|Selected news articles which highlight important policy issues.||
News: Weekly Archives
News for the week of 10-05-2005
The FDA has made enormous strides in expanding access to over-the-counter (OTC) medications. Dozens of drugs from Tylenol to Claritin, Aleve and Nexium are available without a prescription, giving consumers convenient access to relatively safe, valuable treatments at affordable prices.
Physicians, however, still seem leery about moving simple medical procedures out of high-cost, hard to reach doctors’ offices and into less expensive and more accessible venues. As a result, patients and insurers face inflated health care costs, and seriously ill patients compete with patients suffering from minor ailments for doctor’s appointments.
The quest for profits, however, is leading retailers like Wal-Mart to facilitate an end-run around doctors for many procedures that can be performed safely and easily by nurse-practitioners in small clinics:
Americans can increasingly get basic medical care in the same place they buy toothpaste and light bulbs. In a development that has broad implications for the nation's primary-care system, a rising number of major pharmacy and retail chains -- including CVS Corp., Wal-Mart Stores Inc. and Target Corp. -- are opening in-store health clinics. They offer patients fast access to routine medical services such as strep-throat tests, sports physicals and flu shots. The clinics, which typically charge between $25 and $60 per visit, don't require an appointment and are open during pharmacy hours including evenings and weekends.
To keep costs down, they are staffed by nurse practitioners, who can legally treat patients and write prescriptions in most states. The trend is rapidly spreading in pharmacy chains as they look for ways to stem losses to mail-order pharmacies and big-box stores. Three of the nation's largest drugstore chains -- Rite Aid Corp., Brooks Eckerd Pharmacy and Osco Drug -- have announced plans to open health clinics in the coming months. …
The trend is drawing criticism from some doctors groups, who could lose business if patients turn to the clinics for basic care. Doctors also contend that patients could wind up with lower-quality care because the clinics don't have physicians on-site. “Serious illnesses sometimes present with simple symptoms," says Edward Hill, president of the American Medical Association. "A cough might be something as simple as a cold, or something as serious as congestive heart failure. The ability to ferret out the 20% of serious illnesses that present with simple symptoms is what we went to medical school for."
It is certainly true that “serious illnesses sometimes present with simple symptoms.” But the same can be said for headaches, joint aches, and fevers, and consumers have access to dozens of OTC medicines for treating those symptoms without a doctor’s supervision.
The bottom line is that doctors’ insistence on remaining gatekeepers for simple procedures wastes valuable resources that are better spent elsewhere. By injecting more division of labor into health care, retailers like Wal-Mart are doing everyone a favor. And this includes physicians, who can now concentrate their time and expertise where it is needed most—on seriously ill patients.
WHO: Chronic Diseases May Kill 400 Million by 2015
While media attention has been focused on the spread of communicable diseases in developing nations (AIDS, malaria, and tuberculosis), policymakers have lost sight of the much larger toll that chronic diseases like heart disease and diabetes inflict in both wealthy and poor nations. A new report from the WHO quantifying the global toll of chronic diseases is likely to lead to a fresh debate about global health priorities.
There is certainly more that can be done to develop effective, affordable treatments for communicable diseases like malaria that disproportionately affect low-income countries. But we shouldn’t lose sight of the fact that those nations suffer even more death and disability from diseases Western citizens typically associate with affluence:
Heart disease, diabetes and other chronic ailments will kill nearly 400 million people over the next 10 years, but many of those deaths can be prevented by healthier lifestyles and inexpensive medication, the World Health Organization said Wednesday. The financial burden from an increasing death toll from such non-communicable diseases will also be enormous, costing countries such as China and India billions of dollars, WHO said in a report.
"The lives of far too many people in the world are being blighted and cut short by chronic diseases," said Lee Jong-Woo, WHO director-general.
He was citing the latest WHO report to draw attention to the increasing threat from diseases that can be prevented in part by healthier diets and giving up smoking. Until recent years, these chronic conditions were overshadowed by infectious diseases like HIV/AIDS, though they cause far more deaths. Chronic, or noncommunicable diseases, account for three out of five deaths worldwide, the WHO says. [Ed: emphasis added]
The relentless focus on communicable diseases is not just about media headlines. It has also been used to assault pharmaceutical companies for their focus on chronic diseases that supposedly only afflict wealthy nations. Philip Stevens, director of health projects at the International Policy Network, noted in reply to the WHO report that:
The WHO is right to point out that poor countries suffer from an increasingly similar spread of diseases as rich countries. This is in some ways a positive finding, as the rise of chronic diseases is the result of more and more people living beyond middle age, thanks to greater global economic growth and prosperity.
What the WHO’s findings do show, however, is that activists’ attempts to skew funding of R&D away from these so-called ‘western’ diseases towards tropical and neglected diseases are way off the mark. People in lower income countries need drugs for chronic conditions as much as people in wealthy nations. It is therefore reassuring that global R&D spending patterns do currently reflect this reality.
More information on global research patterns, and how they help address the disease burden in developing nations can be found in Mr. Steven’s report, Diseases of Poverty and the 10/90 Gap.
Cervical cancer prevented in 2-year study
True cancer vaccines—that allow the body to recognize and attack cancer cells effectively—are still in their infancy, but scientists are making headway developing vaccines against infectious diseases associated with some types of cancer. An experimental Merck vaccine based on two human papilloma viruses (HPV) known to cause 70% of all cervical cancer cases has displayed nearly 100% effectiveness in preventing the disease in preliminary findings from a late-stage (phase III) trial.
An experimental vaccine to prevent cervical cancer protected virtually all the women who took it during a large international trial, boosting chances that future generations of girls throughout the world might live their lives free of risk of the disease. Results of the two-year study, involving more than 12,000 women, were released Thursday at a conference of infectious disease specialists convened this week in San Francisco. …
The new vaccine prevents cervical cancer by blocking certain strains of the human papilloma virus. Chronic infection with HPV -- a sexually transmitted virus -- is responsible not only for cervical cancers, but also precancerous lesions and genital warts. …
Cervical cancer is relatively uncommon in the United States, due to a vigorous screening program of annual Pap smears designed to detect early signs of the disease. Still, it strikes more than 10,000 women annually, and each year it kills about 3,700 in the United States, according to the American Cancer Society.
Worldwide, it is the second-leading form of cancer among women, and the third-leading cause of women's cancer deaths -- ranked behind lung and breast cancer.
The article notes that the “most promising benefit of a cervical cancer vaccine may be in the developing world, where routine Pap smears don’t occur and cervical cancer is the leading cause of cancer death among women.” Let’s hope that the success of Merck’s vaccine is a harbinger of a general revitalization of the flagging vaccine industry—which has been declining for decades thanks to low prices combined with growing regulatory and liability costs.
New Breakthroughs mean better outcomes
As chronicled in our October 14, 2005 Spotlight article by Elizabeth Whelan, M.D., breast cancer is one area of cancer research where medical advances have been nothing short of astonishing in recent years. Declines in breast-cancer mortality are the result of years of painstaking research into the molecular evolution of cancer cells. This research eventually culminated in new, less toxic “targeted” treatments for breast cancer that have revolutionized how the disease is treated—and how breast cancer patients view their diagnosis.
A new generation of "targeted" drugs, long the dream of researchers, is changing the landscape of breast cancer treatment. These treatments zap diseased cells, leaving healthy ones alone. Experts predict the advent of drugs with names like Herceptin, Avastin and Femara is only a taste of what is to come. …
The death rate from breast cancer has been dropping steadily since the 1990s, according to statistics compiled by the American Cancer Society. Most experts attribute the improvement to early detection. Also, many more patients have taken tamoxifen, a drug proven in clinical trials to prevent recurrence of the disease. …
In addition, researchers have produced advanced treatments to ward off a relapse. An international study of 8,000 postmenopausal women released last May showed that those who took a new drug called Femara (generic name: letrozole) were 19 percent less likely to relapse than women who took tamoxifen, the standard treatment. Femara is one of a new class of drugs called aromatase inhibitors.
Public and private efforts are turning the tide in the battle against breast cancer, but more innovative research, and new therapies, are still needed to turn the disease into a fully manageable—or perhaps even preventable—chronic illness.
Lawmakers push plan to cut Medicaid costs
Two Republican policymakers in Congress have drafted legislation designed to fund a 10-state experiment to see if consumer-controlled health savings accounts can help reduce Medicaid spending. The legislation, if enacted, could encourage smarter spending by Medicaid recipients without compromising access to health care.
The legislation, drafted by Rep. Mike Rogers of Michigan and Sen. Mike Crapo of Idaho, both Republicans, would create health care savings accounts for Medicaid recipients. Rogers says the measure would encourage Medicaid patients to seek less expensive care, partly by using generic rather than brand-name drugs. He says that would result in long-term savings for Medicaid, the federal-state health program for poor people. …
Under the proposal, 10 states would volunteer to experiment with the accounts for five years. Each year, the federal and state governments would put money -- up to $2,500 for an adult and up to $1,000 for a child -- into a savings account that beneficiaries could use for their health care.
Since the amounts would be capped except in cases of certain medical needs, such as surgery, the program theoretically would encourage beneficiaries to seek lower-cost care. The proposal also would allow states to impose a deductible equal to 10% of the savings account limit on beneficiaries whose costs exceed the limit.
More information on the proposal, the Health Account Opportunity Act of 2005, can be found on Rogers’ Web site. Although Hurricane Katrina was the worst U.S. disaster in decades, the costs of reconstruction may actually force Congress to rethink how the federal government funds entitlement programs like Medicaid and Medicare. Hopefully, this legislation will help focus more attention—and garner more support—for market-driven Medicaid reforms.
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