The National Community Pharmacists Association, which represents independent pharmacies, on Thursday said a rule recently proposed by CMS that would revise the Medicaid reimbursement formula for certain prescription drugs could force many members to close, CQ HealthBeat reports. NCPA said that, based on a recent Government Accountability Office report on pharmacy acquisition costs, the rule would “force pharmacists to accept Medicaid drug reimbursement that is, on average, 36% below their cost.” According to a survey released by NCPA, 86% of independent pharmacies said that the rule would “influence their decision” on whether to continue participation in Medicaid. NCPA officials said that many independent pharmacies operate in underserved rural and inner city areas and that closures would affect access to prescription drugs for a number of Medicaid beneficiaries. NCPA CEO Bruce Roberts said, “Medicaid cuts, combined with low or slow reimbursement under the Medicare Part D program, could force many pharmacies to close so that all patients lose access.” However, CMS has questioned the methodology that GAO used to estimate pharmacy acquisition costs in the report and disagrees with the conclusion that acquisition costs would exceed Medicaid reimbursements under the rule for most of the 77 prescription drugs examined (Reichard, CQ HealthBeat, 2/9).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

Food, fitness or family??¦which one is most to blame for childhood obesity? New research from Mintel shows today’s parents aren’t sure, and they’re feeling overwhelmed and worried as they try to prevent obesity in their own children.

In an exclusive consumer survey of American parents, Mintel found confusion over whether diet or exercise is most important for keeping kids at a healthy weight. Nearly three quarters of parents (72%) believe kids have too much access to junk food, while 69% feel that a lack of exercise is more to blame for obesity. In addition, two in five parents (40%) are concerned that their children might develop obesity.

“Parents aren’t sure where to focus first to ensure their children’s health-diet, exercise or both simultaneously,” states Marcia Mogelonsky, senior analyst at Mintel.

According to Mintel, parents need help when it comes to promoting healthy eating with their children. While 95% feel that this is very or somewhat important, only 82% believe they are somewhat or very successful at doing so. Similarly, while 93% consider it very or somewhat important to limit their children’s access to junk food, only 77% feel they have been very or somewhat successful at accomplishing this.

Additionally, many parents blame kids’ sedentary lifestyles for obesity. According to parents, less than half of kids are physically active five or more hours per week-less than an hour a day. These sedentary habits are not enough to offset the caloric intake of kids with poor eating habits.

“When it comes to placing the blame, most parents look to themselves,” states Marcia Mogelonsky. “Seventy-eight percent of parents believe the fault lies with them, yet most seek more information on nutrition so they can improve their children’s health.”

More than half of parents (57%) are worried that their children don’t get enough information about healthy living at school, and 47% believe children should have ongoing diet and nutrition classes.

The prevalence of overweight and obesity among children aged two to 19 is significant at 12%. While there are hints that these rates are leveling, they have yet to decline. The government has set a goal of 5% incidence in obesity among children for 2010.

Source
Mintel Continue reading →

A survey of parents who had a child die of cancer found that one in eight considered hastening their child’s death, a deliberation influenced by the amount of pain the child experienced during the last month of life, report Dana-Farber Cancer Institute researchers in the March issue of Archives of Pediatrics & Adolescent Medicine.

The study, the first to explore this sensitive area, suggests that many parents worry that their children will suffer from uncontrollable pain, and that some parents might consider that an early death would be preferable. The researchers say the findings underscore the importance of managing patients’ pain, and of communicating with parents about the tools available for easing progressive pain.

“The problem is that conversations about these family worries may not always happen,” said senior author Joanne Wolfe, MD, MPH, Division Chief of Pediatric Palliative Care at Dana-Farber and Director of Palliative Care at Children’s Hospital Boston. “Parents may not have the opportunity to express these feelings and considerations, and as clinicians, we may not be adequately enabling sufficient opportunity for them to talk about their concerns.”

Wolfe, along with first author Veronica Dussel, MD, MPH, a Dana-Farber research fellow, undertook the research to gain an understanding of why some parents would consider a measure as extreme as intentionally ending a child’s life.

The researchers interviewed 141 parents of children who had died of cancer and were treated at Dana-Farber, Children’s Hospital, or Children’s Hospitals and Clinics of St. Paul and Minneapolis, Minn.

The scientists queried parents about their behaviors and feelings leading up to their child’s death and at the time the survey was conducted, which was a year or more after the death. The parents were also presented with hypothetical vignettes involving a terminally ill child with uncontrolled excruciating pain or who was in an irreversible coma.

One in eight (13 percent) of parents had considered asking caregivers about the possibility of ending their child’s life, though only 9 percent reported having such a discussion. Five parents, or 4 percent, had requested that their child’s death be hastened, and 3 parents said it had been carried out, using morphine. Wolfe commented, however, that “this may not reflect what actually happened, because morphine is used in increasing doses to manage worsening pain without the intent or the effect of ending life.”

In response to the hypothetical vignettes, 50 percent of parents said they endorsed hastening death in situations of uncontrollable pain or if the child was in an irreversible coma. Parents were 40 percent more likely to approve hastening death for a child experiencing extreme pain than for a terminally ill child in a coma.

Wolfe said it is important to keep the findings in perspective. Only five parents reported having talked about hastening their child’s death, and 19 said they considered it. Wolfe said it is her experience that parents are comforted by having conversations about pain management and that most are reassured by knowing what will be done to ease their child’s suffering.

“We’ve come a long way, because we have a good palliative and supportive care program for children with cancer,” said Wolfe, who is also an assistant professor of pediatrics at Harvard Medical School.

But she acknowledged, “I can never promise that their child will be pain free. We still have quite a way to go in figuring out the best way to ease suffering at the end of life.” The gap exists in part, Wolfe said, because this area is not one given high priority for research funding agencies.

Other authors of the report are Steven Joffe, MD, MPH, and Jane Weeks, MD, MSc, of Dana-Farber; Joanne Hilden, MD, of the Peyton Manning Children’s Hospital at St. Vincent in Indianapolis, Ind.; and Jan Watterson-Schaeffer of Children’s Hospitals and Clinics, St. Paul, Minn.

The project was funded in large part by the Agency for Health Research and Quality and the National Cancer Institute.

Dana-Farber Cancer Institute is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive cancer center by the National Cancer Institute. It is the top ranked cancer center in New England, according to U.S. News & World Report, and one of the largest recipients among independent hospitals of National Cancer Institute and National Institutes of Health grant funding.

Source: Dana-Farber Cancer Institute Continue reading →

In the face of rising health care costs, hospitals “have stepped up as unexpected partners in lowering costs for businesses” by providing a variety of preventive health services, the Wichita Eagle reports. Hospitals are helping businesses — “particularly those under their insurance umbrellas” — by paying for consultants, hiring health program directors and offering smoking cessation classes, according to the Eagle. The efforts are a way for the hospitals to increase patient volume and gain additional contracting leverage. For example, Raytheon Aircraft participates in preventive health programs offered by Wichita-based Wesley Medical Center, which this year acquired Raytheon in its insurance contracts. Nita Long, director of compensation and benefits at Raytheon, said, “It’s not just a matter of shopping for the cheapest health care coverage. It’s a matter of educating your work force and offering programs to help them improve their health so they don’t need to use their coverage as much.” James Early, founder of a corporate wellness program at Via Christi Regional Medical Center and director of clinical preventive medicine at the University of Kansas School of Medicine, said, “What is now happening is we have matured from the ideas of doing wellness as an add-on to marketing and are making it a viable and vital part of the delivery of overall health care services to industry.” Early added, “We no longer have the financial freedom to just treat illness. (Health care providers) are going to be required to provide legitimate preventive services or businesses will go elsewhere” (Atwater, Wichita Eagle, 11/12).

“Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

Mayo Clinic researchers have found that bipolar disorder (BPD) is a more costly chronic condition than diabetes, depression, asthma and coronary artery disease (CAD), based on a review of health care claim costs. Specialty care costs (the costs of seeing any specialist and all tests ordered) were especially higher for bipolar patients. Results of this review were presented at the Annual Meeting of the American Psychiatric Association in San Francisco.

“Psychiatric care costs represented only a portion of the specialty care costs for these chronic conditions, explains Mark Williams, M.D., a Mayo Clinic psychiatrist and lead researcher. This suggests that many of the specialty costs for bipolar patients are not directly related to seeing a mental health provider.”
A data review of health care claims over a four-year period, showed patients with BPD had significantly higher total per member per month costs when compared with the other groups. Only patients with both CAD and diabetes had higher costs than patients with BPD. Total costs, specialty care visits, specialty care costs, outpatient psychiatric costs and outpatient psychiatric visits were compared.

Source:
John Murphy

Mayo Clinic Continue reading →

The oral, once daily, investigational anticoagulant rivaroxaban (Xarelto®) is significantly more effective than enoxaparin, the standard of care, in preventing venous thromboembolism (VTE) in patients undergoing total hip replacement surgery. Data from the RECORD1 study show a 70% relative risk reduction (RRR) for rivaroxaban in total VTE when compared with enoxaparin (p Continue reading →

Cholera, an acute diarrheal disease caused by the bacterium Vibrio cholerae, has reemerged as a global killer. Outbreaks typically occur once a year in Africa and Latin America. But in Bangladesh the epidemics occur twice a year – in the spring and again in the fall.

Scientists have tried, without much success, to determine the cause of these unique dual outbreaks – and advance early detection and prevention efforts – by analyzing such variables as precipitation, water temperature, fecal contamination and coastal salinity. Now, researchers from Tufts University, led by Professor of Civil and Environmental Engineering Shafiqul Islam, have proposed a link between cholera and fluctuating water levels in the region’s three principal rivers – the Ganges, Brahmaputra and Meghna.

“What we are establishing is a way to predict cholera outbreaks two to three months in advance,” says Islam, who also holds an appointment as professor of water and diplomacy at The Fletcher School at Tufts. “It’s not a microbiological explanation. The key is the river discharge and regional climate.”

The Tufts researchers’ findings were reported in the latest issue of Geophysical Research Letters, published October 10, 2009.

Understanding cholera’s environmental catalysts

Vibrio cholerae lives and thrives among phytoplankton and zooplankton in brackish estuaries where rivers come into contact with the sea. The Bengal Delta, which scientists have considered the native land of cholera, is fed by three rivers.

Almost all of the rainfall in the region occurs during the four-month monsoon season between June and September. Water levels in the river system rise, causing floods that cover 20 percent of the land in an average year. Water levels then fall rapidly, though low-lying, depressed areas remain submerged for weeks.

The Tufts team tracked the month-by-month incidence of cholera using data from the International Center for Diarrhoeal Disease Research, a treatment center that recorded incidences of cholera for the biggest population center of Bangladesh from 1980 to 2000.

The Tufts team correlated these cholera incidence statistics with an analysis of water discharges from the three rivers. Their findings suggested two distinctive epidemic patterns that are associated with the seasonal cycles of low river flows and floods.

A spring outbreak occurs in March, during the period of low river flow in Bangladesh. The low river flow allows seawater from the Bay of Bengal to move inland, transporting bacteria-carrying plankton.

A second epidemic occurs in September and October, after monsoon rains have raised water levels. Here, a different dynamic takes place. Floodwaters have mixed water from sewers, reservoirs and rivers. As the floods recede, contamination is left behind..

Predicting cholera before it happens

Islam and his team linked the incidence of cholera cases to the level of water flow in the rivers. In order to confirm their findings, the researchers looked for a consistent pattern. They analyzed the incidence of cholera in five years of severely low river flow from 1980 to 2000 and compared it with five years of average and below average river flow. The same analysis was done for extreme, average and below average floods to study the fall epidemic.

The researchers found a relationship between the magnitude of cholera outbreaks and the severity of the region’s seasonal low river flow and floods. “The more severe the low river flow, the larger the spring epidemic,” says Islam. “The same thing is true with flooding during the fall.” Islam says that the findings will contribute to the development of systems to anticipate and predict cholera outbreaks based on the hydroclimate of the region.

This research was funded in part by the National Science Foundation and a National Institutes of Health Fellowship. Researchers included engineering doctoral students Ali S. Akanda and Antarpreet S. Jutla.

Akanda, A. S., A. S. Jutla, and S. Islam (2009), “Dual peak cholera transmission in Bengal Delta: A hydroclimatological explanation,” Geophys. Res. Lett., 36, L19401, doi: 10.1029/2009GL039312.

Source: Alexander Reid

Tufts University Continue reading →

A significant number of people world-wide suffer with chronic pain, which affects every aspect of their lives, and often results in depression.

Researchers at Kent State University and Case Western University, led by Kent State nursing professor Wendy Lewandowski, tracked the experience of 44 patients being treated for chronic pain. Patients in one group listened to a seven-minute audio tape that helped them to relax, focus on the sensory images their pain evoked, and then guided them to change the sensory images. This technique, known as “guided imagery,” is an effective supplement to medication therapy. Unlike those in the control group, the guided imagery patients in the study described their pain as ultimately more tolerable or easier to control.

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The study’s findings were published in the journal Pain Management Nursing.

For more information about chronic pain and the use of alternative therapies in chronic pain management, contact Lewandowski at wlewandokent.edu.

Contact: Lisa Lambert

Kent State University Continue reading →

While mainstream news coverage is still a primary source of information for the latest in policy debates and the health care marketplace, online blogs have become a significant part of the media landscape, often presenting new perspectives on policy issues and drawing attention to under-reported topics. To provide complete coverage of health policy issues, the Kaiser Daily Health Policy Report offers readers a window into the world of blogs in a roundup of health policy-related blog posts. “Blog Watch,” published on Tuesdays and Fridays, tracks a wide range of blogs, providing a brief description and relevant links for highlighted posts.

The American Prospect’s Ezra Klein discusses U.S. government health spending, saying that “we’ve managed to offload an incredible amount of spending onto government but done so in a way that ensures the government can’t use its size or regulatory power to cut spending growth or produce a manageable, moral health system.”

Michael Cannon from CatoLiberty argues that the uninsured are not “free riders” in part because “it’s not at all clear that when people don’t buy health insurance, they are imposing costs on the rest of us.”

Igor Volsky from the Center for American Progress Action Fund’s Wonk Room Blog says that presumptive Republican presidential nominee Sen. John McCain’s (Ariz.) health plan “would remove the employer’s incentive to provide coverage and could potentially unravel the current system.” Volsky disagrees with Douglas Holtz-Eakin, McCain’s chief domestic policy adviser, who on Thursday said that McCain’s plan would “buttress … the traditional source of health insurance, which is employers.”

Gert Westert on the Health Affairs Blog provides an overview of the Dutch health system, which many have suggested could be a model for the U.S.

The Health Care Blog’s Matthew Holt writes about a presentation by Andrew Dillon, head of the United Kingdom’s National Institute for Clinical Excellence, on methods the agency uses to compare cost and clinical effectiveness. Holt also expresses skepticism that a similar agency could “be established or even survive” in the U.S.

Lindsay Tucker from Health Care for All’s A Healthy Blog writes that Massachusetts health reform “has been successful — and continues to be,” in response to a New York Times article about insurance coverage and chronic disease that quoted an expert saying, “the state experiments have all failed because of cost.”

Bob Laszewski from Health Care Policy and Marketplace Review hosts the most recent edition of Health Wonk Review, a biweekly compendium of more than two dozen health policy, infrastructure, insurance, technology and managed care bloggers. A different participant’s blog hosts each issue.

Health Populi’s Jane Sarasohn-Kahn responds to a new survey by the ERISA Industry Committee and the National Association of Manufacturers that finds only 30% of employers measure the results of their wellness programs. She writes that more data is needed to discern which incentives work best for different wellness components.

Conn Carroll from the Heritage Foundation’s The Foundry writes that “libertarians may have plenty of other grounds to criticize McCain on, but on health care McCain is advocating a libertarian vision.” Carroll disagrees with an article from Reason that says “neither party wants change in the current system.”

Insure Blog’s Bob Vineyard discusses high deductibles and low annual limits in the Healthy Indiana Plan and asks, “[R]ather than creating a special plan just for the 130,000 uninsured, why not use the tax money to subsidize the purchase of health insurance plans that already exist in the marketplace? Isn’t that a better use of resources?”

Joe Paduda from Managed Care Matters disagrees with blogger Catron’s (here) use of statistics from a recent Lancet study that finds the U.S. has the highest rates of survival for certain cancers.

Joanne Kenen from the Century Foundation’s New Health Dialogue discusses Kentucky’s efforts to reduce health costs by recruiting eligible state employees and retirees into disease management programs offered by the state’s Employees Health Plan.

Jacob Goldstein of the Wall Street Journal’s Health Blog discusses secrecy surrounding FDA’s rejection of drug applications.

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved. Continue reading →

Carlos Mar?­a Romeo Casabona is Director of the Interuniversity Professorship in Law and the Humane Genome at Deusto University and the University of the Basque Country. The Professorship is largely made up of jurists but also has other experts such as researchers in the fields of molecular biology, medicine and even specialists in ethics.

The Interuniversity Professorship in Law and the Humane Genome at the Universities of Deusto and the Basque Country was created in 1993. The worldwide Humane Genome project was then involved in sequencing the genome – i.e. identifying all the genetic components – for the human being. Various problems arose, such as, if the genes could or should be patented, the use to which the information would be put, and so on. Once the programme was concluded and, based on this knowledge, the Professorship in Law focused on studying how this knowledge could be applied to the diagnosis of certain illnesses. Mr Romeo explained, “What is involved is identifying genes responsible for certain illnesses, as it is known that, if one has certain genes, the risk of contracting specific illnesses is higher. This is the case, for example, of breast cancer”. The Professorship also looked at stem cells and cloning. “Our field of study is evolving as the foci of research evolves”, he added.

Research and Law

The scientific advances with the humane genome over the past decade has meant that science is in a very favourable position to treat illnesses that previously lacked any medical response and, what is more, has opened a wide range of therapeutic possibilities that are really surprising. Nevertheless, this intense scientific advance is also generating social and judicial conflicts regarding the privacy of persons, protection of data, etc. Mr Romeo recognises that all this involves information that is highly sensitive. This has spurred the Professorship to take on board this topic of data protection regarding a person’s health and other personal data. “As people we are very vulnerable regarding our personal information, more so with information which our genes provide about our health – data that is predictive, looking to the future”, explained Mr Romeo.

“This is why, research and legislation should go hand in hand”, underlined Mr Romeo. According to this researcher, the challenge for legal rights is for it to go hand in hand with advances in research, as much as possible; it has to be dynamic in the sense that it should change according to needs as they arise, given that research matters are ever-changing, especially in this case. “If research is carried out responsibly, the limits that legislation places on biomedical research should not go beyond what is necessary at each period of time” explained Mr Romeo.

“For example, the legislation on the removal and transplant of organs passed in 1979 – I drew up the text of the Bill, states Mr Romeo-, will be 30 years old at the end of this month of October.” According to Mr Romeo, there has been no need to modify this law. “The essential was there and nothing has changed, given that it would appear to be evident that permission has to be sought of a living donor to extract an organ, or the heart cannot be removed if this were to cause death, and so on”. There has been no need to make changes to this. In other cases, however, it is indeed necessary to modify existing legislation.

Source: Irati Kortabitarte

Elhuyar Fundazioa Continue reading →