|Selected news articles which highlight important policy issues.||
News: Weekly Archives
News for the week of 06-21-2004
Genomic medicine is transforming how physicians think about myriad diseases, but perhaps none more than heart disease. Thanks to research on Iceland's relatively small gene pool, researchers have been able to isolate genes responsible for producing a protein that "nearly doubles the risk of heart attack by boosting levels of a molecule that promotes inflammation of the artery walls." This moves doctors away from an emphasis merely on controlling cholesterol to looking at drugs that can inhibit the inflammation that constricts critical blood vessels.
On the basis of this genetic insight, one biotech company is testing an old asthma drug that will, hopefully, counteract arterial inflammation. If effective, it will prove to be a critical development because of the toll that heart disease takes on Americans every year: nearly 700,000 annual deaths and $133 billion in costs. Worse still, half of all American men may eventually suffer from heart disease.
Ultimately, following models used to treat other diseases, physicians may rely on multiple drug cocktails of statins (to lower cholesterol), anti-inflammatories, and drugs that boost levels of "good" cholesterol to control the genetic disposition to develop heart disease. Optimistically, some researchers estimate that cocktails like this may prevent as many as 75% of all heart attacks.
This is not to understate the enormous clinical strides made in the last decade. As it stands now, statins lower heart attack rates by 1/3. Nonetheless, we are only just beginning to understand how complex cardiovascular disease really is, and a silver bullet treatment may remain on the horizon for some time to come.
Silencing "Syndrome X"
At the same time that scientists are focusing on the genetic basis of heart disease, we are also learning more about the links between a deadly interactions between pathologies that are epidemic in modern America: hypertension, heart disease, and diabetes. For nearly two decades scientists have been trying to unravel "Syndrome X", which may affect 25% of all Americans and be implicated in our high-fat, high sugar diets. Syndrome X leads to obesity, high-cholesterol, high blood sugar levels, and inflamed arteries - all of which increase the odds of developing one or more of the deadly diseases mentioned above.
Currently, physicians are forced to treat each of these symptoms in isolation, whereas we are learning more about the underlying metabolic syndrome that may be implicated in all of them. New drugs in late stage trials show promise at attacking the roots of Syndrome X. These drugs, in a new class called peroxisome proliferator-activated receptors (PPARs) modulate how the body reacts to sugar and fat intake. "Researchers hope that drugs that stimulate multiple PPARs at once could affect virtually every heart and diabetes risk factor."
Critics of America's healthcare sector focus on the price tag - but not on the enormous savings and productivity gains that improved health care can offer. By focusing more on outcomes and strategic spending (as in Syndrome X), rather than initial costs, policymakers can gain a better understanding of the issues as stake, and refrain from blindingly rationing spending.
New Way to Curb Medical Costs: Make Employees Feel the Sting
Whole Foods Inc., one of the nation's largest natural and organic foods grocery chains, has embraced consumer driven health care. Under this system, Whole Foods offers each of its 30,000 employees a tax-free medical savings account (MSA) into which the company makes a contribution (based on seniority, from $300 to $1,800), and which employees can use for routine medical expenses. This account is then combined with a high deductible health insurance ($1500). After reaching the maximum deductible, the plan operates on a traditional insurance model, "picking up 80% of most medical expenses" thereafter. If the employees don't use up their MSA in any given year, any remainder is rolled over into next year's account, creating a cushion for future health contingencies.
The beauty of consumer driven health plans is that employees can see up front exactly how much physicians and other health care providers are charging them for care, and either bargain with those providers for reduced fees or forgo unnecessary or overly expensive procedures altogether. In short, consumer health care is a model plan for driving down health care costs and pressuring providers to increase productivity. So far, Whole Foods is more than pleased by the results: last years, medical-claims costs declined 13% and hospital admissions plummeted 22%. The company spent the same per employee in 2003 as in 2002 while, nationally, health plan premiums rose nearly 14%. Employee participation in the Whole Foods health plan is nearly universal: 95% of eligible employees are enrolled.
MSA's are the leading edge of consumer driven health care and, thanks to companies like Whole Foods, the future of health care is available to their employees today.
Cost of prescriptions does affect health
A health care system that was focused on the best outcomes would increase incentives to provide the most effective treatments possible. Unfortunately, our health care system reimburses based on a fee-for-service model, regardless of the quality of care provided. Still, if we did shift to a quality based system, evidence is mounting that we would spend disproportionately more on prescription drugs than we do now - because they work so well. A recently released University of Michigan study followed 8,000 elderly patients for three years. Researchers found that patients who stopped taking prescription drugs to cut down on expenses were "50 per cent more likely to have suffered a heart attack, stroke or chest pain episode than those who had not cut back." They were also much more likely to suffer declines in their overall health. The implications for U.S. health policy: not funding prescription drug costs for patients who cannot afford them will lead to more health care problems, not less. Medicare drug coverage should help to offset problems like this one, but it should also cause health plans to rethink their approach to prescription drug coverage.
Dutch company guilty on Aids drugs.
The right kind of discrimination can be a good thing - at least when it comes to drug pricing. Price discrimination means offering different prices to different buyers based on their ability to pay; for instance, selling AIDS drugs at higher prices in developed nations and at deep discounts in developing nations. In this sense, price discrimination allows pharmaceutical manufacturers to fund drug innovation while at the same time offering the world's poorest citizens access to the world's best medications.
The scheme falls apart, however, if drug importers buy up medications in poor countries for resale in higher priced markets. This article documents how a Dutch company was found guilty of reimporting inexpensive AIDS drugs from Africa into Europe, selling them at an enormous profit. This practice not only hurts the patients in developing nations who despeately need access to these drugs, it hinders innovation - cutting off tomorrow's patients (rich and poor alike) from the next generation of life-saving medicines.
An established hemophilia drug, used to stop bleeding, has shown in early trials to be incredibly effective in curbing the damage caused by the most devastating type of stroke, a bleeding stroke. Researchers found that a single infustion of the drug NovoSeven, given within three hours of stroke onset, "cut by about one third the risk of death or severe disability among patients in the midst of a bleeding stroke." This type of stroke affects about 80,000 victims in the U.S. every year, and 2 million worldwide. This is only the second treatment that has shown any effectiveness in treating any type of stroke, and the first one for bleeding strokes. While larger studies will have to be conducted to confirm the results and the drug's safety, reseachers were impressed by the results and optimistic the findings would hold up. The drug's costs is $7,000 per dose - but offsets the severe disability costs (due to brain damage or coma) that regularly accompany bleeding strokes.
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