MPT WWW
Selected news articles which highlight important policy issues.

News: Weekly Archives

News for the week of 06-11-2007

Clearing the haze of Chemo; A drug to boost cancer patients’ memory is one of several research advances
Los Angeles Times, 6-11-07

Editor's Notes:

All drugs come with side effects, but few drugs have harsher side effects than those associated with cancer chemotherapy. While there have been important advances in recent years in creating more targeted oncology drugs with fewer side effects, problems still remain. One issue, discussed in this article, is "chemo brain", caused by the drugs' toxic effects on the brain. Thankfully, researchers may have found a promising treatment to offset these effects.

By the time Brenda Oathout had finished chemotherapy for her breast cancer, the Caledonia, N.Y., woman noticed a distinct change in her ability to think.

"Everything was a struggle. I couldn't remember things," she said. "Forgetfulness is not a strong enough word. My thought process was clouded. The more you struggle to think and remember, the more fatigued you become. By 3 o'clock, I was exhausted, overwhelmed with life."...

Many oncologists do not believe it is a real condition, but three papers published last December provided a strong scientific foundation to the idea. They showed that chemotherapy drugs can kill brain cells and that the brains of women who are receiving them undergo significant changes.

Oathout's life changed when she was invited to enroll in a new clinical trial at New York's University of Rochester Medical Center studying the effects of modafinil, a drug already being used to treat the sleeping disorder called narcolepsy.

"The very first day I took it, I noticed the difference," she said. Now, "I can be me again—mother, grandmother, wife, good employee. All the things that I used to be that I had lost for a while."

Results of this trial were among several promising advances reported last week at a Chicago meeting of the American Society for Clinical Oncology...

For Oathout, the benefits of modafinil were so great that she now pays $742.48 a month out of her own pocket for the drug because her insurance company will not.

Oathout was one of 68 breast cancer victims who enrolled in a study by Sadhna Kohli of Rochester's James P. Wilmot Cancer Center on the effects of modafinil, which is sold by Cephalon Inc. under the trade name Provigil. Although the study was small, it demonstrated great potential for using the drug to treat this disabling aftereffect of cancer therapy.

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Mandatory Coverage Is Easier Said Than Done
The New York Times, 6-11-07

Editor's Notes:

Massachusetts's novel experiment in universal health insurance has been the focus of pundits and journalists across the country since it was announced in 2006. Now comes the hard part: getting it to work. The Times writes that the state's individual insurance "mandate" (read: buy insurance or pay a small fine) is proving more challenging to implement than it was to pass.

Requiring people who can afford health insurance to buy it—the same way that car owners must buy auto insurance—appeals to those who believe that mandatory coverage is fairer than asking everyone else, directly or indirectly, to pick up the health care costs of those who choose not to buy it.

In Massachusetts, lawmakers were able to pass the measure because it was viewed as a grand compromise among employers, the government and individuals.

But the state is discovering that making health insurance mandatory is easier said than done. It has spent the past year dealing with questions about how much basic coverage people need, and how much they can be expected to pay. (The poorest residents receive free or subsidized coverage.)

The state has had to work with insurers to create a market for individual insurance where affordable policies were not readily available. With a half–dozen companies, it developed an array of plans that it offered for the first time last month.

Up to now, Massachusetts has maintained the public's support for the mandate, said Paul B. Ginsburg, a health economist who is president of the Center for Studying Health System Change, a Washington research group. "So far, there has not been any evidence of uproar," he said, because the state has been sensitive to those who may not be able to afford insurance and has been slow to levy a large fine on anyone who fails to get coverage.

A mandate is critical, however, to helping the state achieve near–universal coverage, Mr. Ginsburg said. The compromise asks something of corporations, the state and individuals. Companies with 11 or more workers that do not offer insurance to their employees are required to help finance the program by paying $295 a year for each worker. The state is providing money from its Medicaid program and some of the hundreds of millions of dollars it normally pays hospitals and clinics each year for care for the uninsured.

The Bay State's experiment depends on making individual health insurance affordable; but the state has declined to dismantle the many insurance mandates that drive up the cost of health insurance for individuals and small businesses or allow residents to purchase out of state insurance policies. Without true health insurance reform, policies will remain too expensive for many uninsured, mandate notwithstanding.

[permanent link]

Who Pays for Efficiency?
The New York Times, 6-11-07

Editor's Notes:

The short answer to "who pays for efficiency" in health care is the providers. While we'd like have doctors to embrace many health reforms like electronic health records or aggressive disease prevention programs, physicians and other providers operate in a "market" where prices are largely dictated by third party payors, i.e., public and private insurers.

When doctors innovate and lower treatment costs, insurers respond by lowering reimbursements to physicians. When it comes to health care, all too often "no good deed goes unpunished."

The path to saving can be particularly uncertain in the United States' fragmented health care economy—a mix of risk, regulation and profit in which the incentives are often contradictory. A physician, for example, may try new approaches to trim the costs of providing care, but the results usually benefit insurers more than doctors. Strides in efficiency may be good for society, though there may be scant financial motivation for the doctors themselves.

The experience of Dr. Richard Baron, who practices with three other physicians in an office in Philadelphia, provides a glimpse into the predicament. In 2004, Dr. Baron and his colleagues made the transition from ink and paper to computers and electronic health records. They were doing what health care reformers had been advocating for years. But the arithmetic of investing in health–information technology is daunting, especially for small practices like Dr. Baron's. His office spent $140,000 on personal computers, including tablet PCs, servers, software and installation.

The office's annual technology costs, he said, were about $50,000, including maintenance and technical support, and he plans to upgrade the three–year–old computers at a cost of $54,000. Those costs do not include the lost productivity in the first year, when the staff was learning to use the new technology.

Dr. Baron's office has saved money—in transcribing medical reports, for example—and his practice now handles its 6,000 patients with three fewer office employees. He described other benefits, mainly the ability to find information quickly for patients, hospitals, insurers and labs with a few keystrokes.

The technology, Dr. Baron said, has also helped make him become a more adept physician. But it has not yet paid off in dollars and cents: the savings in salaries is less than the costs entailed in computerization. "It is a high–risk venture," he said, "and you do it at your own financial peril."...

Dr. Anne Wilson has her own internal–medicine practice in Rockville, Md., and has felt the pinch of reimbursement cutbacks from Medicare and other insurers. Buying computers and software for electronic health records, Dr. Wilson said, would mean a big cost with no clear payoff.

"I can't capture the economics of scale as a sole practitioner," she said. "Electronic health records may well be a good thing, as a collective good, but why should I make the investment if I don't get any of the gains?"

Dr. Wilson and Dr. Baron are being asked by regulators and insurers to bear enormous risk with little certainty of eventual financial reward.

In normal markets, innovators are rewarded by consumers who are willing to pay premium prices for quality or productivity gains. As Dr. Regina Herzlinger argues, until consumers have more control over their own health care spending, true cost–saving innovations in health care will be few and far between.

[permanent link]

Milkshake drug to 'feed' brain cells among promising Alzheimer's experiments
Associated Press Newswires, 6-11-07

Editor's Notes:

Today, Alzheimer's Disease affects 5 million Americans, and the number of cases is expected to increase sharply as the population ages. Sadly, there are few good treatments for the disease, with current therapies offering only a temporary slowing of mental decline. Still, research is moving forward rapidly, and more effective treatments may be available in the next few years as they are tested in late stage (Phase III) clinical trials.

One of these therapies may involve offering brain cells affected by Alzheimer's an alternative source of energy.

Drinking a milkshake–style medicine at breakfast seems to feed brain cells starved from Alzheimer's damage, researchers reported Monday. It is one of four promising experimental drugs poised for large–scale testing against the brain–destroying disease.

The milkshake drug, called Ketasyn, provides a dramatically different approach to dementia. It hinges on recent research that suggested diabetic–like changes in brain cells' ability to use sugar for energy play a role in at least some forms of Alzheimer's.

Special fatty acids in Ketasyn offer an alternate food source to rev up those hungry neurons, researchers told an international Alzheimer's meeting in Washington on Monday. In a study of 150 patients, adding Ketasyn to their regular medicines produced a small but important boost in mental functioning—but only in people who do not carry an Alzheimer's gene called ApoE4. Still, that is about half of all patients.

[permanent link]

Who Pays for Efficiency?
The New York Times, 6-11-07

Editor's Notes:

The short answer to "who pays for efficiency" in health care is the providers. While we'd like have doctors embrace many health reforms like electronic health records or aggressive disease prevention programs, physicians and other providers operate in a "market" where prices are largely dictated by third party payors, i.e., public and private insurers.

When doctors innovate and lower treatment costs, insurers respond by lowering reimbursements to physicians. When it comes to health care, all too often "no good deed goes unpunished."

The path to saving can be particularly uncertain in the United States' fragmented health care economy—a mix of risk, regulation and profit in which the incentives are often contradictory. A physician, for example, may try new approaches to trim the costs of providing care, but the results u

[permanent link]



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