HEALTH
CARE BRIEFS -- August, 2005
compiled by Dan Butts
Runaway Health Care Costs
"Report: Californians Increasingly Priced Out of Healthcare"
(labor & consumer reps in high-level forums -- may be laying
the groundwork for **Universal Health Care)
(Michigan groups pushing reforms to help the uninsured,
mental health parity, and more -- see fall reports)
"9,000 University of California Nurses to Strike"
("patient-centered" nurses lead nation in back-related
injuries)
"Government to Decide Morning-After Pill's Fate by Month's
End"
"Birth Control Patches Linked to Women's Deaths"
"Breast Cancer Drug Outshines Tamoxifen"
(yet is FAR more expensive)
"Women Hurt by Health Costs"
"Junk Food Nation"
(junk food giants seek protection from Bush)
"Closings Alone Won't Solve Hospitals' Troubles, Panel Chairman
Says"
"Rulings Trim Legal Leeway Given Medicaid Recipients"
"New York Medicaid Fraud May Reach Into Billions"
"U.S. Report Faults States' Medicaid Tactics"
"Big Pharma's Free Ride"
(CAFTA denies poor access to cheaper generics)
"Prices of Drugs for Elderly Said to Far Outrun Inflation"
Doctors Prescribe More Expensive Drugs
"Flaws in Drug Agency Put Consumer at Risk"
"Review Finds Scientists with Ties to (Drug) Companies"
(highlights)
Runaway Health Care Costs
"Malpractice claims and legal bills account for less than
1 % of
health spending."
The latest study, conducted by Johns Hopkins University research-
ers and reported this month in Health Affairs, offers more evidence
of soaring costs. The United States spent $5,267 per person on
health care in 2002. That's more than double, per capita, what 29
other industrialized nations spent. The total amounts to 14.6 %
of
the U.S. gross domestic product. The United Kingdom, by compari-
son, spent 7.7 %.
The costs are surging like an uncontrolled fever, and what the
researchers found is that politicians are devoting an extraordinary
amount of time to changes that have little appreciable impact.
The high-profile push to limit medical malpractice claims, for
example, may help doctors in high-risk practices. But it won't do
much to stem overall health care costs. Malpractice claims and
legal bills account for less than 1 % of health spending, the research-
ers said, and aren't appreciably higher than in other developed
nations.
The push to get patients out of hospitals and doctor's offices
for less expensive treatment options doesn't seem to help, either.
Americans now see doctors less often and spend a fifth less time
in hospitals than people in other countries. Yet we still pay more.
-- "The Wrong Treatment," The Saint Petersburg Times
editorial,
July 16, 2005
"Report: Californians Increasingly Priced Out of Healthcare"
The report, "Priced Out," was released Wednesday by California
Insurance Commissioner John Garamendi, which he used to condemn
a healthcare system that he says is in a "death spiral."
(6.6 million citizens have no insurance, nearly a third of health-
care dollars go to cover administrative costs, and premiums for
private coverage have soared 60 % in the past four years.)
"The structure of compensation for health insurance companies,
as well as for the executives who run them, is a major factor in
the
dysfunction of this current system," Garamendi said. "We
must find
a way to determine how much compensation is appropriate and ration-
ally required to provide essential services."
The report and the hearings are part of a new drive by Gara-
mendi to reform the healthcare system and LAY THE GROUNDWORK
FOR UNIVERSAL ACCESS TO HEALTHCARE.
Much of the report was generated from a series of high-level
healthcare forums with industry and medical experts from around
the state and nation, the commissioner said. They included labor
and consumer groups, legislators, principals from major healthcare
trade associations, CEOs of health plans, and representatives from
pharmaceutical companies.
-- The Sacramento Business Journal, August 3, 2005
"9,000 University of California Nurses to Strike" (July
21st?)
University of California Plans Major Cuts in Nurses' Retirement
Plan Matching Gov. Schwarzenegger's Goals.
"Nurses are sending a strong message that UC should address
the nursing shortage by including in the CNA (CA Nursing Association)
contract nurse-to-patient safe staffing ratios, competitive wages,
health insurance and pension protections because in health or sick-
ness, patients deserve the best qualified experienced RNs around,"
said UC Irvine RN Tam Nguyen.
Schwarzenegger last year vetoed a CNA-sponsored bill, after
heavy lobbying by the UC, requiring all California hospitals to
emplo
safe lift policies, such as providing lifting equipment and training
to employees to avoid debilitating back and other musculoskeletal
injuries.
**RNs, licensed vocational nurses and certified nursing assistants
lead the nation in work-related back injuries, with 37.5 % more
such
injuries than truck drivers, according to U.S. Bureau of Labor Statis-
tics data. Surveys show that 52 % of RNs report chronic back pain
and 12 % who leave the profession say back injuries were the main
or a significant reason.
"The UC system needs to learn from UCLA's Lift Team program.
UCLA's nurses musculoskeletal injuries has decreased from 27 to
7 last year," said Manny Punzalan, a UCLA RN. "This saved
UCLA
$600,000 and has improved the quality of patient care. This is one
of UCLA's best investments with regards to patient safety. A guar-
anteed Lift Team in all UC medical centers will assure quality patient
care and RN's safety."
-- California Nurses Association, July 8, 2005
"Government to Decide Morning-After Pill's Fate by Month's
End"
http://www.truthout.org/issues_05/081505WB.shtml
By month's end, federal health officials will decide whether to
let women buy emergency contraception without a prescription -
and if so, if the morning-after pill will be treated more like aspirin
off the shelf or like cigarettes.
"Birth control patches linked to women's deaths"
About a dozen women died last year from blood clots believed
to be related to the contraceptive... Dozens more survivefd strokes
and other clot-related problems, according to federal drug safety
reports (several lawsuits have been filed).
(In a related article on the same page) "Sexy marketing blitz
promotes patch." Manufacturer Ortho McNeil spent millions of
dollars in advertising... the patch which was chosen as one of Time
magazine's "Coolest Inventions" in 2002... American sales
of Ortho
Evra were estimated at $400 million in 2004.
-- Detroit News, July 18, 2005
"Breast Cancer Drug Outshines Tamoxifen"
The latest study, published in the (British) Lancet medical journal,
is based on results among Austrian and German women. It confirms
a treatment switch can lower the risk of cancer recurring in the
same breast, in the other breast or elsewhere.
But anastrozole, marketed by AstraZeneca as Arimidex, is far
costlier, and it will be another 15 months before a decision is
made
on whether it is supported for widespread use in the National Health
System.
Patricia Hewitt, the health secretary, has recently agreed to
fast-
track the intravenous drug Herceptin, made by Roche and costing
up
to £20,000 (or about $35,000) a year, which has shown remarkable
results in tackling aggressive breast cancers when used in addition
to standard chemotherapy.
-- James Meikle, The UK Guardian, August 5, 2005
"Women Hurt by Health Costs"
San Francisco - Despite making many of the household health-
care decisions and using medical services more often than men, more
than one in four U.S. women are delaying care they think they need
because of costs, according to a new study.
"The issue of costs is one that cuts across all insurance
group
of women, both privately insured and uninsured women," said
Alina
Salganicoff, vice president and director of women's health policy
at the Kaiser Family Foundation, which recently surveyed more than
2,700 women on health questions.
The overall portion of women delaying care due to costs rose
to 27 % in 2004 from 24 % in 2001. The portion of working-age
women without health insurance who delayed or chose not to get
needed care ballooned to 67 % from 59 % in 2001, the study said.
Working-age women with private coverage weren't home free
either: 17 % of them put off care because they couldn't afford it,
up from 13 % four years ago. And 20 % of women didn't fill a pre-
scription for similar reasons versus 14 % for men.
-- Kristen Gerencher, Market Watch, July 10, 2005
"Junk Food Nation" (Gary Ruskin and Juliet Schor)
http://www.truthout.org/docs_2005/081205Q.shtml
In recent months the major food companies have been trying
hard to convince Americans that they feel the pain of our expanding
waistlines, especially when it comes to kids. But behind the scenes
it's hardball as usual, with the junk food giants pushing the Bush
Administration to defend their interests.
"Closings Alone Won't Solve Hospitals' Troubles, Panel Chairman
Says"
(NY Times, July 14, 2005)
Chairman Stephen Berger said in an interview that "I assume
we
will have (NY state) hospital closings (many public hospitals in
the
city have already closed--db). But the answer is not just closing
institutions. It is restructuring the delivery of health care."...
Berger... said the panel will look broadly at the general structure
of hospitals, suggesting that **not every function needs to be avail-
able under a single roof. Instead, he said, the responsibilities
of some
hospitals could be narrowed into ambulatory care centers or other
roles (nursing home finances will also be examined).
"There is no single body that we have seen of recent vintage
that
has been dedicated to a holistic view of the health care system,"
said Kenneth E. Raske, the president of the Greater New York Hospi-
tal Association. But he cautioned that if it was not careful, the
commission could do more harm than good.
"If you have incomplete answers, you will have wrong answers,"
he said.
The state also has a large pot of cash available to make its recom-
mendations reality. This year's state budget has $1 BILLION set
aside
to reorganize health care facilities. Governor Pataki is also hoping
to
receive $1.5 billion from the federal government for the same purpose.
"Rulings Trim Legal Leeway Given Medicaid Recipients"
<A HREF="http://www.truthout.org/issues_05/081605HA.shtml">
http://www.truthout.org/issues_05/081605HA.shtml</A>
In a series of rulings, federal judges are limiting the ability
of
poor people to turn to the courts to fight for Medicaid benefits
to
which they believe they are entitled.
"New York Medicaid Fraud May Reach Into Billions"
(Program for Poor, State's Biggest Expense, Becomes
Target for Egregious Abuse, NY Times, July 2005)
"U.S. Report Faults States' Medicaid Tactics"
(NY Times, June 28, 2005)
New York State's Medicaid program has become a $44.5 BILLION
target for the unscrupulous and the opportunistic.
It has drawn dentists like Dr. Dolly Rosen, who within 12 months
somehow built the state's biggest Medicaid dental practice out of
a Brooklyn storefront, where she claimed to have performed as
many as **991 procedures a day in 2003... Dr Rose and two associ-
ates have been indicted on charges of stealing more than $1 MILLION
from the program.
Nursing home operators have received substantial salaries and
profits from Medicaid payments, while keeping staffing levels below
the national average (examples of this and other abuses cited in
the
article).
***
Two-thirds of the states use consultants to help them get more
federal Medicaid money, often by using "questionable billing
practices,"
and then reward those consultants by giving them a share of the
money as a contingency fee, according to Congressional investigators.
As of 2004, 34 states -- up from 10 states in 2002 -- used con-
tingency-fee consultants for this purpose.
The Government Accountability Office said that a consultant helped
Georgia obtain $1.5 billion of additional federal Medicaid money
from
2000 to 2004, in return for contingency fees of $82 million... The
state billed Medicaid $62 a day while paying less than $37 a day
for
rehabilitation services for children with disabilities.
In other cases, state agencies and consultants got a substantial
share of the federal money that was supposed to reimburse schools
for health services provided to children on Medicaid. In some states,
schools received "as little as $7.50 for every $100 in Medicaid
claims"
for school-based services, according to Kathryn Allen, director
of
health care issues for the GAO.
"Big Pharma's Free Ride"
<A HREF="http://www.truthout.org/issues_05/081205HA.shtml">
http://www.truthout.org/issues_05/081205HA.shtml</A>
Pharmaceutical companies are using free trade deals like CAFTA
to eliminate global competition -- and deny poor patients access
to
cheaper generic drugs.
"Prices of Drugs for Elderly Said to Far Outrun Inflation"
<A HREF="http://www.truthout.org/issues_05/081605HB.shtml">
http://www.truthout.org/issues_05/081605HB.shtml</A>
For the third consecutive year, the average prices of dozens
of brand-name prescription drugs widely used by elderly Americans
have risen more than twice as fast as general inflation, according
to a survey to be released today by the advocacy group AARP.
Doctors Prescribe More Expensive Drugs
Writing in the current issue of The American Journal of Medicine,
researchers say medical residents who have access to samples are
more likely to write prescriptions for heavily advertised drugs
than
for less expensive brands, generic versions or even over-the-counter
medicines.
The study, the researchers said, contradicts the argument made
by many doctors that the samples do not influence them. It also
undercuts the suggestion that the samples save patients money
("their primary purpose is to market new and expensive drugs").
If the samples were really influencing doctors, the authors said,
**it would appear to violate national guidelines on the relationship
between drug companies and doctors.
-- NY Times, August 9, 2005
"Flaws in Drug Agency Put Consumer at Risk"
FDA regulators rush to review applications for new medicines
but are slow to address serious problems that surface with the
drugs once they come on the market, interviews with physicians,
scientists, government officials and medical school researchers
suggest.
That (new drug review) process took 33 months, on average,
in 1992. Today, drug company user fees total more than $200
million a year, review times have dropped to an average of about
13 to 14 months and the pharmaceutical industry professes to
be very satisfied with the results.
More than 1,000 people now work in the FDA's Office of New
Drugs, compared with (only) about 110 in the Office of Drug Safety,
which evaluates the safety of drugs once they are on the market.
Perhaps most important, according to several drug safety ex-
perts, the FDA cannot compel pharmaceutical companies to perform
clinical studies to resolve safety questions that arise about drugs
on the market.
According to information published in the Federal Register,
fewer than half of the studies that companies agree to do after
a drug is approved are started.
-- Judith Graham & Frank James, The Chicago Tribune, February
20, 2005
"Review Finds Scientists with Ties to (Drug) Companies"
Forty-four government scientists have violated ethics rules
on collaborating with pharmaceutical companies, a preliminary
review by the National Institutes of Health shows.
Nine of the scientists may have violated criminal laws, the
report said.
The review was outlined in a July 8 letter the agency's
director, Dr. Elias A. Zerhouni, sent to the House Energy and
Commerce Committee, which is investigating conflicts of interest
by government researchers.
Because the N.I.H. is investigating 103 people who have been
accused of ethics violations, Dr. Zerhouni had asked the committee
to keep his letter confidential. But its leaders - Representatives
Joe L. Barton, Republican of Texas and John D. Dingell, Democrat
of Michigan - said in a statement yesterday that they were releasing
it because of "the compelling public interest."
"The ethical problems are more systemic and severe than
previously known," Mr. Barton said.
The institutes' review found that the 44 scientists had either
failed to disclose income from outside work, had failed to get per-
mission to consult or had done the work on government time rather
than their own.
-- Donald G. McNeil Jr., The New York Times, July 15, 2005
*****
Dan Butts
August 19, 2005
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