In the Spotlight
KerryCare for the Greatest Generation?
Robert Goldberg, Ph.D., 9-23-04
John Kerry calls his Medicare plan the "Compact with the Greatest Generation". But his proposals break faith with the American promise that today's elderly have come to expect: that their children, and their children's children, will have longer and healthier lives thanks to America's pursuit of medical progress.
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Fight to Legalize Drug Imports Has Unlikely Ally -- Pfizer Executive Will Join Washington Lawmakers In a High-Visibility Event
Wall Street Journal, 9-22-04
The debate over legalized drug importation should really be a debate over price controls – because that is what the U.S. would have if it opens its doors to universal importation from Canada and other price-controlled markets.
The reality is that price controls represent an enormous transfer of health and wealth from future generations of patients to today's consumers. The European system of price controls and parallel importation substantially slows the pace of pharmaceutical investment and R&D, leading to worse health care for hard to treat, expensive conditions, and fewer innovative new drugs coming to market. Since the U.S. accounts for the lion's share of global drug sales, price controls here would further erode access to new medicines in the U.S., Europe, and the developing world.
This is the real debate: the present versus the future, today’s cancer and Alzheimer's drugs, versus tomorrow's breakthroughs. The evidence is that, on balance, innovation saves more lives than the status quo, and it is precisely on this question that the importation debate should focus – not whether or not a lone Pfizer executive from Europe is in favor of importation.
So much for tripping the life fantastic; The increase in rates of arthritis and the lengthening of surgical wait times makes it harder for many people to stay active
The Globe and Mail, 9-22-04
Like most advanced countries, Canada’s population not getting any younger. As it ages, the quality of Canadian health care and health care financing will become increasingly potent – and divisive – issues.
Notably, according to the Canada-based Institute for Clinical and Evaluative Sciences (ICES), the health care treatments being demanded by elderly Canadians to ease chronic and degenerative medical conditions are becoming harder and harder to come by due to lengthy waiting lists. Patients waiting for surgical knee replacements did so for an average of 29 weeks in 2002, up from 20 in 1994. Patients waiting for hip replacements average "only" 20 weeks, up from 16 in 1994.
"The fundamental problem is that demand for these procedures continues to increase but availability remains remarkably flat", said Dr. Elizabeth Bradley, an ICES researcher. Dr. Bradley also noted that this is just "the tip of the iceberg", since growing percentages of the Canadian population are experiencing arthritis and the burgeoning costs associated with pain management drugs. Related services for arthritis patients – orthopedic surgeons, rheumatologists, physiotherapists, occupational therapists, and chiropractors – are also becoming increasingly rare.
Canadian demand is growing, but the supply of critical services is static – because prices are fixed by the government and consumption is subsidized, i.e. consumers have no incentives to ration their use of the system, and new providers have no incentives to bring new services to market. Until the incentives change (for both patients and providers), Canada’s "free" health care will grow increasingly out of reach for those who most need it.
The Informed Patient: Electronic Medical Records Are Taking Root Locally
Wall Street Journal, 9-22-04
This story gives a whole new meaning to the phrase "think globally, act locally." In New York, the Taconic Health Information Network is one of the pioneers in the race to ensure that all Americans have electronic health records that physicians can easily consult to ensure that patients are receiving the best care possible. These health records would also be completely portable, following patients regardless of employment or location of treatment.
Currently, Taconic is one of over 100 local and state groups that are using small grants from the federal government and nonprofit groups to implement their own e-health records on a regional basis. "By using a single network, regional health groups says they can reduce medical mistakes, better track patients with chronic diseases such as diabetes, zip prescriptions electronically to pharmacies, and cut costs by eliminating duplicated lab tests and x-rays.
Regional groups also believe they have an advantage over a single national system by tailoring health records to fit the health care "needs of specific geographic populations." Although creating e-health records is a daunting and expensive task, smaller alliances of providers and insurers are joining together to build the system from the bottom up. In this model, the federal government’s limited role would be to push for agreement on a "single technical standard that will let all the different medical records in the country eventually talk to each other and share data, all the while allowing access only to authorized users, to ensure privacy."
Eventually, the regional systems would operate much as the Internet does, with local nodes all adhering to a common information standard without sacrificing diversity or being burdened by excessive regulation.
After the Hospital, Get the Checklist: Study Finds Heart Patients Fare Much Better if Given Reminders on Drug Regime
Wall Street Journal, 9-21-04
"All too often", heart disease patients are treated at hospitals, only to receive poor follow-up for cholesterol and blood pressure drugs once they are discharged, leading to readmission and higher mortality rates later on.
Recently, a group of hospitals, led by Intermountain Health Care, "[reported] success in boosting the number of patients" who get life-saving medications and check-up lists upon discharge. The hospitals showed that with these "systematic medication programs" hospitals reduced the likelihood of readmission or death in discharged heart disease patients. "The study found that a strategy implemented in 1997 using checklists, reminder cards, follow-up phone calls, and educational brochures was effective in tracking whether the patients got prescriptions and in improving doctor's adherence to recommended standards of care." The program's checklist adheres to guidelines established by the American College of Cardiology and the American Heart Association.
Effective disease management programs like these have the potential to save lives and reduce costs, and policymakers should offer Medicare and Medicaid payment incentives to providers that provide better risk-adjusted outcomes than their competitors.
Scared parents keep young out of antidepressant trial
Washington Times, 9-20-04
One potential side-effect of the recent furor over anti-depressant use among adolescents is that parents with severely depressed children will shy away from drug treatment due to the media’s recent focus on the small risk of suicidal tendencies associated with the drugs – about 2 or 3 percent. ("For every 100 children taking antidepressants in controlled clinical trials, two to three experienced increased suicidal tendencies.")
In fact, this may already be happening. Researchers are beginning a new study financed by the National Institute of Mental Health designed to test which schedule of treatments (anti-depressants, behavioral therapy, or both) can best prevent future suicide attempts among adolescents who have already attempted suicide once. However, the study is already having problems recruiting patients. "We're trying to increase the number who are treated [for depression], said one researcher working on the NIH study, and [the FDA black-box warning] is definitely not going to help."
Currently, only a fraction of patients who are diagnosed as clinically depressed receive any treatment at all. While antidepressants may not show much effect in children with mild or moderate depression, who often improve on their own over time, there is a real risk that parents of children with severe or persistent depression will exaggerate the perceived risks of antidepressant treatment versus the suicide risks associated with severe depression.
The challenge for clinicians is to disaggregate serious depression from transient episodes, and to monitor children aggressively when they receive any type of treatment (including antidepressants). Whether or not that message is making its way to parents through the media firestorm is another issue entirely.
MEDICINE; Patients who cut corners on drugs don't tell doctors; Rising costs are forcing many to reduce doses or skip them entirely. Physicians don't bring up the issue; often, neither do patients.
Los Angeles Times, 9-20-04
A new study has documented that when patients stop taking or skip doses of prescription drugs due to cost concerns, they often do not discuss the issue with their physicians – and physicians are not likely to ask if cost is a consideration when they issue prescriptions. The study also found that patients with expensive chronic conditions like asthma, diabetes, heart disease, and ulcers are most effected by non-compliance issues related to cost.
The study seems to highlight the issue of patient-physician communication, and physician education. There are many options for assisting low-income patients with prescription drug costs that patients and physicians may be unaware of; for instance, the Medicare website compares prices for similar drugs for the same illness and can help physicians identify less costly alternative treatments. Also, many pharmaceutical companies offer low-cost or free drugs to low-income patients. Drug discount cards are also available through the Medicare program, state and local government programs, and retailers.
Technology Inc.: Company helps drug makers beat odds | Chemnavigator supports discovery, testing phases
The San Diego Union-Tribune, 9-17-04
Much of the cost of drug development can be attributed to promising starts that turn into dead ends late in the clinical testing process: drugs that looked promising in test tubes turn out to be useless or harmful in the human body.
In San Diego, an innovative company called Chemnavigator is using advanced computer modeling to help companies "beat the bad odds of drug development, first by helping them find potential compounds, then by allowing them to test the compounds on computer models." Drug companies spend $30 billion per year in "traditional" testing in which scientists hover over petri dishes in laboratories trying to see if chemical compounds bind with the target receptors that are the molecular pathways for disease. Chemnavigator's "software and databases of compounds allow customers to search through 13 million compounds catalogued in [their] library" to weed out the best candidates. Once a compound has been purchased, Chemnavigator can test the compounds against target proteins in computer models much the same way you test keys in a lock to see which one fits. Chemnavigator has also contracted with a German company with its own computer database of drug targets that can help determine if a drug has toxic properties before it is ever used in the human body. Increasingly, computer technologies like these will be used to speed up the drug development process, getting better drugs to market faster and less expensively.
Medicare Web Site Points Out Less Costly Drugs
Wall Street Journal, 9-16-04
The Medicare website now offers a feature comparing the prices of similar drugs for five common illnesses. "The new price information covers 52 medications for high cholesterol, high blood pressure, allergies, arthritis and stomach ailments." The information is designed to help physicians and their patients choose the most cost-effective drugs for their illnesses.
Health and Human Services Secretary Tommy Thompson hopes that "the more Americans compare prices, the more market pressure will drive prices down. That's what [the Medicare web site] is all about." Indeed, and the more patients and doctors become savvy purchasers of medicines, the more manufacturers will compete on price and quality. This is one of the first, albeit small, tremors in the tectonic shift to consumer driven health care, and policymakers like Secretary Thompson and CMS Administrator Mark McClellan should continue to shake up the status quo by providing the public with better information – and more control – over their own health care.
Statins May Be Particularly Useful in Chronic Kidney Disease Patients
Approximately 11 percent of Americans suffer from chronic kidney disease (CKD), which puts them at a greater risk for heart disease and adverse cardiovascular events. According to researchers, moderate CKD is associated with a "26% increase in MI [myocardial infarction or heart attacks], coronary death, or revascularization." The researchers analyzed data from three placebo-controlled trials that examined statin effects in patients with or at high risk of cardiovascular disease. Of these 19,700 subjects, approximately 4500 had moderate CKD at baseline.
"In both the moderate CKD and normal renal function groups, pravastatin therapy reduced the risk of the primary outcome [MI, coronary death, revascularization] by about 23%, the investigators state. In addition, pravastatin therapy was tied to a 14% reduction in the risk of all-cause mortality in the moderate CKD group." Statin drugs continue to show effectiveness across a wide range of ailments that increase the risk of heart disease: first for diabetes, now CKD. Hopefully, physicians will use these new studies to improve the standard of care for patients, leading to reduced mortality and more cost-effective treatments.
Drug companies under attack
Elizabeth Whelan, Washington Times, 9-21-04
Whelan points out that Marcia Angell’s new book, The Truth About the Drug Companies: How They Deceive Us and What to Do About It, makes two contradictory arguments: the first is that the drug industry doesn’t produce any useful drugs. The second is that the public badly needs important drugs that are too expensive. So which is it? Are the useless drugs overpriced? If so, no one needs them; they are useless.
In short, if the "drugs are too expensive, the logical follow-up is: Compared to what? Premature death? Weeks or months of hospitalization? Pain and suffering, say, from osteoarthritis?" Angell doesn’t answer the logical follow-up question because it would weaken her ideological prosecution of the pharmaceutical industry. Some of the people who could answer this question: the thousands of AIDs, cancer, and heart disease patients who are alive today thanks to the industry’s useless drugs.
Health Savings Accounts and the FEHBP: Perfect Together
Andrew Grossman, Robert E. Moffit, Ph.D., Heritage Foundation, 9-21-04
Opponents of HSAs in Congress have been trying to strip the HSA options from the Federal Employees Health Benefits Plan, using the argument that HSAs will promote adverse selection, i.e. healthy patients will flock to HSAs, leaving the sickest – and most expensive – in the FEHBP system. Moffit and Grossman argue that the best evidence available shows a different story: "even enrollees with a history of illness or expectation of high medical expenses can benefit from plans with savings accounts and solid catastrophic coverage. Sicker enrollees often dislike traditional managed care the most because they, even more than other patients, want greater control over their health care decisions." Members of Congress should reject this attempt to sabotage HSAs and continue to promote them as powerful tools for promoting consumer choice and lowering health care costs.
ECONOMIC VIEWPOINT A Prescription For Health-Care Reform
R. Glenn Hubbard, Business Week, 9-20-04
A key component of consumer-driven health care is in place now: tax-free Health Savings Accounts are available for the vast majority of Americans. Glenn Hubbard, Dean of the Columbia University Business School, suggests a few simple regulatory changes that can help make them more popular: "Let all Americans deduct expenditures on insurance and out of pocket expenses as long as they purchase at least insurance against catastrophes." By allowing tax deductions for routine medical expenses or insurance purchases, government could help level the playing field between employer-based insurance and self-purchased insurance, thus encouraging more people to manage their own health care costs and save against future expenses.
Analyzing the Kerry and Bush Health Proposals: Estimates of Cost and Impact
Joseph R. Antos, Ph.D.,
American Enterprise Institute , September 2004
Joseph Antos and team of "independent actuaries and cost estimators" have presented a study with the most detailed analysis to date of the competing health proposals issued by the rival presidential campaigns. To date, the only estimate of the Kerry campaign has been issued by Kenneth Thorpe, an economist at Emory University who is also a Kerry advisor. The study found that:
— The Kerry plan would increase federal spending over the ten-year period 2006–2015 by $1.5 trillion. Over the same period, the Bush plan would cost the federal government $128.6 billion.
— Under their proposals, Senator Kerry would dedicate $622 billion to the uninsured; President Bush would commit $39.4 billion.
— The Kerry plan would newly insure 27.3 million Americans. The Bush plan would newly insure 6.7 million.
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