Michelle Obama Highlights Breast Cancer Awareness
But thats where the Rockford, Ill., woman was Friday as she stood in a White House flower garden and shared her story of being repeatedly denied health insurance because of the cancer in her past.
In less than four minutes at the microphone, Lownsdale helped the Obama administration mark Breast Cancer Awareness Month and, more importantly, provide a flesh-and-blood illustration for why President Barack Obama wants to overhaul the system.
First lady Michelle Obama said the U.S. has come a long way from the days when people thought breast cancer was something to be ashamed of and kept a secret, when it was treated as something not discussed in polite company.
More women are getting mammograms, the five-year survival rate is above 90 percent and research spending is at $900 million - 30 times the amount spent in 1982. But 1 in 8 women will still be diagnosed with breast cancer in her lifetime and 40,000 women a year still die from the disease, she said, and the current health care system doesnt work for many women who are living with the cancer.
“Its a system that only adds to the fear and stress that already comes with the disease,” the first lady said.
At the end of her treatment for a pea-sized tumor, Lownsdale said her doctor said she had a 94 percent chance of remaining cancer free, “very similar to a woman whos never had breast cancer.” Then in 2005, her insurer notified her that her health care premiums would more than double.
The married, 40-something graphic designer shopped around for new coverage and repeatedly was denied. She ended up with coverage through Illinois high-risk pool, and currently pays $600 a month for her coverage alone.
Despite her good health, she said the diagnosis “left a target on my back.”
“I will most likely be cancer free for the rest of my life, but having the word cancer written on my medical chart is enough to generate an automatic rejection from insurance coverage,” Lownsdale told a gathering of breast cancer survivors, advocates, members of Congress and Jill Biden, the vice presidents wife. Mrs. Biden started a breast cancer education program in Delaware after some close friends were diagnosed.
Mrs. Obama said health care changes the president is pushing Congress to pass would help consumers by barring insurers from denying coverage because of pre-existing conditions, like breast cancer, and require coverage for preventive screenings like mammograms.
“Perhaps most heartbreaking of all is the fact that right now, today in America, there are people in this country who have breast cancer but dont even know it because they cant afford a mammogram,” said Mrs. Obama, a former hospital administrator in Chicago.
One in five women age 50 or older havent had a mammogram in the past two years, she said, citing a Health and Human Services Department report.
Novo Nordisk Drug Helps Healthy Lose Weight, Axe Blood Pressure
The study involving 564 people found just five months of liraglutide injections shaved 4.8 kilograms (10.6 pounds) to 7.2 kilograms from their frames, compared with 4.1 kilograms for those on Xenical and 2.8 kilograms for those given placebo.
The research suggests that liraglutide may be more effective than currently available treatments for obesity. About half of Europeans and two-thirds of Americans are overweight, and 30 percent are considered obese, studies show. Few treatments are available. Novo Nordisk, based in Bagsvaerd, Denmark, funded the research that appears in the journal Lancet and has another trial under way.
“Overall, the results of this study indicate the potential benefit of liraglutide, in conjunction with an energy-deficit diet, in the treatment of obesity and associated risk factors,” said the researchers, led by Arne Astrup, from the University of Copenhagens department of human nutrition. “Liraglutide offers a new mode of action for the treatment of obesity and improved efficacy compared with currently available therapies.”
The research is the second of three phases of trials generally needed to win regulatory approval. Novo Nordisk said it is waiting to hear from U.S. regulators this quarter about the use of the drug for diabetes before it starts additional weight loss trials. Liraglutide is already approved for diabetics in Europe, where its marketed under the name Victoza.
Lower Blood Pressure
Blood pressure levels dropped in all patients taking liraglutide, while signs of impending diabetes, marked by slightly elevated blood sugar levels, fell by as much as 96 percent, the study found.
“Liraglutide improved several factors associated with cardiovascular events over 20 weeks, which are regarded as more clinically relevant than weight loss per se,” the researchers said. “The long-term risk-benefit profile for liraglutide, as well as its weight maintenance capabilities, remain to be established.”
The most common side effects were nausea and vomiting, which generally occurred within the first month. There were no signs of other serious side effects, including pancreatitis, psychiatric complications or thyroid cancer. Participants in the study also followed a calorie-restricted diet and increased their physical activity.
Increased Obesity
The rising rates of obesity during the past two decades have coincided with a dramatic increase in diabetes, leading many public health officials to declare that epidemics are under way with both conditions.
Healthy patients in Astrups study lost more weight than diabetics in earlier studies who were taking the same doses of the drug, said George Bray, from Louisiana State Universitys division of clinical obesity and metabolism in Baton Rouge, in an editorial. It may be that people without diabetes are more responsive to the drug, which stimulates insulin production, slows the emptying of the stomach, and decreases food intake, he said.
“Whether long-term use of an injectable drug is palatable as a treatment for obesity is yet to be established,” Bray wrote. “From what we do know about GLP-1 agonists and their mechanisms, we can be optimistic that their promise for the treatment of obesity will be fulfilled.”
Past Setbacks
Efforts to develop obesity drugs have suffered setbacks. Sanofi-Aventis SA pulled Acomplia off European shelves last year after regulators recommended suspension of sales. The medicine failed to win the backing of a U.S. advisory panel in 2007 after it was linked to suicide.
Merck & Co. last year stopped development of taranabant, in the same class of medicine as Acomplia, because it made people depressed and irritable. Pfizer Inc., the worlds biggest drugmaker, also ended early-stage work on obesity treatments as part of a research overhaul last year.
GlaxoSmithKline Plc sells a form of Xenical, known chemically as orlistat, in a lower-dose, over-the-counter formulation known as Alli.
— Editors: Phil Serafino, Kristen Hallam
Hospital Bonds Approach $2.4 Billion This Week In Muni Market
Catholic Health Initiatives, the second-largest Catholic health-care system after Ascension Health, today is offering $1.16 billion in bonds to replace variable- and auction-rate debt, reimburse itself for previous capital spending and cover new projects. State agencies in Colorado and Kentucky and Ohios Montgomery County will issue the bonds and banks led by Morgan Stanley are marketing them.
Easing the way for hospital borrowers are a drop this year in fixed-rate borrowing costs and lower penalties for canceling derivatives contracts linked to types of adjustable-rate debt popular before the credit crisis, according to Concord, Massachusetts-based research firm Municipal Market Advisors.
“The health-care book is jumping up in size,” said Matt Dalton, chief executive of Belle Haven Investments, a fixed- income management firm in White Plains, New York. “Hopefully, the market can hold together” for the deals to be completed.
The yield gap between Merrill Lynch & Co. indexes of hospital bonds and AAA municipal debt tightened to a 10-month low of 186 basis points since Oct. 14, before rising to 191 basis points yesterday. A basis point is 0.01 percentage point.
Municipal Market Advisors daily survey of benchmark 10- year bond yields slid 3 basis points to 3.18 percent yesterday after reaching a three-month high of 3.22 percent last week.
Hospital Sales
Health-care bond sales in the municipal market fell 38 percent to $30.1 billion during the first three quarters of 2009, compared with the year-earlier period, which was boosted by hospitals refinancing debt that jumped in cost, according to data compiled by Thomson Reuters.
Denver-based Catholic Health Initiatives plans to issue almost $890 million of fixed-rate bonds and about $275 million of so-called put bonds, whose rates may change on agreed-upon dates when the nonprofit buys them back.
“We are very optimistic that we will be able to issue the $1.16 billion,” Diane Albrecht, director of capital finance for the health-care system, said in an e-mail. “We had an investor call earlier this week that we believe went very well.”
The health-care system operates 78 hospitals in 20 states and has annual revenue of $8.2 billion, according to its Web site. It carries credit grades of AA from Fitch Ratings and Standard & Poors, and Aa2 from Moodys Investors Service.
30-Year Bonds
Intermountain Healthcare, rated AA+ by S&P and Aa1 by Moodys, borrowed $250 million in a deal arranged by Riverton, Utah. Bonds set to mature in 2041 had a 5.1 percent yield.
Municipal issuers in Indiana, Michigan, Mississippi, North Carolina and Tennessee also planned hospital borrowings this week, according to data compiled by Bloomberg.
Following are descriptions of some pending sales of municipal bonds; the timing and amounts may change.
MINNESOTA is negotiating the sale of about $535 million of general obligation bonds today through a group of underwriters led by Barclays Plc, according to state officials. The proceeds will refinance debt and fund about $470 million in projects for parks, education, pollution control, transportation, natural resources and agriculture. The states full faith, credit and taxing power pledge carries S&P and Fitchs top rating of AAA and Moodys second-highest grade, Aa1. (Updated Oct. 22)
PENNSYLVANIA TURNPIKE COMMISSION, operator of the states toll roads, plans to issue $524 million of revenue bonds through Goldman Sachs Group Inc. this week. The commission is financing a payment, set by a 2007 law called Act 44, to the Pennsylvania Department of Transportation for capital projects. The debt, secured by a subordinate lien on turnpike revenue, is rated A2 by Moodys and A- by S&P. (Added Oct. 19)
SOUTH CAROLINAS SANTEE COOPER, the largest producer of electricity in the state, plans to sell almost $420 million of debt this week through Goldman Sachs Group Inc. Taxable bonds will make up $100 million of the deal; the rest will be tax- exempt. The state-owned electric and water utility will use the money raised to cover costs related to the expansion of the Summer nuclear power plant and refinance debt issued a decade ago. The Moncks Corner-based agency is known officially as the South Carolina Public Service Authority. (Added Oct. 20)
CALIFORNIA, the largest borrower among U.S. states, plans to sell $3 billion of bonds to refinance debt that patched previous state budget deficits. Underwriters led by Barclays Plc will market the so-called economic recovery bonds to investors next week. They are payable primarily from revenue of a dedicated 0.25 percent sales tax and also supported by Californias general pledge to meet its obligations. The deal will level out its repayment schedule through 2023, after a record 11 percent decline in sales tax revenue forced the state to tap a reserve account to meet debt service. The new issue is rated A+ by S&P, A1 by Moodys and A by Fitch. (Added Oct. 22)
Study: Heart Failure Drug Guidelines Often Ignored
Only one-third of 12,565 patients eligible for the drugs got them - even though they were treated at 201 hospitals that had voluntarily enrolled in the American Heart Associations Get with the Guidelines program.
Reasons why so few doctors “got with the program” are unclear. But the study authors offered some theories, from lack of marketing for the decades-old drugs to concerns about their safety.
The main drug studied, spironolactone, is a water pill that helps prevent kidneys from absorbing too much sodium, which can lead to excess fluid. In heart failure, water often builds up in lungs, blood and tissue because the heart cant pump properly.
The pills studied have been shown to reduce hospitalizations and deaths. But they also can be hard on the kidneys and when used in the wrong patients, side effects can be deadly - another reason some doctors may avoid them.
The study found that inappropriate use - in patients with signs of kidney trouble or other specific conditions - was uncommon.
The study appears in Wednesdays Journal of the American Medical Association.
Spironolactone is an old generic drug that is not heavily marketed, so doctors may lack promotional material on how to use it, said Cleveland Clinic researcher Nancy Albert, the studys lead author.
Another reason for infrequent use is that the original 2005 American College of Cardiology/American Heart Association guidelines said these drugs “should be considered.” The wording was changed this year to “recommended,” after the 2005-2007 study ended, the study authors said.
Dr. Ileana Pina, a spokeswoman for the heart group and professor at Clevelands Case Western Reserve University, said the results arent surprising since other reports have shown doctors dont always follow guidelines.
But because these drugs can improve survival, she said the study results should serve as “a call to action” for doctors who treat heart failure patients.
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On the Net:
American Heart Association: http://www.heart.org
Obama Says Insurers Using Smoke And Mirrors In Health Debate
In his weekly address on the radio and Internet, Obama criticized a report released by the trade group Americas Health Insurance Plans earlier this week that warned a Senate proposal would more than double insurance premium costs.
“Like clockwork, weve seen folks on cable television who know better, waving these industry-funded studies in the air,” Obama said. “Its smoke and mirrors. Its bogus.”
Two days after the release of the health insurance study, the Senate Finance Committee approved its 10-year, $829 billion overhaul of the nations health-care system.
The Senate committee was the last of five congressional panels producing health-care bills. Congressional leaders are working to combine the different proposals into versions that will be considered by the full Senate and House of Representatives.
“We are closer to reforming the health-care system than we have ever been in history,” Obama said. “But this is not the time to pat ourselves on the back.”
Obama said that insurance companies are engaged in a “last-ditch effort” to block health-care legislation as a way to protect their profits. He also said a possible congressional review of antitrust exemptions for insurance companies is a correct step.
The president said there is a growing consensus among medical-care workers, hospitals, and drug companies about the need for a health-care overhaul.
Big Guns
“The insurance industry is rolling out the big guns and breaking open their massive war chest to marshal their forces for one last fight to save the status quo,” Obama said. “What we all must oppose are the same old cynical Washington games that have been played for decades even as our problems have grown and our challenges have mounted.”
In the Republican address, Representative Kevin Brady of Texas said the $787 billion economic stimulus approved by Congress in February and signed into law by Obama has failed to produce jobs.
“The truth is: no jobs. No recovery,” Brady said. “Lets finally admit Americas recovery cant be built on the unsteady Democratic doctrine of spending more, borrowing more and higher taxes.”
The economy has lost more than 7 million jobs since the recession started in December 2007, and the unemployment rate rose in September to 9.8 percent — the highest since 1983.
Brady also said Democratic proposals to overhaul the health-care system will lead to government interference in medical decisions and new taxes that will be passed on to consumers and businesses.
Brady criticized the growing federal budget deficit, which widened to a record $1.42 trillion this year.
“Under the Obama administrations budget, our country is set to rack up $6.7 trillion in debt over the next decade,” Brady said. “Democrats in Washington continue to pursue costly policies that tax too much, spend too much, and borrow too much.”
Merck, Glaxo Prepare For Hpv Vaccine Battle With U.s. Approvals
The Food and Drug Administration authorized sales of Gardasil to prevent genital warts in males ages 9 to 26 and Glaxos Cervarix to prevent cervical cancer in females ages 10 to 25, the companies said today in separate statements. Gardasil has been approved in the U.S. since 2006 and is part of routine vaccinations for school-age girls.
The shots target strains of human papillomavirus, or HPV, a common sexually transmitted virus that can cause cancer and serious infections. Concerns about Cervarixs safety contributed to a regulatory delay in 2007, helping give Merck a head start on the U.S. market. Outside advisers to the FDA on Sept. 9 backed Cervarix as well as Mercks proposal to expand Gardasils market.
“Nearly 17,000 new cases of genital HPV infection, of any type, occur each day in the United States, in both males and females,” said Anna Giuliano, a program leader in risk assessment, detection and intervention at the Moffitt Cancer Center in Tampa, Florida, in Mercks statement.
Broader use could revive Gardasils sales, which declined 5 percent last year to $1.4 billion amid questions about side effects and cost.
Approval in boys may add as much as $200 million to $300 million in annual sales for Merck, of Whitehouse Station, New Jersey, Leerink Swann & Co. analyst Seamus Fernandez said in a research report last month.
Challenge for Glaxo
London-based Glaxo faces a challenge in winning doctors and parents support for Cervarix because Gardasil also protects against genital warts. Cervarix is cleared in 100 countries, including approval today in Japan, and had sales of 125 million pounds ($232 million) last year, about one-sixth as much as Gardasil. The average estimate of three analysts surveyed by Bloomberg calls for sales worth 603 million pounds in 2013.
Demand for both vaccines will likely be affected by recommendations of the Centers for Disease Control and Preventions Advisory Committee on Immunization Practices next week. The 15-member panel that sets national guidelines plans to review Cervarix for girls and Gardasil for boys at an Oct. 21 meeting in Atlanta.
Twenty million Americans are infected with HPV, and most will be able to fight off the infection naturally. This year, an estimated 11,270 new cases of cervical cancer will be diagnosed in the U.S. and 4,070 women will die of the disease, according to the National Cancer Institute, a U.S. agency. About 1 percent of sexually active men in the U.S. will develop genital warts from HPV, according to the CDC.
Three Doses
Gardasil and Cervarix are given in three doses during a six-month period to trigger immune responses that help protect against the two HPV strains responsible for most U.S. cervical cancer cases. Gardasil also protects against two additional strains of HPV that cause 90 percent of genital warts.
It would cost more than $100,000 to vaccinate enough boys with Gardasil to get one year of additional life compared with less than $50,000 for girls, according to a study by Harvard University researchers presented in June. Mercks studies show it would cost $50,000 for boys and girls at a price of $400 per vaccine.
Paying for Shots
Merck will expand a patient rebate and dose replacement program to help cover the cost of the vaccine for 19- to 26- year-old men without health insurance and those with private insurance with partial or no coverage for the shots, according to the companys statement.
Glaxos studies showed a slight increase in miscarriages among young women who took Cervarix. Outside advisers to the FDA who backed the safety and effectiveness of Cervarix said Glaxos plan to register patients and monitor for pregnancies would mitigate any potential risks.
American depositary receipts of Glaxo, each representing two ordinary shares, fell 8 cents to $41.20 at 4:01 p.m. in New York Stock Exchange composite trading. Merck dropped 9 cents to $33.21.
Some Poor Nations Succeeding In Fighting Hunger
Thanks to fertilizer he couldnt afford without government help, Jesitala harvested enough corn to feed his family this year. A report released Friday praised Malawis program, saying governments simply making agriculture a top priority and offering financial and other incentives to small farmers have seen some poor countries quickly move from importing food to producing surpluses.
In its report, ActionAid International ranked Malawi among the top five successful developing nations, with Brazil taking the lead, for cutting child malnutrition by 73 percent in six years.
“Whos Really Fighting Hunger” said Brazil succeeded at cutting child malnutrition by investing extensively in small-holder farmers and implementing strong social welfare policies.
In Malawi, the past two growing seasons have ended with impressive surpluses of the staple crop, corn. President Bingu wa Mutharika persisted with his program to help farmers buy fertilizer despite opposition from Western donor nations and agencies that see subsidies as contrary to free market principles.
During the 2008-09 growing season, the government spent $183 million on the farm subsidy program, which resulted in Malawi realizing a surplus of 1.3 million metric tons of maize. Under the program, a farming family gets two 50-kilogram bags of fertilizer and packets of seed.
Before he started using fertilizer, Jesitala harvested fewer than 15 bags of corn from his one-acre plot. This year, he harvested 40 bags, enough to feed his family for the year.
“We will also even sell some of the maize,” he said.
Malawi, which has had acute food shortages in the past, has been a donor in recent times, giving 500 metric tons of corn each to Swaziland and Lesotho and selling some to Zimbabwe in the 2007-08 growing season. Talks are under way to sell to Kenya and Zimbabwe this year.
The World Food Program is warning that, because of drought, Malawians in some southern regions will need food aid this year despite the national surplus. But the Ministry of Agriculture and Food Security says theres enough stock to respond to any food emergency.
The U.N. Food and Agriculture Organization said in a report released Wednesday that the worlds hungry reached 1.02 billion this year, attributing the steady rise in the number of undernourished people to governments reducing their spending on agriculture for more than a decade.
“Its the role of the state and not the level of wealth, that determines progress on hunger,” said Anne Jellema, ActionAids policy director.
“Every six seconds a child dies from hunger, but this scandal could easily be ended if all governments took determined action,” said Jellema.
The report grades rich nations on the measures they have taken to end hunger such as how much agriculture aid they give or what they are doing to reverse the effects of climate change.
Luxembourg tops the list of 22 rich nations, followed by Finland and Ireland.
“Whos Really Fighting Hunger,” ranks 51 countries where either ActionAid has a presence or have reliable data that makes comparisons possible. So, for example, Zimbabwe is not included because of doubts about data generated in that country.
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Maliti contributed from Nairobi, Kenya.
Robotic Prostate Surgery May Mean Large Trade-off
The results add to confusion around prostate cancer treatments, which sometimes lead to urinary and sexual problems. Its not clear that either kind of surgery is superior to radiation alone or watchful waiting, which means simply monitoring the prostate for changes.
Laparoscopic, or keyhole, surgery is increasingly chosen by men having a cancerous prostate removed. And often it involves the highly marketed da Vinci robotics system. Da Vincis popularity has been rising even though theres never been a rigorous head-to-head comparison between it and standard surgery.
“Theres been a rapid adoption of this relatively new technique,” said the studys lead author Dr. Jim Hu of Brigham and Womens Hospital in Boston.
For the study, appearing in Wednesdays Journal of the American Medical Association, researchers analyzed Medicare data for nearly 9,000 prostate cancer patients who had surgical treatment from 2003-07. Of those, 1,938 patients had minimally invasive surgery and 6,899 patients had standard surgery. The data did not indicate how many of the less invasive cases involved robotics.
The patients who had keyhole surgery left the hospital in two days, rather than three, on average. They also had lower rates of blood transfusions, breathing problems and internal scarring.
There was no difference in the rate of additional cancer therapy down the road, suggesting the two techniques were about the same for cancer control.
But the men who had keyhole surgery were more likely to report complications in the first 30 days after surgery involving genital and urinary function. About 5 percent of the minimally invasive surgery patients vs. about 2 percent of the standard surgery patients had these complications. And after 18 months, they had more incontinence and erectile dysfunction.
“The take-home message for men is they need to dig deeper than simply the message they might be getting from planted stories from device manufacturers or radio ads or billboards,” Hu said.
In laparoscopic surgery, small incisions are made and the doctor uses a tiny camera and instruments for the operation. When robotics is used for this, the doctor sits at a console and manipulates similar instruments attached to robotic arms that work on the patient.
From 2001-06, use of the da Vinci system - the only robot available for this operation - rose from 1 percent to 40 percent of all radical prostatectomies. During that time, the stock price of da Vincis maker, Sunnyvale, Calif.-based Intuitive Surgical Inc., increased 11-fold.
To compete for patients, more hospitals are buying robotic systems and advertising faster recovery times. More doctors are taking the two-day training to learn Intuitives da Vinci Surgical System.
But many doctors perform too few robot-assisted surgeries to get good at it, Hu said, and that could explain the lasting problems that showed up in the study. Previous research has shown doctors who perform the most surgeries get the best results.
Dr. Steve Freedland of Duke University School of Medicine in Durham, N.C., said he doubts the findings will dampen the enthusiasm for robotic surgery - he termed it “mass hysteria over new technology” - because surgeons will claim better-than-average results when they talk to men considering their options.
Freedland, who does prostate surgery, said the results just reinforce his decision to stick with traditional, open surgery.
“One of the reasons why health care in this country is extremely expensive is because its assumed that whats newest must be best,” Freedland said.
The researchers found that the less-invasive surgery was more popular among more affluent, highly educated men. So it might be that those patients are more likely to seek help for urinary and sexual problems compared to men who had traditional surgery, said Dr. Ashutosh Tewari, director of the Prostate Cancer Institute at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
Tewari, who receives research funding from Intuitive Surgical and had no role in the study, faulted the research for lumping all minimally invasive surgeries together, both robotic and those using older laparoscopic techniques.
Seasonal Vaccine Shortage In U.s. Stoked By Swine Flu Vigilance
The two influenza strains, which carry similar symptoms and outcomes, may circulate concurrently in the U.S. for the first time beginning this month, normally the official start of the flu season, the Centers for Disease Control and Prevention said. They require separate vaccinations that can be given at the same time, government health officials said on Oct. 9.
About 77 million doses of seasonal vaccine have already shipped in the U.S., more than ever before at this time of year, the CDC said. Still, doctors are reporting delays in getting the product, and CVS Caremark Corp. and Walgreen Co., the two largest U.S. drugstore chains, last week reported spot shortages. The first doses of vaccine for swine flu, also known as H1N1, were given to health-care workers and children on Oct. 8, with about 6.8 million doses available for ordering.
“Every doctor I know has run out or never received any” seasonal vaccine, said Brett Buchmiller, an allergist and immunologist at Allergy & Asthma Specialists in Dallas. “I have had to tell my patients, do not wait for me.”
Buchmiller ordered 1,200 doses in January for delivery in mid-September. He said he hasnt received any of his shipment and was told by his distributor that he may not get any.
Doctors Offices
Shortages at doctors offices and health clinics have also been reported in upstate New York, Vermont, Minnesota, North and South Dakota, Illinois and Arizona, according to the Web sites of local newspapers including the Addison County Independent in Vermont, the Star Tribune in Minneapolis and the Grand Forks Herald of North Dakota.
CVS MinuteClinics in Austin, Texas, and New York ran out of the seasonal-flu vaccine within the past week before restocking, according to calls to 13 stores by Bloomberg News. Calls to eight Walgreen stores in Manhattan on Oct. 5 determined none had it at the time. There are also shortages in the South and Southeast, said James Cohn, a Walgreen spokesman.
Demand for seasonal-flu vaccinations has soared because of public awareness of swine flu, Walgreens Cohn said. While the Atlanta-based CDC is no longer counting swine flu cases, it reported last week that H1N1 is spread widely in 37 U.S. states.
Americans are demanding both vaccinations, even though about 99 percent of laboratory tested flu viruses are of the H1N1 variety. Walgreen administered 2.5 million seasonal flu vaccine doses last month, more than twice as many as in the entire 2008 flu season, Cohn said.
Given Simultaneously
The vaccinations can safely be administered simultaneously, Anthony Fauci, director of the National Institute of Allergy and Infectious Disease in Bethesda, Maryland, said last week, citing studies in 800 people. Supplies of the H1N1 vaccine, though, may be limited for the next few weeks, according to the CDC.
“Every single customer that we have has gotten at least their initial shipment from us,” Cary said.
More doses are being shipped, and in a few weeks, there should be enough of both vaccines for everyone who wants to get them, said Anne Schuchat, head of the National Center for Immunization and Respiratory Diseases at the CDC, on Oct. 9.
Good News, Bad News
“The good news is that we have more seasonal-flu vaccine out than we typically would this time of year,” Schuchat said. “The bad news is that more people want it than can seem to be able to get it.”
When retail pharmacy chains run out of vaccine at one location, they can redistribute doses from areas where demand isnt as great. Thats not always the case for doctors.
“We tried to go to several other manufacturers and distributors and have had no luck,” said Adam Stracher, director of primary care for the Weill Cornell Physician Organization in New York, in an Oct. 9 telephone interview. “Distributors are telling me they havent gotten their full shipments yet.”
Stracher ran out of vaccine for his doctors offices after receiving 1,800 doses of his 7,000-dose order from Sanofi. He said hes expecting another shipment of about 2,000 vaccines in the next two weeks, and that Sanofi couldnt guarantee the rest of his order.
Report: Limiting Medical Lawsuits Might Save $41b
The latest analysis from the nonpartisan Congressional Budget Office estimates that government health care programs could save $41 billion over ten years if nationwide limits on jury awards for pain and suffering and other similar curbs were enacted. Those savings are nearly ten times greater than CBO estimated just last year.
“Recent research has provided additional evidence that lowering the cost of medical malpractice tends to reduce the use of health care services,” CBO Director Douglas Elmendorf wrote lawmakers, explaining the agencys shift. Previously, CBO had ruled that any savings would be limited to lower malpractice insurance premiums for doctors, saying there wasnt clear evidence physicians would also change their approach to treatment.
On Friday, Elmendorf essentially acknowledged what doctors have been arguing for years: fear of being sued leads them to practice defensive medicine. Some doctors will order a $1,500 MRI for a patient with back pain instead of a simple, $250 X-ray, just to cover themselves against the unlikely chance theyll be accused later of having missed a cancerous tumor.
Republicans immediately called for liability limits to be incorporated in the health care overhaul legislation advancing in Congress. The Senate Finance Committee bill now gives a nod of recognition to doctors concerns, but little more. Heeding a call from President Barack Obama, the legislation calls for promoting state experiments with programs to resolve cases before they go to court.
“The more federal health care programs spend on unnecessary tests, the less money is available for necessary patient care,” said Sen. Charles Grassley of Iowa, the ranking Republican on the Finance Committee. “Cutting medical liability costs would help preserve patients access to care. “
Tens of billions of dollars in savings is “not chump change,” added Grassley. “Its a no-brainer to include tort reform in any health care legislation.”
However, Republicans were unable to pass malpractice limits when they controlled Congress and the White House, and its unlikely that Democrats would do so now.
For one thing, trial lawyers who file malpractice lawsuits have traditionally been heavy contributors to Democratic politicians.
But also, patient advocates argue that fixed limits on jury awards as in California and some states are unfair to those who have suffered the most harm because of a doctors negligence. A patient who was given the wrong drug and had to spend several days in the hospital recovering from a bad reaction would likely be able to collect adequate compensation. But a family whose youngster was left brain damaged by an anesthesiologists mistake probably would not be able to offset all the costs of lifelong care.
Obama has tried to straddle the argument, siding with the doctors on defensive medicine and agreeing with the lawyers who say limits on jury awards are the wrong remedy. He wants to promote alternatives to litigation; studies have shown anger over cover-ups by doctors is a principal reason that families sue.
Trial lawyers said Friday the projected malpractice savings have to be viewed in the context of the $2.5 trillion a year the U.S. spends on health care.
“Medical malpractice claims have almost no effect on overall health care spending,” said Anthony Tarricone, president of American Association for Justice, which lobbies for lawyers. “The vast majority of empirical evidence suggests that there are only minuscule savings to be found in reforming our nations civil justice system.”
Even in the health care debate, thats real money.
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On the Net: http://www.cbo.gov