Thursday, May 21, 2009

News Clipping Archives

 

Maryland / Regional

Study puts high price on medical residents' rest (The Gazette)

Center provides prescription help (Hagerstown Herald-Mail)

 

National / International

Activists seek inquiry into health insurers' consolidation (Baltimore Sun)

Balancing drug's risk, rewards (Baltimore Sun)

WHO says almost a third fewer children under 5 dying than in 1990 (Baltimore Sun)

Beer tax on tap for health care? (Washington Post)

Health-Care Fraud to Be Targeted (Washington Post)

When Patients Put Doctors at Risk (New York Times)

 

Opinion

Guest Column: It's up to adults to put an end to underage drinking (Annapolis Capital Commentary)

 

 

Maryland / Regional

 

Study puts high price on medical residents' rest

Cutting workload could cost up to $2.5 billion

 

By Stephanie Desmon

The Gazette

Thursday, May 21, 2009

 

The cost of reducing the workloads of sleep-deprived medical residents could reach as high as $2.5 billion a year, according to a report out today, even though there is little clear research showing that shorter shifts improve patient care.

 

The study in the New England Journal of Medicine comes on the heels of a report that proposed limiting the maximum number of hours that hospital residents can work without time to sleep to 16 (from 30), increasing the number of days they must have off and improving supervision of new doctors. The recommendations would profoundly change the way medical residencies have operated.

 

"Fundamentally, there is no free lunch," said Dr. Daniel Munoz, a cardiology fellow at Johns Hopkins Hospital who was on the Institute of Medicine committee that recommended the rule changes. "To mandate these recommendations without [the needed financial resources] would be reckless and do more harm than good. There is a hefty price tag to this in order to be done responsibly."

 

Resident work hours, a contentious topic in medical circles, have already been limited once this decade. In 2003, residents who had long worked as many as 120 hours a week during their medical training were limited to 80-hour workweeks, though those hours haven't always been followed to the letter. Some of the work that residents were doing, such as paperwork, transferring patients to nursing homes or drawing blood, was given to lower-skilled employees, so the doctors-in-training could focus more on the direct patient care and on learning the craft from senior doctors.

 

Dr. Teryl K. Nuckols, the lead author of the journal article, said hospitals would most likely have to hire more residents or bring in other experienced doctors to take care of patients in the hours that residents would be unavailable. Her study estimates the cost per teaching hospital could be $3.2 million a year, though others believe that figure is low.

 

"In general, a lot of the low-hanging fruit has been tapped and now we're getting to the bone in terms of educational opportunities and what types of people would have to do the work," said Nuckols, who is an assistant professor of medicine at the University of California, Los Angeles.

 

Hospitals have long used medical residents as a form of cheap labor, working them long hours and paying them a fraction of what other doctors earn. Residents are new doctors who spend three or more years training at hospitals after earning their medical degrees.

 

While many believe that well-rested doctors are better doctors, the data do not show conclusively that reducing resident work hours would reduce medical errors, a stated goal of the proposed reforms. Some have suggested the opposite, that shorter shifts mean more hand-offs of unstable patients from one doctor to another, more times when a doctor who is not up to speed on a case can make a mistake.

 

Dr. Kenneth S. Polonsky, chairman of the department of medicine at Washington University School of Medicine in St. Louis, said that on the face of it, naps after 16 hours seems a minor tweak to the system.

 

But, he said, shorter shifts are likely to equate to truncated care and a loss of important teaching moments. He sees situations where a patient has worked with the same resident for 15 hours and is doing well, but then suddenly something major happens like an embolism or a heart attack.

 

"What the rule says - and there are no exceptions - is you've got to go," he said. "What they are saying is the major determination of health outcomes and patient safety is how much sleep a resident has had and everything is secondary to that."

 

Said Dr. Charles Wiener, director of the medical training program at Johns Hopkins Hospital: "Somehow, patient safety and resident work hours have been equated as one issue and they're not."

 

If the research is done to show that shorter shifts can equate to better patient outcomes, Polonsky said, it would be worth the high cost. The estimate ranges, according to Nuckols' study, from $1.1 billion to $2.5 billion a year. The money would mostly cover the cost of doctors - additional residents or experienced doctors - who would fill gaps in resident coverage.

 

If the reforms were highly effective, Nuckols said, they could reduce patient harm at a low or no cost to society. But, she added, the impact of many medical errors goes beyond the walls of teaching hospitals, preventing people from returning to work or putting them in a nursing home. Those costs are not borne by hospitals and therefore could not be recouped by them even if more errors were prevented, she said.

 

"If it succeeds, the big winners will be patients and society," she said. "Regardless, teaching hospitals are going to be out a lot of money."

 

The American Council for Graduate Medical Education is studying the Institute of Medicine's recommendations and won't likely issue any changes to its rules until next year. Many groups of doctors have come out against the proposals. Public Citizen, a nonprofit consumer advocacy organization, has said the recommendations didn't go far enough to protect patients or residents.

 

"Nobody can work 168 hours in a week, but at the same time, if I take my mom to the doctor, not only do I want to make sure they were paying attention during their residency," Munoz said, "I hope they weren't looking to cut out early."

 

Copyright 2009 Frederick News-Post.

 

Center provides prescription help

 

By Marlo Barnhart

Hagerstown Herald-Mail

Friday, May 21, 2009

 

HAGERSTOWN - Since the inception of the Maryland Medbank program in 2000, Audrey Miller has watched the numbers of discount prescription drug recipients rise and fall with the economy.

 

She also has witnessed the breakaway of Washington County from the statewide Medbank program two years ago, forming the Medication Assistance Center for Washington County, of which she is director.

 

“We wanted an individual identity,” Miller said. “Now, we can look a little deeper for grants.”

 

And with a more localized identity, the center can more easily get funds from local fundraisers, such as a recent car show at Next Dimensions in Funkstown that brought in $1,200.

 

Housed at the Fennel Building at 324 E. Antietam St., Suite 201, the Medication Assistance Center can be reached at 301-393-3443.

 

Miller was on board from the beginning, working out of the office that dealt with clients in Allegany, Garrett and Washington counties.

 

“Our site was one of the first,” Miller said.

 

Baltimore City and Baltimore County then came on board and the movement spread through the state.

 

Medbank supplies prescription medications to low-income Marylanders who lack other prescription drug coverage. Since its inception, Medbank has distributed $90 million in free medication to 32,000 patients statewide.

 

Medbank is administered by a private entity that partners with pharmaceutical companies to distribute the medications.

 

Washington County Hospital provides the center with space, utilities and other needs, Miller said. Since the breakaway, the local center is getting only $20,000 so a movement is on to secure more funds to keep the work going.

 

Nine years ago, the center’s work was aimed at any Washington County resident without prescription insurance. At that time, there was no Medicare D prescription assistance for older residents, Miller said.

 

Now, the center’s work focuses more on the working poor and those who have lost or are losing their jobs, Miller said.

 

“We are trying to keep them out of the emergency room so we work closely with the hospital social workers and then we follow up,” she said.

 

Most of the assistance comes in the form of lower-cost maintenance medications. Miller said the cost is linked to the household income eligibility requirements.

 

“There are also discount cards for other medications,” Miller said. “Quite a few pharmacies participate.”

 

Initial screening is conducted over the telephone with prospective clients. Then, documentation is submitted in person at the office.

 

“At any one time, we have around 350 clients,” Miller said.

 

That number is growing because of the economy, she said.

 

A medical assistant by training, Miller is a Pennsylvania native. She is married and has two children.

 

Copyright 2009 Hagerstown Herald-Mail.

 

National / International

 

Activists seek inquiry into health insurers' consolidation

 

By Laura Smitherman

Baltimore Sun

Thursday, May 21, 2009

 

Health care activists on Wednesday urged the Justice Department to open a wide-ranging investigation into consolidation and a lack of competition among health insurers, which they blame for soaring premiums in recent years. Health Care for America Now, a coalition of community groups, labor unions and others, also released a report on insurance markets that they say bolsters the argument, being debated in Congress, for setting up a government health plan to compete with private insurers. In Maryland, the group found that CareFirst BlueCross BlueShield and UnitedHealth Group together control more than 70 percent of the market. That near-monopoly contributes to higher prices and fewer choices, the group contends. America's Health Insurance Plans, an industry group, dismissed the report and said that rising health care costs stem from increases in hospital rates, physician expenses and pharmaceutical drug prices.

 

Copyright 2009 Baltimore Sun.

 

Balancing drug's risk, rewards

MS patients welcome close monitoring of Tysabri use

 

Tribune reporter

By Robert Mitchum

Baltimore Sun

Thursday, May 21, 2009

 

The drug was like a life preserver, as Daisy Roque describes it, the first effective ally she had found in her battle against multiple sclerosis.

 

But when Tysabri was taken from the market in 2005 due to the appearance of a rare but deadly side effect, that preserver was pulled away from Roque, leaving her back in the thrall of the disease's progressive damage.

 

"It was devastating," said Roque, 35, of Crystal Lake. "It was saying 'you can't do this,' even though the drug is so wonderful, even though it was two years of having my life back."

 

But after the development of a unique monitoring system that allows doctors -- and Tysabri's manufacturer -- to keep close watch on every single U.S. user of the drug, it was allowed to return to market. Now, in light of encouraging results from that monitoring system presented last month, Tysabri may serve as a model for how hazardous drugs could be used safely in treating serious chronic illnesses.

 

"We're rethinking this whole thing," said Dr. Anthony Reder, a neurologist at the University of Chicago Medical Center. "MS actually is a pretty bad disease; your brain's being destroyed. So maybe we should try to treat it with drugs that are a little dangerous."

 

Multiple sclerosis, a disease in which the body's immune defense mistakenly attacks its own nervous system, afflicts 400,000 people in the United States, according to the National Multiple Sclerosis Society. As a protein called myelin, which insulates neurons and allows them to rapidly communicate signals, is degraded by the body's defenses, patients can develop problems walking and moving, blindness, fatigue and even paralysis.

 

Tysabri was designed by drug company Biogen Idec to prevent immune cells from crossing the blood-brain barrier, the body's protective wall around the nervous system. Infused once every four weeks, the drug was shown in clinical trials to reduce the number of "flare-ups" -- attacks of serious symptoms that usually lead to hospitalization -- experienced by MS patients.

 

Roque, who was a subject in the clinical trial, said she would have two or three flare-ups each year on other MS medications, losing vision or balance and putting her in the hospital for days at a time. But even though the clinical study was "blind," meaning neither she nor her doctor knew whether she was being given Tysabri or a placebo, she could tell the difference right away.

 

"During the two years, not one exacerbation," Roque said. "I pretty much knew I was on it."

 

But shortly after the encouraging trial led to accelerated approval by the Food and Drug Administration, an alarming statistic came to light. Three patients taking Tysabri in the clinical trial contracted progressive multifocal leukoencephalopathy, or PML, a deadly brain disease with no known treatment.

 

Though the disease appeared in only 1 in 1,000 patients given Tysabri, that number was high enough for the drug company to immediately suspend its sale. Over the next year, as many MS patients and doctors argued that the benefits of the drug were still worth the risk, Biogen and the FDA came up with a compromise: Every person prescribed Tysabri would be followed in a national database and closely screened for early signs of PML. If any worrisome symptoms arose, the drug would be stopped immediately and flushed from the patient's system.

 

Since Tysabri's return to the market in late 2006, the monitoring system has followed more than 50,000 patients taking the drug. And though cases of PML continue to appear -- a sixth case was announced last month -- the disease has been detected earlier in patients, leading to only one death. Carmen Bozic, vice president/global head of drug safety and risk management at Biogen Idec, said that data presented by the company last month at a neurology meeting indicated a lower risk of PML than previously thought, closer to 1 in 10,000 patients.

 

But even that risk is enough for doctors to use extreme care in how they prescribe Tysabri to patients. The drug is recommended as a second-line defense, only used after other MS drugs prove ineffective, said Dr. Bruce Cohen, director of the multiple sclerosis program at Northwestern Memorial Hospital. Even then, the decision about taking Tysabri is difficult for patients after they hear about its potential side effects, Cohen said.

 

"About half of the people we offer the drug to decide not to take it, because of concern over risk of PML," Cohen said. "This drug carries a black box warning, and it deserves to: PML is a very real and anticipated part of this drug's risk profile. It's a rare risk, but nonetheless it's a legitimate one."

 

For Deborah Burroughs, 54, of Elwood, that decision was not easy. Diagnosed with MS in 1981, she had tried basically every medication designed to treat the disease, with varying results. When her doctor told her about the risks associated with Tysabri, Burroughs and her family decided the possible benefits outweighed the potential danger.

 

"I thought, 'What's the difference? I'll go for it,' " Burroughs said.

 

Now, although Burroughs still can't play baseball with her son as she used to, she can appreciate the ability to accomplish smaller things that had become impossible: walking through the backyard, cleaning the house or even thinking of the right word when she's having a conversation.

 

"I would give an A-plus compared to before," Burroughs said. "I really felt like there was no hope before, but now I'm just so thankful."

 

Copyright © 2009, Chicago Tribune.

 

WHO says almost a third fewer children under 5 dying than in 1990

 

By Associated Press

Baltimore Sun

Thursday, May 21, 2009

 

GENEVA (AP) — The World Health Organization says almost a third fewer young children are dying than in 1990.

 

The global health body says about 9 million children under 5 years old died in 2007, the last year with figures available.

 

WHO says the number of under-5 deaths was 12.5 million in 1990.

 

The Geneva-based body says the 27 percent drop shows progress in achieving a two-thirds cut in deaths by 2015. That is one of the U.N.'s so-called 'Millennium Development Goals'.

 

The figures were among more than 100 health trends published Thursday by the World Health Organization.

 

Copyright 2009 Associated Press. All rights reserved.

 

Beer tax on tap for health care?

 

The Associated Press

By Ricardo Alonso-Zaldivar

Washington Post

Thursday, May 21, 2009

 

WASHINGTON -- Joe Six-Pack may have to hand over nearly $2 more for a case of beer to help provide health insurance for all.

 

Details of the proposed beer tax are described in a Senate Finance Committee document distributed to lawmakers before a closed-door meeting Wednesday. Senators are focusing on how to pay for expanding health insurance for an estimated 50 million uninsured Americans, a cost that could range to some $1.5 trillion over 10 years.

 

You can't raise that from beer money alone.

 

Lawmakers are looking at an extensive list of spending cuts and tax increases, including a new levy on the value of job-based health insurance. The latter proposal seems to be gaining ground. It could lead to higher income taxes for some people with particularly generous job-based health care.

 

Finance Committee Chairman Max Baucus, D-Mont., said no decisions were made, but he will use the feedback to shape legislation he intends to introduce in the next few weeks. The committee has a critical role to play in the health care overhaul, since it writes tax law and oversees the government's giant medical insurance programs. Baucus wants to write a bipartisan bill, a goal for President Barack Obama.

 

"Nothing's pushed off the table," Baucus told reporters after the daylong meeting. He said senators have come closer on some issues, but much remains to be resolved.

 

While many of the revenue raisers involve obscure provisions of federal law, most consumers can relate to a beer tax.

 

Taxes on wine and hard liquor would also go up.

 

And there might be a new tax on soda and other sugary drinks blamed for contributing to obesity. A tax of 3 cents per 12-ounce drink would raise about $50 billion over 10 years, according to congressional estimates. Diet drinks, however, wouldn't be taxed.

 

The idea behind the proposed increases is to tax lifestyle choices that contribute to rising medical costs. Obesity puts people at risk for diabetes and heart problems. Alcohol abuse is a risk factor in several types of cancer, liver disease and psychological problems.

 

The soft drink industry and beer and wine producers are already lobbying to stop the proposals before they gain traction. The tax increases would lead to job losses for workers and higher costs for recession weary consumers, say the industries. Wine makers are also pointing to studies that suggest a glass a day can be good for health.

 

"Singling out wine for higher taxes to reform health care is misguided because wine is part of a healthy diet and lifestyle for millions of Americans," said Robert P. Koch, president of the Wine Institute, which represents California's industry.

 

Under the proposal lawmakers are considering, beer taxes would be increased by 48 cents a six-pack, from the current 33 cents. Beer is still the favorite choice of Americans who drink alcohol.

 

Wine taxes would rise by 49 cents per bottle, from the current 21 cents.

 

And the tax on hard liquor would increase by 40 cents per fifth, from the current $2.14.

 

Percentage-wise, wine drinkers would take the biggest hit, a 233 percent tax increase per bottle. The Wine Institute said the tax increase would be even bigger for wines with a higher alcohol content.

 

Hard liquor would see the smallest proportional increase, 19 percent per fifth.

 

The beer tax would rise by 145 percent per six-pack.

 

Proponents of the idea say it would equalize the tax treatment of alcoholic drinks, by charging the same tax rate based on alcohol content to all. But that would put an end to the current tax advantage enjoyed by beer and wine.

 

The higher alcohol taxes would bring in nearly $60 billion over 10 years.

 

© 2009 The Associated Press.

 

Health-Care Fraud to Be Targeted

New Task Force Will Focus on Costly Waste and Abuse

 

By Carrie Johnson

Washington Post

Thursday, May 21, 2009

 

Senior Obama administration officials launched a high-level task force yesterday to use technology to help detect and prevent health-care fraud, which robs the nation's coffers of billions of dollars each year.

 

Attorney General Eric H. Holder Jr. and Health and Human Services Secretary Kathleen Sebelius also directed federal investigators and prosecutors to expand special strike forces to Detroit and Houston, where "erratic" billing data suggest high levels of fraud, waste and abuse in Medicare and Medicaid programs.

 

Together, the actions signal the Obama administration's biggest push yet to halt fraudulent claims in programs that expend hundreds of billions of dollars a year for health care for the poor, elderly and disabled.

 

"When individuals and corporations cross the line, we will hold them accountable," Holder said at a news conference in Washington.

 

Sebelius added: "What we're talking about today is theft, plain and simple."

 

The announcement comes a week after the trustees who monitor Medicare's finances predicted that the trust fund that pays hospital bills for elderly patients will be depleted by 2017, a year earlier than previously expected. Medicare's eroding financial stability increases the pressure on authorities to crack down on fraud.

 

The Health Care Fraud Prevention and Enforcement Action Team will be composed of senior-level officials at the Justice Department and HHS. The group will use electronic claims data, as well as the threat of federal prosecution, to look for unusual billing problems.

 

The largest sums by far recovered by the federal government in recent years have come through Justice Department intervention in whistleblower lawsuits, many filed under the False Claims Act against pharmaceutical companies. Such settlements are on track to reach record highs for fiscal 2009, said lawyers who follow the cases.

 

In January, Eli Lilly agreed to pay $1.4 billion in criminal fines and civil damages to resolve allegations that it defrauded Medicaid and Medicare through improper marketing of its anti-psychotic drug Zyprexa as a treatment for dementia and other diseases afflicting the elderly, for which it was not approved by the FDA. Cases involving two related drugs marketed by other manufacturers are pending, lawyers said. False-claims cases often proceed for years under seal while prosecutors and civil division lawyers investigate.

 

Last month, Quest Diagnostics agreed to plead guilty and pay more than $300 million in connection with faulty test kits sold to labs across the country, one of the largest such recoveries in a medical device case.

 

Other major pharmaceutical companies have reserved hundreds of millions of dollars for possible settlements that could come this year, said analysts who have followed the issues. And Monday, top Justice Department officials announced that the federal government and 16 states would intervene in a major whistleblower case alleging that Wyeth overcharged the government for stomach acid drugs purchased through the Medicaid program.

 

Department lawyers have been sorting through a backlog of the complex cases. Under the president's 2010 budget request, the Justice Department would receive $10 million to police fraud in the bailout and stimulus programs.

 

"The Department of Justice has done great work," said Patrick Burns, a spokesman for Taxpayers Against Fraud, a lawyers group that represents whistleblowers. "I just wish the civil division had more people to help reel in the fraudsters already on the line, as scores of billions of dollars are waiting to be recovered from the health-care industry alone."

 

Tony West, new leader of the Justice Department's civil division, said in an interview this week that pursuing such cases is a high priority.

 

"There is an incredible amount of money that can be recovered and returned to the health-care trust fund, and that has a real impact," West said. "I think you will see stepped-up enforcement in this area. You will see proactive and assertive efforts."

 

Health care, he said, has the "biggest single impact on the budget" and pursuing cases in that arena is "consistent with the president's agenda on health-care reform. We are following his lead."

 

Staff writer Amy Goldstein contributed to this report.

 

Copyright 2009 Washington Post.

 

When Patients Put Doctors at Risk

 

By Tara Parker-Pope

New York Times

Thursday, May 21, 2009

 

Getty Images Caring for others with a contagious illness puts health care workers at risk.

 

When we think of dangerous work, doctoring isn’t usually what comes to mind. Of course, police and firefighters, construction site workers and window washers face daily risks, but doctors?

 

As Dr. Pauline Chen writes in her latest Doctor and Patient column, caring for patients with contagious diseases puts every health care worker on the front lines of a potentially deadly outbreak. Whether it’s a physician treating swine flu or a nurse working amidst the deadly SARS outbreak in Asia, health care workers face far higher risk of exposure than the rest of us. The issue became all too real for Dr. Chen as she performed a procedure on a very sick patient with hepatitis C. She writes:

 

I felt a sharp sting. Looking down, I saw a small scarlet drop emerging from the tip of my left index finger. I had stabbed my finger against the needle I had just used to anesthetize Jean’s skin, a needle I still held in my right hand.

 

I stared at the tiny red bloom on my fingertip. And for a moment, I felt the floor beneath my feet give way, pulling everything — Jean, my heart, my work, my life — down with it. I stood there paralyzed, staring at the puncture wound on my fingertip and unable to stop the movie playing in my mind’s eye, a movie of a future like Jean’s.

 

To hear more, read Dr. Chen’s full column, “Fear of Contagion.” And then please join the discussion below. If you’re a doctor, nurse or other health care worker, have you ever worried about the personal health risks of caring for patients?

 

Copyright 2009 New York Times.

 

Opinion

 

Guest Column: It's up to adults to put an end to underage drinking

 

By Pietro Di Pilato

Annapolis Capital Commentary

Thursday, May 21, 2009

 

Ending underage drinking is critically important. As a resident of Maryland, an employee of Diageo, the world's leading spirits, wine and beer company, and as a parent, I take perhaps an even more pointed interest than most in the topic of preventing underage drinking.

Advertisement Click Here

 

We all know prom season is upon us and for us parents this is an important opportunity to proactively talk to our kids about alcohol. Did you know that in study after study, kids list their parents among the top influences in whether or not they choose to drink? It is our job to help them make smart, responsible decisions when given the choice.

 

Nationwide, underage drinking is at historic lows. The University of Michigan's annual Monitoring the Future survey on underage drinking shows that teen drinking has declined considerably since reaching peak use in the mid-1990s, and underage drinking is at its lowest level since 1975. According to the National Institute of Drug Abuse, Monitoring the Future is the largest and most significant survey of youth drinking among eighth-, 10th-, and 12th-grade students nationwide. In Maryland, meanwhile, great progress also is being made. According to the Substance Abuse and Mental Health Services Administration, from 2002-2006, alcohol use by Maryland children ages 12-20 decreased significantly and remained below the national average.

 

The Monitoring the Future study found that the number of eighth-graders who reported drinking an alcoholic beverage at least once in the 30 days prior to the survey has fallen by 40 percent since peaking in 1996. The study's authors hypothesize that the decline may reflect their decreasing access to alcohol, which means there is still work that needs to be done.

 

And it is just that - access to alcohol - that is at the heart of the matter. Any access to alcohol by underage drinkers is too much, and it is critical to recognize that the key to keeping alcohol away from kids is targeting their number one source: adults.

 

The U.S. Department of Health and Human Services recently found that nearly 70 percent of minors who drink don't purchase alcohol themselves. Bottom line, the key to reducing underage drinking lies in restricting teen's access to alcohol.

 

Maryland took an important stand on this issue when Gov. O'Malley introduced and the General Assembly enacted HB 299 / SB 261. The bill, which was based on recommendations from the Governor's Task Force to Combat Driving Under the Influence of Drugs and Alcohol, implements provisions to strengthen Maryland's underage drinking laws, including making it a criminal offense for any adult to purchase, attempt to purchase or otherwise obtain alcohol for minors. This legislation puts the onus on adults to stand together in the fight against underage drinking and build upon the positive trends we are seeing when it comes to underage drinking in Maryland.

 

Legislation, however, is just one way to combat this complex, multifaceted problem. If we have any chance of ending underage drinking - which I believe we do - we all need to work together toward a solution-oriented approach that makes us, as adults, more accountable. Let's focus on the real issue: taking responsibility for keeping alcohol out of the hands of our kids.

 

The writer is vice president of operations at Diageo's Relay, Maryland facility.

 

Copyright 2009 Annapolis Capital.

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