MPT WWW
Selected news articles which highlight important policy issues.

News: Weekly Archives

News for the week of 07-20-2005

U.S. Affirms Support for Vaccines Amid Worries Over Autism Link
Wall Street Journal, 7-20-05

Editor’s Notes:

The incidence of autism in the U.S. population appears to have risen sharply in recent years. Experts are largely at a loss to explain whether the increase can be attributed to increased efforts to identify and treat autistic children, or to other unknown genetic or environmental factors. The problem is that too little is known about the causes of the disease. What mainstream experts seem to agree on is that a mercury-based preservative—thimerosol—formerly used in childhood vaccines isn't the source of the problem.

Dr. Gerberding [Director of the Centers for Disease Control] said the predominance of the evidence shows no link between thimerosal-containing vaccines and autism—a report last year by the Institute of Medicine found none—though she adds, "I can't tell you with 100% certainty that there will never be a link." Dr. Gerberding recently met with parents of autistic children and says she understands their frustration at the lack of a known cause. …

Peter Hotez, a vaccine researcher at George Washington University and father of a 12-year-old with autism, said he doesn't believe that there is any link between the condition and vaccines. "We need a war on autism, not a war on childhood vaccines," he said.

It may take several more years and more epidemiological studies (there have already been four) before distraught parents are convinced. In the meantime, there are plenty of firebrands—like environmental activist Robert Kennedy, Jr—who allege that there is an international thimerosol conspiracy (including the Institute of Medicine and the CDC) to protect vaccine manufacturers.

This effort is reminiscent of an attack on the pertussis vaccine that began in 1974 with an alleged link to brain damage. Hundreds of lawsuits and millions of dollars later, the number of vaccine companies making the important vaccine had dropped from four to one—despite the fact that the link was eventually refuted by science. There are currently hundreds of thimerosol suits pending in U.S. courts that may, yet again, push the vaccine industry to the brink of extinction and put millions of children's lives at risk.

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Who's fighting cancer in kids?
USA Today, 7-20-05

Editor's Notes:

Making vaccines for children is, as we noted above, an extremely risky proposition, given the enormous potential liability exposure facing companies that vaccinate large populations of (apparently) healthy children.

Making cancer drugs for children is equally difficult for a diametrically opposed reason—because there are so few children who contract cancer. Pediatric cancers are, in fact, so rare that it is unprofitable for pharmaceutical companies to design drugs specifically for pediatric patients.

A government report in April found a "near absence" of research into pediatric cancer drugs. About half of the oncology drugs used to treat children are at least 20 years old, according to the report by the Institute of Medicine, a non-profit group that advises the government on health policy. Most drugs given to children were developed for adults, then passed down to children. In the past 10 years, only one cancer drug, Clolar, has received initial approval for children. …

…adults attract more cancer research than children because they are a far larger and more lucrative market. Patients younger than 20 make up 12,400 of the nearly 1.4 million Americans stricken with cancer each year. Drug companies are generally unwilling to invest hundreds of millions of dollars into such a small market...

One promising approach for developing new therapies for pediatric cancer is to catalogue the genetic abnormalities involved. That is exactly what is being done now in the National Cancer Institute's Pediatric Oncology Preclinical Protein -Tissue Array Project (POPP-TAP). Once these targets have been identified, drug companies can use them to help develop new cancer drugs and identify which adult cancer therapies will work best in children.

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Report highlights high costs of ignoring health tech
Government Health IT, 7-22-05

Editor’s Notes:

Critics of America’s health care system like to portray it as a market failure. If only it were a true market to begin with. In reality, American health care is dominated by third-party payers who reimburse hospitals and doctors regardless of the quality of care provided to patients. Some observers think that new information technology systems will help employers, insurers, and the government better direct payments to providers who offer health care to patients:

The U.S. health care industry has neglected widely used systems engineering tools and technologies, and that neglect has contributed to the nearly 100,000 preventable deaths a year, according to a new report from the National Academy of Engineering and the Institute of Medicine.
The health care industry’s collective inattention to systems engineering has a mind-boggling cost of a half-trillion dollars a year due to inefficiency, the report states. The report says tools used for supply chain management, financial engineering and risk analysis could be harnessed to measure, characterize and optimize performance at higher levels of the health care system, such as health care organizations, regional care systems and the public health system.
Private insurers, large employers and the Centers for Medicare and Medicaid Services should all provide incentives for health care providers to use systems engineering tools to improve the quality of care and efficiency of health care…

This is a very interesting idea, and it should certainly be pursued. But efficiency and quality will lag until patients can direct more of their own health-care spending and shop for doctors and hospitals who offer the best value.

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Long-Term-Care Insurance: How Much Is Too Much?
The New York Times, 7-24-05

Editor’s Notes:

What do car insurance, health insurance, and homeowner’s insurance all have in common? Answer: Americans have embraced them as tools to ward off rare but potentially devastating financial setbacks. Unfortunately, many aging Americans have yet to enter the market for long term care insurance to protect themselves (and their estates) against the high costs associated with nursing homes or other assisted living environments:

After more than two decades on the market, long-term-care insurance remains a tough sell. Only 10 percent of people over 65 own policies, with many holdouts saying that they are intimidated by high costs and the bewildering array of benefit levels, deductible periods and other features.

Like most insurance, policies for long-term care protect against improbable events. But unlike homeowners' insurance and auto insurance, this coverage often requires a lifetime commitment to one insurer; premiums can rise sharply if the policyholder switches. And while health insurance covers immediate issues, buyers of long-term-care insurance can pay premiums for decades with no way to predict if their coverage is what they will need. …
But a new study shows that only a small percentage of policyholders need care for long periods - four years or more. So a growing number of specialists recommend more modest policies for which the policyholder pays a bigger share of the costs.

But what the Times only notes in passing is that many state Medicaid programs have effectively become the insurer of last resort for middle-class Americans who don’t purchase long term care insurance. Consequently, without additional reform, Medicaid provokes a moral hazard. Since consumers expect the government—and taxpayers—to eventually shoulder the burden, Medicaid acts as a disincentive to purchase long term care insurance.

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Inefficient Spending Plagues Medicare; Quality Often Loses Out as 40-Year-Old Program Struggles to Monitor Hospitals, Oversee Payments
Washington Post, 7-24-05

Editor’s Notes:

Would you return to a mechanic who, every time he fixed one thing, broke something else? This may seem absurd, but it is exactly how the U.S. government compensates doctors and hospitals through its Medicare program, the nation’s largest insurer. For instance,

As far back as 1999, federal and state regulators began to receive complaints that the heart surgery unit at Palm Beach Gardens Medical Center in Florida was a breeding ground for germs. …
State inspectors in 2002 found "massive post operative infections" in the heart unit, requiring patients to undergo more surgery and lengthy hospital stays. In a four-year period, 106 heart patients at Palm Beach Gardens developed infections after surgery, according to lawsuits and government records. More than two dozen were readmitted with fevers, pneumonia and serious blood infections. The lawsuits included 16 patients who died.

How did Medicare, the federal health insurance program for the elderly, respond? It paid Palm Beach Gardens more…Medicare's handling of Palm Beach Gardens is an extreme example of a pervasive problem that costs the federal insurance program billions of dollars annually while rewarding doctors, hospitals and health plans for bad medicine. …
Researchers at Dartmouth Medical School, who have been studying Medicare's performance for three decades, estimate that as much as $1 of every $3 is wasted on unnecessary or inappropriate care. Other analysts put the figure as high as 40 percent.

Shocked? You shouldn’t be. Any pricing system that separates the customer (e.g., patients) from the payer (in this case, the government) is bound to generate misallocation of resources, waste, and fraud. In a true market system, prices for goods tend to decline over time, because competition between producers encourages efficiency. Lower quality producers are driven out of the system because customers send their business elsewhere. Until Americans have more ability to control their own health care spending—through health savings accounts or other mechanisms—Medicare will continue to send good money chasing after bad.

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Personalized Approach to Cancer; Genitope hopes its custom-made vaccines for lymphoma will lead to extended remissions.
Los Angeles Times, 7-25-05

Editor’s Notes:

Cancer isn’t just one disease with one underlying mechanism. It is really a shorthand description of a number of mutations in the genetic machinery responsible for regulating cell division and cell death. Once those genes atrophy, uncontrolled cell growth leads to cancer. These mutations can vary from individual to individual, or even in the same patient over time. The variability and adaptability of cancer is what makes the disease so fearsome and the search for successful treatments so challenging.

In order to fight cancer more effectively, patients need medicines that are every bit as individualized as the disease itself. Thankfully, companies are becoming ever more adept at creating targeted therapies, ranging from drugs like Herceptin (which targets cancers expressing the HER/neu gene) to more experimental therapies like cancer vaccines:

…Genitope Corp. of Redwood City, Calif., [has been] toiling to commercialize a [cancer] vaccine invented at Stanford University in the late 1980s.

More than 200 patients have been given MyVax, the vaccine produced by Genitope. What each patient received was not mass-produced, but customized to attack his or her specific tumor….A small study completed four years ago was encouraging, and although the latest trial of 300 patients was not scheduled to end until 2007, the company believes that it could see results -- and get the vaccine to market -- sooner. …

While cancer vaccines may never offer patients a total cure, they could become useful adjuncts in a multi-front war on cancer that bombards rogue cells with several different therapies and helps a patient’s own immune system control the disease.

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INTERVIEW-WHO will fail to meet AIDS drugs goal
Reuters News, 7-26-05

Editor’s Notes:

The World Health Organization has failed to hit its target of having three million people on anti-retroviral drugs by 2005. As a matter of fact, it missed its target by two-thirds, i.e. two million people. Nonetheless, the WHO is still confident that it will be able to provide “universal access” to ARV drugs by 2010:

Dr. Jim Yong Kim, director of the WHO's HIV/AIDS department, said its three million target would not be reached due to a slow start because of disagreement on whether poor nations had the capacity to administer HIV treatment programs. But he said that having one million people now on the program was major progress and he expected there would be more by late 2005.

He also praised Brazil's free treatment program as well as the G8 nations' endorsement of universal access to HIV treatment by 2010. This could mean as many as 10 million people would be covered, he said. "I think all the activity that we see now about treatment is thanks to Brazil," he told Reuters on the fringes of an international AIDS conference in Rio de Janeiro. "If Brazilians did it, then I'm going to put everything I have into reaching that target for everybody by 2010," he added.

It is hard to take WHO’s optimism about ARV treatment very seriously since there were 3.2 million new AIDS infections in Africa in 2003. Estimates of new AIDS cases by 2010 range from just a “few” million to 30 million—making it very possible that the WHO program will be swamped by new cases. It is also hard to look at relatively wealthy Brazil (which has low infection rates) as a model for AIDS treatment in Africa, where countries are significantly poorer and infection rates are much higher. In short, universal access to affordable AIDS drugs in Africa is a noble goal—but it is more important to focus on prevention, which will make that goal significantly more attainable.

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