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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Different listings of NYC Apartments

about 41 minutes ago - No comments

One of the brewing stories out of the UK is that the country’s aggressive austerity scheme — which one praise in the media a few months ago — will probably not be so drastic in the end. Budget cutting is HARD. When you cut spending, you end up hurting all kinds of politically vindictive interest [...]

about 1 hour ago - No comments

The climate is perfect in the New York City. New York City Real Estate is the best place to live. Numerous people moves into this beautiful city daily to fulfill their dreams and get a suitable living place. But finding the appropriate apartments is becoming difficult due to the high prices of the NYC apartments. [...]

about 1 hour ago - No comments

Hiring a broker to sell the NYC Apartments is a good idea. But if you hire a broker then you have to pay handsome amount of money to him. But if you don't involve the brokers in the selling process of NYC Apartments for sale, then it is difficult for you to find good tenants. [...]

about 1 hour ago - No comments

In the urbanized part of the New York City, finding good NYC Apartments for rent is clumsier as these apartments are very costly. These NYC Apartments are out of the reach of the common mass. Everyone is aware of the fact that NYC Apartments are very beautiful that provides all the facilities and amenities but [...]

about 1 hour ago - No comments

All the dreams and aspirations can be easily fulfilled in the New York City. This city is a wonderful city where all the luxuries and amenities are present. To fulfill these aspirations and dreams, several people are coming daily to this city and seek good apartments. But finding suitable apartments in reasonable prices is little [...]

about 1 hour ago - No comments

New York is one of the populous cities in this world. This city is full of all luxuries that a person needs to lead a happy life. Therefore every individual has a dream of living in this wonderful city. To fulfill the dreams, almost every day numbers of people are moving in this city and [...]

about 1 hour ago - No comments

As New York is financial capital of the world, it is expensive. The cost of living is too high in this city. Finding good NYC Apartments that comes into the budget is difficult due to the sky high prices of these apartments. Manhattan apartments are much more costly than the other NYC Apartments. This article [...]

about 1 hour ago - No comments

Every person has a dream of owning a beautiful home in the financial capital of the world i.e. New York. This city has everything that a person dreams of. But finding the best apartment that can suit the lifestyle and personality of a person is little difficult as NYC Apartments are decreasing day by day [...]

about 1 hour ago - No comments

New York is one of the beautiful cities in this world and the NYC Apartments are the striking features of this beautiful city. All the NYC apartments are wonderful that provides all the amenities and luxuries a person wants. These apartments are built according to the latest trends that can suit the lifestyle and varied [...]

about 1 hour ago - No comments

Using various agents, you can find the NYC Apartments for rent. There is a classified section in each newspaper that helps to find the best NYC Apartments for rent. Regarding the apartment rentals, you can also take the help of your relatives and friends. Local newspapers also provide the ideas about the leasing lands. Numerous [...]

View the original article here

What is a Lobby Tracking System

about 3 months ago - 1 comment

Equator, a software provider for the default servicing industry, has launched Professional (PRO) Short Sale and PRO HAFA modules to automate the offer management workflow for smaller firms operating in the REO industry. The software is part of Equator’s PRO Workstation application. Equator said the technology extends the efficiencies enjoyed by larger institutions to loan [...]

about 5 months ago - No comments

Every Home Business Entrepreneur will tell you that TIME is your most valuable asset. And they'll also tell you that most FREE traffic strategies are HUGE time wasters. But there are some incredibly simple ways to maximize your free traffic generation efficiencies. Read this article for free internet traffic generation strategies and tips. @import ‘http://heyzap.com/elightbox/lightbox.external.css’; [...]

about 6 months ago - 1 comment

The so-called “bad banks” of Northern Rock (now NRAM) and Bradford and Bingley (B&B) plan to merge. The move is designed to cut costs and bring greater efficiencies for the UK taxpayer, who owns both businesses. They are set to be brought under one holding company with a single management team, although there is no [...]

about 7 months ago - No comments

Filed under: Good news, PepsiCo (PEP) Over the past year, PepsiCo (PEP) has been making the right moves. Perhaps one of the biggest was to buy up its key bottlers in the U.S. so as to improve cost efficiencies, as well as to broaden the product mix. In fact, Coca-Cola (KO) also realized the logic [...]

about 7 months ago - No comments

Rumors of Papandreou’s resignation as Greek prime minister have been swirling all morning, and adding to the swirling a la carte buffet of false news coming out of Athens. However, as of now, that particular rumor is being refuted: the Prime Minister’s spokeswoman has just announced that “the PM has definitely not resigned.” We give [...]

View the original article here