The leader of dementia research in CSIRO’s Preventative Health National Research Flagship, Dr Cassandra Szoeke, says the report highlights the challenge the nation faces with the number dementia sufferers predicted to double to 465,000 by 2030.

“About 80 per cent of dementia in Australia is caused by Alzheimer’s disease,” Dr Szoeke, says. “Early diagnosis is crucial if we are to begin managing this crisis more effectively.”

“By the time sufferers show symptoms of memory loss, severe irreversible brain cell death may have already occurred.”

“In Australia every week another 1000 people are being diagnosed with dementia. It is only by early diagnosis that treatment can be effective, preserving memory and brain.”

“With the initiation of the AIBL (Australian Imaging, Biomarker and Lifestyle) cluster study the combined institutions have potentially brought forward the detection of Alzheimer’s disease by 18 months,” Dr Szoeke says.

“Early detection can not only aid with future treatment options but it can also help with the planning and delivery of dementia care services in Australia.”

Released earlier this week, the Access Economics report also found that investment in dementia research is a key strategy for addressing the epidemic.

“There is no question that research is the key to reducing the burden of the disease on the community for the future and CSIRO and its partners will continue to seek effective, new approaches to prevention, diagnosis and treatment of these diseases,” Dr Szoeke says.

* The Australian Imaging, Biomarker and Lifestyle (AIBL) Flagship Study of Ageing is a collaboration initiated by the CSIRO Preventative Health National Research Flagship. AIBL is a joint activity between the Flagship, the University of Melbourne, Edith Cowan University – Western Australia, Neurosciences Australia, the Mental Health Research Institute of Victoria and the National Ageing Research Institute.

National Research Flagships

CSIRO initiated the National Research Flagships to provide science-based solutions in response to Australia’s major research challenges and opportunities. The nine Flagships form multidisciplinary teams with industry and the research community to deliver impact and benefits for Australia.

What’s OK for the kidney and brain may not be best for the heart, expert says

(HealthDay News) — While too-high blood pressure is a clear hazard for most people, too-low pressure can apparently be a threat in some cases as well.

A new study of 10,001 people with coronary artery disease found what statisticians call a J-shaped curve of mortality, meaning a higher death rate for people with the lowest blood pressure. Dr. Franz H. Messerli, a professor of clinical medicine at Columbia University Medical Center and director of the hypertension program at St. Luke’s-Roosevelt Hospital in New York City, reported on the finding Thursday at the American Society of Hypertension meeting in San Francisco.

“It stands to reason that there has to be a J-shaped curve,” Messerli said. “If your blood pressure were zero, you would be dead.”

He acknowledged that the people in the study were a bit out of the ordinary, with already-diagnosed coronary artery disease. The study was aimed at determining the effect of treatment with different amounts of a cholesterol-lowering statin drug, with blood pressure measured as a matter of routine.

When the results were in, the lowest rate of deaths and major coronary problems such as heart disease was seen not in the participants with the lowest blood pressure but in those slightly to the right on the curve, with a reading of 139.9 for systolic pressure (the reading when the heart contracts) and 79.2 for diastolic pressure.

Though Messerli stressed that this was “a unique population, with coronary artery disease, where the coronary arteries are compromised,” he noted that “there has to be a point where lowering blood pressure is counterproductive.”

That point can be seen on the curve of systolic pressure in this group, he said. “When you go from 120 to 130, even from 110 to 130, there is very little difference,” Messerli said. “When it goes below 110, then all of a sudden it becomes very obvious.”

 The effect is more pronounced for diastolic pressure readings. “If you go to 70 or below, say to 60, there is a fourfold higher risk in the primary outcomes,” he said.

A too-low reading, he noted, could mean that the brain is not getting enough blood. “Obviously, if there is a lack of blood, there can be danger similar to that when there is too much blood,” Messerli said.

The finding in this particular group certainly doesn’t mean that most people should worry about blood pressure being too low, he said. “By and large, within reason, lower is better,” Messerli said.

But that might not be true in special cases, he said. “You can have a funny situation where one organ in the body is demanding more blood than is good for the rest of the body,” Messerli said. “What is OK for the kidney and OK for the brain may not be OK for the heart.”

Controlling high blood pressure remains a major concern for physicians, Messerli said. “There are a lot of patients who are untreated and uncontrolled,” he said. “We need to do a better job.”

Dr. Alan H. Gradman, professor of medicine at Temple University, said that the study should be treated with caution because the number of people with very low blood pressure was small, but he said that “it does suggest that there may well be a J curve in people with coronary artery disease.”

Though many other studies have not shown a J curve, “which is why the idea that you can’t go too low is out there,” the new study results might mean a slight revision of that rule in some cases, Gradman said.

“If you treat people with coronary artery disease for hypertension, you don’t want to go too low, to diastolic pressure below about 70,” he said. “That’s the take-home message here.”

You have been given zanamivir because you may have been exposed to the swine influenza (swine flu). As you may already be aware, a public health emergency has been declared in the U.S. due to a current outbreak of swine influenza virus. You can decide whether to take this drug. Taking zanamivir may help you or your child recover more quickly if you have swine flu or may help keep you or your child from getting sick from swine flu. If you are taking zanamivir as directed and you begin to feel sick, get medical care right away.

What is Swine Flu?

Swine flu is a respiratory disease of pigs caused by a virus that regularly causes outbreaks of influenza in pigs. Spread of swine flu can occur through contact with infected pigs or environments, or through contact with a person with swine flu.

What is Zanamivir?

Relenza® (zanamivir) is a medicine that is approved by the U.S. Food and Drug Administration (FDA) to treat and prevent influenza.* The FDA-approved package insert on zanamivir can be found via Drugs@FDA on www.fda.gov/cder.

Who should not take Zanamivir?

Do not take zanamivir if you have ever had a severe allergic reaction to zanamivir or lactose. Zanamivir is not recommended for people with chronic lung disease such as asthma or COPD. Zanamivir should only be used for treatment of persons aged 7 years and older, and for prevention in persons aged 5 years and older. It should not be used for prevention of flu in nursing home patients.

What is the dose of Zanamivir?

• For Treatment: 10 mg (2 inhalations) twice daily for 5 days

• For Prevention: Household Setting: 10 mg (2 inhalations) once daily for 10 days

Community Outbreaks: 10 mg (2 inhalations) once daily for 28 days

The dose should be given at approximately the same time each day.

How should zanamivir be taken?

Zanamivir is packaged in a medicine disk called a Rotadisk® and is inhaled by mouth using a delivery device called a Diskhaler®. Each Rotadisk® contains 4 blisters. Each blister contains 5 mg of active drug and 20 mg of lactose powder (which contains milk proteins). Each packaged box of zanamivir contains 5 Rotadisks (total of 10 doses) and a Diskhaler® inhalation device. Read the “Patient Instructions for Use” in the package and refer to your healthcare provider for instructions on how to use the Diskhaler®. Zanamivir should be given to children only under adult supervision and instruction.

What are the possible severe side effects from Zanamivir?

People should be aware of the risk of increased difficulty breathing, especially among people with a history of underlying breathing problems. If patients have increased difficulty breathing, they should stop Relenza and get medical attention right away. People with the flu, particularly children and adolescents, may be at an increased risk of seizures, confusion, or abnormal behavior early in their illness. These events may occur after beginning zanamivir or may occur when flu is not treated. These events are uncommon but may result in accidental injury to the patient. Therefore, patients should be observed for signs of unusual behavior and a healthcare professional should be contacted immediately if the patient shows any signs of unusual behavior.

How do I report side effects with Zanamivir?

Call your healthcare provider if your child experience side effects that bother you or that do not go away. Report side effects to FDA MedWatch at www.fda.gov/medwatch or call 1-800-FDA-1088.

*Certain aspects of this emergency use are not part of the approved drug applications. However, the FDA Commissioner has authorized the emergency use of zanamivir. Additional information can be found on www.cdc.gov/swineflu.

Representatives of major health industry trade groups are scheduled to meet with President Obama Monday to outline their plan to cut increases in projected health care costs by $2 trillion over the next decade.

Obama said in prepared remarks that the groups are voluntarily committing to cut the growth rate of national health care spending by 1.5 percent a year from 2010 through 2019 by streamlining the industry, although details have not been released.

Since his days on the campaign trail, the president has promised to push for affordable health care for Americans, often citing his mother’s plight as she struggled with mounting bills for treatment of ovarian cancer.

“We cannot continue down the same dangerous road we’ve been traveling for so many years with costs that are out of control, because reform is not a luxury that can be postponed, but a necessity that cannot wait,” the president said.

Representatives of health insurers, doctors, hospitals, drugmakers and unionized health care workers were scheduled to attend the White House meeting, which begins at 12:30 p.m. ET.

Although the groups have often been at odds, the White House meeting reflects a growing awareness that changes to the health care system are coming — and that stakeholders should participate in the discussion.

“That is why these groups are voluntarily coming together to make an unprecedented commitment,” Obama said.

Under the health industry’s plan, a family of four could save $2,500 a year within five years, according to the Obama administration. After 10 years, the savings could help eliminate the federal budget deficit.

South Florida’s reputation as the capital of Medicare fraud came under the congressional spotlight Wednesday with U.S. Attorney R. Alexander Acosta telling a Senate panel the best tool for fighting scams is tightening oversight at the top.

Acosta, who since 2006 has prosecuted more than 700 people responsible for more than $2 billion in fraudulent Medicare billings, told the U.S. Senate Special Committee on Aging that he started focusing on fraud because he was “absolutely disgusted” by the level of scams in South Florida.

But he told the Senate panel that prosecutions aren’t the solution.

“If one wants to prevent traffic accidents, one puts up red lights, one puts up stop signs, one has good rules of the road that prevent accidents in the first place,” he said. “The same applies for healthcare fraud. With additional resources my office could easily double or triple prosecutions . . . but the best way by far to prevent fraud in the first place is to improve the rules of the road.”

He called for changes at the Centers for Medicare and Medicaid Services “to ensure rapid payment, yet at the same time identify and deny fraudulent bills.”

And he noted that as South Florida prosecutors crack down on fraudsters, they tend to migrate elsewhere. He said the Tampa and Orlando districts have noticed a spike in fraud and that he has been told Atlanta “has seen an increase as people leave South Florida and set up shop elsewhere.”

Acosta suggested some fixes could be “common sense solutions.”

He said he has directed his prosecutors to look for suppliers who provide medical equipment to a substantial number of patients who don’t live near the supplier, “in the theory that most people don’t travel a few hundred miles for an inhaler or wheelchair.”

Florida Sen. Mel Martinez, the top Republican on the panel, noted that it was “embarrassing” that some of the most egregious cases of fraud originate in Florida. Noting South Florida was “unfortunately a leader in many kinds of fraud,” Acosta said the scams are not confined to South Florida: “When changes are going to be made, they should go beyond South Florida,” Acosta said. “It’s a problem in Florida, but in part because we are doing so much the problems have been identified. It has to be a nationwide set of solutions.”

James Frogue, project director for the Center for Health Transformation, a project launched by former House Speaker Newt Gingrich, noted that Miami-Dade County has 897 licensed home health agencies – more than the entire state of California. And in New York, he said, 55 men got maternity benefits over a two-year period.

Martinez has filed two bills aimed at cracking down on fraud, by, among other provisions, eliminating the use of Social Security numbers for Medicare beneficiaries and putting billing statements under increased scrutiny.

Daniel R. Levinson, inspector general at the U.S. Department of Health and Human Services, told the panel that healthcare attracts fraudsters because the penalties are lower than for other criminal offenses, schemes are easily replicated and there is a perception they won’t be caught.

“We need to alter the criminals’ cost-benefit analysis by increasing the risk of swift detection and the certainty of punishment,” Levinson said.

From World Health Organization- May 2, 2009

Is an effective vaccine already available against the new Influenza A(H1N1) virus?

No, but work is already underway to develop such a vaccine. Influenza vaccines generally contain a dead or weakened form of a circulating virus. The vaccine prepares the body’s immune system to defend against a true infection. For the vaccine to protect as well as possible, the virus in it should match the circulating “wild-type” virus relatively closely. Since this H1N1 virus is new, there is no vaccine currently available made with this particular virus. Making a completely new influenza vaccine can take five to six months.

What implications does the declaration of a pandemic have on influenza vaccine production?

Declaration by WHO of phase 6 of pandemic alert does not by itself automatically translate into a request for vaccine manufacturers to immediately stop production of seasonal influenza vaccine and to start production of a pandemic vaccine. Since seasonal influenza can also cause severe disease, WHO will take several important considerations such as the epidemiology and the severity of the disease when deciding when to formally make recommendations on this matter. In the meantime, WHO will continue to interact very closely with regulatory and other agencies and influenza vaccine manufacturers.

How important will Influenza A(H1N1) vaccines be for reducing pandemic disease?

Vaccines are one of the most valuable ways to protect people during influenza epidemics and pandemics. Other measures include anti-viral drugs, social distancing and personal hygiene.

Will currently available seasonal vaccine confer protection against Influenza A(H1N1)?

The best scientific evidence available today is incomplete but suggests that seasonal vaccines will confer little or no protection against Influenza A(H1N1).

What is WHO doing to facilitate production of Influenza A(H1N1) vaccines?

As soon as the first human cases of new Influenza A(H1N1) infection became known to WHO, the WHO Collaborating Center in Atlanta (The Centers for Disease Control and Prevention (CDC) in the United States of America) took immediate action and began the work to develop candidate vaccine viruses. WHO also initiated consultations with vaccine manufacturers worldwide to facilitate the availability of all necessary material to start production of Influenza A(H1N1) vaccine. In parallel, WHO is working with national regulatory authorities to ensure that the new Influenza A(H1N1) vaccine will meet all safety criteria and be made available as soon as possible.

Why is WHO not asking vaccine manufacturers to switch production from seasonal vaccine to a Influenza A(H1N1) vaccine yet?

WHO has not recommended stopping production of seasonal influenza vaccine because this seasonal influenza causes 3 million to 5 million cases of severe illness each year, and kills from 250,000 to 500,000 people. Continued immunization against seasonal influenza is therefore important. Moreover, stopping seasonal vaccine production immediately would not allow a pandemic vaccine to be made quicker. At this time, WHO is liaising closely with vaccine manufacturers so large-scale vaccine production can start as soon as indicated.

Is it possible that manufacturers produce both seasonal and pandemic vaccines at the same time?

There are several potential options which must be considered based on all available evidence.

What is the process for developing a pandemic vaccine? Has a vaccine strain been identified, and if so by whom?

A vaccine for the Influenza A(H1N1) virus will be produced using licensed influenza vaccine processes in which the vaccine viruses are grown either in eggs or cells. Candidate vaccine strains have been identified and prepared by the WHO Collaborating Center in Atlanta (The Centers for Disease Control and Prevention (CDC) in the United States of America)¹. These strains have now been received by the other WHO Collaborating Centers which have also started preparation of vaccine candidate viruses. Once developed, these strains will be distributed to all interested manufacturers on request. Availability is anticipated by mid-May.

How quickly will Influenza A(H1N1) vaccines be available?

The first doses of Influenza A(H1N1) vaccine could be available in five to six months from identification of the pandemic strain. The regulatory approval will be conducted in parallel with the manufacturing process. Regulatory authorities have put into place expedited processes that do not compromise on the quality and safety of the vaccine. Delays in production could result from poor growth of the virus strain used to make the vaccine.

How would manufacturers be selected?

There are currently more than a dozen vaccine manufacturers with licenses to produce influenza vaccines. The vaccine strain will be available to each of them for vaccine production.

What is the global manufacturing capacity for a potential Influenza A(H1N1) pandemic vaccine?

While this cannot be assessed precisely since there is much uncertainty regarding the appropriate formulation for an effective and protective vaccine, a conservative estimate of global capacity is at least 1 to 2 billion doses per year.

How is production capacity for influenza vaccines distributed geographically?

More that 90% of the global capacity today is located in Europe and in North America. However, during the past five years, other regions have begun to acquire the technology to produce influenza vaccines. Six manufacturers in developing countries have done so with technical and financial support from WHO.

What will be the storage requirements for Influenza A(H1N1) vaccine?

The vaccine should be stored under refrigerated conditions at between 2°C and 8°C.

It has been impossible so far to develop vaccines for major killers such as HIV and malaria. How sure are we that there will not be scientific or other hurdles in developing an effective Influenza A(H1N1) vaccine?

Typically, development of influenza vaccines has not posed a problem. Influenza vaccines have been used in humans for many years and are known to be immunogenic and effective. Each year seasonal influenza vaccines with varying composition are produced for the northern and southern hemisphere influenza seasons. Vaccine manufacturers will employ a number of different technologies to develop their vaccines. They will take advantage, notably, of novel approaches that were developed over the past years for H5N1 avian influenza vaccines. One key unknown is yield of vaccine virus production, since some strains grow better than others and the behavior of the new Influenza A(H1N1) strain in manufacturers’ systems is not yet known. New recombinant technologies are under development, but have not yet been approved for use.

Will Influenza A(H1N1) vaccines be effective in all population groups?

There are not data on this but there also is no reason to expect that they would not, given current information.

Will the Influenza A(H1N1) vaccine be safe?

Licensed vaccines are held to a very high standard of safety. All possible precautions will be taken to ensure safety and new Influenza A(H1N1) vaccines.

How can a repeat of the 1976 swine flu vaccine complications (Guillain-Barré syndrome) experienced in the United States of America be avoided?

Guillain-Barré syndrome is an acute disorder of the nervous system. It is observed following a variety of infections, including influenza. Studies suggest that regular seasonal influenza vaccines could be associated with an increased risk of Guillain-Barré syndrome on the order of one to two cases per million vaccinated persons. During the 1976 influenza vaccination campaign, this risk increased to around 10 cases per million vaccinated persons which led to the withdrawal of the vaccine.

Pandemic vaccines will be manufactured according to established standards. However, they are new products so there is an inherent risk that they will cause slightly differently reactions in humans. Close monitoring and investigation of all serious adverse events following administration of vaccine is essential. The systems for monitoring safety are an integral part of the strategies for the implementation of the new pandemic influenza vaccines. Quality control for the production of influenza vaccines has improved substantially since the 1970s.

Will it be possible to deliver new Influenza A(H1N1) vaccine simultaneously with other vaccines?

Inactivated influenza vaccine can be given at the same time as other injectable vaccines, but the vaccines should be administered at different injection sites.

If the virus causes a mild pandemic in the warmer months and changes into something much more severe in, say, 6 months, will vaccines being developed now be effective?

It is too early to be able to predict changes in the Influenza A(H1N1) virus as it continues to circulate in humans or how similar a mutated virus might be to the current virus. Careful surveillance for changes in the Influenza A(H1N1) virus is ongoing. This close and constant monitoring will support a quick response should important changes in the virus be detected.

Will there be enough Influenza A(H1N1) vaccine for everyone?

The estimated time to make enough vaccine to vaccinate the world’s population against pandemic influenza will not be known until vaccine manufacturers will have been able to determine how much active ingredient (antigen) is needed to make one dose of effective Influenza A(H1N1) vaccine.

In the past two years, influenza vaccine production capacity has increased sharply due to expansion of production facilities as well as advances in research, including the discovery and use of adjuvants. Adjuvants are substances added to a vaccine to make it more effective, thus conserving the active ingredient (antigen).

What is WHO’s perspective on fairness and equity for vaccine availability?

The WHO Director-General has called for international solidarity in the response to the current situation. WHO regards the goal of ensuring fair and equitable access by all countries to response measures to be among the highest priorities. WHO is working very closely with partners including the vaccine manufacturing industry on this.

Who is likely to receive priority for vaccination with a future pandemic vaccine?

This decision is made by national authorities. As guidance, WHO will be tracking the evolution of the pandemic in real-time and making its findings public. As information becomes available, it may be possible to better define high-risk groups and to target vaccination for those groups, thus ensuring that limited supplies are used to greatest effect.

Will WHO be conducting mass Influenza A(H1N1) vaccination campaigns?

No. National authorities will implement vaccination campaigns according to their national pandemic preparedness plans. WHO is exploring whether the vaccine can be packaged, for example, in multi-dose vials, to facilitate the rapid and efficient vaccination of large numbers of people.

Developing countries are very experienced in administering population-wide vaccination campaigns during public health emergencies caused by infectious diseases, including diseases like epidemic meningitis and yellow fever, as well as for polio eradication and measles control programmes.

How feasible will it be to immunize large numbers of people in developing countries against a pandemic virus?

Developing countries have considerable strategic and practical experience in delivering vaccines in mass campaigns. The main issue is not feasibility, but how to ensure timely access to adequate quantities of vaccine.

What is the estimated global number of doses of seasonal vaccine used annually?

The current annual demand is for less than 500 million doses per year.

Will seasonal influenza vaccine continue to be available?

At this time there is no recommendation to stop production of seasonal influenza vaccine.

¹National Institute for Biological Standards and Control (UK), Food and Drug Administration/Center for Biologics Evaluation and Research (USA), New York Medical College (USA), Victorian Infectious Diseases Research Laboratory (Australia)

Medicare Today releases new survey data on Medicare prescription drug benefit

WASHINGTON, April 29 /PRNewswire-USNewswire/ — Healthcare leaders today announced the latest results of a national survey of seniors showing that the vast majority of Medicare beneficiaries remain satisfied with the Medicare Part D drug benefit. Medicare Todayhas been tracking senior satisfaction with the drug benefit since 2006.

The survey, commissioned byMedicare Today, a project of the Healthcare Leadership Council, and conducted in March by KRC Research, confirms that senior Medicare beneficiaries continue to see the prescription drug program as a success. Overall satisfaction with the Medicare prescription drug benefit has grown from 78 percent to 84 percent, up six points since early 2006.

“Before the Medicare Part D drug benefit was created, many seniors faced uncertainty when it came to accessing prescription drugs. The drug benefit provides millions of seniors with peace of mind,” said Mary R. Grealy, president of the Healthcare Leadership Council, a coalition of the nation’s leading health care companies and organizations

“With the economic crisis threatening many household budgets, it is important that Medicare Part D drug benefit continue to provide access to prescription drugs to the millions of seniors who depend on the program to help them live healthy lives,” said former U.S. Senator and Medicare Today Co-Chairman John Breaux. “And in light of the growing debate about health care reform this year, it’s important to understand the value of the Medicare prescription drug benefit as a part of the U.S. health care system and how seniors feel about the benefit.”

“We also need to make sure that seniors know that a low income subsidy is available for those who may need extra financial assistance,” Grealy added.

Unfortunately, not all eligibe seniors have enrolled in Medicare Part D. Medicare Todayis encouraging seniors to take advantage of this health care benefit. For those seniors who need extra financial assistance, a low income subsidy is available to help pay for their coverage. Nearly four in 10 seniors who would likely qualify for extra financial assistance are not aware that the low income subsidy exists.

Despite annual changes to prescription drug plan options, survey findings continue to show widespread support for the program. In addition to high satisfaction rates, the survey found that beneficiaries are saving money under Medicare Part D prescription drug plans. With 88 percent of seniors surveyed stating that their plan offers good value and nearly 70 percent reporting that they’ve lowered their prescription drug spending, the program costs less than was originally predicted.

Seniors across various demographics and political party lines continue to have positive feelings towards Medicare Part D, citing convenience, smooth operations and fair prices as reasons why they feel their plans are working well. More than 90 percent of seniors feel fortunate to have Part D and say it gives them peace of mind. Most seniors agree that their plan is delivering what it said it would when they signed up, and almost three in ten now get medications they once had to skip or ration.

Prior to the addition of Part D coverage, millions of Medicare beneficiaries had coverage for hospital and doctor expenses, but not prescription drug expenses. Today, all Medicare beneficiaries have access to coverage and lifesaving medicines and more than 90 percent of seniors have signed up. Beneficiaries can choose an affordable plan to meet their individual needs, and they can change it yearly if they’re not satisfied. The program offers a wide variety of plan choices to fit every budget.

Current and potential beneficiaries can speak with a Medicare counselor for information about the benefit by calling 1-800-MEDICARE (1-800-633-4227). To prepare for a discussion with a counselor, beneficiaries should have on hand a list of the prescription drugs they take, including the dosage and frequency, and a preferred pharmacy.

The Social Security Administration can also provide assistance for those who may qualify financially for extra help with the cost of prescription drugs. Medicare beneficiaries interested in applying for extra help or those who have previously applied and want to check their status can call 1-800-772-1213 to contact their local Social Security office.

About the Survey

This nationally representative telephone survey of Medicare Part D beneficiaries was conducted March 19-25, 2009. The margin of error for seniors with a Medicare Rx plan is plus or minus 4.9 percentage points. To view the survey results in their entirety, go towww.medicaretoday.org.

About Medicare Today

Healthcare Leadership Council launched Medicare Today in November 2004 to reach out to Medicare beneficiaries who needed reliable information on how to get the greatest value from the new Medicare benefits. Medicare Today administers the partnership of over 400 national and local organizations including AARP, National Association of Family Physicians, and National Alliance for Hispanic Health.Medicare Today develops innovative tools for use by all partners, commissions research studies, and undertakes earned media efforts and outreach to inform beneficiaries about the value of the new benefits under the Medicare Modernization Act (MMA).

SOURCE Medicare Today
Copyright©2009 PR Newswire.
All rights reserved

A new report from Harvard Medical School explains how and why the swine flu virus is threatening humans and describes what to do if the infection reaches your community.

Boston, MA (Vocus) April 28, 2009 — A new report from Harvard Medical School explains how and why the swine flu virus is threatening humans and describes what to do if the infection reaches your community.

The United States government declared a public health emergency as a result of an increasing number of cases of swine flu, a new type of influenza virus that contains genes from pig (swine), bird and human influenza viruses. Although the effect of the disease in the United States has been mild thus far, swine flu has killed many people in Mexico, and is spreading around the globe.

The infection is spreading in the U.S., Mexico, and other parts of the world. The World Health Organization and the U.S. Centers for Disease Control and Prevention (CDC) have expressed concern that the illness could turn into a global pandemic. Global pandemics can cause great suffering, economic losses, and loss of life.

In response, Harvard Health Publications (HHP), a Division of Harvard Medical School, has published a Special Health Report, Swine Flu: How to understand your risk and protect your health. The report explains what the illness is, how it is diagnosed and treated, and how families and businesses can protect themselves against it–written in language that anyone can understand. The report can be purchased electronically in PDF file format, for download from the HHP Web site: www.health.harvard.edu/SF.

The 43-page Special Health Report answers questions such as:

Harvard Health Publications will also maintain a Flu Resource Center web page (www.health.harvard.edu/flu) that includes the latest information on the number of reported swine flu cases, the number of deaths, the countries where cases have been reported, travel restrictions, and other frequently changing information, as well as general influenza information.

Harvard Health Publications will also frequently update the Special Health Report itself, as major new developments occur in this dynamic new epidemic. People who purchase the Report will receive e-mails alerting them that an updated version of the report is available to them, for free, from the Harvard Health Publications Web site.

Swine Flu: How to understand your risk and protect your health is available for $18 from Harvard Health Publications, the publishing division of Harvard Medical School. Order it online at www.health.harvard.edu/SF.

Computers are increasingly used in daily life: 56 percent of workers use one on the job and 62 percent of households own one. Arthritis is a leading cause of work disability, and those with the disesase may have difficulty performing physically demanding jobs, and may select jobs that appear less strenuous but require intensive computer use. Computer use is a risk factor for pain and musculoskeletal disorders in the general population; arthritis patients are more at risk because of difficulties performing tasks due to pain, restricted movement, muscle weakness, or fatigue. Little is known about the magnitude of problems experienced by those with arthritis during computer use, but a new study explored this question among people with rheumatoid arthritis (RA), osteoarthritis (OA) and fibromyalgia (FM). The study was published in the May issue of Arthritis Care & Research (http://www3.interscience.wiley.com/journal/77005015/home).

Led by Nancy A. Baker of the University of Pittsburgh and funded by the Western Pennsylvania Chapter of the Arthritis Foundation, the study involved 315 arthritis patients who completed a specially-designed survey that contained questions on computer use, discomfort experienced while using a chair, desk, keyboard, mouse and monitor, and problems associated with each piece of equipment. The results showed that many people with arthritis experience both discomfort and problems that could lead to work limitations: 84 percent of respondents reported a problem with computer use attributed to their underlying disorder and 77 percent reported some discomfort related to computer use. Of the three categories of disease, significantly more respondents with FM reported severe discomfort, more problems and greater limitations related to computer use than those with RA or OA. “Because those with arthritis may experience pain and discomfort even under ideal circums

ances, it is not surprising that the prevalence of respondents reporting discomfort with computer use is considerably higher than the general population of computer users,” the authors note.

Respondents reported problems with finding a comfortable position while using the computer and in manipulating the keyboard and mouse. It was expected that those with RA and OA would have more problems manipulating the keyboard and mouse than those with FM because of their restricted movements. However, in this study those with FM reported more problems. The authors hypothesized several explanations: People with FM may have increased clumsiness due to abnormalities in sensory processing or fatigue, they have diffuse rather than localized pain that may affect manipulation, or those with movement limitations, such as RA and OA, have found it easier to adapt their environment than those with unpredictable diffuse pain, such as FM.

In recent years, numerous products have been designed to reduce discomfort and problems during computer use, such as adjustable chairs and monitors and adapted keyboards and mice. “Providing people with arthritis with appropriate strategies and equipment to prevent computer problems may significantly reduce work limitations and prevent those with arthritis from discontinuing computer use,” the authors state. They add that computer use in the home appears to have a greater potential to place people at risk for upper extremity musculoskeletal disorders, since most people do not set up their home computer environment to reduce risk factors. Those with arthritis should therefore have both their work and home computer set-ups evaluated to ensure that problems are minimized.

The authors point out that the ability to use a computer is one method of preventing work limitations and eventual disability, as well as a vital tool for both work and home activities. They conclude that “health professionals must work with people with arthritisto identify problems experienced during computer use and implement computer workstation modifications to ensure safe, effective, and comfortable use of all computer equipment.”

Arthritis can have significant physical and psychological repercussions that impact quality of life and for those of working age, it can affect their ability to remain employed. Compared to individuals with other types of chronic diseases or disabilities, arthritis appears to have a more profound effect on a person’s ability to work. Previous studies have found that about half of those with severe forms of arthritis were not working, leading to a loss of skilled workers and increasing the personal and socioeconomic burden of the disease. Few studies have looked at sex differences in the work experiences of people with arthritis, but a new study found that women may be more likely to leave employment, while men may be more likely to remain working and report negative experiences. The study was published in the May issue of Arthritis Care & Research(http://www3.interscience.wiley.com/journal/77005015/home).

Led by Simone A. Kaptein of the Toronto Western Research Institute, the study used data from the Canadian Participation and Activity Survey, a national telephone survey administered in 2001-2002 to almost 29,000 individuals. The study analyzed responses for almost 9,000 individuals between the ages of 25 and 64. Respondents were questioned about the intensity and frequency of activity limitations for activities likely to be encountered in the work place, such as standing for long periods, bending and picking up objects, climbing stairs, carrying objects, using their fingers, traveling by car and moving about between rooms. They were also asked whether they needed work place accommodations, what type and whether these were available, as well as questions about workplace discrimination or disadvantage.

The results showed that 2.3 percent of the working-age population had arthritis disability, the second-most frequent cause of disability after back and spine conditi

ns. More than half of those with arthritis disability reported being out of the labor force, almost 41 percent were unemployed, and 5 percent were unemployed and looking for work. A higher proportion of women were out of the labor force than men.

Although men with children were more likely to remain employed, in contrast to previous studies, the current study found that single or previously married women were more likely to be out of the labor force. Married women were more likely to continue working, possibly due to the fact that these women may have the option of working part-time, which would be difficult for sole-income earners who may have had to give up employment and receive disability insurance. “Additional research needs to examine in more detail the specific reasons that men and women give up employment and their relationship to family composition and marital status,” the authors state.

Not surprisingly, older individuals with arthritis disability were more likely to take early retirement than their younger counterparts. The authors point out, however, that the financial ramifications of retirement may be more serious for those with arthritis disability, since they may have to give up medication coverage and extended health care benefits, they may not be as financially prepared for retirement having often worked reduced hours prior to retiring, and arthritis is often associated with extra financial costs for medications and other expenses.The study found that greater education was significantly associated with being in the labor force for both men and women and may act as a resource enabling individuals to more easily change or modify their jobs. It also showed that men were more likely to report perceived arthritis-related discrimination than women and were more likely to make changes such as the amount or type of work they performed, which may account for the higher percentage of men remaining in the work force.

The authors conclude that the study highlights “the need for greater attention to differences in gender roles that may influence the impact of arthritis in the lives of women and men.”

Almost half of those in ICU had deficient levels, study shows

WEDNESDAY, April 29 (HealthDay News) — Vitamin D levels are deficient in many critically ill patients, new research shows.

In a small study, Australian researchers found that almost half of people in an intensive care unit were deficient in vitamin D.

“Vitamin D deficiency is likely to be common in seriously ill patients,” said study author Dr. Paul Lee, an endocrinologist and research fellow at the Garvan Institute of Medical Research in Sydney, Australia. “In our study, 45 percent of critically ill patients were vitamin D-deficient. It appears that the sicker they were, the lower their vitamin D. However, it is uncertain whether it is just an association, or whether vitamin D deficiency itself contributes to disease severity.”

Results of the study were published as a letter in the April 30 issue of the New England Journal of Medicine.

Vitamin D is a fat-soluble vitamin that the body manufactures after exposure to sunlight, according to the U.S. government’s Office of Dietary Supplements (ODS). Few foods naturally contain vitamin D. Those that do include fatty fish, such as salmon and tuna, cheese, egg yolks and some mushrooms. Vitamin D is also found in fortified milk and cereals.

The recommended daily intake of vitamin D is 200 international units (IU) for adults under 50; 400 IUs for adults between 51 and 70, and 600 IUs for those 71 and older, according to the ODS. However, some experts believe these recommendations are too low, as vitamin D deficiency is increasingly being linked to adverse health outcomes.

Lee said that vitamin D is involved in controlling blood sugar levels, calcium levels, heart function, gastrointestinal health, defending against infection and more.

In the latest study, the researchers measured vitamin D levels in 42 people being treated in an intensive care unit. Almost half were vitamin D-deficient.

Three patients died during the study, and the researchers found that they had the lowest levels of vitamin D in the study group.

Lee said the researchers don’t know the exact cause of the vitamin D deficiency. A lack of sun exposure could play a role, as could a lack of dietary intake of vitamin D. But, Lee said, “it may be postulated that the tissue demand for vitamin D is increased during infection, metabolic disturbances and inflammation. Vitamin D may therefore be used up during critical illness. However, it is a hypothesis, and the relationship between vitamin D and critical illness requires further studies in the future.”

Dr. David Weinstein, a nephrologist at Beaumont Hospital in Royal Oak, Mich., agreed that more research needs to be done to tease out what the cause of the vitamin D deficiency is, and studies need to be done to see if replacing the lost vitamin D would benefit these patients.

“We know that in stable situations, vitamin D deficiency definitely has a potential link to mortality, and vitamin D replacement does improve outcomes,” said Weinstein. But, he added, “from this study, it’s too early to tell if there would be a mortality benefit from vitamin D replacement.” And for immobile patients, there’s a risk of creating calcium levels that are too high, he added.

In the current study, 10 patients were given vitamin D supplements, and no protective effect was found.

Dr. Kirit Tolia, chief of endocrinology at Providence Hospital in Southfield, Mich., said his sense is that replacing vitamin D in such critically ill patients may be too late. “If you go into illness with a significant vitamin D deficiency, it makes whatever the underlying cause of the hospitalization worse,” he said. For example, if someone is being treated for sepsis — a serious infection — if their vitamin D levels are low, it makes it harder for them to fight the infection, he explained.

Tolia added that he wasn’t surprised by the findings, because he sees a lot of vitamin D deficiency, but that he was “alarmed at the severity of the deficiency and the prevalence of it.”

Additionally, he said he believes that healthy adults should get about 1,000 IUs of vitamin D daily, and that those who are elderly or in poor health should get about 1,500 IUs daily. “That gives them a fair chance of maintaining vitamin D in the normal range,” he said.

More information

Learn more about vitamin D and its sources from the U.S. government’s Office of Dietary Supplements.
SOURCES: Paul Lee, M.B., endocrinologist, research fellow, Garvan Institute of Medical Research, Sydney, Australia; Kirit Tolia, M.D., chief, endocrinology, Providence Hospital, Southfield, Mich.; David Weinstein, M.D., nephrologist, Beaumont Hospital, Royal Oak, Mich.; April 30, 2009, New England Journal of Medicine

Noninvasive method detects dangerous levels of artery-blocking proteins

WEDNESDAY, April 29 (HealthDay News) — A urine test to detect coronary artery disease has worked well in a small trial, German researchers report.

The test looks for fragments of the protein collagen, which plays a major role in blocking heart arteries, said study author Dr. Constantin von zur Muehlen, a fellow in cardiology at University Hospital Freiberg. He was scheduled to report the findings Wednesday at an American Heart Association meeting in Washington, D.C.

“Collagen forms a fibrous cap on the epithelium, the lining of the arteries,” Muehlen explained. “These fibrous caps produce collagen fragments.”

High concentrations of those fragments, called proteomes, in urine can signal atherosclerosis (hardening of the arteries), which can lead to a heart attack, Muehlen said.

The urine test was done for 67 people with symptoms of coronary artery disease, he said. Two techniques to detect proteins, mass spectrometry and capillary electrophoresis, were used to find levels of 17 protein fragments that the researchers had identified as being associated with atherosclerosis.

When the results were compared to coronary angiography, an X-ray exam that is a standard method for diagnosing atherosclerosis, the urine tests were found to be 84 percent accurate, Muehlen said.

But a urine test to detect heart disease will not be developed quickly, he said. The German researchers have gone back to the laboratory, working with a strain of mice genetically engineered to develop coronary artery disease as they age.

“We went to this mouse model and found that, over time, the pattern of proteomes becomes more heavily expressed,” Muehlen said. “The older the animal, the more extreme the pattern will be.”

While he hopes to do a larger human study, no timetable for one has been set, Muehlen said.

More animal studies are needed to fill in knowledge gaps, he said. “We don’t know if stable regions of atherosclerosis produce more collagen than unstable regions,” Muehlen explained. Unstable collagen is more likely to rupture, blocking an artery completely.

This is not the first report of a urine test for coronary artery disease. In 2007, physicians at Brigham and Women’s Hospital in Boston found that the presence of the protein albumin in urine of people with stable cardiovascular disease indicated an increased risk of death.

Albumin is normally found in blood, but not in urine. Leakage of albumin into the urine indicates damage to the blood vessels of the kidney, and so points to an increased risk of cardiovascular death, the researchers said.

The German study is “interesting, but I’d be cautious,” said Dr. Alan Daugherty, director of the Cardiovascular Research Center at the University of Kentucky.

“In general, it obviously would be desirable to be able to diagnose coronary artery disease without an angiogram,” Daugherty said. “There has been a tremendous amount of effort looking for biomarkers.”

But a good deal of work is needed to move the results of the study toward clinical use, he said. “We’ve been trying to do something like this for decades,” Daugherty noted.

More information

Learn about coronary artery disease from the U.S. National Heart, Lung, and Blood Institute.

Morning Edition, April 29, 2009 ·How hard is it to remake the nation’s health care system? It’s so hard that even if policymakers do everything right, most observers still don’t give them more than a 50-50 chance of getting a bill passed.

That’s about the situation President Obama finds himself in 100 days into his presidency on one of his top domestic priorities.

“The good news is they understand it and I think they’re trying to do it in a very reasonable way,” said Stuart Altman of Brandeis University, a veteran of health overhaul efforts under presidents Nixon, Carter and Clinton. “The idea that they came up with principles as opposed to a 1,300-page bill is good, and the principles are on the right track,” he said, referring to the massive measure written by President Clinton’s secret task force in 1993.

“But I think the tough part is just hitting us, which is that if we’re going to have comprehensive reform, it’s going to require new money,” Altman said. “In the short run, it’s just not possible to save the kind of dollars that would be needed,” he says, to cover the estimated 46 million Americans with no health insurance.

Strong Steps Toward Health Care Change

By just about any measure, the administration can already claim several health care accomplishments since the president was sworn in Jan. 20. One of the first bills he signed was an expansion of the State Children’s Health Insurance Program, adding an additional 4 million children to the 7 million current enrollees. President Bush had twice vetoed similar measures.

Then, as part of the economic stimulus measure passed in February, the administration convinced Congress to include a long list of its health care priorities: $90 billion for state Medicaid programs, $25 billion to help laid-off workers continue their employer-provided health insurance, $19 billion to begin to computerize the nation’s paper medical records, and just over $1 billion to study the relative effectiveness of various medical drugs, tests and treatments.

That prompted the president to pronounce in his Feb. 24 speech to Congress that “already we have done more to advance the cause of health care reform in the last 30 days than we have in the last decade.”

Perhaps more importantly, though, the president made it clear in that speech that he is keeping the pressure on, despite calls to put health on the back burner until the economy is more under control. “Let there be no doubt: Health care reform cannot wait, it must not wait and it will not wait another year,” he said.

Involving All Parties

Just days later, Obama called a health care “summit” at the White House, bringing together not only Democrats and Republicans from Capitol Hill, but also representatives from health care provider groups, the insurance industry, business and labor.

The summit drew praise even from those with serious philosophical disagreements with the administration’s approach to health care, like Grace-Marie Turner of the Galen Institute, which advocates for less government involvement in health care. She says the summit is still generating “a lot of positive feedback” from the administration’s “bringing so many different players to the table.”

Those who support the president’s goals are positively gushing.

“I would give President Obama an A-plus,” said Ron Pollack of the consumer advocacy group Families USA. He says what this president has really done well is get the debate off to a quick start. That’s a marked contrast to President Clinton, he says, “who did not give a speech on health care reform until September of 1993 and did not introduce his proposal until November of 1993.”

To Move Forward, Compromise Likely

Yet despite ambitious timetables issued by leaders in Congress and promises from Republicans to try to reach bipartisan agreements, even big boosters like Pollack remain wary. “It’s a very heavy lift to pass meaningful health care reform,” he said.

One big reason is what Turner calls the “80-20 rule.” The idea is that most of the public and health care interest groups are willing to go along with 80 percent of the agenda, she says. But 20 percent of the agenda, they simply can’t live with. “And the problem they’ve got is everyone’s got a different 20 percent,” she says.

That means that while employers might be perfectly happy with a health reform plan that includes an option run by the government, they won’t stand for a requirement that all employers offer their workers coverage. And health care providers like doctors and hospitals might be fine with an “employer mandate,” but they would vehemently oppose a government-run plan that would likely mean lower pay.

So while the administration has made a lot of progress in its first 100 days, Turner says, “I do think the rubber’s about to hit the road in how they’re actually going to get to the details of some much more controversial pieces of this health care reform. So the second 100 days is going to be particularly interesting.”

Staff at pharmacies are frequently giving inappropriate and occasionally dangerous advice to patients, a survey has suggested.

Staff at Which? magazine visited 101 pharmacies in the UK, and claimed they received “unsatisfactory” advice on a third of occasions.

In some instances, powerful migraine drugs were sold without any supervision by the pharmacist.

One pharmacy body said its own “mystery shoppers” had seen improvements.

The patient in the heart failure clinic had all the symptoms of digitalis toxicity from taking too much of the heart medicine digoxin. However, his dose was right and no one was sure what the problem was.

This was a riddle Herb Patterson, Pharm.D., a University of North Carolina at Chapel Hill pharmacy professor who treats patients in the UNC heart failure program, had to solve. Patterson quizzed the patient on the medicines he was taking and discovered he had received two prescriptions for digoxin by different doctors: one for the generic version and one for the brand name. The patient was having them filled at different pharmacies and was taking both, not knowing they were the same drugs.

That example is the kind of medication mistake that can cost people money, time, their health and sometimes their lives. It is also the kind of error that can be significantly reduced by closely involving a pharmacist in caring for patients with cardiovascular disease and high blood pressure, according to a new study from UNC researchers published in the April 27, 2009, issue of the Archives of Internal Medicine.

People with high blood pressure and heart disease, including heart failure, were more than a third less likely to experience problems with their medications when under a pharmacist’s care than patients who received no special attention from a pharmacist, researchers found. Preventing unnecessary hospitalizations, emergency room visits and associated health-care costs saved approximately $2,600 per patient.

“By working closely with doctors and nurses, pharmacists can help people avoid problems with their medications for chronic conditions such as high blood pressure and heart failure with favorable effects on health and health-care costs,” said Michael D. Murray, Pharm.D, Mescal S. Ferguson Distinguished Professor at the UNC Eshelman School of Pharmacy and lead author of the journal paper.

In the study, researchers monitored two types of patients for approximately one year. Complicated patients had been previously diagnosed with heart failure, coronary heart disease, stroke, heart attack or kidney problems. Uncomplicated patients had high blood pressure but no other evidence of a heart or kidney condition. All were taking at least one medication, with complicated patients taking an average of more than ten. The 800 patients had an average age of 59 and received their care from Wishard Health Services, a city-county hospital in Indianapolis.

Complicated and uncomplicated patients assigned to the control group did not receive any extra attention from a pharmacist. Patients in the intervention group were assigned to a pharmacist who took a medical history, tracked medication refills, monitored body weights and laboratory tests, taught patients how to best take their medications, and communicated regularly with patients and their doctors and nurses.

Over the study period, 90 percent of all adverse events that occurred were experienced by participants in the complicated group who had more serious heart conditions. However, researchers found that a pharmacist’s guidance and advice reduced adverse drug events and medication errors by 34 percent.

Murray is chair of the school’s division of pharmaceutical outcomes and policy. The other authors of the paper are Mary Ritchey, a doctoral student at the UNC Gillings School of Global Public Health, and Wanzhu Tu, Ph.D., and Jingwei Wu, biostatisticians at Indiana University School of Medicine. James Young, Pharm.D, is the study pharmacist at Wishard Health Services in Indianapolis. Murray and Tu are also affiliated with Regenstrief Institute in Indianapolis.

The study was funded by a grant from the National Institutes of Health.

Source: University of North Carolina at Chapel Hill

by Joanne Silberner

Deciding which medical treatments work better than others is a tough job, but health policy experts say it could help hold down health care costs. Still, Americans aren’t too sure they want the government deciding which treatments their insurance should pay for, according to a new poll conducted by NPR, the Kaiser Family Foundation and the Harvard School of Public Health.

More than half of Americans polled said they would trust an independent scientific panel to make decisions about which medical treatments insurers could cover. Yet only 42 percent said they would trust a government health agency to do the same job.

The government stimulus package includes $1 billion to conduct comparative effectiveness research, which would carefully study the different types of medical treatment to determine what works best. The Obama administration has been soliciting the advice of health experts and the public on how it should be done, and who should have the final word.

Right now, there are no national standards for what health insurance contracts are required to cover.

Some say decisions about comparative effectiveness can be left to the marketplace. Insurance companies could make it clear what they would and would not pay for, and people could decide between policies.

Some of that is already going on, says Grace-Marie Turner, president of the Galen Institute, a nonprofit institute that promotes free-market solutions. “We have lots of companies now that are doing a lot of work to decide what treatments have value, and what don’t.”

But other health policy experts say it will take a government body or an independent board to really determine what works and what doesn’t. A government board could handle it, says health economist Uwe Reinhardt of Princeton University, but an independent board might be more acceptable to the public.

What’s important, Reinhardt says, is that something gets done soon.

“The idea that every American has the right to everything imaginable — whether it’s been shown to work or not — is just tragic,” he says. “Ultimately that leads to what we’ve had, where health spending grows 2.5 percentage points faster than the rest of the GDP. For the last 40 years we’ve had this.”

He says if we continue on this path, in 2050 we’ll be spending 40 percent of the GDP on health care.

Men taking generic drugs may be more likely to have less effective results and more adverse events than if they were using branded medications, according to new data from researchers in New York. Researchers presented a study at the 104th Annual Scientific Meeting of the American Urological Association (AUA) showing that generic substitutes for alpha blockers and 5-alpha reductase inhibitors (5-ARIs), two classes of medications used to treat lower urinary tract symptoms (LUTS) in men, are less effective than their branded counterparts.

Over eight weeks, the study tested 212 men taking branded alpha blockers or 5ARIs with an average age of 64, who were switched to generic alternatives by their primary care physician or due to insurance coverage. The researchers measured the efficacy of the medications using several parameters, including the International Prostate Symptom Score (IPSS), peak flow rate (Qmax), post-void residual urine (PVR), voiding diary information, International Index of Erectile Function (IIEF), ejaculatory function and the prevalence of adverse events.

In the men who were switched to generic medications, the IPSS and PVR rates increased and Qmax decreased. In addition, the men experienced several new side effects, including dizziness (4.6 percent), nasal congestion (3.2 percent) and ejaculatory dysfunction (3.6 percent) for those switching alpha blockers, and ejaculatory dysfunction (4.7 percent) and erectile dysfunction (5.8 percent) for those switching to generic 5-ARIs.

“This preliminary study shows that some generics are not as effective as their branded counterparts and that men should consult a physician if a generic alternative is not providing results. Given that this is an early study, interpretation should be cautious as patients were not blinded as to which medication they were receiving and there may be a bias against generic medications on the part of patients,” said Kevin McVary, MD, an AUA spokesman. “Often, men switch because of cost or insurance company regulations; but, it is important to ensure efficacy and consider potential side effects prior to switching medications. A physician should be able to monitor the patient and may recommend switching back to the branded medication if efficacy decreases or side effects increase while taking a generic medication.”

Kaplan, S; Chung, D; Sandhu, J; Te, A. Generic substitutes are neither as safe nor effective as branded medications: experience in men treated for lower urinary tract symptoms (LUTS). J Urol, suppl. 2009: 181, 4, abstract 1799

Previous Studies Show Bryostatin Protects Against Alzheimer’s Protein, Rewires and Repairs Brain Damage

MORGANTOWN, W.Va., April 22 /PRNewswire-USNewswire/ — The Food and Drug Administration (FDA) has given the Blanchette Rockefeller Neurosciences Institute (BRNI) the go-ahead to conduct Phase II clinical trials of Bryostatin for the treatment of Alzheimer’s disease patients. The drug showed pre-clinical efficacy to not only treat Alzheimer’s disease symptoms, but also its underlying causes.

“We are very excited about the FDA’s agreement for BRNI to move forward with clinical trials,” said Dr. Daniel Alkon, Scientific Director of BRNI. “Bryostatin shows the promise to repair and protect against neurodegeneration caused by Alzheimer’s disease, stroke and other brain trauma, as well as enhance the brain’s normal memory functions.”

Bryostatin was originally created as an anti-cancer chemotherapy. When BRNI scientists extensively tested PKC activators against Alzheimer’s disease models, they discovered the drug’s hidden potential to stop Alzheimer’s disease. Over the past six years, the drug has shown remarkable possibilities. In preclinical testing, BRNI scientists experimented with Bryostatin on three species of Alzheimer’s disease transgenic mice, each species based on different human Alzheimer’s disease genes. The test results revealed that Bryostatin, and a related class of drugs discovered at BRNI, can reduce the toxic Alzheimer’s disease protein A Beta, restore lost synapses, and protect against the loss of memory functions. In related preclinical testing, Bryostatin has been shown to enhance and restore memory by rewiring connections in the brain previously destroyed by stroke, head trauma, or aging itself.

The Phase II trials, slated to begin in approximately two to four months, will test these preclinical findings on human Alzheimer’s disease patients as well as controls, along with Bryostation’s effects on molecular targets in the human body, such as the signaling enzyme PKC. The drug’s side effects will also be carefully monitored using low doses that were previously found to be generally benign in human cancer patients.

“With the potential to not just treat symptoms, but also stop the causes, the Bryostatin trial on Alzheimer’s disease patients represents a new direction for the treatment of a disease with no current cure,” said Alkon. “And the timing is crucial because as many as 5.3 million people live with Alzheimer’s disease in the United States alone, with a new American developing Alzheimer’s disease every 70 seconds.”

About BRNI

BRNI is the world’s only non-profit institute dedicated to the study of both human memory and diseases of memory. Its primary mission is to accelerate the transfer of neurological discoveries from the lab to the doctor’s office where it can benefit patients who suffer from neurological and psychiatric diseases.

BRNI is operated in alliance with West Virginia University in Morgantown as well as in collaboration with other academic institutions such as Johns Hopkins University. West Virginia Senator Jay Rockefeller founded the Institute in memory of his mother, Blanchette Hooker Rockefeller, who died of Alzheimer’s disease.

Reviewed By Louise Chang, MD

April 2, 2009 — The FDA has approved a new drug called Afinitor to treat advanced renal cell carcinoma after other treatments fail. Renal cell carcinoma is the most common type of kidney cancer.

Afinitor (everolimus) is taken orally. It’s part of a class of drugs called kinase inhibitors, which interfere with cell communication to prevent tumor growth.

The FDA approved Afinitor for advanced renal cell carcinoma patients who have already tried another kinase inhibitor — Sutent or Nexavar.

The FDA based its decision on a clinical trial that was discontinued when interim results showed that the growth or spread of the tumor was delayed in patients taking Afinitor.

In that trial, half of the patients taking Afinitor also had slower worsening of their kidney cancer; their disease progressed after about five months, compared to two months in patients who didn’t receive the drug.

The most frequent side effects in the trial included inflammation in the mouth, loss of strength, diarrhea, poor appetite, fluid buildup in the extremities, shortness of breath, coughing, nausea, vomiting, rash, and fever.

Lab tests also showed that at least half of all patients experienced anemia, low white blood cell counts, high cholesterol, high triglycerides, and high blood sugar, according to the FDA.

Afinitor is made by the drug company Novartis.

SOURCES: News release, FDA. News release, Novartis.

©2009 WebMD, LLC. All Rights Reserved.

Prices of the most frequently used brand-name prescription drugs are rising despite the current economic recession, but prices of generic drugs are declining and more older U.S. residents are switching to the lower-cost alternatives, according to an annual AARP report released on Wednesday, the AP/Myrtle Beach Sun News reports. For the report, AARP examined the costs of the 219 most widely used brand-name drugs and found that manufacturers increased price on the drugs by 8.7% in 2008, compared with the general inflation rate of 3.8% over the same period. Acid reflux treatment Prevacid increased the most, at 30%, while depression drug Wellbutrin and sleep medication Lunesta were second and third at 21% and 20%, respectively.

According to the AP/Sun News, some financial analysts have said that the rising cost of prescription drugs can be attributed to drugmakers’ attempts to increase profit during the current economic recession. In addition, some drugmakers have raised prices of certain drugs before their patent expires and generic versions of the treatment become available, the AP/Sun News reports.

Meanwhile, the costs of generic drugs declined by 10.6% on average in 2008, according to the report. AARP officials said they hope to continue persuading people to use more generic medications, as well as push lawmakers to focus on reducing drug prices. John Rother, AARP’s public policy director, said, “Just about everybody in today’s economy is feeling some economic pressures and it does not help that the drugs you take to keep healthy are much more expensive than last year,” adding, “I think this makes the case for health reform.” Rother said the price increases help make the case for policy changes, such as allowing the government to negotiate drug prices and drug reimportation.

The Pharmaceutical Research and Manufacturers of America called the report “one-sided,” saying that it focused on selective brand-name medicines. PhRMA Senior Vice President Ken Johnson said, “Unfortunately, AARP distorts the true, overall picture in hopes of dramatizing its report and deflecting attention from the millions of dollars it earns each year from its insurance businesses” (Werner, AP/Myrtle Beach Sun News, 4/15). 

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

© 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

As influenza season shifts into high gear, with 24 states now reporting widespread activity, the nation’s infectious diseases experts are urging supermarket pharmacies with free-antibiotics promotions to educate their customers on when antibiotics are the right prescription – and when they can do more harm than good. 

Several grocery store chains nationwide began offering free antibiotics this winter. Some are linking the promotion to cold and flu season, despite the fact that antibiotics do not work against these viral illnesses. Furthermore, antibiotics can have serious side effects, and their misuse is contributing to the increase in antibiotic-resistant infections such as methicillin-resistant Staphylococcus aureus (MRSA). 

Therefore, the Infectious Diseases Society of America (IDSA) and the Centers for Disease Control and Prevention (CDC) have written to supermarkets with free-antibiotics promotions asking them to join “Get Smart: Know When Antibiotics Work,” a campaign from CDC to educate consumers about the importance of using antibiotics appropriately. 

“Taking an antibiotic when you don’t need it won’t help you, and may in fact do more harm than good,” said IDSA President Anne Gershon, MD. “At a time when antibiotic overuse is helping to create drug-resistant superbugs such as MRSA and few new antibiotics are being developed, supermarkets need to be responsible in how they promote antibiotics.” 

Studies show many people believe that antibiotics can cure a cold or the flu, and tend to ask or pressure their clinicians to provide them. Every year, tens of thousands of people are prescribed antibiotics for these conditions, even though they will do no good and can be harmful. A recent study in Clinical Infectious Diseasesestimates that antibiotics are responsible for 142,000 emergency department visits each year, mostly because of allergic reactions. 

“Supermarkets have the power to protect their customers’ health,” said Lauri Hicks, DO, medical director of CDC’s “Get Smart” program. “If they sought to educate people about when antibiotics work and when they don’t, they would be doing a great public service.” 

In letters to Wegmans, ShopRite, Stop and Shop, and Giant, IDSA and CDC suggest that supermarkets could begin with CDC’s easy-to-understand posters, brochures, and other educational materials. 

IDSA suggests supermarkets offer free flu shots rather than free antibiotics as a way to save customers money while protecting their health. “We applaud supermarkets’ desire to look out for their customers in these difficult economic times,” Dr. Gershon said. “As flu season heats up, free influenza vaccinations would be a proven-effective way to keep customers healthy.” 

—————————-
Article adapted by Medical News Today from original press release.
—————————- 

The Infectious Diseases Society of America (IDSA) is an organization of physicians, scientists, and other health care professionals dedicated to promoting health through excellence in infectious diseases research, education, prevention, and patient care. The Society, which has more than 8,600 members, was founded in 1963 and is based in Arlington, VA. For more information, visit http://www.idsociety.org/. 

Source: Steve Baragona 
Infectious Diseases Society of America 

STORY HIGHLIGHTS

• New generation of anti-addiction drugs effective, some experts say
• Drugs seem to block release of brain chemicals linked to pleasure, excitement
• Established rehab programs slow to adopt the use of medication
• Critics: Drug therapy does not address behavioral aspects of addiction

By Caleb Hellerman
CNN Senior Medical Producer

CENTRAL FALLS, Rhode Island (CNN) – A no-frills bar called Goober’s, just north of Providence, Rhode Island, is probably the last place you’d expect to find a debate over cutting-edge addiction therapy. But this is where Walter Kent, a retired mechanic, spends his Fridays. He helps in the kitchen and hangs out in the bar, catching up with old friends.

Most addiction specialists would call this playing with fire, or worse. That’s because for more than 30 years, Kent was a hard-core alcoholic. His drinks of choice were Heineken beer and Jacob Ginger brandy, but anything with alcohol would do.

“It’s like a little kid wanting a piece of candy. You see it, you want the taste of it.” He closes his eyes and sniffs the air, remembering the feeling. “You can be by yourself, and all of a sudden get even a hint of alcohol, just the smell of it, and say, ‘Oh, I need a drink.’ That sensation is not something you can get rid of.”

But today, Kent isn’t tempted in the least. He says the credit goes to a prescription medication — a pill called naltrexone. It’s part of a new generation of anti-addiction drugs that may turn the world of rehab on its head.

Dr. Mark Willenbring, who oversees scientific research at the National Institute on Alcoholism and Alcohol Abuse, says alcoholism has reached a point similar to one depression reached 30 years ago — when the development of Prozac and other antidepressants took mental health care out of the asylum and put it in homes and doctors’ offices.

“There will be a ‘Prozac moment,’ ” Willenbring says, “when primary care doctors start handling functional alcoholics.”

Among the findings that are causing excitement:

• A study led by Dr. Bankole Johnson of the University of Virginia found that topiramate (Topamax) — already used to treat epilepsy and migraines — reduced the number of days on which alcoholics drank heavily, by 25 percent more than among alcoholics who got just therapy.

• A federally funded study known as COMBINE compared cognitive-behavioral therapy alone with therapy along with naltrexone. Patients receiving both were more likely to stay abstinent and drank less if they did relapse.

These findings highlight what’s become increasingly clear: Addiction is a brain disease, not just a failure of willpower. Naltrexone and topiramate have slightly different mechanisms, but both seem to block the release of brain chemicals that are linked to pleasure and excitement. Unlike earlier drugs used to treat alcoholics, neither is addictive or carries significant side effects. It does appear that each might work better in certain subgroups — topiramate for repeat relapsers, and naltrexone in people with a strong family history of alcoholism. 

Johnson is a paid consultant to the company that makes Topamax, but his study appeared in the Journal of the American Medical Association and he says other medications can also work well. “I think everybody who’s an alcoholic should be given medication if they’re willing to take it,” he says. “It’s been shown over and over with research studies that effects of medicine are over and above that of therapy. And if you’re not getting the medicine, it’s a bit like having one hand tied behind your back.”

Before he found naltrexone, Kent had tried to quit drinking more times than he can remember. “I was the kind of person who only drank if he was alone or with somebody. Other than that, it was never a problem,” he jokes now. He did two stints in residential rehab programs and went to countless AA meetings, but nothing worked. Kent is a giant of a man — he stands a broad-shouldered 6 feet 5 inches tall, and has two sons who played professional basketball in Israel — but for most of his life, he couldn’t find the strength to put down the bottle.

It got worse in 2000, after an injury from falling off a ladder forced him to stop working. Depressed and in pain, with time on his hands, Kent began boozing from 8 o’clock in the morning, every morning. It went on a few months until his wife, a woman he’d known since grammar school, handed him an ad from a newspaper and an ultimatum: “She said, ‘You’re killing the marriage, and you’re killing yourself,’ ” Kent said. ” ‘ Get help or I’m gone.’ “ 

The ad was recruiting alcoholics for research at Roger Williams Hospital, part of Brown University. Kent signed up. It was part of the COMBINE study. Kent got 16 weekly visits and also something most addicts never hear about: medication. This time, he stayed sober, even after his doctor took him off naltrexone. That was more than eight years ago. 

Despite studies showing effectiveness, established rehab programs have been slow to adopt the use of medication. At Hazelden in Minneapolis, Minnesota, a small proportion of patients receive anti-addiction drugs, but medical director Dr. Kevin Clark says the traditional model — based on intensive therapy and the 12 steps popularized by Alcoholics Anonymous — is still best. “It is a disease of the brain, but it’s a multifaceted disease. It has a spiritual component, a behavioral component to it,” says Clark. “Our experience tells us that having the network of support and recovery is what really makes the difference.”

John Schwarzlose, executive director of the Betty Ford Center, echoes that but takes a more stringent approach. No patients at Betty Ford receive anti-addiction drugs as part of treatment, although a handful of long-time addicts may be referred to a prescribing physician once their stay is over. “Where we battle with [the National Institute on Alcoholism and Alcohol Abuse] is when they say we have trials of a new drug, and then proclaim this is a treatment for alcoholism,” says Schwarzlose. “They’re smart people, but they’re missing how complex this disease is.”

Schwarzlose argues that Willenbring and Johnson are using the wrong measure of success. He says abstinence is the only true measuring stick — that an alcoholic who is drinking less is just at a way station on the road to relapse. “Naltrexone has reduced drinking, but once you’re addicted, there is no such thing as ‘OK’ drinking. This is one of those cases where there’s a real schism between the research and actual practice.”

This attitude frustrates Willenbring, who estimates that in the United States only one addict in 10 has even heard about medication options. “In most cases, the treatment is entirely nonmedical. Most people are not even told about the medications that are available for treating alcohol dependence, and I think that’s a crime.”

Still, medication is slowly creeping into mainstream addiction therapy. One big advocate is Percy Menzies, a pharmacist and former sales representative for DuPont, which developed naltrexone. His St. Louis, Missouri-based Recovery Centers for America treats patients in an on-site hospital, then refers them to outside physicians for follow-up treatment. Along with therapy, virtually every patient is given Vivitrol, a long-lasting form of naltrexone that’s given monthly by injection.

Kent says naltrexone saved his life. When the COMBINE program was over, Kent’s doctor told him to call if he felt the old need for a drink coming back. But it never came. “I have yet to go back and say, ‘I have an urge for a drink,’ ” says Kent, lounging in Goober’s. “[My friends] will offer, ‘You want a drink?’ And I say, ‘No, I’m fine. I’ll have a soda.’ I’m fine with that. Because when there’s no urge, no craving, it doesn’t bother me. I’m living proof this can happen.”

Researchers Find Use of Erectile Dysfunction Drugs Does Not Lead to Eye Complications

By Jennifer Warner
WebMD Health News

Reviewed By Louise Chang, MD

April 13, 2009 — Using erectile dysfunction (ED) drugs like Viagra and Cialis for six months shouldn’t lead to vision loss, according to a new study.

Researchers say concerns have been raised about possible vision-related side effects associated with regular use of ED drugs. But their study showed no higher rates of vision loss or other eye complications among men who took Viagra or Cialis daily for six months.

Viagra and Cialis are part of a group of drugs known as selective phosphodiesterase type 5 (PDE5) inhibitors that treat erectile dysfunction by interfering with the action of PDE5 on the blood vessels in the penis.

Researchers say concerns have risen about possible long-term vision-related side effects of PDE5 inhibitors because they may also act on similar compounds in theretina, the part of the eye that receives and transmits images. Levitra is another PDE5 inhibitor drug used for ED, but was not used in this study.

Men taking these drugs have also reported cases of blurred vision, blue-tinged vision, and altered light perception.

In the study, published in the Archives of Ophthalmology, researchers randomly assigned 244 healthy men age 30 to 65, some with mild erectile dysfunction, to take a daily dose of 5 milligrams of Cialis, 50 milligrams of Viagra, or a placebo for six months.

The men had comprehensive vision exams at the beginning and at the end of the study, including electroretinography (ERG, a test used to detect diseases of the retina).

The results showed no significant differences between those who took the erectile dysfunction drugs or the placebo on ERG, vision function tests, pressure within the eyeball, or assessments of the anatomy of the eye.

“PDE5 inhibitors can exert direct effects on the retina, and such effects probably account for many of the visual side effects such as blue-tinged vision and light sensitivity that have been reported,” writes study researcher William H. Cordell, MD of Lilly Research Laboratories, Eli Lilly and Company, which manufactures Cialis and supported the study. However, “our results indicate that there is no cumulative damage or effect of clinical significance for either 5 milligrams of tadalafil [Cialis] or 50 milligrams of sildenafil [Viagra] taken daily for six months.”

SOURCES: Cordell, W. Archives of Ophthalmology, April 2009; vol 127: pp 367-373. News release, American Medical Association.

Research conducted by Prime Therapeutics (Prime) revealed a significant reduction in inappropriate prescription medication use among older adults when a retrospective drug utilization review (RetroDUR) program paired with a provider intervention initiative was implemented. This research was recently published in the American Journal of Geriatric Pharmacotherapy. In addition, a research abstract based on the same study was published in the March issue of the Journal of Managed Care Pharmacy. The study will be presented at the Academy of Managed Care Pharmacy (AMCP) Annual Meeting this week in Orlando, Florida.

According to a 2008 study by Research in Nursing and Health, Persons 65 years of age and older are more likely than younger persons to require hospitalization due to adverse drug events, which have been linked to preventable problems such as depression, confusion, immobility, falls and hip fractures. Although the National Committee for Quality Assurance has created a list of drugs to be avoided in the elderly due to an increased risk of negative health outcomes, the use of these medications, which include muscle relaxants, estrogens and anticholinergic medicines, continues to be widespread.

“Inappropriate prescribing for elderly patients remains prevalent,” said Catherine I. Starner, PharmD, BCPS, CGP, lead author and Senior Clinical Pharmacist at Prime Therapeutics. “Our research suggests an actionable provider letter with member specific prescription claims information appears to be associated with a decrease in potentially inappropriate prescription medication use among older adults.”

The analysis was conducted using retrospectively analyzed pharmacy claims data from three Medicare Part D Blue Cross Blue Shield plans across four states. Prime identified members who were 65 years of age or older who had a claim for one or more drugs to be avoided in the elderly (DAE). Information was mailed to prescribers with patients who had a claim for one or more DAE and for whom a valid mailing address could be established. Plan members were then assessed for the presence of a drug in the same drug class six months after the initial analysis.

Of the eligible plan members, approximately 5 percent had a claim for one or more DAE during the 30-day review period. Overall, almost half of the claims for DAE were defined as discontinued after six months and when compared to a control group, there was a statistically significant reduction in utilization of potentially inappropriate prescription medications use. This translates into one additional DAE discontinued for every 16 DAE claims intervened upon.

The most common drugs identified in the study were estrogens, the analgesic propoxyphene, muscle relaxants, anticholinergics, antihistamines and the antibiotic nitrofurantoin. As a class, anticholinergics had the highest rate of discontinuation. Further research is needed to demonstrate the impact on health care utilization and costs, adverse drug events, and healthcare and quality of life outcomes.

Prime will be presenting this study and other poster presentations at the AMCP meeting on April 17:

– Influence of the Copay Differential Between Generics and Preferred-Brands on the Generic Fill Rate

– High-Deductible Health Plans Trends in Pharmaceutical Utilization and Expenditures

– Multiple Sclerosis Medication Out-of-Pocket Expense Association with Decline to Fill Rate

– Oral Cancer Kinase Inhibitors Utilization Management Opportunity: An Integrated Medical and Pharmacy Claims Analysis

– Assessment of a Retrospective Drug Utilization Review Using Beers’ List of Potentially Inappropriate Medications

– Utilization of the National Provider Identifier for Stratifying Prescribers

Prime Therapeutics LLC is a pharmacy benefit management company dedicated to providing innovative, clinically based, cost-effective pharmacy solutions for clients and members. Providing pharmacy benefit services nationwide to approximately 14.7 million covered lives, its client base includes Blue Cross and Blue Shield Plans, employer and union groups, and third- party administrators. Headquartered in St. Paul, Minnesota, Prime Therapeutics is collectively owned by 11 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those Plans

Source: Prime Therapeutics LLC

Acid Reflux Treatment Has Little Impact, Study Says

By Salynn Boyles
WebMD Health News

Reviewed By Louise Chang, MD

April 8, 2009 — Results from a new, government-funded study should change treatment practices for millions of asthma patients who take acid reflux drugs but have noheartburn symptoms.

The practice of prescribing acid reflux-targeting proton pump inhibitor (PPI) medications to patients whose asthma is not well controlled with treatment has become common in recent years.

But the new study confirms that acid reflux drugs do not improve asthma control in patients with gastroesophageal reflux disease (GERD) who do not have heartburn or other acid reflux symptoms.

An asthma expert with the NIH’s National Heart, Lung and Blood Institute (NHLBI) says millions of asthma patients with so-called “silent GERD” may be taking acid reflux drugs for no reason.

The study appears in the April 9 issue of the New England Journal of Medicine.

“This was a solid, credible trial with results that definitely fill a gap in our knowledge about this practice,” says Virginia Taggart, MPH, program director for the NHLBI Division of Lung Diseases.

Asthma and Acid Reflux

More than 22 million adults and children in the United States have asthma. Studies have found that between 32% and 84% of people with asthma also have acid reflux disease, but many do not have classic acid reflux symptoms, such as heartburn andregurgitation resulting from the backup of acid into the esophagus.

It has been widely believed that acid reflux might contribute to asthma symptoms such as coughing, wheezing, and shortness of breath, by causing airway constriction.

Although this may still be true in asthma patients with GERD symptoms, the study showed that silent GERD is not a factor in poorly controlled asthma, study co-author Robert A. Wise, MD, of Johns Hopkins School of Medicine tells WebMD.

The study involved 412 adult patients whose asthma was poorly controlled despite treatment with moderate to high doses of corticosteroids.

All of the study participants reported either having no acid reflux symptoms or having a history of GERD with minimal symptoms.

When the researchers tested the patients for GERD by measuring acidity levels in the esophagus, they found that 40% of the patients actually did have acid reflux disease.

The study participants were randomly assigned to either twice-daily treatment with a widely prescribed PPI drug or a placebo for six months in addition to asthma treatment. During this time, they kept diaries to track their asthma symptoms, and they underwent monthly lung function testing.

Patients who took a PPI and those who did not showed no significant difference in asthma symptoms over the course of the six-month study. They also had similar self-reported quality-of-life scores.

Outcomes were similar among subgroups of patients who would be expected to benefit most from PPI treatment, such as those with silent GERD and those with nighttime awakening from asthma symptoms.

Pulmonologist and lead investigator John Mastronarde, MD, of Ohio State University Medical Center, tells WebMD that the findings should have an immediate impact on asthma treatment.

“The practice of prescribing a PPI to patients without heartburn is probably not something that I will do anymore,” he says.

Children May Still Benefit

It is not clear how many patients fall into that category, but Mastronarde and Wise say that many millions of adults with asthma in the U.S. may be taking acid reflux drugs for no good reason.

PPIs are also commonly prescribed to children with poorly controlled asthma. A similarly designed, NHLBI-funded trial is now under way to determine if treating silent GERD in children improves their asthma symptoms.

“Kids are not small adults, and it may very well be that treatment (with a PPI) is beneficial,” Mastronarde says.

BY PAULINE TAM, OTTAWA CITIZEN

OTTAWA — Canadians aged 80 and older fill five times as many drug prescriptions a year as the average person, according to new data from Statistics Canada, helping explain why drug side effects are the No. 1 reason they visit emergency rooms.

In 2005, pharmacists filled an average of 74 prescriptions for each person over the age of 80, compared with an average of 14 prescriptions per Canadian, said the Statistics Canada study.

Typically, seniors on multiple drugs see numerous specialists who prescribe various medications to treat a range of chronic ailments: high blood pressure, hypertension, diabetes, Alzheimer’s, arthritis, heart disease and stroke.

Experts have long known that seniors are the major consumers of drugs, but the Statistics Canada study is the first to quantify it nationally.

A study published last year by the Canadian Medical Association Journal revealed that adverse drug reactions accounted for 12 per cent, or more than one in nine, of all emergency-room visits.

Numerous other studies have shown that side effects due to drugs are the No. 1 reason seniors are hospitalized.

Not only do drug reactions cost the health-care system millions of dollars annually in expensive prescriptions, but they also slow down the entire system, causing waiting times to increase, as doctors struggle to diagnose drug-related problems.

Women were more likely than men to be on multiple drugs, according to Statistics Canada, with nearly 14 per cent of them taking more than five medications at any given time. The rates were even higher among women living in nursing homes, where more than half (54 per cent) were on multiple drugs.

Overall, more than half of seniors in nursing homes (53 per cent) and 13 per cent of seniors living in the community reported taking more than five drugs. That amounted to more than half a million seniors, with 94,000 of them in long-term care and 445,000 in households.

The most commonly used drugs were those that treat the nervous system, such as painkillers, antidepressants and sedatives. That was followed by drugs for the gastrointestinal system, such as laxatives, antacids and medications to treat diabetes. Also common were drugs used to treat heart disease.

According to IMS Health Canada, which tracks prescription drug use, Canadians spent a total of $21.4 billion on medications in 2008, up from $20.2 billion in 2007.

By AVERY JOHNSON and KELLY EVANS

Employment in health care, the only major industry outside the federal government still adding jobs, is succumbing to the recession.

In the latest sign, the president of New York City Health & Hospitals Corp. wrote Friday to community organizations as well as employees and unions at its 11 hospitals and four nursing homes, saying the agency will lay off more workers even after slashing 400 jobs last month.

“We now project that HHC’s deficits will worsen, even if we are spared further state cuts,” Alan Aviles wrote to the staff of 39,000. “The challenges will deepen.” He blamed the job losses on state cuts in Medicaid payments to the public-health system.

Across the country, hospitals are taking financial hits. They are seeing losses in the portfolios that they rely on for investment income. The number of uninsured patients is rising. Elective procedures — which reap big profits — are down at a third of hospitals nationwide. Nursing homes are trimming payrolls. And with state governments continuing to cut budgets and talk of health-care reform from Washington, industry executives are preparing for even leaner times.

More than 16 million people — one in eight workers on U.S. payrolls — work in health care today, up from just 1% of the work force 50 years ago. Employment in health care and social assistance — which includes hospitals, doctors offices, nursing homes and social services such as day care — has grown by half a million jobs since the recession began in December 2007, while the rest of the economy has shed 5.1 million jobs.

But the pace of job growth in health services has slowed sharply this year. The sector added an average of 17,000 jobs per month in the first three months of the year, less than half last year’s pace. Health care usually weathers downturns better than many other industries because consumers tend to cut spending on cars or clothes before they forgo trips to the emergency room or pharmacy. But this recession is the deepest in a generation.

“To the extent that health care might have been recession-proof, it is no longer,” said Paul Levy, chief executive of Beth Israel Deaconess Medical Center in Boston, a teaching hospital for Harvard University. The hospital last month announced 140 job cuts, salary freezes, and reductions in vacation allowances and retirement-fund contributions to make up a $20 million budget shortfall.

Mr. Levy began to get worried in October, when Massachusetts cut Medicaid payments to his hospital by $7 million. In November, he noticed researchers weren’t applying for grants as actively as usual, anticipating less government funding; that cost another $7 million in revenue for the hospital, which gets some of the grant money to cover overhead. Then in January, patient volume slowed. During the first three months of this year, hospital discharges — a standard measure of patients treated — dropped to 112 a day from a targeted 122, which translates into $20 million less in yearly revenue.

Big hospitals such as the University of Pittsburgh Medical Center and Akron General Health System in Ohio have announced layoffs recently. In February, the number of mass layoffs for hospitals was double what it was a year ago, according to government data.

In Tarboro, N.C., Kim King, a 49-year-old contract worker in the hospital laboratory at Heritage Hospital, received a letter from her manager last Monday cutting her contract short by three weeks and asking staff to voluntarily reduce hours. The letter cited the economic pressures facing the hospital. Ms. King isn’t sure what she is going to do when her job analyzing blood and other fluids in the hospital lab ends in June. She is looking for work and considering going on unemployment.

She and her ex-husband, a corrections officer, “used to joke that we had the most secure jobs out there, because people always need health care and prisons. It’s not true anymore,” she says. “I’ve never seen it so bad. It’s the one thing you would think wouldn’t be affected by the recession.”

Wick Baker, president of Heritage Hospital, says the hospital is being financially responsible by looking at all of its costs, including replacing contract employees with less expensive full-time staff.

The squeeze isn’t limited to hospitals. Pharmaceutical firms and health insurers also are shedding jobs. On Thursday, health-care conglomerate Johnson & Johnson said it would lay off 900 workers.

Since the Labor Department began tracking monthly unemployment figures in 1958, there have been nine recessions, but employment in health services has declined only a handful of times. The only significant losses to date occurred in mid-1984, as the industry shed 41,000 jobs, based on slightly different historical data, following the double-dip recession of the early 1980s. Since then, no month has seen a drop of more than 4,000 jobs in health care, and there have been no back-to-back declines.

As manufacturing employment has declined, many cities have come to see health care as the employer of last resort. Rochester, Minn., home to the Mayo Clinic, is one illustration of the industry’s power to turn around regional fortunes and revitalize downtowns. Forty years ago, Mayo employed 4,000 workers; today, the international destination for top-tier health care employs some 35,000, more than a third of the city’s total work force.

But Mayo, like the rest of the industry, is now struggling to meet it its capital and payroll obligations. Last month, the ratings agency Standard & Poor’s downgraded Mayo’s debt, citing the hospital system’s large unfunded pension liability and break-even operating margins.

Mayo is freezing salaries for doctors and senior administrators, reducing travel and overtime expenses, and cutting capital spending this year by $150 million, says Chief Financial Officer Jeff Bolton. There have been no layoffs, though temporary staff are being pared back and only essential positions are being filled. Mayo is delaying occupying one floor of a new outpatient exam building on the Rochester campus, since finishing the interior of each floor costs $12 million.

The decline, while unusual, is still likely to be a temporary break in the industry pattern. Growth in health-care spending, and thus employment in the sector, is likely to rebound when the recession ends, a function of the enormous advances in medical technology and Americans’ strong appetite for health care. President Barack Obama has also named the sector one of his three pillars of the future U.S. economy, alongside energy and education. Health expenditures as a share of gross domestic product have more than tripled in the past 50 years to about 16% today, and the government’s Centers for Medicare and Medicaid Services say that figure is likely to hit 20% within a decade.

“It’s a long-term shift reflecting changes in technology and what consumers want,” says Robert Fogel, a Nobel laureate and professor at the University of Chicago’s Booth School of Business. “Health care is the growth industry of the 21st century.”

Write to Avery Johnson at avery.johnson@WSJ.com and Kelly Evans at kelly.evans@wsj.com

Fewer U.S. residents are filling prescriptions because of the current economic recession, according to a study released on Tuesday, the Wall Street Journal reports. Although sales of prescription drugs typically are unaffected by fluctuations in the economy, this recession is “having an unusually negative impact,” according to the Journal.

The study, conducted by Wolters Kluwer Health, found that U.S. patients did not fill 6.8% of the brand-name prescriptions their physicians ordered in the fourth quarter of 2008 because of cost. That figure is a 22% increase over the first quarter of 2007, according to the study. Researchers said that higher copayments and other coverage features contributed to the number of patients who were unwilling to pay for their prescriptions. The study also found that patients did not fill 4.1% of generic prescriptions during the fourth quarter of 2008. Generic prescriptions increased to 2.4 billion in 2008, up 200 million compared with 2007, while orders for brand-name medicines declined by 200 million for 2008 to 1.4 billion, the study found.

The study also found that insurers are denying coverage of brand-name prescriptions when a less-expensive alternative is available. Insurers denied 10.8% of brand-name prescriptions in the fourth quarter of 2008, a 21% increase over the first quarter of 2007, according to the study. In addition, the study found that prescriptions for generic drugs were increasing at a compounded annual rate of 12% between 2004 and 2008, while brand-name prescriptions were falling at a 6.1% annualized rate. 

According to the Journal, the study’s results are not positive developments for drugmakers, who already are “struggling to replace” blockbuster treatments that are scheduled to lose patent protection in the near future. “If you talk to heads of pharmaceutical companies, I don’t think they’d say they’re immune from recessions right now,” Mark Spivers, head of Wolters Kluwer’s health care data and analytics unit, said (Rockoff, Wall Street Journal, 4/8).

The study is available online.

By JONATHAN D. ROCKOFF

More Americans are failing to fill prescriptions because of the economic downturn, according to market research.

Prescription-drug sales are usually immune to the economy’s ups and downs, but the data, released Tuesday by health-information company Wolters Kluwer Health, indicate that the current recession is having an unusually negative impact.

Due to cost, U.S. patients failed to fill 6.8% of the brand-name prescriptions their doctors requested in the 2008 fourth quarter, a 22% increase from the first quarter of 2007. Patients also abandoned prescriptions for generic drugs at a higher rate, failing to fill 4.1% of generic prescriptions.

Higher co-payments required under health-insurance plans and other plan features helped boost the number of patients unwilling to pay for their prescriptions, according to the research. The data also suggest that a patient’s financial footing is now a part of that calculus. That isn’t good news for drug makers already struggling to replace the sales of top-selling medicines losing patent protection over the next several years.

“If you talk to heads of pharmaceutical companies, I don’t think they’d say they’re immune from recessions right now,” said Mark Spiers, who heads Wolters Kluwer Pharma Solutions, the company’s health-care data and analytics unit.

In another ominous sign for drug makers, the data indicate that insurers are flexing their muscle and rejecting coverage for more prescriptions. Health plans denied 10.8% of brand-name prescriptions in the 2008 fourth quarter, a 21% increase from the first quarter in 2007.

Insurers may deny a prescription for a specific drug because a less-expensive alternative is available. Supporters of a health-care overhaul want to encourage use of cheaper generic medicines. The data indicate that government and private insurers are already headed that way.

The research found generic-drug prescriptions were increasing at a compounded annual rate of 12% between 2004 and 2008, while brand-drug prescriptions were falling at a 6.1% annualized rate. Prescriptions for generic drugs increased to 2.4 billion in 2008, up 200 million from 2007, while orders for brand-name medicines fell by 200 million for the year to 1.4 billion.

Write to Jonathan D. Rockoff at jonathan.rockoff@wsj.com

National grade sinks as 2.5M go without health coverage

Christina Rogers / The Detroit News

More than a quarter of Michigan’s population younger than 65 — about 2.5 million residents — went without health insurance at some point in 2007 and 2008, faring better than most other states but quickly losing ground compared with previous years, according to a report by Families USA, a nonpartisan Washington, D.C., health advocacy group.

Michigan ranked 34th nationwide with 28.8 percent of residents lacking insurance at some point during the period. That’s several notches worse than its ranking at No. 40 in the previous period, from 2006 to 2007. Families USA ranks the state with the highest percent of uninsured in the No. 1 position.

Texas ranked the worst in 2007-08 with 45.7 percent of its non-elderly population lacking insurance at some point.

The report counts all individuals who aren’t yet eligible for Medicare but were without insurance at any point during that two-year period, whether it was a month or an entire year.

About 1.7 million Michiganians were without medical coverage for more than six months during the two-year period. Three-quarters of those uninsured, or 76 percent, were in families with at least one member working full- or part-time, the 2009 report found.

Nationwide, the report showed approximately 86.7 million people younger than 65 went without coverage at one point in the 2007-08 timeframe. That’s about one in three Americans.

“The number of people without coverage at this point is worse than an epidemic,” said Ron Pollack, executive director for Families USA. The report is intended to show the magnitude of the fast-increasing uninsured population to lawmakers as they tackle health care reforms aimed at improving coverage for all Americans, Pollack added.

“This really is a problem that’s driven largely by skyrocketing costs,” Pollack said.

Many businesses are dropping health benefits for workers due to rapidly increasing premiums, leaving more people without medical coverage, he added.

Historically, Michigan has fared better than other states because of its strong union presence and fairly expansive public insurance programs, such as Medicaid, which pick up coverage for residents when they lose employer-backed benefits, said Kim Bailey, a senior health policy analyst with Families USA. But Michigan is likely to see its percent of uninsured rise in the coming year with the nation’s recession hitting the state hard, she added.

“We are likely to see a much higher uptick in 2009 and 2010,” Bailey said.

cvrogers@detnews.com (313) 222-2300

HIV and the Older Adult – A Growing Population

By Mark Cichocki, R.N., About.com

Updated: July 16, 2007

About.com Health’s Disease and Condition content is reviewed by the Medical Review Board

When we think of HIV we have certain populations in mind. We hear about its ravages on young men and women; on the gay and transgender populations; on the homeless and the intravenous drug user. We seldom think about hiv and senior citizens. What no one talks about is HIV and the older adult. It’s no wonder that when you talk to our senior citizens, they feel HIV is not a risk to them. Is HIV a risk to older adults. Is HIV over 50 a problem?

The truth of the matter is that HIV surveillance shows that 11 percent of all new AIDS cases are in people over the age of 50. Statistics also show that new AIDS cases rose faster in the over 50 population than in people under 40. The following information sheds light on HIV and the older adult population and what can be done to raise awareness, slow the infection rate, and sustain a high quality of life for our seniors.

What is the HIV Over 50 Myth?

There is a myth that contributes to the growing rate of HIV among the over 50 population.

“Seniors don’t have sex and therefore aren’t at risk for HIV.”

Nothing could be further from the truth. In fact studies from the early 1990s provided data that proved sexual desire does not wane after the age of 50. Experts report that more than half of persons over 50 are having sex a couple times each month. Unfortunately, knowledge of safer sex practices among seniors is much less than that of persons in their late teens and early twenties. This combination of facts explains in part why the HIV population among seniors continues to grow.

HIV Over 50 is Not New – But the Mode of Transmission Is

HIV among adults over 50 is not a new phenomena. Since the early 80′s, HIV in persons older than 50 have accounted for about 10 percent of all cases. What has changed is the mode of transmission. In the early years of the HIV epidemic, blood transfusion was the major transmission mode among the senior population. Today, heterosexual contact and needle sharing among IV drug users older than 50 are the main causes of HIV infection in our seniors. The figures are staggering. Heterosexual transmission in men over 50 is up 94 percent and the rate has doubled in women since 1991. And while prevention and education dollars are concentrated toward young adult populations, seniors are not getting safer sex education and continue to get HIV infected.

Free Online Safer Sex Course

What Can Be Done?

What the HIV medical community do to reverse this trend of a growing over 50 population that is infected with HIV. Interventions that will help include:

• Assess For Sexual Risk Factors
  Change the traditional mode of thinking. Studies have shown physicians do not routinely assess for HIV risk factors in persons over 50. The incorrect belief that people over 50 do not have sexual risk factors for HIV is contributing to the incidence of unprotected sex among seniors and the lack of safer sex education directed at people over 50. For example The Senior HIV Prevention Project in South Florida reports that many seniors still believe that HIV is transmitted only by blood transfusion and casual contact. This lack of HIV knowledge combined with the belief that safer sex is only for young women wanting to prevent pregnancy leads to at risk behavior among our elders. Without intensive education, post menopausal adults are less likely to discuss condom use, now that the risk of pregnancy is removed.

  Taking a Detailed Sexual History

• Breakdown Stereotypes
  Secondly, stereotypes must be broken down. Society stereotypes a gay man as white in his twenties or thirties. Because gay men are an at risk population, Prevention and education money is therefore directed to that groups. When in fact, gay men over the age of 50 is a growing population. People today are living longer, healthier lives, meaning the over 50 population is on the rise; including the number of gay men over 50. While young gay men have always been a target of prevention education, the prevention messages need to be adjusted to include the over 50 gay population. Proper and targeted prevention messages have been shown to have a bigger impact on behavior than does porly targeted education.

  10 Issues Gay Men Should Discuss With Their Doctor

• IV Drug Users Are Getting Older
  The belief that IV drug users are younger adults couldn’t be farther from the truth. The consensus used to be that IV drug users out grew their addiction, either by getting treatment or dying. Actually the Centers for Disease Control (CDC) has reported a trend of heroin use starting much later in life. The typical story goes something like this.
  An older man develops a relationship with a younger, drug addicted woman. One thing leads to another and the seductive link between sex and drug use results in men over 50 trying heroin for the first time. Once addicted, the same rules hold true as they drug with young drug addicted persons. Sharing needles and “works” results in an increased risk of HIV transmission via needle sharing in the over 50 population.

Substance abuse treatment programs must consider this when developing substace abuse programs. Substance abuse rehab programs must include messages targeted to people over 50.

Today we are faced with new challenges in HIV treatment and prevention. We must take great effort in providing adults over 50 with the HIV prevention education they need to stay healthy. We must erase the myths and realize HIV can strike anyone. So many times our elderly are left to fend for themselves. We forget the contributions they have made and the respect they deserve. Society and the medical community must not forget our seniors. That much they deserve.

Simple and Straightforward

April 2, 2009 • Volume 9, Issue 13

The Centers for Medicare & Medicaid Services (CMS) took important steps this week toward cleaning up the marketplace for Medicare private health plans. In the 2010 Call Letter, which sets the contract terms for next year, CMS told the insurance companies to consolidate their plan offerings by eliminating plans that have low enrollment or offer substantially similar benefits as other options offered by the same company. CMS is looking for companies to come up with no more than three options for each market, with each option presenting a meaningful difference for the consumer, such as the choice between an HMO and a PPO.

This directive should go a long way toward reducing confusion in the marketplace and clarifying the choices available to consumers. When consumers are frustrated and confused by their coverage choices, they are more likely to give in to the pat answers and high pressure tactics of unscrupulous agents out for a quick buck. Agents who are trying to give their clients affordable, quality coverage will have an easier time identifying and explaining the best coverage options.

Even more importantly, CMS made it clear that plans will no longer be able to design benefits to discriminate against consumers with serious health problems. We hope that means no more benefit packages that begin charging daily copays for care at skilled nursing facilities before the 21st day, which is when Original Medicare starts to assess daily copays.

The agency is pushing all plans to set an annual out-of-pocket limit for ALL medical services of $3,400. We hope that means that plans will no longer be able to advertise an out-of-pocket limit and carve out certain services in the fine print, making enrollees pay unlimited copays for doctor visits or chemotherapy drugs.

The first step in implementing these reforms is a rigorous review of the benefit packages submitted by the plans. The second step will involve simplifying the information consumers receive about benefit packages on medicare.gov, in the Medicare and You handbook and in the marketing materials provided by the plans. For example, consumers should know, without calling the plan or hunting through the fine print, that the plan’s out-of-pocket limit includes all Medicare-covered medical services.

Medical Record

“In order for beneficiaries to have a choice of plans that represent genuine differences, we would expect [Medicare Advantage Organizations] to offer no more than three Medicare Advantage plans by plan type in a market area, and ensure that each plan offered is readily distinguishable from the others based on plan type, benefits offered, access, or other features that permit beneficiaries to choose a health care plan most suitable to their needs.” (2010 Call Letter, Centers for Medicare & Medicaid Services, March 2009)

“Setting more specific minimum benefit standards would help to guarantee consumers adequate coverage regardless of which plan they select. No enrollee would have to worry about making the “wrong” choice and ending up with a plan that provides skimpy benefits or imposes unaffordable out-of-pocket costs for a medical condition that the individual develops during the year.” (Rules of the Road: How an Insurance Exchange can Pool Risk and Protect Enrollees, Center on Budget and Policy Priorities, March 2009)

“The federal government offers some help as beneficiaries navigate their choices, but this help is poorly coordinated and often inadequately executed. Instead of being a role model for the private sector as it could be, Medicare has offered an example of ‘what not to do.’ Hearings in the summer of 2008, for example, included reports of the large number of incorrect answers given to beneficiaries who call the ‘1-800-Medicare’ hotline. Moreover, Medicare has to compete with information provided by private plans that have a stake in placing a positive spin on their own offerings. Medicare expends a large amount of money on providing information but it does not spend those resources wisely.” (Lessons from Medicare for Health Care Reform, Center for American Progress, April 2009)

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Medicare Part D Appeals Help for Advocates Is Here!

Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process by the Medicare Rights Center offers an easy-to-understand, comprehensive overview of the entire appeals process, including real-life case examples, a glossary of important appeals terms, a sample protocol for advocates, and links to important resources.

Download a FREE copy of this great resource.

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The Louder Our Voice, the Stronger Our Message

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Asclepios—named for the Greek and Roman god of medicine who, acclaimed for his healing abilities, was at one point the most worshipped god in Greece—is a weekly e-newsletter designed to keep you up-to-date with Medicare program and policy issues, and advance advocacy strategies to address them. Please help build awareness of key Medicare consumer issues by forwarding this action alert to your friends and encouraging them to subscribe today.

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The Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives.

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