XMRV On Everyone’s Mind at a Chronic Fatigue Syndrome Meeting

The Chronic Fatigue Syndrome Advisory Committee — which advises the head of HHS on policy and scientific issues related to CFS — just wrapped up its latest meeting. During three days of presentations and debate (you can watch it all here), it was hard to avoid talking or thinking about XMRV.

That?s the retrovirus that was linked to CFS in a study published last year in the journal Science. Scientists have been debating the finding ever since, with some labs finding the virus in a majority of CFS patients and other labs not finding XMRV in a single case.

At the meeting’s public comment period, CFS patients pressed for more funding to study XMRV and to launch clinical trials. Many of the patients wore shirts with “NIH: What have you done for ME/CFS today?” emblazoned on the front. And some held up “Act Now” placards. (”ME” refers to myalgic encephalomyelitis/encephalopathy, another term used to describe the condition.)

For the first time, an extra day was added to the advisory committee meeting to focus solely on scientific developments; XMRV got prominent billing. In its final recommendations to HHS, the committee called for the creation of a national clinical trials network. “When [the science behind] XMRV gets sorted out, we?ll be ready to jump,” advisory committee member Nancy Klimas, a University of Miami professor who runs a CFS clinic and researches the condition, tells the Health Blog.

The idea, Klimas says, is to set up a network of at least five centers to serve as a kind of hub for research, clinical care and education. Doctors would start collecting standardized clinical and research data from patients at the sites, and teams of investigators would work together to develop common clinical trial protocols to start pushing drug development for CFS.

Yet a number of scientists at the meeting expressed caution about XMRV. Stuart LeGrice, who has helped lead XMRV efforts at NCI, gave the scientific talk on the virus and urged patients to wait until more is known before taking anti-retroviral medications. (Some are already taking the meds, as the WSJ reported recently.) “We?re not far from a controlled clinical trial,” he told participants during a Q&A session.

And while XMRV is a hot topic, Christopher Snell, the chair of the advisory committee, said at the meeting that research on XMRV has “overshadowed” other possible CFS research avenues. Klimas tells the Health Blog that research in CFS is finally yielding a number of possible therapeutic strategies that spring from other hypotheses unrelated to XMRV.

However, for patients like Robert Miller — who testified at the meeting — it’s clear what’s providing the momentum in CFS research. “This all started because of XMRV,” he said.

Image: iStockphoto

View the original article here

What Happens to Screening Rates When the Deductible Disappears?

You can see why insurers and employers would want to encourage people to take advantage of preventive care — in theory, it will cut the chances of later developing potentially costly diseases and conditions. (In practice, prevention may improve individual health, but there’s evidence that at least some of it doesn’t save the system money.)

As we’ve written, many companies pick up all or part of the costs of tests and procedures considered to fall under the preventive-care umbrella, including some cancer screening tests, annual physicals and flu shots.

Researchers funded by the government, Rand Corp.’s Bing Center for Health Economics and Merck wanted to see if that kind of incentive works. So they looked at whether screening rates changed at all when an employer eliminated the deductible for preventive tests and routine physical exams. (People still had to pay between 20% and 30% of the cost, in the form of co-insurance.) They analyzed data covering three different groups: people in high- and low-deductible plans, before and after the preventive care deductible was eliminated; and a control group from another employer where the deductible for preventive care didn’t change. Their findings were published in Health Services Research.

Scrapping the deductible “modestly” improved screening rates for blood-cholesterol tests, Pap smears, mammograms and fecal-occult blood tests, the researchers conclude. After adjusting for demographics and the overall trend of the test’s use, “there were between 23 and 78 additional uses per 1,000 eligible patients of covered preventive screens.”

But they recommend that “patients’ predisposing characteristics merit attention.” They’re referring to the finding that the expanded prevention coverage had a smaller effect on screening rates among people with high-deductible plans — perhaps because those folks are less risk-averse than the people who opt for low-deductible plans, or prefer to interact less with the health-care system. Or they could just be different in some other way that wasn’t controlled for by the study — such as income. (We wonder if they’re more skeptical about the value of some screening tests whose risk-benefit ratio isn’t so clear, such as mammograms for women in their 40s.)

The point is, though, that not everyone will respond in the same way to an incentive that would seem to work in a pretty straightforward way, i.e. lowering the out-of-pocket costs of a certain test or office visit. If the goal is to increase screening rates among the people who opt for high-deductible plans, other approaches — like patient or physician reminders or education — should also be studied, the researchers conclude.

Further reading:

Image: iStockphoto

View the original article here

XMRV On Everyone’s Mind at a Chronic Fatigue Syndrome Meeting

The Chronic Fatigue Syndrome Advisory Committee — which advises the head of HHS on policy and scientific issues related to CFS — just wrapped up its latest meeting. During three days of presentations and debate (you can watch it all here), it was hard to avoid talking or thinking about XMRV.

That?s the retrovirus that was linked to CFS in a study published last year in the journal Science. Scientists have been debating the finding ever since, with some labs finding the virus in a majority of CFS patients and other labs not finding XMRV in a single case.

At the meeting’s public comment period, CFS patients pressed for more funding to study XMRV and to launch clinical trials. Many of the patients wore shirts with “NIH: What have you done for ME/CFS today?” emblazoned on the front. And some held up “Act Now” placards. (”ME” refers to myalgic encephalomyelitis/encephalopathy, another term used to describe the condition.)

For the first time, an extra day was added to the advisory committee meeting to focus solely on scientific developments; XMRV got prominent billing. In its final recommendations to HHS, the committee called for the creation of a national clinical trials network. “When [the science behind] XMRV gets sorted out, we?ll be ready to jump,” advisory committee member Nancy Klimas, a University of Miami professor who runs a CFS clinic and researches the condition, tells the Health Blog.

The idea, Klimas says, is to set up a network of at least five centers to serve as a kind of hub for research, clinical care and education. Doctors would start collecting standardized clinical and research data from patients at the sites, and teams of investigators would work together to develop common clinical trial protocols to start pushing drug development for CFS.

Yet a number of scientists at the meeting expressed caution about XMRV. Stuart LeGrice, who has helped lead XMRV efforts at NCI, gave the scientific talk on the virus and urged patients to wait until more is known before taking anti-retroviral medications. (Some are already taking the meds, as the WSJ reported recently.) “We?re not far from a controlled clinical trial,” he told participants during a Q&A session.

And while XMRV is a hot topic, Christopher Snell, the chair of the advisory committee, said at the meeting that research on XMRV has “overshadowed” other possible CFS research avenues. Klimas tells the Health Blog that research in CFS is finally yielding a number of possible therapeutic strategies that spring from other hypotheses unrelated to XMRV.

However, for patients like Robert Miller — who testified at the meeting — it’s clear what’s providing the momentum in CFS research. “This all started because of XMRV,” he said.

Image: iStockphoto

View the original article here

Author Rick Riordan’s Ideas For Helping ADHD Kids Enjoy Reading

Rick Riordan’s latest book, which kicks off a new series.

We at the Health Blog are not afraid to admit that we devoured Rick Riordan’s blockbuster “Percy Jackson and the Olympians” series of kids’ books, despite being a few decades older than the target demographic.

So we were intrigued to read that the series sprang from the bedtime stories the author used to tell his son Haley, who — like Percy — has dyslexia and ADHD. And as Riordan writes today on WSJ’s Speakeasy blog, Haley, now 16, has become an avid reader.

(We’ve written about the drug treatments for ADHD, which are a big driver of increased spending on kids’ meds.)

Riordan offers up four tips he’s gleaned from being a dad and a classroom teacher for encouraging a reading habit among kids with ADHD, dyslexia or other learning “differences,” as he says. We think they sound like good advice for any parent trying to get any kid — ADHD or not –to put down the Nintendo Game Boy and pick up a book.

First, Riordan recommends parents model reading at home to give children the “sense that it is a valuable part of your daily routine.” He continues:

Sometimes the Riordan family will read books together. Sometimes we?re all reading different things. But we value books, and we have great conversations about our favorite authors and stories.

To read all of Riordan’s suggestions, check out the Speakeasy post.

View the original article here

FDA Sniffing Around Pfizer’s Doggy Weight-Loss Drug Slentrol

Not only have we in the U.S. made ourselves fat, we’ve dragged our dogs along with us. Hence, Slentrol, Pfizer’s FDA-approved drug to help pudgy pugs lose a neck roll or three.

But the FDA says a preliminary analysis suggests a “potential correlation” between the breed of the dog and certain side effects of the drug, Dow Jones Newswires reports, citing an agency document. The FDA is planning to study genetic data on dogs that have taken Slentrol to see if certain breeds are more susceptible to problems. It didn’t specify which adverse events it’s tracking.

Pfizer disagrees with this plan, DJN reports. The company says side effects listed on the label, including vomiting, diarrhea and lethargy, are usually mild, and that specific breeds don’t seem to be disproportionately affected.

The breeds most commonly associated with adverse events with Slentrol — Labrador retriever, beagle, golden retriever, dachshund, pug and Chihuahua — are also very common, and some are predisposed to obesity, Pfizer says.

Meantime, there’s been lots of action on the diet-drugs-for-humans front. Last week Abbott pulled Meridia from the market at the FDA’s behest, on concerns of cardiovascular side effects. Three experimental drugs are up for FDA consideration; an advisory panel has voted not to recommend two of them, Arena’s lorcaserin and Vivus’s Qnexa. Orexigen’s Contrave comes before the panel late this year. (The FDA doesn’t have to follow the advice of its advisory panel, though it often does.)

Humans on the hunt for new options shouldn’t steal Fido’s Slentrol, however. The FDA has said that Pfizer tested the drug in a small number of people and it produced swollen abdomens, stomach pain, diarrhea, flatulence, nausea and vomiting.

Further reading:

Photo by dboy via Flickr

View the original article here

Study Suggests Electronic Medical Records Improve Adverse-Event Reporting

Digitized medical records and systems have been proposed as a remedy for a lot of problems, from the difficulty of deciphering a doctor’s handwriting to decentralized and inaccessible patient medical information to long ER wait times. (Whether electronic records can live up to all the hype is, of course, not clear.)

Now a new Pfizer-sponsored study suggests digitized records may improve the reporting of adverse events associated with prescription drugs, the WSJ reports. (The paper also wrote about this project when it was in progress.)

Research suggests the vast majority of harmful drug-related side effects go unreported to the FDA. This small study — covering 26 physicians at two Boston hospitals over a five-month period — set out to see if incorporating reporting into the electronic medical record system could help change that. As the WSJ describes it: “When one of the doctors in the study recorded discontinuing a medicine because a patient experienced an adverse event, the hospital’s electronic patient record system generated an alert. The system asked the doctor whether the side effect was serious and submitted a report to regulators.”

The physicians in the study reported 217 side effects to regulators during the study period, compared to none the year before.

Only about 20% of the flagged side effects were serious, and the Brigham and Women’s Hospital internist who led the study tells the paper the system may need some rejiggering to reduce the number of reports of non-serious issues. A common complaint of physicians who use electronic medical records is that they issue so many automated alerts for things such as drug interactions that doctors end up ignoring many of the messages.

Further reading:

Image: iStockphoto

View the original article here

Survey: Plenty of Uncertainty on Impact of Health-Care Overhaul

Almost half of private-company CEOs and CTOs surveyed by PricewaterhouseCoopers say health-care overhaul legislation may affect their business financially, while another 31% say it’s too soon to assess the impact.

The uncertainty isn’t totally surprising, since most of the provisions of the bill haven’t kicked in yet. But employers are still sussing out even the provisions that took effect Sept. 23 — or will in the next plan year.

Take the requirement that plans cover dependents until age 26, for example: 28% say they’re not certain of the impact (or didn’t answer the question). Another 29% said it would likely have no impact, and 43% said it would have either a slight or moderate/significant impact.

The executives surveyed said the increase in Medicare tax on high-income individuals would have the biggest financial impact — 31% reported it would have a moderate or significant impact. (Then again, 27% said it would likely have no impact.) The provision getting the greatest proportion of “no impact” votes — 66% –? was the penalty for companies with 50 or more employers that fail to provide minimal affordable coverage.

The new PwC survey covers the views of 224 CEOs and CTOs representing private companies averaging $257 million in annual sales.

Even without knowing the full financial impact of the law, some 70% say they’ll reevaluate their company’s overall benefit strategy and 60% plan to change benefits to comply with the law. More than half — 52% — say they’re likely to change employee contributions for medical coverage. That’s not too far off from a recent National Business Group on Health survey reporting 63% of big employers plan to increase the proportion of premiums paid by workers.

Further reading:

View the original article here

A.M. Vitals: Case Claiming Individual Mandate is Unconstitutional to Proceed

Case to Proceed: A federal judge says the assertion by 20 states that the health-care overhaul law’s individual coverage mandate is unconstitutional is “a plausible claim,” the WSJ reports. Judge Roger Vinson of U.S. District Court for the Northern District of Florida is permitting the states’ case to go forward. He was more skeptical about the claim that the expansion of Medicaid included in the bill is also unconstitutional, but permitted it to go forward as well. The case is likely to make it to the Supreme Court, the WSJ says.

Offering Suggestions: UnitedHealth Group suggests that to save money, health benefits for the nine million people eligible for both Medicare and Medicaid should be administered via managed-care plans, Bloomberg News reports. The insurer issued a report proposing several measures for Medicare and Medicaid it says can save $3.5 trillion over the next 25 years.

FDA Reversal: The FDA said it shouldn’t have allowed the Menaflex knee implant to reach the market because political influence affected the approval process, and is now revoking its approval of the device, the WSJ reports. As the paper wrote in 2009, the implant, made by ReGen Biologics, was approved following a lobbying campaign by four members of Congress — even after FDA staff questioned its safety and efficacy. ReGen says it’s weighing its options, which include an appeal of the decision.

Fighting Bacteria?: Chiquita Brands’ Fresh Express, which makes bagged salad mixes, says washing greens in a mixture of two organic acids — rather than the usual chlorine — is a more effective way to kill off potentially dangerous bacteria, the New York Times reports. The company will switch to the FreshRinse wash and will also license it to other producers; food-safety experts tell the NYT that without published data, it’s impossible to verify the wash’s effectiveness. Fresh Express has recalled packaged greens three times this year over bacterial contamination worries, the NYT says.

Image: iStockphoto

View the original article here

What Happens to Screening Rates When the Deductible Disappears?

You can see why insurers and employers would want to encourage people to take advantage of preventive care — in theory, it will cut the chances of later developing potentially costly diseases and conditions. (In practice, prevention may improve individual health, but there’s evidence that at least some of it doesn’t save the system money.)

As we’ve written, many companies pick up all or part of the costs of tests and procedures considered to fall under the preventive-care umbrella, including some cancer screening tests, annual physicals and flu shots.

Researchers funded by the government, Rand Corp.’s Bing Center for Health Economics and Merck wanted to see if that kind of incentive works. So they looked at whether screening rates changed at all when an employer eliminated the deductible for preventive tests and routine physical exams. (People still had to pay between 20% and 30% of the cost, in the form of co-insurance.) They analyzed data covering three different groups: people in high- and low-deductible plans, before and after the preventive care deductible was eliminated; and a control group from another employer where the deductible for preventive care didn’t change. Their findings were published in Health Services Research.

Scrapping the deductible “modestly” improved screening rates for blood-cholesterol tests, Pap smears, mammograms and fecal-occult blood tests, the researchers conclude. After adjusting for demographics and the overall trend of the test’s use, “there were between 23 and 78 additional uses per 1,000 eligible patients of covered preventive screens.”

But they recommend that “patients’ predisposing characteristics merit attention.” They’re referring to the finding that the expanded prevention coverage had a smaller effect on screening rates among people with high-deductible plans — perhaps because those folks are less risk-averse than the people who opt for low-deductible plans, or prefer to interact less with the health-care system. Or they could just be different in some other way that wasn’t controlled for by the study — such as income. (We wonder if they’re more skeptical about the value of some screening tests whose risk-benefit ratio isn’t so clear, such as mammograms for women in their 40s.)

The point is, though, that not everyone will respond in the same way to an incentive that would seem to work in a pretty straightforward way, i.e. lowering the out-of-pocket costs of a certain test or office visit. If the goal is to increase screening rates among the people who opt for high-deductible plans, other approaches — like patient or physician reminders or education — should also be studied, the researchers conclude.

Further reading:

Image: iStockphoto

View the original article here

CVS Will Pay $75 Million After ‘Smurfers’ Bought Meth Ingredients

If you’d been in a CVS in Los Angeles during 2008, you might have witnessed people coming into the store and clearing the store’s shelves of cough and cold medicines. It also might have occurred to you that they weren’t just facing a bad case of the sniffles.

According to federal prosecutors in L.A., those folks were “smurfing”: making “multiple purchases of pseudoephedrine in small amounts with the intent to aggregate the purchases for use in the illegal production of methamphetamine.” And CVS became smurfing central as those folks discovered that those stores, “unlike other large chain retail pharmacies, allowed customers to make repeated purchases of pseudoephedrine that exceeded federal daily and monthly sales limits,” the U.S. Attorney’s Office for the Central District of California says.

That big whoopsy-daisy is costing CVS $75 million in civil fines (and the estimated $2.6 million it made on the medications).

As the Associated Press reports, CVS was supposed to be monitoring and limiting how much pseudoephedrine its customers purchased. It had an automated “Meth Tracker” electronic logbook to record purchases, but did nothing to stop the smurfers (we can’t stop saying that word!) from making multiple purchases in a day.

CVS Caremark CEO Thomas Ryan said that the chain violated its own policies. “To make certain this kind of lapse never takes place again, we have strengthened our internal controls and compliance measures and made substantial investments to improve our handling and monitoring of [pseudoephedrine] by implementing enhanced technology and making other improvements in our stores and distribution centers,” he said in a statement.

The AP says CVS declined to comment on the government’s allegation that the company failed to follow up on reports from employees and store managers about the repeat purchases.

Prosecutors say the violations occurred in Nevada and elsewhere, too; this settlement covers liability in 25 states. As part of the deal, the government won’t seek criminal charges against CVS.

Image: iStockphoto

View the original article here

People Are Suing Hospitals for Malpractice More Frequently, Report Finds

The pace of malpractice claims against hospitals is picking up, according to a recent report from Aon Risk Solutions and the American Society for Healthcare Risk Management.

Earlier in the decade, growth in the frequency of claims declined for several years in a row, down to a 1.81% increase for incidents occurring in 2006. The pace has now ticked up for the past three years, to 1.95% for incidents occurring last year, the report says.

It estimates the cost of the 44,000-odd claims arising from incidents occurring last year will top $8.6 billion (that covers hospitals only, not physicians or long-term care facilities.) Obstetrics-related claims alone will run an estimated $1.4 billion.

Erik Johnson, health care practice leader for Aon Risk Solutions’ Actuarial and Analytics Practice, tells the Health Blog it’s not clear why the frequency of claims against hospitals is edging up. Possibilities include a weakening of tort reforms in some states and the recession — he says hard times may make people more likely to file a claim.

Health-care overhaul legislation didn’t affect the forecast, Johnson says. While hospitals may be focused on how that law will impact their business, “they should focus at least one eye on this [liability] expense,” he says.

It’s also possible that as community hospitals increasingly employ physicians, some liability costs may be shifting from doctors to hospitals, he says.

The average loss per claim (including expenses) is rising at a steady 4% annual rate, the report says. It’s expected to be $153,000 for incidents that occurred last year. That stat covers only losses up to $2 million, which is to limit the influence of rare large awards and also to reflect the expenses likely to be borne directly by the hospital — Johnson says most hospitals have a significant deductible and that insurance doesn’t kick in until a payout hits a certain amount.

A full 23% of hospital professional liability costs are associated with health-care acquired infections, health-care acquired injuries, medication errors, objects left in surgery and pressure ulcers, the report says.

Further reading:

Image: iStockphoto

View the original article here

Before You Increase That Dose, Check Past Use: Medco Study

Before upping the dose of an antidepressant, doctors may want to ask how often patients actually take their current prescriptions.

That?s the suggestion of a new study from big pharmacy-benefit manager Medco Health Solutions, presented Thursday at an American Psychiatric Association meeting. Researchers from the company’s research affiliate, the Cleveland Clinic and the Scottsdale Center for the Advancement of Neuroscience looked at 53,530 patients in Medco?s prescription database who had gotten their antidepressant doses increased. Then they examined how consistently those people had been taking their earlier, lower dose of the medication in the six months before the boost.

The upshot was that 29.7% of the folks hadn’t been taking their earlier, lower dose regularly. (The study defined “adequate adherence” as filling a prescription often enough to have the pills on hand at least 80% of the time.) Around 7.4% of the patients studied had their earlier dose on hand less than half the time.

David Muzina, national practice leader for neuroscience at Medco, suggests that patients may be suffering from side effects or feel some stigma from being on an antidepressant. They may also simply not see any difference in symptoms if they skip a few doses. Still, he tells the Health Blog, as a psychiatrist he was “flabbergasted” by the number who weren?t taking their meds regularly, since patients are “generally really eager for help and want help” with conditions like depression.

The study also found that 65 or older were generally much more likely to be taking their antidepressants regularly, while those who were 18 or younger were much less reliable. Men were a bit better about taking their drugs than women. And people with more other medical conditions were also more compliant pill-takers. The study tied medication adherence to use of mail-order pharmacy, which PBMs like Medco tend to push over retail pickups. PBMs typically make more money when enrollees use their mail order services.

PBMs are getting increasingly aggressive about research and services that push medication compliance, which isn?t a big surprise because they make money partly based on prescriptions being filled. Their corporate clients are interested in such efforts because research shows that only about half of people who are prescribed drugs for chronic conditions are still taking them regularly after a year, and those dropouts can generate much bigger medical claims down the line.

Further reading:

Image: iStockphoto

View the original article here

XMRV On Everyone’s Mind at a Chronic Fatigue Syndrome Meeting

The Chronic Fatigue Syndrome Advisory Committee — which advises the head of HHS on policy and scientific issues related to CFS — just wrapped up its latest meeting. During three days of presentations and debate (you can watch it all here), it was hard to avoid talking or thinking about XMRV.

That?s the retrovirus that was linked to CFS in a study published last year in the journal Science. Scientists have been debating the finding ever since, with some labs finding the virus in a majority of CFS patients and other labs not finding XMRV in a single case.

At the meeting’s public comment period, CFS patients pressed for more funding to study XMRV and to launch clinical trials. Many of the patients wore shirts with “NIH: What have you done for ME/CFS today?” emblazoned on the front. And some held up “Act Now” placards. (”ME” refers to myalgic encephalomyelitis/encephalopathy, another term used to describe the condition.)

For the first time, an extra day was added to the advisory committee meeting to focus solely on scientific developments; XMRV got prominent billing. In its final recommendations to HHS, the committee called for the creation of a national clinical trials network. “When [the science behind] XMRV gets sorted out, we?ll be ready to jump,” advisory committee member Nancy Klimas, a University of Miami professor who runs a CFS clinic and researches the condition, tells the Health Blog.

The idea, Klimas says, is to set up a network of at least five centers to serve as a kind of hub for research, clinical care and education. Doctors would start collecting standardized clinical and research data from patients at the sites, and teams of investigators would work together to develop common clinical trial protocols to start pushing drug development for CFS.

Yet a number of scientists at the meeting expressed caution about XMRV. Stuart LeGrice, who has helped lead XMRV efforts at NCI, gave the scientific talk on the virus and urged patients to wait until more is known before taking anti-retroviral medications. (Some are already taking the meds, as the WSJ reported recently.) “We?re not far from a controlled clinical trial,” he told participants during a Q&A session.

And while XMRV is a hot topic, Christopher Snell, the chair of the advisory committee, said at the meeting that research on XMRV has “overshadowed” other possible CFS research avenues. Klimas tells the Health Blog that research in CFS is finally yielding a number of possible therapeutic strategies that spring from other hypotheses unrelated to XMRV.

However, for patients like Robert Miller — who testified at the meeting — it’s clear what’s providing the momentum in CFS research. “This all started because of XMRV,” he said.

Image: iStockphoto

View the original article here

A.M. Vitals: Case Claiming Individual Mandate is Unconstitutional to Proceed

Case to Proceed: A federal judge says the assertion by 20 states that the health-care overhaul law’s individual coverage mandate is unconstitutional is “a plausible claim,” the WSJ reports. Judge Roger Vinson of U.S. District Court for the Northern District of Florida is permitting the states’ case to go forward. He was more skeptical about the claim that the expansion of Medicaid included in the bill is also unconstitutional, but permitted it to go forward as well. The case is likely to make it to the Supreme Court, the WSJ says.

Offering Suggestions: UnitedHealth Group suggests that to save money, health benefits for the nine million people eligible for both Medicare and Medicaid should be administered via managed-care plans, Bloomberg News reports. The insurer issued a report proposing several measures for Medicare and Medicaid it says can save $3.5 trillion over the next 25 years.

FDA Reversal: The FDA said it shouldn’t have allowed the Menaflex knee implant to reach the market because political influence affected the approval process, and is now revoking its approval of the device, the WSJ reports. As the paper wrote in 2009, the implant, made by ReGen Biologics, was approved following a lobbying campaign by four members of Congress — even after FDA staff questioned its safety and efficacy. ReGen says it’s weighing its options, which include an appeal of the decision.

Fighting Bacteria?: Chiquita Brands’ Fresh Express, which makes bagged salad mixes, says washing greens in a mixture of two organic acids — rather than the usual chlorine — is a more effective way to kill off potentially dangerous bacteria, the New York Times reports. The company will switch to the FreshRinse wash and will also license it to other producers; food-safety experts tell the NYT that without published data, it’s impossible to verify the wash’s effectiveness. Fresh Express has recalled packaged greens three times this year over bacterial contamination worries, the NYT says.

Image: iStockphoto

View the original article here

Survey: Plenty of Uncertainty on Impact of Health-Care Overhaul

Almost half of private-company CEOs and CTOs surveyed by PricewaterhouseCoopers say health-care overhaul legislation may affect their business financially, while another 31% say it’s too soon to assess the impact.

The uncertainty isn’t totally surprising, since most of the provisions of the bill haven’t kicked in yet. But employers are still sussing out even the provisions that took effect Sept. 23 — or will in the next plan year.

Take the requirement that plans cover dependents until age 26, for example: 28% say they’re not certain of the impact (or didn’t answer the question). Another 29% said it would likely have no impact, and 43% said it would have either a slight or moderate/significant impact.

The executives surveyed said the increase in Medicare tax on high-income individuals would have the biggest financial impact — 31% reported it would have a moderate or significant impact. (Then again, 27% said it would likely have no impact.) The provision getting the greatest proportion of “no impact” votes — 66% –? was the penalty for companies with 50 or more employers that fail to provide minimal affordable coverage.

The new PwC survey covers the views of 224 CEOs and CTOs representing private companies averaging $257 million in annual sales.

Even without knowing the full financial impact of the law, some 70% say they’ll reevaluate their company’s overall benefit strategy and 60% plan to change benefits to comply with the law. More than half — 52% — say they’re likely to change employee contributions for medical coverage. That’s not too far off from a recent National Business Group on Health survey reporting 63% of big employers plan to increase the proportion of premiums paid by workers.

Further reading:

View the original article here

Study Suggests Electronic Medical Records Improve Adverse-Event Reporting

Digitized medical records and systems have been proposed as a remedy for a lot of problems, from the difficulty of deciphering a doctor’s handwriting to decentralized and inaccessible patient medical information to long ER wait times. (Whether electronic records can live up to all the hype is, of course, not clear.)

Now a new Pfizer-sponsored study suggests digitized records may improve the reporting of adverse events associated with prescription drugs, the WSJ reports. (The paper also wrote about this project when it was in progress.)

Research suggests the vast majority of harmful drug-related side effects go unreported to the FDA. This small study — covering 26 physicians at two Boston hospitals over a five-month period — set out to see if incorporating reporting into the electronic medical record system could help change that. As the WSJ describes it: “When one of the doctors in the study recorded discontinuing a medicine because a patient experienced an adverse event, the hospital’s electronic patient record system generated an alert. The system asked the doctor whether the side effect was serious and submitted a report to regulators.”

The physicians in the study reported 217 side effects to regulators during the study period, compared to none the year before.

Only about 20% of the flagged side effects were serious, and the Brigham and Women’s Hospital internist who led the study tells the paper the system may need some rejiggering to reduce the number of reports of non-serious issues. A common complaint of physicians who use electronic medical records is that they issue so many automated alerts for things such as drug interactions that doctors end up ignoring many of the messages.

Further reading:

Image: iStockphoto

View the original article here

Author Rick Riordan’s Ideas For Helping ADHD Kids Enjoy Reading

Rick Riordan’s latest book, which kicks off a new series.

We at the Health Blog are not afraid to admit that we devoured Rick Riordan’s blockbuster “Percy Jackson and the Olympians” series of kids’ books, despite being a few decades older than the target demographic.

So we were intrigued to read that the series sprang from the bedtime stories the author used to tell his son Haley, who — like Percy — has dyslexia and ADHD. And as Riordan writes today on WSJ’s Speakeasy blog, Haley, now 16, has become an avid reader.

(We’ve written about the drug treatments for ADHD, which are a big driver of increased spending on kids’ meds.)

Riordan offers up four tips he’s gleaned from being a dad and a classroom teacher for encouraging a reading habit among kids with ADHD, dyslexia or other learning “differences,” as he says. We think they sound like good advice for any parent trying to get any kid — ADHD or not –to put down the Nintendo Game Boy and pick up a book.

First, Riordan recommends parents model reading at home to give children the “sense that it is a valuable part of your daily routine.” He continues:

Sometimes the Riordan family will read books together. Sometimes we?re all reading different things. But we value books, and we have great conversations about our favorite authors and stories.

To read all of Riordan’s suggestions, check out the Speakeasy post.

View the original article here

What Happens to Screening Rates When the Deductible Disappears?

You can see why insurers and employers would want to encourage people to take advantage of preventive care — in theory, it will cut the chances of later developing potentially costly diseases and conditions. (In practice, prevention may improve individual health, but there’s evidence that at least some of it doesn’t save the system money.)

As we’ve written, many companies pick up all or part of the costs of tests and procedures considered to fall under the preventive-care umbrella, including some cancer screening tests, annual physicals and flu shots.

Researchers funded by the government, Rand Corp.’s Bing Center for Health Economics and Merck wanted to see if that kind of incentive works. So they looked at whether screening rates changed at all when an employer eliminated the deductible for preventive tests and routine physical exams. (People still had to pay between 20% and 30% of the cost, in the form of co-insurance.) They analyzed data covering three different groups: people in high- and low-deductible plans, before and after the preventive care deductible was eliminated; and a control group from another employer where the deductible for preventive care didn’t change. Their findings were published in Health Services Research.

Scrapping the deductible “modestly” improved screening rates for blood-cholesterol tests, Pap smears, mammograms and fecal-occult blood tests, the researchers conclude. After adjusting for demographics and the overall trend of the test’s use, “there were between 23 and 78 additional uses per 1,000 eligible patients of covered preventive screens.”

But they recommend that “patients’ predisposing characteristics merit attention.” They’re referring to the finding that the expanded prevention coverage had a smaller effect on screening rates among people with high-deductible plans — perhaps because those folks are less risk-averse than the people who opt for low-deductible plans, or prefer to interact less with the health-care system. Or they could just be different in some other way that wasn’t controlled for by the study — such as income. (We wonder if they’re more skeptical about the value of some screening tests whose risk-benefit ratio isn’t so clear, such as mammograms for women in their 40s.)

The point is, though, that not everyone will respond in the same way to an incentive that would seem to work in a pretty straightforward way, i.e. lowering the out-of-pocket costs of a certain test or office visit. If the goal is to increase screening rates among the people who opt for high-deductible plans, other approaches — like patient or physician reminders or education — should also be studied, the researchers conclude.

Further reading:

Image: iStockphoto

View the original article here

People Are Suing Hospitals for Malpractice More Frequently, Report Finds

The pace of malpractice claims against hospitals is picking up, according to a recent report from Aon Risk Solutions and the American Society for Healthcare Risk Management.

Earlier in the decade, growth in the frequency of claims declined for several years in a row, down to a 1.81% increase for incidents occurring in 2006. The pace has now ticked up for the past three years, to 1.95% for incidents occurring last year, the report says.

It estimates the cost of the 44,000-odd claims arising from incidents occurring last year will top $8.6 billion (that covers hospitals only, not physicians or long-term care facilities.) Obstetrics-related claims alone will run an estimated $1.4 billion.

Erik Johnson, health care practice leader for Aon Risk Solutions’ Actuarial and Analytics Practice, tells the Health Blog it’s not clear why the frequency of claims against hospitals is edging up. Possibilities include a weakening of tort reforms in some states and the recession — he says hard times may make people more likely to file a claim.

Health-care overhaul legislation didn’t affect the forecast, Johnson says. While hospitals may be focused on how that law will impact their business, “they should focus at least one eye on this [liability] expense,” he says.

It’s also possible that as community hospitals increasingly employ physicians, some liability costs may be shifting from doctors to hospitals, he says.

The average loss per claim (including expenses) is rising at a steady 4% annual rate, the report says. It’s expected to be $153,000 for incidents that occurred last year. That stat covers only losses up to $2 million, which is to limit the influence of rare large awards and also to reflect the expenses likely to be borne directly by the hospital — Johnson says most hospitals have a significant deductible and that insurance doesn’t kick in until a payout hits a certain amount.

A full 23% of hospital professional liability costs are associated with health-care acquired infections, health-care acquired injuries, medication errors, objects left in surgery and pressure ulcers, the report says.

Further reading:

Image: iStockphoto

View the original article here

CVS Will Pay $75 Million After ‘Smurfers’ Bought Meth Ingredients

If you’d been in a CVS in Los Angeles during 2008, you might have witnessed people coming into the store and clearing the store’s shelves of cough and cold medicines. It also might have occurred to you that they weren’t just facing a bad case of the sniffles.

According to federal prosecutors in L.A., those folks were “smurfing”: making “multiple purchases of pseudoephedrine in small amounts with the intent to aggregate the purchases for use in the illegal production of methamphetamine.” And CVS became smurfing central as those folks discovered that those stores, “unlike other large chain retail pharmacies, allowed customers to make repeated purchases of pseudoephedrine that exceeded federal daily and monthly sales limits,” the U.S. Attorney’s Office for the Central District of California says.

That big whoopsy-daisy is costing CVS $75 million in civil fines (and the estimated $2.6 million it made on the medications).

As the Associated Press reports, CVS was supposed to be monitoring and limiting how much pseudoephedrine its customers purchased. It had an automated “Meth Tracker” electronic logbook to record purchases, but did nothing to stop the smurfers (we can’t stop saying that word!) from making multiple purchases in a day.

CVS Caremark CEO Thomas Ryan said that the chain violated its own policies. “To make certain this kind of lapse never takes place again, we have strengthened our internal controls and compliance measures and made substantial investments to improve our handling and monitoring of [pseudoephedrine] by implementing enhanced technology and making other improvements in our stores and distribution centers,” he said in a statement.

The AP says CVS declined to comment on the government’s allegation that the company failed to follow up on reports from employees and store managers about the repeat purchases.

Prosecutors say the violations occurred in Nevada and elsewhere, too; this settlement covers liability in 25 states. As part of the deal, the government won’t seek criminal charges against CVS.

Image: iStockphoto

View the original article here

FDA Sniffing Around Pfizer’s Doggy Weight-Loss Drug Slentrol

Not only have we in the U.S. made ourselves fat, we’ve dragged our dogs along with us. Hence, Slentrol, Pfizer’s FDA-approved drug to help pudgy pugs lose a neck roll or three.

But the FDA says a preliminary analysis suggests a “potential correlation” between the breed of the dog and certain side effects of the drug, Dow Jones Newswires reports, citing an agency document. The FDA is planning to study genetic data on dogs that have taken Slentrol to see if certain breeds are more susceptible to problems. It didn’t specify which adverse events it’s tracking.

Pfizer disagrees with this plan, DJN reports. The company says side effects listed on the label, including vomiting, diarrhea and lethargy, are usually mild, and that specific breeds don’t seem to be disproportionately affected.

The breeds most commonly associated with adverse events with Slentrol — Labrador retriever, beagle, golden retriever, dachshund, pug and Chihuahua — are also very common, and some are predisposed to obesity, Pfizer says.

Meantime, there’s been lots of action on the diet-drugs-for-humans front. Last week Abbott pulled Meridia from the market at the FDA’s behest, on concerns of cardiovascular side effects. Three experimental drugs are up for FDA consideration; an advisory panel has voted not to recommend two of them, Arena’s lorcaserin and Vivus’s Qnexa. Orexigen’s Contrave comes before the panel late this year. (The FDA doesn’t have to follow the advice of its advisory panel, though it often does.)

Humans on the hunt for new options shouldn’t steal Fido’s Slentrol, however. The FDA has said that Pfizer tested the drug in a small number of people and it produced swollen abdomens, stomach pain, diarrhea, flatulence, nausea and vomiting.

Further reading:

Photo by dboy via Flickr

View the original article here

Before You Increase That Dose, Check Past Use: Medco Study

Before upping the dose of an antidepressant, doctors may want to ask how often patients actually take their current prescriptions.

That?s the suggestion of a new study from big pharmacy-benefit manager Medco Health Solutions, presented Thursday at an American Psychiatric Association meeting. Researchers from the company’s research affiliate, the Cleveland Clinic and the Scottsdale Center for the Advancement of Neuroscience looked at 53,530 patients in Medco?s prescription database who had gotten their antidepressant doses increased. Then they examined how consistently those people had been taking their earlier, lower dose of the medication in the six months before the boost.

The upshot was that 29.7% of the folks hadn’t been taking their earlier, lower dose regularly. (The study defined “adequate adherence” as filling a prescription often enough to have the pills on hand at least 80% of the time.) Around 7.4% of the patients studied had their earlier dose on hand less than half the time.

David Muzina, national practice leader for neuroscience at Medco, suggests that patients may be suffering from side effects or feel some stigma from being on an antidepressant. They may also simply not see any difference in symptoms if they skip a few doses. Still, he tells the Health Blog, as a psychiatrist he was “flabbergasted” by the number who weren?t taking their meds regularly, since patients are “generally really eager for help and want help” with conditions like depression.

The study also found that 65 or older were generally much more likely to be taking their antidepressants regularly, while those who were 18 or younger were much less reliable. Men were a bit better about taking their drugs than women. And people with more other medical conditions were also more compliant pill-takers. The study tied medication adherence to use of mail-order pharmacy, which PBMs like Medco tend to push over retail pickups. PBMs typically make more money when enrollees use their mail order services.

PBMs are getting increasingly aggressive about research and services that push medication compliance, which isn?t a big surprise because they make money partly based on prescriptions being filled. Their corporate clients are interested in such efforts because research shows that only about half of people who are prescribed drugs for chronic conditions are still taking them regularly after a year, and those dropouts can generate much bigger medical claims down the line.

Further reading:

Image: iStockphoto

View the original article here

A.M. Vitals: Case Claiming Individual Mandate is Unconstitutional to Proceed

Case to Proceed: A federal judge says the assertion by 20 states that the health-care overhaul law’s individual coverage mandate is unconstitutional is “a plausible claim,” the WSJ reports. Judge Roger Vinson of U.S. District Court for the Northern District of Florida is permitting the states’ case to go forward. He was more skeptical about the claim that the expansion of Medicaid included in the bill is also unconstitutional, but permitted it to go forward as well. The case is likely to make it to the Supreme Court, the WSJ says.

Offering Suggestions: UnitedHealth Group suggests that to save money, health benefits for the nine million people eligible for both Medicare and Medicaid should be administered via managed-care plans, Bloomberg News reports. The insurer issued a report proposing several measures for Medicare and Medicaid it says can save $3.5 trillion over the next 25 years.

FDA Reversal: The FDA said it shouldn’t have allowed the Menaflex knee implant to reach the market because political influence affected the approval process, and is now revoking its approval of the device, the WSJ reports. As the paper wrote in 2009, the implant, made by ReGen Biologics, was approved following a lobbying campaign by four members of Congress — even after FDA staff questioned its safety and efficacy. ReGen says it’s weighing its options, which include an appeal of the decision.

Fighting Bacteria?: Chiquita Brands’ Fresh Express, which makes bagged salad mixes, says washing greens in a mixture of two organic acids — rather than the usual chlorine — is a more effective way to kill off potentially dangerous bacteria, the New York Times reports. The company will switch to the FreshRinse wash and will also license it to other producers; food-safety experts tell the NYT that without published data, it’s impossible to verify the wash’s effectiveness. Fresh Express has recalled packaged greens three times this year over bacterial contamination worries, the NYT says.

Image: iStockphoto

View the original article here

FDA Sniffing Around Pfizer’s Doggy Weight-Loss Drug Slentrol

Not only have we in the U.S. made ourselves fat, we’ve dragged our dogs along with us. Hence, Slentrol, Pfizer’s FDA-approved drug to help pudgy pugs lose a neck roll or three.

But the FDA says a preliminary analysis suggests a “potential correlation” between the breed of the dog and certain side effects of the drug, Dow Jones Newswires reports, citing an agency document. The FDA is planning to study genetic data on dogs that have taken Slentrol to see if certain breeds are more susceptible to problems. It didn’t specify which adverse events it’s tracking.

Pfizer disagrees with this plan, DJN reports. The company says side effects listed on the label, including vomiting, diarrhea and lethargy, are usually mild, and that specific breeds don’t seem to be disproportionately affected.

The breeds most commonly associated with adverse events with Slentrol — Labrador retriever, beagle, golden retriever, dachshund, pug and Chihuahua — are also very common, and some are predisposed to obesity, Pfizer says.

Meantime, there’s been lots of action on the diet-drugs-for-humans front. Last week Abbott pulled Meridia from the market at the FDA’s behest, on concerns of cardiovascular side effects. Three experimental drugs are up for FDA consideration; an advisory panel has voted not to recommend two of them, Arena’s lorcaserin and Vivus’s Qnexa. Orexigen’s Contrave comes before the panel late this year. (The FDA doesn’t have to follow the advice of its advisory panel, though it often does.)

Humans on the hunt for new options shouldn’t steal Fido’s Slentrol, however. The FDA has said that Pfizer tested the drug in a small number of people and it produced swollen abdomens, stomach pain, diarrhea, flatulence, nausea and vomiting.

Further reading:

Photo by dboy via Flickr

View the original article here

Study Suggests Electronic Medical Records Improve Adverse-Event Reporting

Digitized medical records and systems have been proposed as a remedy for a lot of problems, from the difficulty of deciphering a doctor’s handwriting to decentralized and inaccessible patient medical information to long ER wait times. (Whether electronic records can live up to all the hype is, of course, not clear.)

Now a new Pfizer-sponsored study suggests digitized records may improve the reporting of adverse events associated with prescription drugs, the WSJ reports. (The paper also wrote about this project when it was in progress.)

Research suggests the vast majority of harmful drug-related side effects go unreported to the FDA. This small study — covering 26 physicians at two Boston hospitals over a five-month period — set out to see if incorporating reporting into the electronic medical record system could help change that. As the WSJ describes it: “When one of the doctors in the study recorded discontinuing a medicine because a patient experienced an adverse event, the hospital’s electronic patient record system generated an alert. The system asked the doctor whether the side effect was serious and submitted a report to regulators.”

The physicians in the study reported 217 side effects to regulators during the study period, compared to none the year before.

Only about 20% of the flagged side effects were serious, and the Brigham and Women’s Hospital internist who led the study tells the paper the system may need some rejiggering to reduce the number of reports of non-serious issues. A common complaint of physicians who use electronic medical records is that they issue so many automated alerts for things such as drug interactions that doctors end up ignoring many of the messages.

Further reading:

Image: iStockphoto

View the original article here

Before You Increase That Dose, Check Past Use: Medco Study

Before upping the dose of an antidepressant, doctors may want to ask how often patients actually take their current prescriptions.

That?s the suggestion of a new study from big pharmacy-benefit manager Medco Health Solutions, presented Thursday at an American Psychiatric Association meeting. Researchers from the company’s research affiliate, the Cleveland Clinic and the Scottsdale Center for the Advancement of Neuroscience looked at 53,530 patients in Medco?s prescription database who had gotten their antidepressant doses increased. Then they examined how consistently those people had been taking their earlier, lower dose of the medication in the six months before the boost.

The upshot was that 29.7% of the folks hadn’t been taking their earlier, lower dose regularly. (The study defined “adequate adherence” as filling a prescription often enough to have the pills on hand at least 80% of the time.) Around 7.4% of the patients studied had their earlier dose on hand less than half the time.

David Muzina, national practice leader for neuroscience at Medco, suggests that patients may be suffering from side effects or feel some stigma from being on an antidepressant. They may also simply not see any difference in symptoms if they skip a few doses. Still, he tells the Health Blog, as a psychiatrist he was “flabbergasted” by the number who weren?t taking their meds regularly, since patients are “generally really eager for help and want help” with conditions like depression.

The study also found that 65 or older were generally much more likely to be taking their antidepressants regularly, while those who were 18 or younger were much less reliable. Men were a bit better about taking their drugs than women. And people with more other medical conditions were also more compliant pill-takers. The study tied medication adherence to use of mail-order pharmacy, which PBMs like Medco tend to push over retail pickups. PBMs typically make more money when enrollees use their mail order services.

PBMs are getting increasingly aggressive about research and services that push medication compliance, which isn?t a big surprise because they make money partly based on prescriptions being filled. Their corporate clients are interested in such efforts because research shows that only about half of people who are prescribed drugs for chronic conditions are still taking them regularly after a year, and those dropouts can generate much bigger medical claims down the line.

Further reading:

Image: iStockphoto

View the original article here

Author Rick Riordan’s Ideas For Helping ADHD Kids Enjoy Reading

Rick Riordan’s latest book, which kicks off a new series.

We at the Health Blog are not afraid to admit that we devoured Rick Riordan’s blockbuster “Percy Jackson and the Olympians” series of kids’ books, despite being a few decades older than the target demographic.

So we were intrigued to read that the series sprang from the bedtime stories the author used to tell his son Haley, who — like Percy — has dyslexia and ADHD. And as Riordan writes today on WSJ’s Speakeasy blog, Haley, now 16, has become an avid reader.

(We’ve written about the drug treatments for ADHD, which are a big driver of increased spending on kids’ meds.)

Riordan offers up four tips he’s gleaned from being a dad and a classroom teacher for encouraging a reading habit among kids with ADHD, dyslexia or other learning “differences,” as he says. We think they sound like good advice for any parent trying to get any kid — ADHD or not –to put down the Nintendo Game Boy and pick up a book.

First, Riordan recommends parents model reading at home to give children the “sense that it is a valuable part of your daily routine.” He continues:

Sometimes the Riordan family will read books together. Sometimes we?re all reading different things. But we value books, and we have great conversations about our favorite authors and stories.

To read all of Riordan’s suggestions, check out the Speakeasy post.

View the original article here

CVS Will Pay $75 Million After ‘Smurfers’ Bought Meth Ingredients

If you’d been in a CVS in Los Angeles during 2008, you might have witnessed people coming into the store and clearing the store’s shelves of cough and cold medicines. It also might have occurred to you that they weren’t just facing a bad case of the sniffles.

According to federal prosecutors in L.A., those folks were “smurfing”: making “multiple purchases of pseudoephedrine in small amounts with the intent to aggregate the purchases for use in the illegal production of methamphetamine.” And CVS became smurfing central as those folks discovered that those stores, “unlike other large chain retail pharmacies, allowed customers to make repeated purchases of pseudoephedrine that exceeded federal daily and monthly sales limits,” the U.S. Attorney’s Office for the Central District of California says.

That big whoopsy-daisy is costing CVS $75 million in civil fines (and the estimated $2.6 million it made on the medications).

As the Associated Press reports, CVS was supposed to be monitoring and limiting how much pseudoephedrine its customers purchased. It had an automated “Meth Tracker” electronic logbook to record purchases, but did nothing to stop the smurfers (we can’t stop saying that word!) from making multiple purchases in a day.

CVS Caremark CEO Thomas Ryan said that the chain violated its own policies. “To make certain this kind of lapse never takes place again, we have strengthened our internal controls and compliance measures and made substantial investments to improve our handling and monitoring of [pseudoephedrine] by implementing enhanced technology and making other improvements in our stores and distribution centers,” he said in a statement.

The AP says CVS declined to comment on the government’s allegation that the company failed to follow up on reports from employees and store managers about the repeat purchases.

Prosecutors say the violations occurred in Nevada and elsewhere, too; this settlement covers liability in 25 states. As part of the deal, the government won’t seek criminal charges against CVS.

Image: iStockphoto

View the original article here

People Are Suing Hospitals for Malpractice More Frequently, Report Finds

The pace of malpractice claims against hospitals is picking up, according to a recent report from Aon Risk Solutions and the American Society for Healthcare Risk Management.

Earlier in the decade, growth in the frequency of claims declined for several years in a row, down to a 1.81% increase for incidents occurring in 2006. The pace has now ticked up for the past three years, to 1.95% for incidents occurring last year, the report says.

It estimates the cost of the 44,000-odd claims arising from incidents occurring last year will top $8.6 billion (that covers hospitals only, not physicians or long-term care facilities.) Obstetrics-related claims alone will run an estimated $1.4 billion.

Erik Johnson, health care practice leader for Aon Risk Solutions’ Actuarial and Analytics Practice, tells the Health Blog it’s not clear why the frequency of claims against hospitals is edging up. Possibilities include a weakening of tort reforms in some states and the recession — he says hard times may make people more likely to file a claim.

Health-care overhaul legislation didn’t affect the forecast, Johnson says. While hospitals may be focused on how that law will impact their business, “they should focus at least one eye on this [liability] expense,” he says.

It’s also possible that as community hospitals increasingly employ physicians, some liability costs may be shifting from doctors to hospitals, he says.

The average loss per claim (including expenses) is rising at a steady 4% annual rate, the report says. It’s expected to be $153,000 for incidents that occurred last year. That stat covers only losses up to $2 million, which is to limit the influence of rare large awards and also to reflect the expenses likely to be borne directly by the hospital — Johnson says most hospitals have a significant deductible and that insurance doesn’t kick in until a payout hits a certain amount.

A full 23% of hospital professional liability costs are associated with health-care acquired infections, health-care acquired injuries, medication errors, objects left in surgery and pressure ulcers, the report says.

Further reading:

Image: iStockphoto

View the original article here

XMRV On Everyone’s Mind at a Chronic Fatigue Syndrome Meeting

The Chronic Fatigue Syndrome Advisory Committee — which advises the head of HHS on policy and scientific issues related to CFS — just wrapped up its latest meeting. During three days of presentations and debate (you can watch it all here), it was hard to avoid talking or thinking about XMRV.

That?s the retrovirus that was linked to CFS in a study published last year in the journal Science. Scientists have been debating the finding ever since, with some labs finding the virus in a majority of CFS patients and other labs not finding XMRV in a single case.

At the meeting’s public comment period, CFS patients pressed for more funding to study XMRV and to launch clinical trials. Many of the patients wore shirts with “NIH: What have you done for ME/CFS today?” emblazoned on the front. And some held up “Act Now” placards. (”ME” refers to myalgic encephalomyelitis/encephalopathy, another term used to describe the condition.)

For the first time, an extra day was added to the advisory committee meeting to focus solely on scientific developments; XMRV got prominent billing. In its final recommendations to HHS, the committee called for the creation of a national clinical trials network. “When [the science behind] XMRV gets sorted out, we?ll be ready to jump,” advisory committee member Nancy Klimas, a University of Miami professor who runs a CFS clinic and researches the condition, tells the Health Blog.

The idea, Klimas says, is to set up a network of at least five centers to serve as a kind of hub for research, clinical care and education. Doctors would start collecting standardized clinical and research data from patients at the sites, and teams of investigators would work together to develop common clinical trial protocols to start pushing drug development for CFS.

Yet a number of scientists at the meeting expressed caution about XMRV. Stuart LeGrice, who has helped lead XMRV efforts at NCI, gave the scientific talk on the virus and urged patients to wait until more is known before taking anti-retroviral medications. (Some are already taking the meds, as the WSJ reported recently.) “We?re not far from a controlled clinical trial,” he told participants during a Q&A session.

And while XMRV is a hot topic, Christopher Snell, the chair of the advisory committee, said at the meeting that research on XMRV has “overshadowed” other possible CFS research avenues. Klimas tells the Health Blog that research in CFS is finally yielding a number of possible therapeutic strategies that spring from other hypotheses unrelated to XMRV.

However, for patients like Robert Miller — who testified at the meeting — it’s clear what’s providing the momentum in CFS research. “This all started because of XMRV,” he said.

Image: iStockphoto

View the original article here

What Happens to Screening Rates When the Deductible Disappears?

You can see why insurers and employers would want to encourage people to take advantage of preventive care — in theory, it will cut the chances of later developing potentially costly diseases and conditions. (In practice, prevention may improve individual health, but there’s evidence that at least some of it doesn’t save the system money.)

As we’ve written, many companies pick up all or part of the costs of tests and procedures considered to fall under the preventive-care umbrella, including some cancer screening tests, annual physicals and flu shots.

Researchers funded by the government, Rand Corp.’s Bing Center for Health Economics and Merck wanted to see if that kind of incentive works. So they looked at whether screening rates changed at all when an employer eliminated the deductible for preventive tests and routine physical exams. (People still had to pay between 20% and 30% of the cost, in the form of co-insurance.) They analyzed data covering three different groups: people in high- and low-deductible plans, before and after the preventive care deductible was eliminated; and a control group from another employer where the deductible for preventive care didn’t change. Their findings were published in Health Services Research.

Scrapping the deductible “modestly” improved screening rates for blood-cholesterol tests, Pap smears, mammograms and fecal-occult blood tests, the researchers conclude. After adjusting for demographics and the overall trend of the test’s use, “there were between 23 and 78 additional uses per 1,000 eligible patients of covered preventive screens.”

But they recommend that “patients’ predisposing characteristics merit attention.” They’re referring to the finding that the expanded prevention coverage had a smaller effect on screening rates among people with high-deductible plans — perhaps because those folks are less risk-averse than the people who opt for low-deductible plans, or prefer to interact less with the health-care system. Or they could just be different in some other way that wasn’t controlled for by the study — such as income. (We wonder if they’re more skeptical about the value of some screening tests whose risk-benefit ratio isn’t so clear, such as mammograms for women in their 40s.)

The point is, though, that not everyone will respond in the same way to an incentive that would seem to work in a pretty straightforward way, i.e. lowering the out-of-pocket costs of a certain test or office visit. If the goal is to increase screening rates among the people who opt for high-deductible plans, other approaches — like patient or physician reminders or education — should also be studied, the researchers conclude.

Further reading:

Image: iStockphoto

View the original article here

Survey: Plenty of Uncertainty on Impact of Health-Care Overhaul

Almost half of private-company CEOs and CTOs surveyed by PricewaterhouseCoopers say health-care overhaul legislation may affect their business financially, while another 31% say it’s too soon to assess the impact.

The uncertainty isn’t totally surprising, since most of the provisions of the bill haven’t kicked in yet. But employers are still sussing out even the provisions that took effect Sept. 23 — or will in the next plan year.

Take the requirement that plans cover dependents until age 26, for example: 28% say they’re not certain of the impact (or didn’t answer the question). Another 29% said it would likely have no impact, and 43% said it would have either a slight or moderate/significant impact.

The executives surveyed said the increase in Medicare tax on high-income individuals would have the biggest financial impact — 31% reported it would have a moderate or significant impact. (Then again, 27% said it would likely have no impact.) The provision getting the greatest proportion of “no impact” votes — 66% –? was the penalty for companies with 50 or more employers that fail to provide minimal affordable coverage.

The new PwC survey covers the views of 224 CEOs and CTOs representing private companies averaging $257 million in annual sales.

Even without knowing the full financial impact of the law, some 70% say they’ll reevaluate their company’s overall benefit strategy and 60% plan to change benefits to comply with the law. More than half — 52% — say they’re likely to change employee contributions for medical coverage. That’s not too far off from a recent National Business Group on Health survey reporting 63% of big employers plan to increase the proportion of premiums paid by workers.

Further reading:

View the original article here

Don’t hold your breath on home appreciation

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To improve the credit score, so that you the best terms on a home equity loan, the first step is to learn all you can about the items included on your credit reports. There are three major credit bureaus and each of them can have different information. Some or all of the credit bureau reports [...]

about 3 days ago - 1 comment

Your home is a valuable asset. You can tell the home equity people know this by the numerous ads aggressively promoting home equity loans and home equity lines of credit. They suggest you bring your home system to work. But it is a good idea for you? And if so, should consider what you choose? [...]

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How many students will stop by the hardships and necessary steps in their education once they are completed and successfully passed, know that it's time to start their own independent lives. With school out of the way, jobs on the horizon and looking for a great future in front of many of them to buy [...]

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EVCA.OB, NKE, NLTX, NTT, – EVCARCO Clean Technologies, Footwear and Telecommunications! From CRWESelect.com

about 2 days ago - 1 comment

All electric vehicles seem to be a new wave of energy excitement, and this green company has moved into an area that understands green technology. EVCARCO is pioneering a new way to meet the demands of 21st century car buyers. EVCARCO is bringing to market eco-friendly vehicles with an emphasis on performance and affordability and [...]

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EVCARCO (OTC.BB:EVCA) is pioneering a new way to meet the demands of 21st century car buyers. EVCARCO is bringing to market eco-friendly vehicles with an emphasis on performance and affordability and the latest in developed technology. The board of EVCARCO is pleased to announce that, pursuant to a strong demand from the US Federal Government [...]

about 5 days ago - 1 comment

All electric vehicles seem to be a new wave of energy excitement, and this green company has moved into an area that understands green technology. EVCARCO is pioneering a new way to meet the demands of 21st century car buyers. EVCARCO is bringing to market eco-friendly vehicles with an emphasis on performance and affordability and [...]

about 6 days ago - No comments

Spare Backup, Inc. (SPBU.OB) previously announced that the Carphone Warehouse Limited (CPW), a unit of Best Buy Europe Distributions Limited (BBE), has launched its Geek Squad Max Computing and Max Mobile protection programs bundled with Spare Backup’s Co-branded My-Hub backup and cloud computing services along with Spare Mobile. Management anticipates this U.K. launch generating up [...]

about 6 days ago - 1 comment

EVCARCO (OTC.BB:EVCA) is pioneering a new way to meet the demands of 21st century car buyers. EVCARCO is bringing to market eco-friendly vehicles with an emphasis on performance and affordability and the latest in developed technology. The board of EVCARCO is pleased to announce today that pursuant to a strong demand from the US Federal [...]

about 6 days ago - No comments

The Gabelli Global Gold, Natural Resources & Income Trust (AMEX:GGN) –The Board of Trustees of The Gabelli Global Gold, Natural Resources & Income Trust recently declared monthly cash distributions of $0.14 per share for October, November, and December 2010. The distribution for October 2010 will be payable on October 22, 2010 to common shareholders of [...]

about 1 week ago - 1 comment

Filed under: Earnings reports, Forecasts, NIKE, Inc’B’ (NKE) Nike Inc. (NKE), which said it stands by embattled Tiger Woods, is scheduled to discuss its financial results for the second quarter of fiscal 2010 in a conference call Thursday, December 17, at 5:00 PM (ET). You can catch the live webcast of the call on the [...]

about 1 week ago - 1 comment

Filed under: Marketing and advertising, NIKE, Inc’B’ (NKE) With companies like Accenture (ACN) and Procter & Gamble (PG) cutting, or at least weakening, their ties with embattled ladies’ man Tiger Woods, it’s interesting to look at who is standing by him: Upper Deck, a leading producer of sports cards and other memorabilia, has opted to [...]

about 1 week ago - 1 comment

EVCARCO (OTCBB: EVCA)is the first automotive retail group dedicated to deploying a coast-to-coast network of environmentally friendly franchised dealerships and vehicles. EVCARCO is bringing to market the most advanced clean technologies available in plug-in electric, alternative fuel, and pre-owned hybrid vehicles. EVCARCO has developed a dealer network allowing growth into most US States by 2012. [...]

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The American Consumer Needs To Wake Up And Realize He’s Got Money To Spend

Given that households account for 70 percent of all spending in the U.S. economy, consumer psychology tends to get a lot of attention, especially now. Readings on consumer confidence have plunged in recent months, signaling that people feel lousy about the economy and have little faith that things will turn around any time soon. But that doesn’t necessarily mean that consumers are about to short circuit the economic recovery.

More important to the outlook for consumer spending are income, credit, and wealth and each has shown improvement through the third quarter. Modest job gains are generating income growth. Credit is flowing more freely to households, as consumers cut back on debt with a lot less pain than many analysts had expected. Plus, stock-market gains in the third quarter have been an important wealth booster.

Consumers don’t always behave the way they say they feel. Contrary to earlier fears that consumers were about to abandon the recovery, spending continues to grow at a steady, albeit modest, clip. Although confidence readings are about where they were more than a year ago, when consumer spending was contracting, household outlays in the third quarter appear to have grown close to the first-half pace of about 2 percent. That’s one reason many economists are taking a second look at their forecasts for third-quarter GDP growth. “We see considerable upside risk to our forecast of 1.5 percent growth,” says economist Sam Coffin at UBS, admitting that 3 percent for the quarter is not out of the question.

Consumer spending is holding up partly because of continued gradual improvement in the job markets. Overall payrolls fell by 95,000 workers in September, the Labor Dept. said last Friday, but excluding fewer Census workers and declines in state and local government payrolls, private-sector jobs increased by 64,000 last month with small upward revisions to July and August gains. Monthly increases in private industry jobs have averaged 77,000 since April.

Although that’s a lukewarm pace, employment income has accelerated, reflecting longer work hours and modest growth in hourly pay. In the past six months, private-sector earnings from wages and salaries grew at a 4.2 percent annual rate, compared with no growth at all in the previous six months. Payrolls are still not growing fast enough to dent the unemployment rate, which held at 9.6 percent in September, but the renewed downtrend in weekly jobless claims, which tend to foreshadow labor market trends, suggests stronger job gains in coming months and a further pickup in income growth.

Gains in employment income are partly responsible for the steady growth in consumer spending, including Thursday’s better-than-expected September sales reports from the nation’s chain stores. A survey by Thomson Reuters showed that 75 percent of stores beat analysts’ expectations last month, amid growing optimism that holiday sales will show improvement over last year. Plus, car sales rose to an 11.8 million annual rate in September, the best monthly showing since the temporary cash-for-clunkers spike last year, and a pace that puts car sales on a clear uptrend.

Buoyant car buying is one sign that cheaper and more accessible credit is helping to lift consumer spending, as households get a little better grip on their finances. Through the second quarter the cash needed to meet monthly payments on consumer credit and mortgages fell to 12.1 percent of after tax income, according to Federal Reserve data, the lowest debt service burden in more than ten years. “We think that American consumers are deleveraging their balance sheets and rebuilding savings faster than expected,” says Morgan Stanley economist Richard Berner.

Record-low mortgage rates are helping the deleveraging process by setting off a refinancing boom, at least among homeowners who can meet eligibility requirements. The 30-year fixed rate in the weekly Freddie Mac survey fell to 4.27 percent on October 7, down nearly a full percentage point since April, and applications to refinance rose about 70 percent over that period. Any new round of  Treasury securities purchases by the Federal Reserve, which looks increasingly likely, would push rates down even further. Although low appraisal values, low credit scores, or unemployment are preventing many homeowners from refinancing, Berner estimates that refi activity is still giving households a $10 billion to $15 billion annual windfall.

Household balance sheets also received a boost from the stock market last quarter. The broad Wilshire 5000 stock index rose 11.1 percent during the third quarter, reversing almost the entire 11.5 percent drop during the second quarter, when worries about European banks and a U.S. double-dip recession spooked investors. That decline resulted in a $1.5 trillion loss in household net worth, which was fully replenished last quarter. In the past year and a half, according to Federal Reserve data, households have regained more than $6 trillion of the $17 trillion in wealth lost during the recession.

A lot of recent consumer angst appears to center around uncertainties about future tax rates. In an unusual divergence, confidence among higher-income households, which are more likely to be adversely affected by an expiration of the Bush tax cuts, fell sharply in September, according to the Reuters/University of Michigan survey, while attitudes of lower-income households actually improved. “We expect confidence to begin to edge higher once political uncertainty subsides,” says economist Theresa Chen at Barclays Capital. However, any substantial gains in optimism will depend on further improvement in the labor market and in household finances, which so far at least are moving in the right direction.

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This entry was posted by Finance on October 11, 2010 at 7:29 pm, and is filled under money. Follow any responses to this post through RSS 2.0. You can skip to the end and leave a response. Pinging is currently not allowed.

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Pips Reserve – Stop being cheated in Forex

Have you ever felt like giving up in Forex, like there’s just no point?

Your system/ robot has packed up or just stopped trading out of the blue and you have no idea why?

Or worse, it never worked in the first place and you can’t help thinking that trading in Forex is IMPOSSIBLE…

There is a logical and simple explanation for this:

==> Visit PIPS Reserve Official Website

PLEASE NOTE: this isn’t the typical load of marketing drivel… And it hasn’t been invented by some self-obsessed Forex “Guru”.

There are some very interesting ideas and a wide range of topics from “ticking time bomb systems”, Monday price-gapping and also broker issues

That’s useful information to know… Check it out whilst the information is available:

==> Visit PIPS Reserve Official Website

He gives you the key components to a successful Forex system and also insight into his very own…

His insights actually MAKE SENSE, are EASY TO UNDERSTAND and absolutely FREE.

If you want to save $1000s in Forex, or even just understand where you’re going wrong, you should see this.

Even if you decide the information is not relevant to you, it’s worth a watch

Make a difference to your trading today…

PIPS Reserve is the newest forex trading robot to hit the market and is scheduled to be released on October 12th at 12 PM EST.

If you’re struggling to make money from Forex, this special tool is exactly what you need… Small amounts to invest? You can start with as little as $100. Don’t have hours to trade? All you need is 12 minutes a day.

Pips Reserve it’s a fantastic system for tackling the Forex markets…

This system truly shows just what profits the Forex markets are capable of yielding. It’s entirely systematized, making your Forex trading efforts little more than a nice walk in the park!

This system is the direct result of years of experience and expertise on the part of its developers. It represents a significant investment of time and money, and is the epitome of Forex trading consistency and perfection.

PIPS Reserve is a forex trading robot, or expert advisor (ea), that seamlessly integrates into your MetaTrader platform.  It is completely hands free once you have set up the robot, which takes approximately 10 to 15 minutes, then it will go to work for you with starting to monitor the market for profitable trades, placing your trading, and exiting your trades.

The PIPS Reserve EA was actually created by a professional trader and not some techie guys who’s just looking to make a program and sell it for all its worth and then run.  There has been over 10 years of work put into this system to finally bring it to what it is today, the PIPS Reserve Robot.  Often times, developers of these expert advisors are so jumpy just to release a product, that they forget about the Research & Development aspect.  This is where PIPS Reserve will truly set itself apart from the others.

The obvious fact is that this forex system simply makes money.  You can watch it in action for yourself while it pulls in a cool 40%.

==> Visit PIPS Reserve Official Website

In the upcoming days there will be some additional videos being released which will show you even more about the PIPS Reserve System.

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This entry was posted by Finance on October 11, 2010 at 7:21 pm, and is filled under forex trading. Follow any responses to this post through RSS 2.0. You can skip to the end and leave a response. Pinging is currently not allowed.

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Choosing the Right Middle Man

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The Honorable Scott Brown United States Senate 317 Russell Senate Office Building Washington D.C. 20510 Dear Senator Brown: I am a constituent who would like to help. My father sent you my book, Panderer to Power: The Untold Story of How Alan Greenspan Enriched Wall Street and Left a Legacy of Recession. You wrote my [...]

about 5 days ago - No comments

The International Monetary Fund says the Middle East and North Africa region is recovering strongly following the global financial meltdown, with sizable stimulus packages and continued strength in oil prices supporting the rebound. The IMF said in its World Economic Outlook released Wednesday that the MENA region’s GDP growth is projected to be 4.1 percent [...]

about 5 days ago - 2 comments

It seems that the recent financial meltdown and lack of financing has invigorated hucksters and those pushing “new” financial products.  I have seen a spate of posts about supposedly innovative financial products for simplistic funding needs.  Fully 40% of every dollar of profit in our country was made on financial products at the height of [...]

about 6 days ago - 1 comment

The Massive Mortgage Mess as we affectionately call it seems to be getting new names with each passing day – the latest one is, quite appropriately, RoboSigning Scandal (funny how after the stock market, “robotic” technology will soon becoming equated with the biggest mortgage scam in history). During today’s Kudlow segment, CNBC’s Diana Ollick who [...]

about 6 days ago - 2 comments

Private Money Lenders are private companies that give personal loans to any individual who wishes to increase their financial needs. They can also be middle man organizations that will get you to an individual investor and are a non-traditional lender that provides you with a real estate loan, secured by property and not by you [...]

about 3 weeks ago - 1 comment

Let me tell you a little bit about me. For years I’ve been an investor and have been fortunate enough to do well. Of course, doing well as a part time investor doesn’t mean the same thing as performing well as a hedge fund manager, but I’m proud of myself nonetheless. In 2009, my life [...]

about 3 weeks ago - 1 comment

During testimony before the House Financial Services Committee, ?Edward J. DeMarco, acting director of the Federal Housing Finance Agency, raised concerns about the Obama Administration’s approach to housing, questioning whether the government should continue to play a significant role in helping borrowers get home loans. “Recently there has been a growing call for some form of explicit [...]

about 3 weeks ago - 1 comment

The industry of the payday loans has evolved with many ups and downs. It started off in rough waters because people were naturally suspicious of non banking financial institutions lending to small customers who are refused a loan from the bank. However, today the industry is mature and flourishing in the midst of an economic [...]

about 4 weeks ago - No comments

Until I heard of Basel III yesterday, I didn’t know there was a Basel I or a Basel II. The three Basel accords exist to give banking systems around the world a framework in which they can operate successfully, and the latest of these accords introduces new requirements for managing risk. For the most part, [...]

about 1 month ago - No comments

The Federal Reserve recently announced that consumer debt declined in July for the sixth straight month. The continuing elimination of personal debt is a positive development on an individual level. Consumers are buying less of what they don’t need and saving money whenever possible. At the same time that savings account balances are increasing throughout [...]

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