|Selected news articles which highlight important policy issues.||
News: Weekly Archives
News for the week of 01-24-2005
Many of the complaints regarding the temporary Medicare drug benefit card program have focused on its complexity. Now we know why: new research seems to show that many seniors over 65 aren’t computer literate, and this hampers their ability to navigate the program effectively.
“About 30% of people aged 65 and older have gone online, compared with 70% of those age 50 to 64, according to the Kaiser Family Foundation study, released earlier this month.”
Computer literacy is the key to finding the best prices for medicines, and also for collecting important information on medical treatments that is often just a key-stroke away. Of course, this problem will be alleviated when the Medicare drug benefit comes online next year.
However, it also bodes well that folks under 65 – and certainly their children and grandchildren – are internet savvy, and can navigate the Web as easily as their parents could walk down to the neighborhood drugstore. Better access to information leads to smarter consumers, and smarter consumers will demand that health care is as cheap and effective as possible.
Merck’s new vaccine, called MRKAd5, uses a harmless virus loaded with copies of three key HIV genes to prime the human immune system to attack the virus. “Researchers hope that these three genes will spark killer cells, known as cytotoxic T-cells, to destroy human cells infected by HIV, the human immune-deficiency virus that causes AIDS.”
Merck is testing its AIDS vaccine in 1,500 volunteers in North America, Latin America, Australia and the Caribbean. These trials are called “Phase II” trials, and are primarily designed to gauge safety outcomes and establish baseline effectiveness. “The study will compare the response of volunteers given three injections of the vaccine over six months against a [placebo group]. The study is expected to last at least 4 ˝ years, and will examine infection rates, as well as severity of disease in the two groups.”
Researchers aren’t expecting this vaccine to be a magic bullet – different versions of the AIDS virus have different gene copies, meaning that a vaccine effective in North America might not work in Africa - but if the vaccine elicits an effective antibody response against the virus it will be a very important step forward.
Study by Vioxx Critic Links Drug to Extra Coronary Cases
Let’s assume, for a moment, that estimates by FDA official David Graham that Vioxx may have caused 140,000 excess cases of heart disease before it was withdrawn from the U.S. last September are correct, and that Vioxx users “had a 34% higher chance of coronary heart disease when compared with people who used other anti-inflammatory drugs.”
Still, this is 140,000 cases out of the estimated 20 million Americans who took Vioxx at one time or another – meaning that the overall risk for any individual Vioxx user was roughly .007%. Further more, this risk was probably correlated with other genetic or environmental factors that we could identify and perhaps weed out through careful prescribing patterns.
Should Vioxx have been prescribed to 20 million people? Almost certainly not, although the blame doesn’t entirely lay with Merck (insurers and doctors should also shoulder some of the blame.) However, some of the 19,960,000 people who took Vioxx truly needed it and got real benefit from the drug.
For those people, the removal of Vioxx from the market did more harm than good.
The Informed Patient: Are Treatment Guidelines Reliable?
A relatively recent study from the RAND institute found that “Americans receive only about 55% of recommended care for a variety of common [health] conditions, and data from experts at Dartmouth show that medical care is often overused, underused, or misused.”
As a correction to this problem, some experts advise greater use of clinical guidelines, or so called evidence-based medicine: “Medical societies, state health groups and academic medical centers are scrambling to churn out new guidelines for everything from asthma to depression based on the latest medical studies, as are a number of for-profit companies that package guidelines to sell to insurers and employers.”
Doctors, however, have proved to be notoriously resistant to guidelines from on high, and patients tend to trust their doctors. Also, there is some concern that cost-cutting bureaucrats will tout treatment standards that are good for budgets, not patients.
What can be done to ensure better patient care? Put the patient in control. Consumer driven health care, linked to information initiatives that compare health provider performance, will force physicians to compete on quality.
If patients can spend their hard-earned dollars on medical care as they see fit, they will become savvy medical purchasers, much the way that consumers now shop for houses, or cars. Will every patient become an expert? They don’t have to. Studies have shown that quality improvements in industries generally follow when the savviest buyers set trends that the rest follow.
Novartis Breast-Cancer Drug Lowers Tumor Risk in Study
Novartis’ new breast cancer drug (Femara) continues to outperform the standard treatment, tamoxifen, that has been in use for decades. A new study has found that the drug “significantly reduced the risk of a tumor growing back” after surgery, and lowered the risk of metastatic cancer. These findings are the “latest in a wave of research supporting Femara and similar drugs known as aromatase inhibitors.”
Novartis’ study followed postmenopausal women with early breast cancer for a median length of 26 months after initial surgery. Patients on Femara had a 19% lower risk of cancer recurrence and 27% lower risk of developing metastatic cancer compared to tamoxifen.
President Bush is advocating a variety of markey-based reforms to contain health care spending, increase the availability of health insurance, and improve the use of information technology in health care settings.
At the core of his plan: “proposing tax credits to encourage expansion of health savings accounts and calling for allowing small businesses to pool together for health coverage across state lines.”
Critics have alleged that market forces will only exacerbate America’s health care crisis, and force poor or sick patients to go it alone. However, America already has a huge subsidy for poor patients—Medicaid—and yet millions of people still forgo access to medical care while government health care spending rages out of control.
The trick is not to keep people out of markets, but to find ways to get them back in. Millions of Americans will benefit from national insurance markets, Health Savings Accounts, and more IT technology in healthcare. Will this be the last word in health care reform? Probably not. But if coming generations have more responsibility for their own health care, and bear more of the costs for routine care, they will have powerful incentives to eat right, exercise, and their spend health care dollars frugally.
That may not solve all of our problems, but it’s the right start.
Report on Eli Lilly Is Retracted
As we noted last week, the British Medical Journal (BMJ) ran a report accusing Eli Lilly of hiding data from the FDA for more than a decade that linked Prozac to a heightened risk of suicide and violent behavior. This week, the BMJ retracted its report (based on an anonymous source) and issued an apology.
“The BMJ accepts that Eli Lilly acted properly in relation to the disclosure of these documents in these claims…The BMJ is happy to set the record straight and to apologize to Eli Lilly for this statement, which we now retract, but which we published in good faith.”
Perhaps with good faith, but not good journalism, if the BMJ didn’t do the due diligence required to support these anonymous claims prior to publication.
The public is often frustrated when corporations are slow disclosing information, or reluctant to comment on health or safety issues affecting their products. However, corporate managers are painfully aware of how their comments affect the threat of product liability suits, shareholder value, and their duty to protect proprietary information. On the other hand, those who make claims against corporations don’t face similar hurdles, and claims of corporate wrongdoing are often taken at face value—for better or worse. Still, both BMJ and Eli Lilly will survive this incident with minimal scarring.
However, one also wonders what cumulative effect stories like this have on doctors and their patients suffering from depression—who are probably more leery than ever of taking Prozac or other antidepressants. That harm is real and lasting.
List saves much-needed Medicaid money, but some say it's too restrictive
Not all drugs are created equal, right? Some are better, more cost-effective or safer, than others. So why not save government money and only allow doctors in public health care programs to prescribe “pre-approved” drugs that are the cheapest and most effective for the average patient?
Michigan started its own prescription drug pre-approval system in 2002. The system forces doctors to “get authorization from the state or its drug contractor First Health Services Corp. before a Medicaid patient can get a prescription filled for drugs that are not pre-approved.”
Some doctors are critical of the plan, complaining that patients must fail on pre-approved treatments before they are allowed to progress to more effective medications—a process that is irksome for doctors and patients that don’t fit the state mandated mold. Doctors also complain that their inability to easily prescribe other medicines drives up health care costs by prescribing treatment twice—once for the pre-approved medicine, and again for the drugs the patients really need.
Still, “Limiting prescription drugs for 500,000 Medicaid recipients has saved the cash strapped state more than $20 million so far because drug companies must provide deep discounts to be available without prior authorization.”
Are cost concerns trumping better health care for Michigan’s Medicaid patients? This is the heart of the dispute. In short, cost is “the elephant in the room that no one is talking about.”
The state has responded by pointing out that the vast majority of requests for authorization are approved. Critics (including doctors, drug makers, and consumer advocates) respond that “doctors with large caseloads and a high number of insurance-related requirements may see the authorization process as a nuisance to avoid…Physicians are more reluctant to prescribe drugs with a prior authorization because it’s more paperwork for them. It’s a hassle.”
In other words, many doctors who would otherwise prescribe patients a different drug just shrug their shoulders and give up. This certainly drives down costs but at the expense of physician autonomy and patient health.
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