MPT WWW
Selected news articles which highlight important policy issues.

News: Weekly Archives

News for the week of 01-02-2007

AIDS drugs offer hope but too late for one man
Los Angeles Times, 1-2-07

Editor's Notes:

George Orwell died of tuberculosis in 1950, just as a combination antibiotic regimen was being developed that would’ve saved his life. As James LeFanu, a Canadian writer, puts it, "Orwell died on the cusp of a paradigm shift [in tuberculosis treatment.]"

The Los Angeles Times chronicles the story of two AIDS patients who were hoping to find themselves on the right side of a medical paradigm shift in the treatment of drug resistant AIDS. A breakthrough may have come—but not in time for both of them.

2006 was destined to be the year Warren Ratcliffe lost his desperate race to survive AIDS, and the year Mark McClelland appeared, finally, poised to win his.

The two Bay Area men were among an estimated 40,000 Americans whose illness could not be controlled by modern HIV drugs because they'd developed a bedeviling resistance to them. Known as "salvage therapy" patients, they had only one hope: that a complicated and ever–changing witch's brew of existing medications, aimed at stalling the famously mutational virus, would keep them alive long enough for entirely new drugs to arrive via the pharmaceutical research pipeline.

In 2006 just such a drug—one that some researchers are calling "truly phenomenal"—did come along, in time, doctors hope, to save the 45–year–old McClelland but too late for Ratcliffe, who was overtaken by AIDS–related cancer and died April 27 at age 58.

The new drug, called an integrase inhibitor, was a highlight of the summer's annual international AIDS conference in Toronto. Newly published clinical studies showed that it, in combination with two existing drugs, reduced the virus to undetectable levels in nearly 100% of HIV patients taking, for the first time, a regimen targeting their condition. It had a similar effect on the virus in up to 72% of salvage therapy patients.

"They tested it on some people who were in deep, deep salvage therapy, and even those people did remarkably well," said Dr. Steven Deeks, a UC San Francisco salvage therapy authority who treated Ratcliffe and still treats McClelland. "It seems to be a truly phenomenal drug that everyone is sort of a little bit in awe of right now and is changing the whole way we think about the management of these patients."

The drug essentially prevents the virus from integrating its DNA with that of a host's cells, thus short–circuiting its ability to replicate itself.

McClelland had several friends in salvage therapy who were part of the integrase inhibitor studies. "They all did extremely well," he said.

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Scientists See Potential in Amniotic Stem Cells: They are Highly Versatile and Readily Available
Washington Post, 1-8-07

Editor's Notes:

While there is a fierce debate raging over the government's current ban on federal funding for new lines of embryonic stem cell research, researchers have announced a new source of stem cells that abrogates the ethical concerns raised by the destruction of embryonic cells:

A type of cell that floats freely in the amniotic fluid of pregnant women has been found to have many of the same traits as embryonic stem cells, including an ability to grow into brain, muscle and other tissues that could be used to treat a variety of diseases, scientists reported yesterday.

The cells, shed by the developing fetus and easily retrieved during routine prenatal testing, are easier to maintain in laboratory dishes than embryonic stem cells—the highly versatile cells that come from destroyed human embryos and are at the center of a heated congressional debate that will resume this week.

Moreover, because the cells are a genetic match to the developing fetus, tissues grown from them in the laboratory will not be rejected if they are used to treat birth defects in that newborn, researchers said. Alternatively, the cells could be frozen, providing a personalized tissue bank for use later in life.

The new cells are adding credence to an emerging consensus among experts that the popular distinction between embryonic and "adult" stem cells—those isolated from adult bone marrow and other organs—those is artificial.

Increasingly, it appears there is a continuum of stem cell types, ranging from the embryonic ones that can morph into virtually any kind of tissue but are difficult to tame, up to adult ones that can turn into a limited number of tissues but are relatively easy to control.

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Healthcare Spending Eases Off
Los Angeles Times, 1-9-07

Editor's Notes:

The Times reports on federal data showing that health care spending slowed somewhat in 2005, although it still surged well ahead of other economic indicators.

The data show that in 2005, spending on healthcare grew 6.9%. That was the smallest rate of increase since 1999, and marked the third straight year in which the pace had moderated. In 2004, for example, spending grew by 7.2%. Because of the time required to collect and analyze data, the 2005 numbers are the latest to be released.

Although the rate of increase declined, healthcare spending in 2005 still grew faster than wages, inflation and the economy as a whole. And with employers continuing to shift more of the cost of job-based medical insurance to workers, the pressure on individuals and families remained high.

A slowdown in spending on prescription drugs was the main reason for the improvement in 2005, the government report found. Analysts credited a continuing shift to generic medications, as well as aggressive cost-control efforts by state Medicaid programs. The report did not factor in the new Medicare prescription benefit, not yet in effect in 2005.

Government experts also found another glimmer of hope in an arcane but important statistic that measures the amount of spending on the sickest people.

Traditionally 5% of patients—the most frail—have accounted for more than half of all spending in any given year. But in 2003, the share of spending on these very ill patients dipped to 49%, suggesting that doctors are reducing costly hospitalizations through better management of chronic diseases such as diabetes.

The article goes on to bemoan the amount that the U.S. is spending on health care compared to other industrialized nations, but it fails to note that U.S. economic growth has been substantially higher as well—and that higher U.S. per capita income undoubtedly explains some of the difference in health care expenditures, especially when combined with the U.S.'s embrace of newer health care technologies. This is not to say that there isn't plenty of fat to cut from the system. But the real question we should be asking is not how much we are spending, but if we are spending it as effectively as we can.

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Gov. Offers Bold Prescription
Los Angeles Times, 1-9-07

Editor's Notes:

Following on the heels of Gov. Romney's health care reforms in Massachusetts, Gov. Schwarzenegger recently announced his own plan for universal health care coverage in California:

"Everyone in California must have health insurance," Schwarzenegger said via teleconference from Los Angeles, where he is recuperating from a broken leg. "If you can't afford it, the state will help you buy it, but you must be insured."

Only Massachusetts has required all residents to carry insurance, but California's larger population of uninsured and poor makes Schwarzenegger's goals much more challenging. To pay for the plan, Schwarzenegger proposed placing new fees and obligations on doctors, hospitals, employers and insurers—all powerful lobbies in Sacramento.

Schwarzenegger was widely praised for tackling such a huge issue so comprehensively. But many leading consumer advocates, academics and business leaders said they feared that the governor's proposal was inadequately financed and would shift more responsibility for healthcare to families while unintentionally encouraging businesses to drop or downgrade the coverage they now offer.

Employers with 10 or more workers would have to offer plans that cost them at least 4% of their payroll. Those who refuse would be required to pay an equivalent amount into the state's insurance fund for people with no other option. That mandate, while greeted skeptically by businesses, was criticized as too lax by advocates who said that a majority of companies that now provide insurance already contribute much more money.

"It's the equivalent of setting the minimum wage at $3 an hour," said Anthony Wright, executive director of Health Access California, a consumer advocacy group.

Those earning more than 2 1/2 times the federal poverty level—a total of $41,500 a year for a family of three—would not receive a subsidy but would still have to buy insurance if their employer did not offer it. The cheapest plan would require families to pay $2,000 a year in premiums, and as much as $10,000 in out-of-pocket medical costs.

"By setting this as a minimum, the tendency will be to undermine and reduce the current level offered by some employers, who will use this to justify reducing their benefits much more," said E. Richard Brown, director of the UCLA Center for Health Policy Research, who nonetheless called the proposal "very impressive" in its reach.

The details of the plan are sure to change over time, after California legislators have an opportunity to digest the fine print. But in its initial reach—and cost—the plan is staggering. What is most striking, however, is that the governor is proposing to add enormous new costs and regulations to an already heavily regulated health care sector.

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Congress mulls how to expand U.S. health insurance
Reuters News, 1-10-07

Editor's Notes:

Providing universal health insurance is quickly becoming a hot-button issue for policymakers across the country, spurred by Massachusetts's passage of legislation mandating insurance coverage last year. On Monday, California Governor Arnold Schwarzenegger laid out his own plan for universal insurance coverage in that state. Following the state's lead, Congress is mulling legislation of its own.

The new Democratic-led U.S. Congress on Wednesday began discussions on how to bring health coverage to millions of uninsured Americans, and heard warnings not to undercut efforts by individual states. Since killing former President Bill Clinton's controversial proposal for universal health coverage in 1994, Congress has not fixed the problem of growing numbers of uninsured Americans and runaway health care costs.

With no progress at the federal level, states including California and Massachusetts have taken steps on their own. Nearly 47 million of America's 300 million people have no health insurance. Sen. Edward Kennedy, a Massachusetts Democrat who favors guaranteed health insurance for all Americans, called a hearing of the Senate Committee on Health, Education, Labor and Pensions to discuss how to proceed.

… The panel heard from witnesses from the insurance industry, business and labor. Over and over, the senators were told that Congress should not interfere with experimentation at the state level.

"Do no harm," said Peter Meade, executive vice president of Blue Cross Blue Shield of Massachusetts. "This means not advancing legislation that would undermine the efforts of the states like Massachusetts, California and Vermont that are trying to decrease costs, increase quality and improve access to health care."

The admonition for policymakers to stay out of state experiments is good advice, and is exactly the strategy the Administration has been following for the last couple years, as it encourages experimentation in the joint federal-state Medicaid program for the poor. Rather than rolling out a plan to capitalize on press interest in the topic, Congress would be much better served in holding fire for the time being until we have time to evaluate the success—or lack thereof—of the various new state initiatives.

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Halting heart drugs a big risk, study finds
The Globe and Mail, 1-10-07

Editor's Notes:

As the old saying goes, you can always lead a horse to water—the trick is to get him to drink. When it comes to health care, prescribing the right medicine for patients is only the first step. Physicians also have to be careful to ensure that patients take their meds correctly and regularly, and that they follow up (where possible) with appropriate life-style changes. This article underscores that without patient compliance, there is only so much doctors can do to improve health.

About a third of heart attack survivors stop taking prescribed medications within a couple of years and, as a result, their risk of dying shoots up, new Canadian research shows.

Those who take drugs such as statins and beta blockers routinely, on the other hand, see their risk of dying fall by about 25 per cent, according to the study.

"In the end, it's a pretty simple message: Take your drugs as prescribed and you will live longer," David Alter, a senior scientist at the Toronto-based Institute for Clinical Evaluative Sciences, said in an interview.

As simple as it may seem on the surface, the challenge for researchers was to disentangle the benefits of drugs from other lifestyle issues. The problem is that people who take their meds also tend to stop smoking, improve their diet and exercise—all factors that can reduce the risk of a subsequent heart attack.

"This study looked just at drug effects, and they are significant," Dr. Alter said. He was quick to add, though, that other lifestyle changes will bring additional health benefits, so patients should not see prescription drugs as a panacea.

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