Medicare Pays Too Much for New Generics

According to this article on The Wall Street Journal Blog when the price of generic drugs plunges, Medicare is slow to reflect that price change.

A report published by the Health and Human Services’ inspector general looks at irinotecan, which is a cancer that went generic in February of this year. The average price of the drug factoring in sales of the branded version was $52. During the current quarter, Medicare was paying about $75 for irinotecan, which is still far above the average price.

Read the full report here.

We're getting ready to launch a new blog that looks at the broader issues of Medicare, update your RSS feed now as we get it ready for our official launch: http://medicareadvantagecongress.blogspot.com.

Numbers of uninsured dropped

In a recent report released by the census bureau, they state that the number of uninsured has decreased 3.2% to 45.7 million, which is 15.3% of the population. According to this article here at Modern Healthcare, authorities state that the reasons why uninsured numbers have decreased is still unknown. The number of uninsured children has dropped as well to 8.1 million, down from 8.7 million in 2007 which is a 6.9% drop.

Fruit Juice Can Reduce Effectiveness of Drugs

BBC News reports findings discussed in a recent US event suggest that fruit juice could reduce the effectiveness of some medicines, including anti-allergy drugs. Grapefruit, orange, and apple juice are said to contain ingredients that interfere with the effectiveness of medication.

Researchers discovered that grapefruit juice especially had a reverse effect to fexofenadine, which is an antihistamine drug, thereby making it less potent. Researchers used volunteers to take the medication with water and with the juice. When taken with the juice, only half of the drug was absorbed. So far, these juices have been found to affect the oral absorption of etoposide, a chemotherapy drug, some beta-blocker drugs used to treat high blood pressure, and cyclosporine, taken by transplant patients to prevent rejection of their new organs. The study author Dr David Bailey mentions:

"This is just the tip of the iceberg - I'm sure we'll find more and more drugs that are affected this way."

Getting Healthy While at Work

Dr. Jim Levine had conducted a study two years ago where the results shocked him. He found that 90% of overweight individuals were sitting 2.5 hours longer per day than individuals who were not considered obese. ABC Health reports that after seeing these results

“It was so staggering that Levine hasn't stopped walking since and even does his work while walking at a low speed on a treadmill.”

The concept behind this, is to introduce low intensity activity into an individuals everyday activities in order to help combat activity. In Levine’s own words

"I spend my entire work day at one mile an hour," he said. "I work at my computer at one mile an hour. I have my meetings at one mile an hour."

This past September he started on a 6 month study to determine if a “treadmill desks at work” would help with obesity. He used the SALO office as his lab, and the office staff who were interested as his subjects. His results show that “low-level activity is crucial to fighting chronic obesity.” Over the course of the 6 months, the staff lost a combined total of over 200 pounds. Levine says that individuals who have the highest success rate are those

“making a commitment to a lot of small adjustments. It's almost a matter of saying, I'm going to change my chair-based life to a dynamic and sort of more exciting life."

The “Exercise” Pill

According to this article in the NY Times researchers at the Salk Institute in San Diego reported that they have engineered two pills that trick the muscles into thinking that they have been working out furiously. For now, testing has been only done on lab mice. These drugs have shown up to 75% increase in endurance in mice, and the results will likely apply to people as well since muscle tone from human and mice are similar.

Dr. Ronald M. Evans, leader of the Salk group, mentions:

“It’s a little bit like a free lunch without the calories.”

The pills should be able to help people who are too frail to exercise, and those who suffer from diabetes and obesity. Diet and exercise are crucial to the treatment of diabetic patients, so there is a possibility that this drug could become widely used if it passes FDA guidelines. More testing and research is still needed in order to finalize the drug before it reaches consumers.

Trans Fat Ban in California

It is a historic day in the fight against trans fat. This article from abchealthnews.com announced that Arnold Schwarzenagger, has just signed into law today a ban against trans fats in California. As announced in this separate article from Harvard School of Public Health, Mayor Michael Bloomberg of New York City, was responsible for making New York City the first city to ban trans fats in all restaurants. He was a recipient of the Richmond Award for promotion of public health, for his proactive stand. In fact, as announced here, July 1^st 2008, marked the completion of the final phase for restaurants in the city to comply to the zero trans fat policy.

What makes the case in California special is that it is the first state in the nation to pass the legislature on such a large scale. While the U.S. is still lagging in terms of making the ban on trans fat a nationwide policy, with the example of California it will interesting to note if the rest of the country follows suit. Also of potential interest, while there is not much text on the role insurance providers play on trans fat legislation, it might be something to see if they will start lobbying Washington for this change.

Bill Gates and Michael Bloomberg Team Up For New Anti-Smoking Effort

According to this latest article in the NY Times, the World Health Organization estimates that tobacco will kill about a billion people in the 21^st century, which is 10 times as many people that it killed in the 20^th century. Most of the deaths are expected to come from poor countries like Bangladesh and middle-income countries like Russia. The Bill and Melinda Gates Foundation has partnered with the Bloomberg Foundation to spend a total of $500 million to stop people around the world from smoking.

Mr. Bloomberg mentions:

“All the money in the world will never eradicate tobacco, but this partnership underscores how much the tide is turning against this deadly epidemic.”

The campaign, named Mpower, will urge governments to prohibit smoking in public places, raise tobacco taxes, start anti-smoking ad campaigns, outlaw tobacco advertising to children, and offer nicotine patches in order to help people quit. Other countries like India and China who have begun anti-smoking ad campaigns in the past have are experiencing an increasing number of people who have quit smoking. The $500 million will be allocated over a time span of 5 years.

US Healthcare Failing Nation

In a recent article at the Washington Post, they report on the failing grade the US health care system received last year. Although the health care in the US hasn’t improved since 2006, the US spends more on health care than any other nation. In 2003, 35% of Americans had no health insurance. In 2007, this number had risen to 42%. The quality of health care was also dramatically different from state to state, and region to region.

The scores of efficiency rated among the lowest of variables. Some of the reasons were:

-Fragmented, poorly coordinated care
-Lack of access that leads to avoidable hospitalizations
-Variations on costs with no return in quality
-Lack of investment in IT
-High insurance overhead costs

Cathy Schoen, the senior vice president for research and evaluation at the Commonwealth Fund had this to say of the situation:

“Overall, we find a failure to improve, with steep declines in access with growing numbers of uninsured and underinsured and ever less affordable care. Overall, the U.S. score averages just 65 out of a possible 100, falling far short of benchmarks with wide gaps in all dimensions of the health system.”

Healthy Dieting: Beyond Weight Loss

According to this article in the NY Times, a study conducted at the Nuclear Research Center in Dimona, Israel followed the patterns of 322 dieters, both men and women, on three different types of diets- a low-fat diet, a Mediterranean diet; and a low-carb diet based on the Atkins diet plan.

By the end of the two year study low-fat dieters had a net loss of six pounds, and the Mediterranean and low-carb dieters had a net loss of about 10 pounds. Even though weight loss was modest, researchers claimed that there were noticeable improvements in cholesterol and other health indicators. Iris Shai, the study’s lead author mentions:

“This suggests that healthy diet has beneficial effects beyond weight loss.”

Intel Health Guide

According to this article on eWeek, a small touch screen PC that includes a new online interface released by Intel that allows patients to connect with their doctors has won approval by the FDA.

The Intel Health Guide will be able to handle a series of patient care services. The system will take the burden away from insurance companies, since the monitoring of patients with chronic and outgoing patients will be done at home instead of the hospital.

Louis Burns, VP and general manager of Intel's Digital Health Group mentions:

"With more people living with chronic diseases, we believe care can be increasingly moved outside of the hospital to the home. Through our research, we've learned that a home-based model of care becomes more than just delivering care to patients at home—it is about creating connections to family, friends, caregivers, and the care team."

Glucose monitors, blood pressure monitors, and other medical devices can be attached to the Intel Health System, and the information gathered can be shared with doctors on the Internet through a secure host server. We can expect the Intel Health System to reach the US market by end of 2008 or by the first quarter of 2009.

Latest Update in Salmonella Outbreak

In this post on July 2, we brought you information stating that the salmonella outbreak may not have been caused by raw tomatoes as was first thought. Since then it has come to light, according to this report from MSNBC, that jalapeno peppers are another potential culprit that has come under investigation from the CDC

This has been one of the largest outbreaks, with over 1,000 reported cases, in recent history. Since May, it has been determined that the outbreaks occur in clusters of individuals across the country that have eaten foods containing both raw tomatoes and jalapenos. As a result, Dr. Robert Tauxe, from the CDC, made this statement:

“We are quite sure that neither tomatoes nor jalapenos explain the entire outbreak at this point. ... We’re presuming that both of them have caused illness,” Tauxe said.

Meanwhile the economic toll totals over $100 million in losses for the tomato industry alone. Industry wide totals for other affected foods like jalapeno and cilantro have not yet been calculated.

Health Care Concerns

The main theme discussed in this post on The Healthcare Blog seems to be that consumers are more concerned about the cost of healthcare than the illness itself. Most Americans are often confused when given many choices of insurance providers to shop for. Consumers aren’t used to shopping for insurance, and so it can be quite troublesome.

A survey conducted by McKinsey also found that there are also differences in health concerns varying by age. Younger people aged 18-34 are far more concerned with dental and accidents, whereas older people are more worried about LTC and major medical events. There is still a long way to go in the health care system when fighting costs is a major concern over fighting diseases.

Cholesterol Screening at an Earlier Age

This recent article in the NY Times points out that pediatricians are beginning to recommend aggressive cholesterol screening for children as early as eight years old. Many experts claim that signs of heart disease show up early in kids, especially when 30 percent of the nation’s children are obese and overweight.

Previously, cholesterol lowering drugs were recommended for children above the age of 10, and only if they fail to lose weight during a 6-12 month period. But now according to the American Academy of Pediatrics, cholesterol drugs might be our youth’s best hope in preventing heart disease. Screenings are highly recommended for those who have a family history of high cholesterol levels. Even though children will now undergo drug treatment at an earlier age, the first goal will still be to lower bad cholesterol through diet and a rigorous exercise program.

FDA Urges Longer Testing Periods for Diabetes Drugs

The NY Times reports in a recent article that Diabetes drugs must face tougher safety standards that protect patients from heart risks associated with these drugs. The FDA has voted 14-2 to prolong trial study time to assure that diabetic drugs do not carry risks of heart problems.

This concern on diabetic drugs came about shortly after the FDA was criticized for handling the release of the GlaxoSmithKline pill. The drug was released in 1999, but only last November was a warning issued about potential heart risks. The problem lies in the testing phase; it takes nearly five to seven years to complete. Studies should begin way before drugs are submitted to the FDA, and finished shortly after its release.

Tainted Tomatoes May not be Cause of Salmonella Outbreak

Two weeks ago we posted on this blog about tainted tomatoes causing a salmonella outbreak. Several news sources, including the Wall Street Journal in this article, have announced that the FDA and the CDC are now saying that they are unsure if tomatoes are truly the culprit. Officials have expanded their investigation, to include other foods, since it is estimated that in only 80% of the 869 reported cases of salmonella poisoning people consumed tomatoes. Many of these individuals reported eating tomatoes that were incorporated into dishes such as salsa, and guacamole which are composed of numerous other raw foods. While tomatoes are still the main suspected cause, the FDC and CDC are looking at other foods such as cilantro which is often eaten in conjunction with tomatoes.

In related news the economic impact of this food scare is estimated at over $250 million according to Donna Garren, vice president of health and safety regulatory affairs for the National Restaurant Association. With other food items coming into focus the financial blow is only going to increase.

Good Cholesterol Improves Memory

The NY Times reports today that higher levels of good cholesterol, known as HDL, might prevent a decline in memory loss. The study led by Archana Singh-Manoux, appears in Arteriosclerosis, Thrombosis and Vascular Biology, an American Heart Association Journal, found that people with more high-density lipoprotein cholesterol did better on memory tests than people with lower levels.

The study was performed on more than 3,600 British civil servants ranging from 55 to 61 years of age. The test consisted of reading a list of 20 words, and then jotting down as many as they could remember in a span of two minutes. Those with higher HDL levels performed better and those whose HDL levels declined also saw a decline in their performance.

Hospitals May Have to Pay for Their Own Mistakes

As reported in this blog post from the Wall Street Journal, currently the state of California, and its MediCal program, is saddled with the cost of preventable hospital errors. A new bill has been introduced, AB 2146, where the government of California will stop reimbursement to hospitals for these avoidable mistakes based on Medicare’s no-pay list.

Maine, Massachusetts, Pennsylvania, and New York, make up a list of some states that have already limited payments. Hospitals in Minnesota, Washington, and Vermont, have already accepted responsibility by stating that they will not request payment from patients for hospital errors.

Privately owned companies, such as Cigna and Wellpoint, have also announced that they will be following this trend, and refuse payment for specific mistakes.

What’s the Real Cost of Healthcare?

Trisha Torrey brings up a good point in her latest post on the Patient Empowerment Blog, the true cost of healthcare remains a mystery still to many patients.

First is the copay, then the insurance takes the rest of the doctors charges if the patient is insured. If there is a balance after the insurance has paid their stated amount, the patient is responsible for remainder of the payment. Costs are sometimes negotiated between insurance companies and doctors, but for those who don’t have insurance, negotiations are made between the patient and the doctor. So here’s a solution that can possibly help patients make wiser decisions when it comes to costs.

Change Healthcare is an online service that finds average costs of doctor visits, services, and what insurance companies typically negotiate with doctors. You can upload information about your own costs to the website. By sharing information, it is possible to help people in your area discover the true costs of healthcare.

Safety Checklist to be Circulated

BBC News reports that a list compiled by the World Health Organization designed to cut the risk of surgical complications will be issued to doctors world-wide. This list is being compiled due to a Lancet study that found that safety measures across hospitals are commonly overlooked.

The Harvard School of Public Health has aided WHO in drawing up this list and its main aim is to reduce the following complications during surgery: preventable infections, preventable complication from bleeding, and safety in anesthesia. The list includes six very basic steps in surgical care including verification of the patient, ensuring that equipment is not neglected and left inside the patient, and administering an antibiotic before making an incision which reduces the risk of infection by at least 50%.

Worldwide, about one million people die a year following major surgery, so hopefully this list can serve an intervention to help prevent common mistakes made in surgical care.

Exercise Helps Battle Age Related Diseases

This latest NY Times article reports that as people age they lose muscle strength and flexibility, and as a result of this it leads to frailty in bones and a loss of mobility. According to Miriam Nelson, director of the John Hancock Center for Physical Activity and Nutrition at Tufts University, exercise is becoming increasingly important in improving quality of life and decreasing the risk of chronic age-related diseases.

A common misconception is that exercise will cause injury or pain, especially with those who suffer from arthritis, but the truth of the matter is that building muscle strength and their joints it will actually reduce pain and decrease the risk of injury. The perfect balance of physical fitness preferred includes aerobic workouts (cardio, swimming, treadmill, crosstrainer), stretching, and muscle training (which can be done in a gym with a series of machines, or dumbbells or resistance bands and tubes at home).