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Selected news articles which highlight important policy issues.

News: Weekly Archives

News for the week of 08-14-2006

AIDS Effort in Zambia Hailed as a Success
The New York Times, 8-14-06

Editor's Notes:

The fight against AIDS in Africa in recent years has been largely been focused on increasing the availability of cheap antiretroviral drugs in the poorest nations. The latest news from Zambia seems to show that, at least in certain countries, these efforts are finally bearing fruit:

Only a few years ago, there was widespread skepticism that AIDS treatment programs would work in poor countries. The drugs were considered too costly and too hard to deliver to those who needed them; the required regimens were seen as too complicated and the side effects too dangerous.

But the effort has worked, the authors of the study said, as health workers have made intensive efforts to use in Zambia and other poor countries the same kinds of drugs and monitoring services that are standard in rich countries.

Reflecting those efforts, Bill Gates said at the conference Sunday night that there was "a new sense of optimism" in Africa because "the world is doing far more than ever before to fight AIDS." Mr. Gates, the chairman of Microsoft, and his wife, Melinda, who have made stopping AIDS the top priority for their foundation, gave keynote addresses at the conference. They called for increased global access to H.I.V. prevention and treatment programs and greater efforts to dispel the stigma of AIDS.

Since the Zambian government opened 18 clinics in April 2004, death rates from AIDS have been reduced to compare favorably to those in the United States among patients who took standard antiretroviral drugs for at least three months, said Dr. Jeffrey S. A. Stringer, who led the team that reported the findings.

This group had 5 deaths for every 100 patient years (the number of patients multiplied by the number of years under treatment), in contrast to 4.34 at the University of Alabama at Birmingham, Dr. Stringer said at a news conference. Dr. Stringer works both at the university and at the Center for Infectious Disease Research in Zambia.

Still, optimism about the effectiveness of this and other similar treatment programs must be tempered by the knowledge that millions of new infections in Africa occur every year. A comprehensive battle plan for treating AIDS in developing countries must be created that combines prevention with treatment, and highlights the regulatory and cultural barriers that impair efforts to control the disease in the areas where it is prevalent. For an additional commentary on the recent 16th annual global AIDS conference in Toronto, Canada, take a look at this Web page at the Campaign for Fighting Diseases.

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Research to Unleash Gene Therapy on Arthritis
The Boston Globe, 8-14-06

Editor's Notes:

Researchers will soon begin clinical trials for arthritis patients using gene therapy. After the death of Jesse Gelsinger, a young patient enrolled in a gene therapy trial at the University of Pennsylvania in 1999, research in the field has slowed markedly due to safety concerns.

Thankfully, however, this and many other ongoing trials are a welcome indication that the field is returning to the great promise it once held. There may, of course, be other tragic setbacks—as there were in the early days of kidney transplants, to use only once example—but the regulators and the media need to keep in mind the potential benefits of gene therapy for millions of patients with diseases ranging from arthritis to cystic fibrosis.

The arthritis studies are part of an expansion of gene therapy research to diseases that are neither purely genetic nor necessarily lethal. Seven years after the death of a healthy teenager in a flawed experiment stalled most gene therapy studies, research is booming in diseases ranging from Alzheimer's and angina to cancer and multiple sclerosis.

In osteoarthritis, one "goal is to convert the joint into a factory that makes its own medicine," said Christopher Evans, a Harvard professor of orthopedic surgery who is leading some of the new research.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases recently awarded Evans a $1.6 million grant for the initial tests of his treatment in people with moderately advanced arthritis. Gayle Lester, who oversees clinical research in osteoarthritis for the institute, calls the work "a very strong and a very rational approach to the disease."

New treatments for osteoarthritis are desperately needed, especially since the popular Cox–2 painkillers Vioxx and Bextra were pulled from the market nearly two years ago. None of the current options—steroids, lubricants, pain pills, or dietary supplements—alter the course of the disease, and some do little to ease the pain and disability. As cartilage in their joints erodes from injury and other unknown causes, nearly 500,000 Americans every year face joint replacement surgery, the Arthritis Foundation said.

"Gene therapy is one of the more promising areas for future therapies for arthritis," said Dr. John Klippel, president of the foundation.

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Options Are Available for Seniors In Medi-Gap
The Star-Ledger, 8-14-06

Editor's Notes:

The recent furor over the Medicare drug benefit coverage gap (known notoriously as the "donut hole") has inspired many pundits to demand that Congress authorize the government to negotiate directly with manufacturers to lower drug prices in order to eliminate the coverage gap.

However, it is important to note that many of those affected by the gap will largely be middle class, not poor seniors, who already receive substantial drug subsidies. In addition, on November 15th seniors in the program will be able to sign up for a new plan without a "donut hole" if they so choose.

But the bottom line is this: Medicare as a universal entitlement is enormously expensive and cannot be sustained in its current form. Throwing price controls onto drugs won't change that equation. Policymakers who are serious about closing the "donut hole" in the federal government should focus on reforming Medicare, including means testing the program that would ensure that the wealthiest seniors pay more than middle class seniors, and middle class seniors pay more than the poorest seniors. This would improve Medicare's fiscal health and allow the program to over better coverage for everyone—without government price controls on prescription drugs. Sometimes, one size doesn't fit everyone.

The Healthcare Leadership Council, a Washington–based advocacy group, said about 25 percent of middle–class seniors who rely exclusively on Part D for prescription drug coverage will hit the doughnut this year. But Michael Freeman, a spokesman for the council, noted that 54 percent of them had no coverage last year. He said they will have saved about $2,000 before they hit the gap.

Despite the focus on the doughnut hole, many seniors are pleased with the program and said they are saving money.

"It took me a long time to make a decision (about what plan to join)," said 87–year–old Harold Rathbun of West Caldwell. "But I think I am saving money in the long run. Everything seems to be going well."

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Scientists Begin to Grasp the Stealthy Spread of Cancer
The New York Times, 8-15-06

Editor's Notes:

Scientists on the cutting edge of cancer research have begun to focus on a critical time during the early stages of the disease to develop better cancer diagnostics and treatments. Researchers are focusing particularly on genes that can help them understand how cancers metastasize, since cancer becomes significantly harder to combat once it spreads from its original site in the body.

The moment when a cancer begins to spread throughout the body—metastasis—has always been the most dreaded turning point of the disease.

Without metastasis, cancer would barely be a blip on the collective consciousness. Fewer than 10 percent of cancer deaths are caused by the primary tumor; the rest stem from metastasis to vital sites like the lungs, the liver, the bones and the brain.

Though chemotherapy and other treatments have lengthened the lives of people with metastasized cancer, no drugs have been specifically formulated to halt the process. That is because metastasis has remained something of a mystery until the last five years or so.

"In the last 30 years, we've learned all about identifying genes whose mutations initiate tumors," said Dr. Joan Massagué, chairman of the Cancer Biology and Genetics Program at Memorial Sloan–Kettering Cancer Center in New York. But these advances, he added, did not explain the metastatic process.

Now, knowledge of metastasis is beginning to accumulate to the point that new therapies are entering the pipeline.

"In terms of milestones or breakthroughs, most of them are about to be made," said Dr. Massagué.

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Medicare Sees No Increase in Premium for Drugs
The New York Times, 8-16-06

Editor's Notes:

According to the Centers for Medicare and Medicaid Services, next year's Medicare premiums for the Part D drug benefit will remain stable at current prices—about $24. This premium is well bellow the $41 that CMS had predicted for 2007.

Premiums for a particular plan may rise next year. But, Dr. McClellan said, "the vast majority of beneficiaries will have access to Medicare drug plans that cost them the same as or less than their coverage in 2006."

In March 2005, the government predicted that the average drug premium would be $37 a month in 2006, rising to $41 in 2007. In August 2005, federal officials lowered the estimate for this year to $32, based on the proposals submitted by drug plan sponsors. In June, after seeing which plans were chosen by beneficiaries, the administration said the average premium turned out to be about $24.

Dr. McClellan said the average premium would remain around $24 if beneficiaries stayed in the same drug plans in 2007 and could decline if they again chose less costly plans.

Lower premiums save money for beneficiaries and the government. Medicare pays insurers a subsidy, which is about three times as much as the beneficiary's premiums.

CMS attributed the low costs to competition and choice in Part D, although critics argued that lower premiums might result in restricted access to certain prescription drugs. The Medicare plan was initiated as part of an ongoing effort to give seniors better health care and more choices. Positive early evidence for the program suggests that seniors may be open to additional market–based Medicare reforms.

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