Sunday, March 8, 2009

News Clipping Archives

 

Monday / Reigonal

Bills Would Increase Accountability and Oversight of Insurers (Washington Post)

National / International

These Nurses Are Taking Their Show on the Road (USA Today)

Opinion

Our Say: Teen suicide problem needs individual attention (Capital Services)

A 'cure' worse than gangrene (Washington Times)

Health care crisis only getting worse (Baltimore Sun)

 

 

Maryland / Regional

 

Bills Would Increase Accountability and Oversight of Insurers

 

By Lisa Rein

Washington Post

Sunday, March 8, 2009; C06

 

Maryland began a major expansion of health insurance to the poor last year. But with tight budgets threatening that investment, lawmakers are moving to improve protections for those who have insurance but struggle to meet their medical costs.

 

As their constituents continue to face soaring premiums and out-of-pocket costs and policies that cover less, legislators have introduced bills that try to provide greater accountability and regulation of the insurance industry. They say the changes will come at minimal cost to taxpayers.

 

Insurers, which are powerful in the capitals of Maryland and Virginia, appear open to some of the proposals. But they oppose others, saying their profit margins are being squeezed by economic and competitive pressure.

 

Bills moving through the Maryland General Assembly would shorten the waiting period that health plans can impose on patients with preexisting medical conditions, crack down on out-of state companies that sell stripped-down policies and force insurers to spend less on administrative costs and more on medical care.

 

In Virginia, Gov. Timothy M. Kaine (D) is expected to sign a bill that makes insurance more affordable by allowing small businesses to offer their workers policies that cost less but provide more limited coverage. Several measures that would have increased oversight of the industry failed in the just-concluded session of the legislature.

 

Some of the proposals in Maryland might appear more technical than substantive. "But it turns out that we're trying to undo outdated rules that are not fair to consumers," said Maryland Insurance Commissioner Ralph S. Tyler, who is pushing many of the proposed changes. "Most citizens don't know what their rights are."

 

In the past decade, the national average cost for annual premiums for individual and family coverage has doubled, to $4,704 and $12,680 last year, according to the Kaiser Family Foundation, a nonprofit group that studies health policy. Health advocates say they want patients to get more for their money.

 

Individual insurance policies, bought by people who are self-employed or do not have coverage through their employer, tend to be the most expensive and, in some cases, the most restrictive. Deborah Schumann, a retired ophthalmologist from Bethesda, discovered this last year when her doctor saw something suspicious on a mammogram and ordered another one. Her policy did not cover the second test, called a screening mammogram. Her out-of-pocket charges came to about $155.

 

"Their view was: You had the wrong kind of mammogram, so we won't pay for it," Schumann said. "I want the money I pay to the insurance company to go to my health care."

 

One proposal in Maryland would prohibit an insurer that fails to resolve all questions about an applicant's preexisting condition from canceling the policy if such a condition is subsequently discovered. Another would reduce from seven to five years the period an insurer can look back at someone's medical records to find preexisting conditions.

 

Tyler also is targeting three out-of-state companies that sell individual policies with severely limited coverage. The policies cost less -- but the health plans are not required to disclose to buyers how bare-bones the coverage is. The bill would require disclosure, and the insurers would have to offer more substantive policies.

 

Another measure would prohibit insurers from discriminating in underwriting against women, who can pay hundreds of dollars a year more than men for identical coverage.

 

"These are rules of the road for how health plans can operate," said Del. Heather R. Mizeur (D-Montgomery), lead sponsor of the gender-equity bill. "And it doesn't cost us money to require more of insurers."

 

The industry justifies the higher premiums on the grounds that women use more health-care services than men do.

 

Several bills passed the House of Delegates with little debate. But the change meeting the most industry resistance would limit the amount of premium money used for what consumer advocates consider excessive profit and administrative costs.

 

Tyler, Mizeur and other advocates want to expand the floor in the "medical loss ratio," or percentage of premium dollars used for medical care, to 85 cents on the dollar from 60 cents in the market for individual policies and 75 cents for policies purchased by small employers. They say insurers in some of the 11 states that mandate the percentage of premium dollars spent on health care have returned millions of dollars to policyholders.

 

But insurers fighting the proposal say that requiring them to increase the ratio will hurt patients by stifling competition in Maryland, which is dominated by two companies, CareFirst and United Health. They said that coverage of wellness programs, electronic health records and other initiatives the industry has undertaken in recent years are considered "administrative costs."

 

"We would have to take those things out of our program," Debbie Rivkin, executive director and lobbyist for the League of Life and Health Insurers of Maryland, told lawmakers on the Senate Finance Committee at a hearing last month.

 

Ron Weinholt of the Maryland Chamber of Commerce, which also opposes increasing the medical-cost ratio, said, "To think we're running up the white flag on competition is a very sad day."

 

Health Secretary John M. Colmers dismissed that argument, saying that requiring insurers to spend more on health care is unlikely to change the dynamics of competition in a market that has few companies.

 

Some lawmakers said they are concerned that insurers would raise premiums to cover their losses if the bill passed. A better approach might be a crackdown by insurance regulators on rate increases, they said. "We shouldn't pass this on to payers," said House Health Committee Chairman Peter A. Hammen (D-Baltimore).

 

Copyright 2009 Washington Post.

 

National / International

 

These Nurses Are Taking Their Show on the Road

Are you allergic to any medicines?

 

By Kim Painter

USA Today

Sunday, March 8, 2009

 

It's one of those basic questions we get (or should get) every time we see a new doctor, check in for a medical procedure or enter an emergency room.

 

And, doctors say, it's a question people routinely answer incorrectly — usually by claiming an allergy to a drug that actually is safe for them.

 

"It's an extremely common scenario," says David Khan, director of allergy and immunology training at the University of Texas Southwestern Medical Center. And it's an expensive, troublesome one, since common drugs people believe are dangerous for them — ranging from penicillin to aspirin — often are the cheapest, best drugs for their illnesses.

 

The problem was illustrated in a study published in February in the Annals of Emergency Medicine. Researchers in a Cincinnati emergency department used a skin test to check for penicillin allergy in 150 patients who said they were allergic to the drug. Only 13 tested positive, meaning more than 90% could almost certainly take penicillin and related drugs without risking a dangerous reaction.

 

Many penicillin studies have found similar results, say researchers Jonathan Bernstein, an allergist and immunologist, and Joseph Moellman, an emergency physician. Both teach at the University of Cincinnati College of Medicine.

 

But the problem goes beyond penicillin. Allergists see patients every day who are wrongly convinced they have drug allergies, say Khan, Bernstein and Stuart Friedman, an allergist and immunologist in Delray Beach, Fla. Among the explanations:

 

• People confuse unpleasant side effects with allergic reactions. For example, lots of people get upset stomachs when they take aspirin.

 

• People trust their mothers, who say they had reactions as children. But often the reaction was a rash caused by an illness, not a drug.

 

• People trust their doctors. Often, people having possible allergic reactions call their doctors and are told to stop taking drugs — but are never examined or questioned in detail to find out whether their problems really were allergic reactions.

 

• People grow out of some allergies. The solution is not for patients to stop telling doctors about suspected drug allergies; the information is potentially life-saving. But doctors could correct a lot of records by taking more detailed histories and by sending patients with hard-to-interpret stories to allergy specialists, experts say.

 

An allergist often can rule out an allergy by giving patients gradually increased doses of the suspect medication, Khan says. And, sometimes, patients who are truly allergic to a needed drug can safely get gradually increased doses under strict, well-tested protocols, he says.

 

Quick allergy skin testing is not workable or available for drugs other than penicillin, mostly for technical reasons. And even penicillin skin tests, used for decades, are not widely available, because the only commercial version was pulled off the market by the Food and Drug Administration in 2004, because of manufacturing concerns. A company called AllerQuest is working with the FDA to return the test kit to the market, says company founder Louis Mendelson, a Connecticut allergist.

 

Widespread penicillin allergy testing could reduce the use of antibiotics that are more likely to spur the growth of drug-resistant germs, Moellman says. The Cincinnati study was the first to show testing could work in an emergency department. The researchers used a test kit made in their own lab and did not receive funding from any company.

 

 

Copyright 2009 USA Today.

 

Opinion

 

Our Say: Teen suicide problem needs individual attention

 

Capital Services Editorial

Sunday, March 8, 2009

 

Teenage suicide is not a subject raised lightly by government officials - or, for that matter, by the media. No one wants to be accused of spreading the problem through irresponsible talk.

 

So it took some troubling indicators to get county officials - including the county executive, the schools superintendent, the chief of police and the acting health officer - to jointly announce a stepped-up effort to prevent teenage suicide.

 

Since July there have been five suicides among those from age 15 to 22, spread across different communities and schools. And on Feb. 25, four middle-school students were found to have skipped class and gone into some nearby woods to discuss suicide.

 

So last week county officials sent home a letter with schoolchildren. It urges parents to be "on the lookout for warning signs that may indicate suicidal thoughts or behaviors." Teachers were gathered to review how to look for and deal with children in crisis. The county's mobile crisis unit is now being sent to schools, and county officials have formed a multiagency suicide-prevention work group.

 

All this is good. But it won't mean much if individual parents and teachers aren't alert to the warning signs. Teenagers need to stay alert, too - for no one knows the moods and behavior of teens better than other teens.

 

Obviously, it should never be taken lightly when anyone talks about suicide or expresses a wish to die. But many of the indications of a looming problem are more subtle. Those indications include impulsiveness, sudden anger and giving away prized possessions. Signs of lasting depression - including anxiety, social withdrawal and sleep difficulties - need attention from parents and teachers, not off-the-cuff dismissal as adolescent "moodiness."

 

Attempts to use drugs and alcohol as a chemical pick-me-up invariably make the situation worse.

 

The current economic slump cannot be helping. Proliferating memorial sites on online services like Facebook may strengthen the delusion that suicide is a way to get affection and pity from peers.

 

But a central problem lies deeper than economic trends or new technologies. Teens lack adult experience and perspective. They haven't repeatedly worked their way out of the doldrums and don't realize how resilient they can be. They don't know that frustrations and disappointments that seem apocalyptic at the moment are going to dwindle when seen in life's rearview mirror.

 

That missing perspective can be supplied by parents, teachers and others - if communication channels are open. The problem is that troubled teens tend to shut themselves off. Leaving them alone is not a good idea.

 

Communication isn't a cure-all for every problem. But it can help with many problems, including this one - the third-leading cause of death among young people from age 10 to 19, according to the National Association of School Psychologists.

 

County, school and health officials deserve nothing but praise for the steps they've taken. But this is a problem that, ultimately, needs to be dealt with by individuals, case by case, and troubled teen by troubled teen.

 

Copyright 2009 Capital Services.

 

A 'cure' worse than gangrene

 

By Jim Copland and Paul Howard

Washington Times Commentary

Monday, March 9, 2009

 

OP-ED:

 

In Greek mythology, both Odysseus and Jason had to navigate the perilous waters between two the horrible sea monsters Scylla and Charybdis.

 

Pharmaceutical manufacturers in America now face a similarly hazardous path - between succumbing to crippling tort lawsuits and adopting drug contraindications injurious to public health - after the Supreme Court ruled in Wyeth v. Levine that state juries can, in essence, override the Food and Drug Administration's considered safety judgments.

 

A Congress in the grip of trial lawyers is unlikely to act, so the Levine decision is likely to have an adverse effect on drug innovation. There is a way out that would both protect innovation and offer real victims a remedy, were Congress to pre-empt drug lawsuits broadly but establish an alternative compensation program for parties injured by unknown drug side effects.

 

The facts in Levine are tragic. In 2000, professional guitarist Diana Levine had to have her arm amputated below the elbow after developing gangrene, caused by an arterial injection of Wyeth´s anti-nausea drug Phenergan. The injection into Mrs. Levine's artery was inadvertent: A physician´s assistant at a Vermont clinic had attempted to administer the product into Mrs. Levine's vein.

 

The risk of the injury Mrs. Levine suffered was neither new nor unknown: Phenergan's label detailed the risk of intravenous (”IV-push”) injection in four specific FDA-mandated warnings that were collaboratively developed over a 30-year period. The label clearly explained that “inadvertent intra-arterial injection” could lead to “resultant gangrene requiring amputation.” Twice more, in bold, upper-case letters, the label emphasized: INTRA-ARTERIAL INJECTION CAN RESULT IN GANGRENE OF THE AFFECTED EXTREMITY.

 

Failing to take proper account of such warnings, Mrs. Levine's physician's assistant administered the drug via IV-push at twice the maximum dosage specified on the label, even after the patient complained of severe pain. In addition to Wyeth, Mrs. Levine sued the physician's assistant, her doctor and the clinic for malpractice; after the case settled, the physician's assistant wrote Mrs. Levine a letter admitting “responsibility” for the tragedy.

 

Rather than wrestle with the label's specificity and the decades-long history over which the Food and Drug Administration and Wyeth developed the warnings at issue, the Supreme Court's majority opinion simply made up facts of its own. Implausibly, the court asserted that “the labeling did not contain a specific warning about the risks of IV-push administration.”

 

The court also relied heavily on the notion that Congress did not “intend” to pre-empt state tort claims in the Food, Drug, and Cosmetic Act. Looking to Congress' intent misses the point, however, since the 1938 law and its 1962 amendments predated the revolution in product liability law that made “failure to warn” suits like Mrs. Levine's possible in the first place, a change ushered in by the California Supreme Court´s landmark 1963 decision, Greenman v. Yuba Power Products. Congress simply did not and could not have known what was coming in state courts when it developed the FDA's regime of drug regulation.

 

Though the FDA's reasons for permitting Phenergan injection by IV-push are not publicly known, one can surmise it may be because the effective onset time for IV-push administration is 3 to 5 minutes, versus 20 minutes for the normally preferred IM-push method; in some circumstances, that time difference could literally be a matter of life and death. Notwithstanding the FDA's judgment, Mrs. Levine´s attorney argued to the jury that the Phenergan label “should not have allowed IV push” under any circumstances - and thus asked the jury to reach a judgment in direct conflict with the FDA's.

 

The outcome in Levine imperils the public health by promoting more litigation, higher prices, and reduced innovation. Juries only consider the case before them, rather than weighing social costs and benefits of drugs and their side effects (the precise calculus the FDA is asked to undertake).

 

Moreover, lay juries are simply unable to make complicated scientific judgments, which is why the morning-sickness drug Bendectin was driven from the market by bogus lawsuits, though it is safely available overseas.

 

The threat of such spurious litigation discourages new drug development, which why there is still not a single morning-sickness drug on the U.S. market. And litigation also drives up health-care prices: in the 1980s, prices for the diphtheria-pertussis-tetanus vaccine rose fortyfold - versus a “mere” doubling of vaccine prices overall - when a wave of lawsuits over the vaccine's side effects pummeled the vaccine's manufacturers.

 

Congress' reaction to the vaccine crisis offers a roadmap for the proper legislative response to the Supreme Court's confused pre-emption jurisprudence concerning pharmaceuticals. In 1986, Congress passed the National Childhood Vaccine Injury Act, which pre-empted vaccine lawsuits and established a federal administrative compensation program to process claims from children injured by vaccine side effects.

 

Congress' program, while hardly perfect, has won plaudits for quickly meting out justice, with administrative costs only a fraction of those in the tort system, where the majority of payments go to lawyers. Furthermore, whereas juries often buy into dubious scientific claims, the congressional program has tended to reach the right answers. Just last month, the special master in charge of the vaccine program jettisoned the thousands of junk-science claims filed by plaintiffs' lawyers that had asserted a link between the vaccine preservative thimerosal and autism.

 

The existing vaccine system would have to be adjusted if applied to all drugs, as we spell out in a forthcoming white paper, but it could serve as a valuable template. We harbor no illusions that the current Congress will work to enact a program along the lines we prescribe, but it is the better choice. For now, manufacturers, consumers, and the broader public health will merely have to suffer.

 

Jim Copland, director of the Center for Legal Policy and Paul Howard, director of the Center for Medical Progress at the Manhattan Institute for Policy Research, have a forthcoming paper, “The Case for FDA Pre-emption and Administrative Compensation.&#8221.

 

Copyright 2009 Washington Times.

 

Health care crisis only getting worse

 

Baltimore Sun Letter to the Editor

Sunday, March 8, 2009

 

According to a study released in late February by the Institute of Medicine on the consequences of not having health insurance, the bad situation in U.S. health care has gotten worse.

 

The number of people getting health insurance through their jobs has continued to decline, the cost of insurance has risen and the number of uninsured Americans has grown.

 

The report also confirms what we see every day in Maryland: People without health insurance do not get the care they need. They must gamble every day that they won't get sick or injured.

 

The IOM report finds there is no change in sight for these trends unless action is taken by the president and Congress on coverage and costs.

 

With more than 775,000 people in Maryland going without health coverage, the report's findings underscore the dire need for the president and Congress to heed the advice of the IOM and act immediately to ensure that all individuals have health insurance.

 

Suzanne R. Gilbert

Baltimore

 

The writer is community outreach director for the Maryland Citizens Health Initiative Education Fund Inc.

 

Copyright 2009 Baltimore Sun.

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