disease: - diarrhea/steatorrhea, fever, arthralgia, oculomasticatory myorhythmia (eye movement disorders and rapid repetitive movements of facial muscles), seizures/ataxia/confusion, endocarditis - Dx: small bowel biopsy + PCR for Tropheryma whipelli - Tx: 12 mo Abx (doxycycline, PCN) Mesenteric ischemia and ischemic colitis: - bowel rest / IVF - acute Dx: selective mesenteric angiography --> Tx: surgery - chronic Dx: conventional angiography or MRA --> Tx: stent *ischemic colitis needs colonoscopy IBS: 3 months of abdominal pain with BM changes - if >50yo or severe sx: get colonoscopy and test for Celiac disease - Tx: Dicyclomine / Hyoscyamine (antispasmodic) > TCA, Paroxetine IBD: associated with uveitis, arthritis, pyoderma gangrenosum *needs colonoscopy with bx 8 years after diagnosis and then every 1-2 years after; if dysplasia --> proctocolectomy (1) Crohn’s disease including Crohn’s colitis: ASCA>pANCA - skip lesions, involves entirety of GI but usually spares rectum - associated with fissures and crypts - mild Tx: use Budesonide if involves ileum/R colon, 5-ASA doesn’t work well - mod Tx: prednisone / MTX / AZT - refractory / fistula Tx: infliximab / adalimumab (2) Ulcerative colitis: pANCA > ASCA - continuous lesions starting from rectum; smoking relieves symptoms - associated with primary sclerosing cholangitis, ankylosing spondylitis, pyoderma gangrenosum - Dx: colonoscopy - mild Tx: 5-ASA - mod Tx: prednisone / 6MP / AT - severe Tx: IV steroid + cyclosporine / infliximab --> surgery vs. Microscopic colitis: associated with NSAIDs; Tx: Budesonide > Loperamide / Bismuth GIB of unknown origin: Dx: endoscopy/colonoscopy --> repeat a scope --> capsule endoscopy - Angiodysplasia: painless hematochezia and chronic anemia in elderly vs. - Meckel’s diverticulum: painless hematochezia in young with normal upper and lower endoscopy Gastric bypass complications: macrocytic anemia, steatorrhea (1) Blind loop syndrome: loose stools + malabsorption - Tx: Abx + nutritional support (2) Dumping syndrome: abdominal cramping, nausea, loose stools 15 minutes after eating --> 90 minutes after: tachycardia, diaphoresis, lightheadedness - Tx: small frequent low carb diet Diarrhea: (1) CVID: pulmonary diseases + Giardia; Dx: Ig levels (2) Traveler’s diarrhea: FQ + Loperamide (3) C. diff: if pregnant GIVE PO VANC Gastric bypass complications: (4) Chronic diarrhea: stool osmolar gap = stool osm(~290) - 2(Na+K): - <50 = 5ecretory diarrhea (5higella / cholera / bacteria, 5tool 5ofteners, VIPoma, carcinoid (Dx: 24hr urinary excretion of 5HIAA)) <--nocturnal symptoms - >125 = osmotic/fatty diarrhea (1actase deficiency, 1axatives (1actulose / Mg citrate), Ce1iac, chronic pancreatitis

Colonic and anorectal disease

Colon cancer screening: colonoscopy - Normal: start >= 50 years old, colonoscopy Q10 years OR get a yearly fecal occult blood test +/- sigmoidoscopy Q5 years - FAP: start at 12 years old with yearly sigmoidoscopy; colectomy by 20 years old - HNPCC: start at 20 years old or 10 years younger than relative with youngest diagnosis, repeat Q1-2 years - IBD: start 8-10 years after initial diagnosis of IBD, repeat with biopsy Q1-2 years - Family history of colon cancer at <60 years old: start at 40 years old or 10 years younger than relative with youngest diagnosis, repeat Q3-5 years Surveillance: - 2-3 months if: adenocarcinoma with >=2mm margin and minimal invasion - 2-6months if: >2cm sessile polyp removed piecemeal - <3 years if: >10 adenomas - 3 years if: >3 adenomas, any adenoma >1cm, villous or high-grade dysplasia - 5 years if: 1-2 <1cm tubular adenomas - 10 years if: small hyperplastic polyps

Diverticular disease: - Dx: CT abdomen (no need for colonoscopy for initial diagnosis) - Tx: 7-10 days cipro or metro --> post-recovery colonoscopy to rule out cancer

Pancreatic disease

Acute pancreatitis: - Dx: U/S --> if severe symptoms/suspect complication or >48 hours: CT scan - labs: elevated Hct, elevated BUN/Cr, lipase > amylase - complications: necrosis / abscess (Tx: surgery); pseudocyst (Tx: Abx and usually resolves spontaneously, otherwise surgery) Autoimmune pancreatitis: - elevated IgG4 - found as a mass in the pancreas that mimics cancer - Tx: steroids Chronic pancreatitis: - associated with EtOH, DM, steatorrhea - Dx: CT abdomen shows pancreatic calcifications *if young patient, do Cystic Fibrosis genetic testing - Tx: supportive / enzyme replacement

Biliary tract disease

Cholelithiasis: elective cholecystectomy Choledocholithiasis: ERCP *Mirizzi: impacted gallstones in cystic duct --> external compression of common bile duct --> obstructive jaundice --> Tx: cholecystectomy Cholecystitis: fevers, leukocytosis, pain - Tx: start broad spec Abx: (1) Amp / Gent / Metro, (2) Ceftaz / Metro, (3) Zosyn / Unasyn + SURGERY WITHIN 48 HOURS vs. Biliary colic: no fevers, no leukocytosis, symptoms <6 hours --> Tx: NSAIDs only vs. Cholangitis: fever / RUQ pain / jaundice + SHOCK + AMS - bilirubin >4, AST/ALT > 1000 - Dx: U/S --> HIDA --> stones?: ERCP - Tx: FQ + ERCP (NOT surgery) Primary sclerosing cholangitis: - young men - associated with UC, cholangiocarcinoma, HCC, BG cancer, colon cancer - Dx: US (with increased Alk Phos) show dilated bile ducts --> ERCP “beads on a string” - Tx: liver transplant; manage symptoms with ursodeoxycholic acid Cholecystenteric fistula: SBO and air in biliary tree AIDs cholangiopathy: RUQ pain, jaundice, and diarrhea associated with Cryptosporidium (CD4<100); Tx: Ursodeoxycholic acid, stenting / sphincterotomy *IFN alpha in HIV Tx is contraindicated in cytopenias, decompensated cirrhosis, active autoimmune diseases, and major depression; associated with causing hypothyroidism vs. Fitz-Hugh-Curtis: RUQ pain (liver capsule inflammation) 2/2 Gonorrhea/Chlamydia PID

Liver disease

Viral hepatitis: (1) Hepatitis A: - give Hep A vaccine to travelers to continents that start with A: Africa/Asia/central or south America - if traveling within 2 weeks, give Ig instead (2) Hepatitis B: - post-exposure PPx: Hep B vaccine + HBIg - associated with membranous GN (and blood clots), PAN - Tx: Lamivudine (3) Hepatitis C: - Dx: antiHCV Ab --> HCV RNA - HBsAb = immunity (via vaccine or past exposure); HBsAg = current infection, HBeAg = high replication - associated with porphyria cutanea tarda (blistering hyperpigmented rash with alcohol and sunlight, hypertrichosis, Tx w phlebotomy), cryoglobulinemia (cold agluttinins, cold fingers, low complement), leukocytoclastic vasculitis - Tx for genotype 2-4: peg-IFN + Ribavirin - Tx for genotype 1: PI (Boceprevir/Telaprevir) Cirrhosis and portal hypertension: - be sure to check endoscopy to rule out varices - calculate SAAG: (1) SAAG >1.1: (a) ascites protein <2.5 = cirrhosis (b) ascites >2.5 = RHF, Budd-Chiari (2) SAAG<1.1: (a) ascites protein <2.5 = nephrotic syndrome (b) ascites protein >2.5 = TB, cancer - SBP: --> Dx: ascites granulocytes > 250, albumin <1g/dL --> Tx: Cefotaxime + Albumin on day 1 and 3 *Hepatic encephalopathy Tx: Rifaximin / lactulose (NOT protein restriction) Drug-induced liver disease other than acetaminophen: amanita mushroom Autoimmune hepatitis: - young female with autoimmune disease (UC, thyroid) with transaminitis, elevated protein, decreased albumin - elevated IgG, antismooth muscle Ab, antiLKM --> Dx: liver biopsy - Tx: steroids + AZT Primary biliary cholangitis: - middle-aged lady with jaundice - Dx: antimitochondrial antibody + RUQ US + liver bx Cholestasis: elevated bili, elevated AlkPhos>>>>AST/ALT elevation Wilson’s disease: - young patient with psych issues, transaminitis, hemolysis, and athetoid movements - Dx: serum copper, ceruloplasmin - Tx: D-Penicillamine or trientine Liver disease in pregnancy: (1) HELLP: 3rd trimester, associated with DIC, MAHA (2) AFLP (acute fatty liver of pregnancy): HELLP with hypoglycemia + AMS + elevated PT Hemochromatosis: - bronze DM, cirrhosis, 2nd and 3rd MCP joint osteoarthritis with hooked osteophytes, also affects shoulders, ankles, and elbows - significantly elevated Ferritin, elevated transferrin (if transferrin >45% --> HFE genetic testing (CY282/H63D)) - Dx: liver biopsy to confirm - Tx: phlebotomy; if cirrhosis: check alpha fetoprotein and get Q6mo US Hepatic vein thrombosis (Budd-Chiari): - SAAG >1.1, ascites protein >2.5 - associated with essential thrombocytosis / JAK2 mutation Fatty liver and nonalcoholic steatohepatitis: Dx: liver bx Alcoholic hepatitis: - severe if Maddrey >32, MELD >18, Glasgow Alcoholic Hepatitis Score (GAHS) >9, ascites or AMS - Tx severe with steroids (*CI in GIB) + pentoxyfylline Gilbert’s syndrome: elevated indirect/unconjugated bilirubin with normal AST/ALT with stress; don’t Tx Hepatocellular carcinoma: - liver nodule <1cm: f/u US in 3mo - >1cm --> MRI with contrast or 4 phase MDCT -->+ = HCC, unsure --> other image or biopsy - Tx: surgical only (no chemo)

#me #gastroenterology #gi #internal medicine #abim #exam #test #studying #notes

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whittlebaggett8 · 6 years ago

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Healthcare CEOs take home some of the biggest pay packages in the world. Here’s what the industry’s top executives earned last year., Defence Online

Healthcare CEOs are some of the most well-paid executives in the US.

We took a look at the compensation packages of the leaders overseeing some of the biggest healthcare companies.

Here’s how much they took home in 2018, according to regulatory filings.

Visit Defence Online’s homepage for more stories.

Leading a top healthcare company is a demanding job – and one for which CEOs are handsomely compensated.

There’s a lot that can come with the job title, from overseeing tens of billions of dollars in market value to testifying in front of Congress and finding ways to serve both shareholders and patients.

We took a look at the compensation packages of some of the leaders overseeing the largest healthcare companies. Included in packages were salaries, stock, and benefits like retirement and other incentives.

The pay packages range from single-digit millions to north of $26 million. Here’s how they stack up.

Allergan CEO Brent Saunders, $6,624,473

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Allergan CEO Brent Saunders.

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Reuters

Brent Saunders has been presiding over Allergan and its billion-dollar Botox empire since 2014, when a $66 billion merger launched the company as a member of Big Pharma.

Lately, though, Saunders’ tenure has hit rocky times. Allergan still turns out a profitable business in cosmetics and eye care, but competition is also shaping up in those areas.

David Tepper’s Appaloosa LP hedge fund has slammed Allergan’s recent track record, calling for an independent board chair at the company – a move seen as an implicit critique of Saunders. Allergan’s stock price was among Appaloosa’s criticisms: It has steadily trended down since mid-2015, losing roughly 50% of its value.

Saunders’ leadership also came under attack in 2017, when he spearheaded an ill-advised gambit to extend patent protection on a key Allergan eye product, and last year, when a strategic review didn’t change much at the company.

Allergan’s market cap: $48 billion

GlaxoSmithKline CEO Emma Walmsley $7,662,210

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GlaxoSmithKline CEO Emma Walmsley.

source

Reuters via handout

Emma Walmsley has led the British drug giant GlaxoSmithKline for about two years, overseeing a time of transition for the company.

Like many of its pharmaceutical rivals, Glaxo is on the hunt for profitable new products that can sustain it for years to come.

Walmsley, who last year was one of just 25 female CEOs in the Fortune 500, comes to the world of healthcare by way of Glaxo’s consumer’s health business. Before joining the drugmaker in 2010, the Oxford University-educated Walmsley worked at L’Oreal, the world’s largest cosmetics company, for nearly 20 years.

But Glaxo is increasingly plotting its way out of consumer health, including its iconic products like Tums and Excedrin, seeing those as incompatible with innovative new products, including in cancer. Late last year, for example, the company announced a $5 billion bet on the cancer drugmaker Tesaro.

GSK’s market cap: $203 billion

Illumina CEO Francis deSouza, $11,067,566

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Illumina CEO Francis deSouza.

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Courtesy Businesswire

Francis deSouza became CEO of Illumina in 2016, succeeding Jay Flatley who had been in the post since 1999.

Illumina makes gene-sequencing technology used to turn samples of DNA into useful data for researchers and genetic testing companies alike.

Illumina’s market cap: $47 billion

Walgreens CEO Stefano Pessina, $13,542,260

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Walgreens CEO Stefano Pessina at the 2018 Forbes Healthcare Summit.

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Forbes/ Victoria Engblom

Following the merger of Boots Alliance and Walgreens in 2014, Stefano Pessina became CEO of the global pharmacy company.

Walgreens’ stock took a hit in April after it missed its second quarter earnings and cut its forecast for 2019. The company has been inking partnerships with companies like Microsoft, Google’s parent company Alphabet, Humana, and Kroger at a time when rivals like CVS Health have pursued big-ticket mergers.

Walgreens‘ market cap: $50 billion

Anthem CEO Gail Boudreaux, $14,184,276

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Anthem CEO Gail Boudreaux.

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Anthem

Gail Boudreaux is the CEO of Anthem, which offers health insurance under the Blue Cross and Blue Shield brand in 14 states. Boudreaux assumed the post at Anthem in November 2017. Prior to that, she served as the CEO of insurer UnitedHealthcare.

In January, Anthem let investors know it planned to launch its own pharmacy benefit manager ahead of schedule, earning praise from analysts.

“CEO Gail Boudreaux is clearly on a roll,” Leerink analyst Ana Gupte wrote in a January note.

Anthem’s market cap: $74 billion

Bausch Health CEO Joseph Papa, $14,741,050

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Bausch Health CEO Joseph Papa.

source

Reuters

Joseph Papa joined Bausch Health in May 2016, during troubled times.

Bausch was then called Valeant, and had weathered a number of yearslong scandals, including around aggressive price increases taken on Valeant drugs and one around accounting.

Papa, who had previously helmed the drugmaker Perrigo, had been wooed over by a generous incentive package of about $65 million. He had also been brought in to right the ship.

One name change later, it’s seemingly still a work in progress. Today, Bausch stock is one-tenth of what it was at peak, in 2015, and has actually declined slightly since Papa took over.

Bausch Health’s market cap: $9 billion

AstraZeneca CEO Pascal Soriot, $14,780,288.24

Pascal Soriot started as CEO of AstraZeneca in 2012, joining from a long career in the pharmaceutical industry, with stints as an executive at Roche and the biotech Genentech, where he led its acquisition by Roche.

Soriot, who trained as a veterinarian and also has an MBA, notoriously fended off a nearly $120 billion takeover by Pfizerin 2014, aiming to turn the company around on his own instead.

On pay, we’ll leave it to Soriot to tell it in his own words.

“The truth is I’m the lowest-paid CEO in the whole industry,” he told The Times of London last fall. “You know, it is annoying to some extent. But at the end of the day, it is what it is.

“I am not going to complain, but me and Emma [Walmsley, CEO of GlaxoSmithKline] are the lowest paid in Europe and the US.��

AstraZeneca’s market cap: $50 billion

Molina Healthcare CEO Joseph Zubretsky, $15,219,770

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Molina Healthcare CEO Joseph Zubretsky.

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World Congress Events/YouTube

Joseph Zubretsky joined health insurer Molina Healthcare in 2017, a few months after Molina’s two top executives were fired from the company. Prior to Molina, Zubretsky was an executive at Aetna.

Molina sells health insurance plans via government programs such as Medicaid, Medicare, and the individual marketplace established under the Affordable Care Act.

Molina Healthcare’s market cap: $9 billion

Humana CEO Bruce Broussard, $16,312,517

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Humana CEO Bruce Broussard.

source

Reuters

Bruce Broussard is the CEO of Louisville, Kentucky-based health insurer Humana, which specializes in Medicare Advantage health plans for the elderly. He joined the company in 2011 and became CEO in 2013.

In 2018, Humana was at the heart of speculation about whether the insurer was going to work more closely with retailers like Walgreens or Walmart. Humana has had close relationships with both companies.

Humana’s market cap: $37 billion

Alexion CEO Ludwig Hantson, $16,490,250

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Alexion CEO Ludwig Hantson.

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Reuters/Lucas Jackson

Ludwig Hantson joined Alexion in 2017, after a turbulent investigation into the company’s sales practices. He took over from interim CEO David Brennan.

Hantson came from leading the biopharmaceutical company Baxalta, and has been trying to control costs through restructuring, including laying off about 20% of Alexion’s workforce the year Hantson joined.

Alexion is also now bringing to market a new version of its most profitable drug, in hopes of staving off competition and extending patent protections.

Alexion’s market cap: $31 billion

Eli Lilly CEO David Ricks, $17,230,337

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Lilly CEO David Ricks.

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Reuters/Caroline Humer

A longtime Eli Lilly employee, David Ricks became CEO in 2017, after having worked in a wide range of the drugmaker’s businesses, including units in the US and China.

Ricks succeeded John Lechleiter, who before retiring had headed the drugmaker for eight years.

Eli Lilly is pushing forward in cancer, with a $8 billion acquisition of Loxo Oncology, but struggling to navigate pricing issues in diabetes, where it has a large portfolio.

The company recently announced a half-price version of a popular insulin, but critics have said it’s not enough.

Eli Lilly’s market cap: $130 billion

Medtronic CEO Omar Ishrak, $17,585,131

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CEO of Medtronic Omar Ishrak speaks during an IBM keynote address at the 2016 CES trade show in Las Vegas.

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Reuters/Steve Marcus

Device-maker Medtronic has been overseen by CEO Omar Ishrak since 2011. Prior to becoming CEO at Medtronic, Ishrak was an executive in GE’s Healthcare business.

The company makes medical technologies like insulin pumps, pacemakers, defibrulators, and other devices often used in surgical procedures.

Medtronic market cap: $111 billion

Merck CEO Ken Frazier, $17,643,087

Ken Frazier became Merck’s CEO in 2011, coming to the job by way of two decades at the pharma giant and, prior to that, a career in law.

Frazier has led Merck during a strikingly succesful, nearly decade-long period, which he credits in part to investing in research and development for new drugs. He recently hinted, though, that he may soon step down.

Already well-known in the healthcare industry, Frazier became even more prominent in 2017, when he quit President Donald Trump’s business council in the wake of Charlottesville.

One news outlet, comparing Frazier with a slate of other pharmaceutical leaders appearing at a recent congressional hearing on drug prices, even called him “the saint” of the bunch.

Merck’s market cap: $210 billion

UnitedHealth Group CEO David Wichmann, $18,107,356

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UnitedHealth Group CEO David S. Wichmann.

source

Twitter/WSJ

David Wichmann was named CEO of UnitedHealth Group in 2017, after working at the health insurer since 1998. His previous roles included president of UnitedHealth, and UnitedHealth CFO.

UnitedHealth is the biggest US health insurer, and runs clinics and a pharmacy benefits manager. The company also has technology and consulting operations.

UnitedHealth’s market cap: $212 billion

Amgen CEO Robert A. Bradway, $18,555,266

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Amgen CEO Robert Bradway.

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Christopher Polk / Getty

Robert Bradway came to Amgen in 2006 as the company’s vice president of operations strategy, from a roughly 20-year-long career in banking at Morgan Stanley.

He quickly climbed the corporate ladder, going on to work as executive vice president and CFO, and then CEO in May 2012. But just two years into his tenure, the pioneering biopharmaceutical company was struggling to grow and, in spite of a major restructuring that included big cuts to its workforce, facing serious criticism from Wall Street.

Amgen pushed through it. The stock has more than doubled over Bradway’s nearly seven years leading the company, and last year six of its drugs brought in a billion dollars or more. Amgen is also moving ahead with developing cutting-edge new drugs in cancer and migraine.

But challenges ahead remain, including the potential for new competitors on some of its best-selling drugs.

Amgen’s market cap: $109 billion

Thermo Fisher CEO Marc Casper, $18,607,103

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Thermo Fisher CEO Marc Casper

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Photo by Suzanne Kreiter/The Boston Globe via Getty Images

Life Sciences company Thermo Fisher has been led by CEO Marc Casper since 2009. Casper joined the company in 2001. Thermo Fisher makes equipment and software that clinical laboratories use to analyze samples and do drug discovery.

In March, Thermo Fisher acquired Brammer Bio, a company that manufactures viral vectors used in cell and gene therapies in a $1.7 billion deal.

Thermo Fisher‘s market cap: $103 billion

Cigna CEO David Cordani, $18,944,045

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Cigna CEO David Cordani speaking at CNBC’s Healthy Returns conference.

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David Grogan / CNBC

David Cordani is the CEO of Connecticut-based health insurer Cigna, a post he’s held since 2009.

In 2018, Cordani oversaw the acquisition of pharmacy benefits manager Express Scripts.

Cigna’s market cap: $63 billion

Pfizer’s Ian Read, $19,549,213

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Pfizer former CEO Ian Read.

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REUTERS/Adam Hunger

Ian Read became CEO of Pfizer in late 2010, and retired early this year, turning the reins over to current CEO Albert Bourla.

Read navigated the US drug giant through tricky times, including loss of patent protection for key products, and by most measures, successfully so.

Today, though, the drug company is striving to reinvent itself again, including by developing a portfolio of cancer drugs that it hopes will be worth $5 billion a year.

Pfizer’s market cap: $235 billion

Johnson & Johnson CEO Alex Gorsky, $20,111,045

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Johnson & Johnson CEO Alex Gorsky.

source

Jonathan Ernst/Reuters

Johnson & Johnson veteran Alex Gorsky was named CEO in 2012. He took over from the pharma giant’s longtime CEO, William Weldon.

At the time, the company was reeling from a series of recalls of products like Tylenol because of poor manufacturing practices.

Consumer trust is again a problem for the iconic baby products maker today. It has been sued over claims that its baby powder is carcinogenic, and recently lost a high-profile case, with more expected to follow this year.

And damning reports from Reuters and The New York Times found that the company had known about these potential issues for years, sending the stock tumbling.

J&J’smarket cap: $360 billion

AbbVie CEO Rick Gonzalez, $21,271,869

Richard (Rick) Gonzalez took over as CEO after Abbott Labs, in 2013, split into two companies, one focused on medical devices and one focused on pharmaceuticals.

Gonzalez, an Abbott veteran, had retired from the company years before the split, facing a battle with throat cancer. Upon recovering, he rejoined the company to head its drug business.

AbbVie’s blockbuster rheumatoid arthritis drug Humira is the best-selling product in the world. But facing competition and scrutiny about Humira’s high price tag, AbbVie has tried to diversify, including with a nearly $6 billion acquisition of a cancer company a few years ago.

But the deal was a flop. The lead drug didn’t pan out in a key area, and AbbVie recently admitted that the biotech was worth $4 billion less than it had thought.

AbbVie’s market cap: $121 billion

HCA Healthcare’s R. Milton Johnson, $21,419,906

R. Milton Johnson was the CEO of HCA Healthcare, a for-profit health system that operates 185 hospitals and 119 freestanding surgery centers around the US and the UK.

Johnson spent 36 years at HCA, becoming CEO in 2014. Johnson retired as of January 2019, but is a member of HCA’s board. Sam Hazen currently serves as HCA’s CEO.

HCA’s market cap: $45 billion

CVS Health CEO Larry Merlo, $21,953,040

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CVS Health President and CEO Larry J. Merlo.

source

Reuters

Larry Merlo has been CEO of Rhode Island-based CVS Health since 2011.

In his role, he oversees the company’s 9,800 pharmacies as well as other lines of business like CVS Caremark, the company’s pharmacy benefit manager, wich negotiates prescription drug prices with pharmaceutical companies.

In 2018, Merlo oversaw the $70 billion acquisition of health insurer Aetna.

CVS Health’s market cap: $70 billion

Abbott Laboratories CEO Miles White $24,254,238

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Abbott CEO Miles White.

source

Getty Images

When Miles White took over Abbott in 1998, he was the unlikely winner of a fierce, three-person race to be CEO.

White had previously led the company’s diagnostics unit, and replaced Duane Burnham, who planned to retire.

After Abbott was split into two companies in 2013, White stayed on as CEO of the medical device company. It’s been a successful streak, especially in recent years, with the stock roughly doubling since late 2016.

White has said he isn’t leaving anytime soon, but did point to a potential successor recently– Abbott veteran Robert Ford, who was named president and chief operating officer in October.

Abbott’s market cap: $138 billion

Gilead Sciences CEO John Milligan, $25,961,831.00

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Gilead former CEO John Milligan.

source

Screenshot via CNBC

John Milligan was the CEO of Gilead Sciences, a company that’s known for its HIV and hepatitis C medications. While there, he oversaw the $12 billion acquisition of cancer drugmaker Kite Pharma.

Gilead in July announced that Milligan planned to step down after 30 years with the company. He had served as president since 2008 and ascended into the seat of CEO after John Martin left the post in 2016.

Former Roche Pharmaceuticals CEO Daniel O’Day replaced Milligan as CEO in March 2019. O’Day came in with a pay package of about $31 million.

Gilead’s market cap: $85.87 billion

Centene CEO Michael Neidorff, $26,122,414

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Centene CEO Michael Neidorff.

source

Reuters

Michael Niedorff has been CEO of St. Louis-based health insurer Centene since 2004. He initially joined the company in 1996.

In March, Centene said it’s acquiring its rival WellCare in a $17.3 billion deal.

The two companies combined have a big presence in the government-funded health-insurance programs Medicaid and Medicare, as well as a big presence on the individual exchanges set up under the Affordable Care Act. All in, the two companies cover about 22 million Americans.

Centene’s market cap: $23 billion

The post Healthcare CEOs take home some of the biggest pay packages in the world. Here’s what the industry’s top executives earned last year., Defence Online appeared first on Defence Online.

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shbettereveryday · 8 years ago

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Day 279 / 280 / 281

As you can tell I am not blogging everyday. As we have started Paraquad gym (PQ) it has been making the other days busy as well since we now don’t schedule things on Tuesday and Thursdays. I look forward to days when we aren’t running to get ready and having to rush through the morning routine. Which usually results in a quicker shower then I would want. The hot water is usually great for my legs. This week has been difficult with spasticity and bladder but we are managing. I have made a new friend at PQ. He works out there and volunteers there. He’s 5 years into his injury, which is similar to mine (t 9-10). He has been great to talk to and is no nonsense. I was complaining about my bladder issues and he told me as a matter of fact that I need to get botox in the bladder, which my urologist doesn’t do, and gave me the name and number of the urologist at Wash U that many of the guys there use for their bladder management including botox. It isn’t a magic bullet, it only lasts up to 6 months and doesn’t completely eliminate problems but helps tremendously, according to them. When I recounted my issues he said Yeah we all have those times, he said you just put in pads and deal with it. When I was talking with him on Thursday we were talking about rehab, I asked where he did rehab, he said Mercy in Chesterfield and Louisville. I asked why Louisville. He said they have a place there that is suppossed to be one of the best post rehab spots in the country that concentrate on excercises trying to stimulate the muscles to encourage walking. He said he spent a couple years and way to much money ‘chasing the dream’ to walk again. He is a T9 complete and it took him years to come to terms with his injury. He told me a quad that he knows got back to his job, sort of. This person did landscaping and had a tree fall on him, causing his injury. He met him at one of his rehabs and that man started a company called Cripple Cutters lawn mowing service. That made me smile. When I asked about support groups he said there isn’t one. He mentioned the one that I went to, but there wasn’t much in the way of SCI support there. The way he got support was playing wheelchair basketball and hanging out with the guys and learning from them. He said they are from 20 - 50, all sorts of people, not all athletic. PQ is the right place to be to meet others and have people to learn from as well as get exercise. One thing funny on Thursday they were assembling and trying out a new therapy device. it is a rolling, standing harness that can be put over a treadmill or used with people who can walk but need support while they do. All the OT folks were over at the treadmill working with it and yelled over to me, Hey new guy do you want to try it? I said I was game sometime. They would put me in the harness on the treadmill and have people move my legs since it is like zero gravity. If I do, there will be pictures. The difference between Monday and the rest of the week is attitude. Still had bladder issues but with the advice of just 'pad up and get on with living' so that is what I had to do. Monday I let it get to me and that is ok but if I didn’t let that go it would have ended the week. PQ just gives me a reason to keep going. Tuesday after my bad Monday I just didn’t want to get out of bed. Didn’t want to go to work but PQ gave me a reason to get out of bed and get on with it. Somedays will be better then others but you just need a reason to get moving and be bettereveryday

#bettereveryday #spinalcordinjury

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bodilouisville · 2 years ago

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sabrinaogan-blog · 4 years ago

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beautybydrkay · 5 years ago

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top10plasticsurgeon-blog · 6 years ago

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deniscollins · 6 years ago

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They Want It to Be Secret: How a Common Blood Test Can Cost $11 or Almost $1,000

Hospitals and insurers negotiate over healthcare prices in private, and they don’t want competitors to know about the deals they’ve been able to cut. As a result, a metabolic blood panel test cost can range from $11 or $952. Should doctors and hospitals be required to publish negotiated prices: (1) Yes, (2) No? Why? What are the ethics underlying your decision?

It’s one of the most common tests in medicine, and it is performed millions of times a year around the country. Should a metabolic blood panel test cost $11 or $952?

Both of these are real, negotiated prices, paid by health insurance companies to laboratories in Jackson, Miss., and El Paso in 2016. New data, analyzing the health insurance claims of 34 million Americans covered by large commercial insurance companies, shows that enormous swings in price for identical services are common in health care. In just one market — Tampa, Fla. — the most expensive blood test costs 40 times as much as the least expensive one.

If you’re a patient seeking a metabolic blood panel, good luck finding out what it will cost. Although hospitals are now required to publish a list of the prices they would like patients to pay for their services, the amounts that medical providers actually agree to accept from insurance companies tend to remain closely held secrets. Some insurance companies provide consumers with tools to help steer them away from the $450 test, but in many cases you won’t know the price your insurance company agreed to until you get the bill. If you have an insurance deductible, a $400 — or even a $200 — bill for a blood test can be an unpleasant surprise.

Outside of health care, a swing of prices as huge as the one for blood tests in Tampa is unheard-of. Recent studies of the retail prices of ketchup and drywall, for example, showed much less variation. A bottle of Heinz ketchup in the most expensive store in a given market could cost six times as much as it would in the least expensive store. But most bottles of ketchup tended to cost around the same. And, in every case, you would know the price of your ketchup before buying it.

“It’s shocking,” said Amanda Starc, an associate professor at the Kellogg School of Management at Northwestern, who has studied the issue. “The variation in prices in health care is much greater than we see in other industries.”

In some cities, the blood test prices look more like the prices for consumer goods. Most tests in Baltimore cost around $30. Most in Portland, Ore., cost around $20. But if you live in Miami or Los Angeles, the price becomes much harder to predict.

Hospitals and insurers negotiate over prices in private, and they don’t want competitors to know about the deals they’ve been able to cut. The data in this article comes from the Health Care Cost Institute, which pools bills from three large insurance companies. (Even the institute can’t say which insurers and providers are attached to the different prices, and it has eliminated certain markets with less competition where it might be easy to guess.)

The Trump administration may eliminate this secrecy, making numbers like the ones in these charts more common and easier to find. As The Wall Street Journal has reported, the administration has asked for comments on a proposal to require doctors and hospitals to publish negotiated prices.

The institute examined several common procedures and observed two kinds of pricing differences. Prices vary considerably between markets. And, in many metro areas, they range widely between one health care provider and another.

Because these are prices paid by insurance companies, many experts say the differences between markets matter more, because they affect insurance premiums that all those with insurance in that area pay, even if they don’t get a blood test or an operation. On average, a cesarean section birth in the Bay Area costs more than three times as much as one near Louisville, Ky., according to the institute’s data.

The average hotel room in the San Francisco area last year cost only around double the average hotel room in Louisville, according to STR, which tracks the industry.

The swing within markets increasingly matters for patients, too, as the share of employer plans with sizable deductibles keeps rising. That means that choosing a provider where your insurance company has failed to strike a good deal could mean significant out-of-pocket costs.

In some cases, prices may be higher because the quality of services or the cost of doing business in a given market is higher. More influential is market power, that of either insurers or hospitals, research shows.

Sherry Glied, a health economist who is the dean of the Wagner School of Public Service at New York University, said a bigger factor was probably how many patients your insurer sent to a given hospital. Popular places are likely to offer better prices, because the insurance company negotiates a bulk discount. The most expensive providers tend to be the ones where the insurance company has little negotiating leverage — and where the service is so rarely used it doesn’t mind the higher price.

“One person buys one hamburger, and another buys 1,000,” she said. “And it completely makes sense that the guy who buys 1,000 hamburgers gets a better price.”

That sort of market power can work in the opposite direction, too. In markets where there is a dominant hospital chain, or a powerful hospital that many patients insist on using, insurers tend to face high prices, with less leverage to bargain the hospitals down. Martin Gaynor, a professor of health economics at Carnegie Mellon University, was a co-author of a recent study showing that in markets where fewer hospitals competed for patients, the hospitals tended to be paid more.

“Some of these really simple diagnostic tests — what the heck?” Mr. Gaynor said. “It does mean, in a sense, the market is broken in terms of problems with market power.”

The prices that hospitals and doctors charge to patients who are not in their insurance networks also range widely, and are typically (though not always) higher than the prices that insurers pay. The Obama administration began publishing these list prices for some of the most common medical services on a government website. The Trump administration recently began requiring hospitals to also publish a comprehensive list of prices on their own sites, though the data can be challenging to use.

For years, Jeanne Pinder, who runs the consumer-oriented website Clear Health Costs, has been collecting the cash prices for medical procedures around the country. She said the only health care services with predictable pricing were the cash-only treatments that insurance doesn’t cover, like Lasik eye surgery, Botox and tooth whitening.

“When you get into M.R.I.s, ultrasounds and blood tests, they are crazy,” she said. “The secrecy in pricing all over this marketplace encourages this behavior.”

#Healthcare Costs

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