|Selected news articles which highlight important policy issues.||
News: Weekly Archives
News for the week of 09-14-2005
The new Medicare “Part D” drug benefit is probably the most controversial federal program since the New Deal. As such, it is drawing an enormous amount of flack—some deserved, some less so. The going conventional wisdom is that the Medicare drug benefit that will be offered beginning in January 2006 is so complex and bewildering that seniors will avoid it in droves. The Journal notes that
…many health-policy experts are voicing concern that beneficiaries will be overwhelmed by the sheer number of choices, and other complexities. "The question is: Will seniors be so overwhelmed by all these choices that they throw up their hands and say, `Forget about it'?" says Tricia Neuman, a Medicare expert at the Kaiser Family Foundation, a Washington nonprofit. Selecting a plan requires seniors not just to evaluate the options in their area, but also to weigh them against other coverage they may have, such as retiree benefits or Medigap policies.
This concern, however, will most likely prove exaggerated. After all, as the Journal notes, depending on the region 11 to 23 companies will be competing to sell drug coverage to seniors, and they all have a financial interest in making those plans as convenient and simple to understand as possible. The process will, undoubtedly, still have its hurdles. But seniors make many complex decisions in their day-to-day lives—from managing health care to mutual funds—and they will have plenty of help navigating the drug benefit.
A Victory for Lilly—With Reservations
The results from the “biggest-study [ever] of treatments for schizophrenia” by the National Institutes of Health were released this week. The study compared an older generic medicine with new branded drugs. Media headlines on the report have focused on the apparent finding that the generic drug seemed to perform just as well as some newer ones. However, this interpretation needs to be taken with a large grain of salt—and the media seems largely to have missed story that we desperately need better drugs for treating schizophrenia.
The biggest-ever study of treatments for schizophrenia emphasizes how difficult the disease, which afflicts 3.4 million Americans, is to treat, and how often patients fail to experience relief from the first drug they try. …
Three times out of four, patients could not get satisfaction from the first drug they were prescribed in the study. They tended to switch either because of side effects, such as severe weight gain or neurological tremors, or because the drugs didn't ease the delusions, hallucinations and emotional numbness that can cripple schizophrenia patients. …
One clear message from the trial is that the medicine that is right for one patient may not be right, in terms of either effectiveness or side effects, for another.
One surprise for many was that the drug perphenazine, an antipsychotic that was discovered in the 1950s and is now a dirt-cheap generic, did as well as the other drugs. …
But John Newcomer, a professor of psychiatry at the Washington University School of Medicine, said the study should not be used to say older drugs, like perphenazine, are comparable with the newer ones. Also, he warned that the higher dose of Zyprexa might bias the results.
"In the absence of clear-cut, clinically significant differences in efficacy and effectiveness," Newcomer says, "the risk of medically significant adverse events should have a major impact on prescribing decisions."
We should also remember that having more treatments—both old and new—increases the likelihood that patients can find an option that works for them. While this study is undoubtedly useful as basic yardstick for current treatments, its generality won’t be of much help to patients or practitioners. What doctors really need is a better understanding of schizophrenia and better ways of predicting how individual patients will react to specific medicines. A glimpse of this future can be seen in the Roche Amplichip CYP 450, which, “with just a drop of blood..scans for two enzyme-producing genes—2D6 and 2C19—that help metabolize up to 25 percent of all prescription drugs, including those for heart disease and depression.”
Tests like this one—and further advances in neurology— should give patients and the medical community much more specific treatment guidance than would be possible from any clinical trial, no matter how large.
Doctors Join to Promote Electronic Record Keeping
Why has the health-care industry not used used information-technologies to improve productivity and cut costs, at least not to the degree that the rest of the economy has? The core problem seems to be that health care providers—for instance, small physicians’ groups—may face substantial upfront capital costs and may not garner any immediate advantage from changes, such as transitioning to electronic medical-records. Physicians are working together, however, to pool resources and develop new business models for adopting IT:
…in a collaboration with 500 like-minded doctors, as well as hospitals, insurers and employers in two Hudson Valley counties, Dr. Heslin and his partners are clearing barriers that have made modern information technology inaccessible to the hundreds of thousands of small doctors' offices around the nation.
The Hudson Valley effort is being watched as a potential model by federal and state government and industry officials, who say that up to 60 percent of Americans receive their primary care at small-scale physicians' offices. Unless those small medical practices can adopt the most modern and efficient information technology, millions of Americans may never know the benefits of the most advanced and safest care. …
To overcome such obstacles, Dr. Heslin and his regional colleagues, who call their cooperative effort the Taconic Health Information Network and Community, are pooling their resources and knowledge.
A Web-based, central database approach means that doctors need little more than a few standard PC's, a high-speed Internet connection and the willingness to pay a monthly subscription fee of $500 to $600, eliminating the initial outlay of tens of thousands of dollars.
Taconic Health represents a tried and true business model, whereby hundreds of small firms pool their funds to create a resource that they wouldn’t have access to individually. If successful, the group could pave the way for similar efforts across the nation.
Drugs Offer Angioplasty Alternative
Critics of prescription-drug prices seldom note that new medicines often replace other, more expensive or potentially dangerous forms of health care. A recent Dutch study, for instance, has found that, for mild heart attacks, a watch-and-wait strategy employing clot-busting drugs and statins was just as good as angioplasty treatment (threading a small balloon into a clogged artery to increase blood flow to the heart).
Doctors can give patients powerful clot-dissolving drugs and drugs to lower their cholesterol and wait to see whether the chest pains go away. If they do, no angioplasty is necessary. …
The study, led by Dr. Robert J. de Winter, director of the cardiac catheterization lab at the Academic Medical Center in Amsterdam, involved 1,200 patients who had chest pains and had suffered mild heart attacks. Mild attacks were characterized by enzyme levels indicating muscle damage without the electrocardiogram pattern known as ST elevations, indicating a major attack.
Half the subjects were randomly assigned to immediate angioplasty. The rest were assigned to wait, receiving medical treatment. If their chest pains did not improve, they were sent to the catheterization lab. Eventually, about half of those assigned to wait ended up having angioplasty. …
"This study should be a bit of a wake-up call," Dr. Boden said. "Perhaps angioplasty and stenting everyone early and aggressively is a runaway freight train. This study would suggest that we perhaps reassess the situation."
The history of the 20th century is one of astonishing medical innovation—largely thanks to new medicines including antidepressants, antibiotics, and immunosuppressants (used for organ transplantation). It is doubly ironic, then, that even in the midst of this scientific revolution the industry driving it is constantly subject to political attacks—as if it produced human misery, rather than alleviating it.
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