WASHINGTON — President Barack Obama’s detailed 2010 budget plan, due out Thursday, will propose to eliminate or consolidate 121 domestic and defense programs to save $17 billion, administration officials said Wednesday.

The trims, though modest, are likely to spark opposition from lawmakers and interest groups seeking to shift to someone else cuts aimed at narrowing next year’s projected $1.2 trillion deficit.

“There are very few programs that don’t have a constituency and someone who is willing to stand up for them in Congress. We understand that,” a senior administration official said. But he added, “A lot of programs are implemented with the best of intentions. Not all of them are effective.”

Compared with the total $3.6 trillion spending plan for 2010, the proposed trims amount to one-half of 1%. Half the cuts would come from defense, especially Pentagon weapons programs already spelled out by Defense Secretary Robert Gates, such as trimming back the fleet of advanced F-22 fighter planes. The other half would come from programs that have strong support among progressive activists who cheered Mr. Obama’s election.

An administration official said that over 10 years, the total saved by the proposed program cuts would exceed $200 billion.

One of the biggest targets, the early childhood education program Even Start, had been on George W. Bush’s target list since 2004.

Other programs slated for elimination are the Education Department’s Jacob K. Javitz fellowship program and Christopher Columbus grants, the latter of which has a $1 million-a-year budget, 80% of which is overhead. Also gone would be an option to have the Earned Income Credit included in weekly or monthly paychecks, and the Justice Department’s State Criminal Alien Assistance Program, which compensated states for some of the costs of incarcerating illegal immigrants who commit crimes. A White House aide also cited the Long Range Radio Navigation System, a $35 million Coast Guard system made obsolete by global positioning systems.

“Some of these have been on the books north of 40 years,” said White House Chief of Staff Rahm Emanuel. “Inertia set in.”

The defense of many targeted programs has already begun. AIDS activists are fuming that an expansion of developing-world health programs will favor other health needs over HIV/AIDS.

Liberal think tanks are worried about a proposed partnership with state governments to root out fraud in joint state-federal programs such as Medicaid and children’s health insurance.

“There is a kind of ‘Nixon going to China’ aspect to this,” said Isabel Sawhill, co-director of the Center of Children and the Family at the liberal-leaning Brookings Institution. Just as only Republican President Richard Nixon could go to communist China in 1972 without being destroyed politically, only a popular Democrat could challenge liberal groups on sacrosanct programs that may have outlived their usefulness, she said.

“There’s a different perspective that exists and a different sense of commitment,” Mr. Emanuel said. “We bring a certain credibility.”

White House officials acknowledged the similarity between Mr. Obama’s 121 program cuts and consolidations and $17 billion savings and Mr. Bush’s 151 programs and $18 billion savings proposed for 2009. About 40% of the programs Mr. Obama has targeted for elimination or consolidation come directly off a similar list proposed by Mr. Bush over the past two budget seasons on Capitol Hill. Congress largely ignored those proposed cuts.

—Greg Hitt contributed to this article.

Write to Jonathan Weisman at jonathan.weisman@wsj.com

BOSTON (Reuters) – Three adults in the northeastern U.S. state of Maine were diagnosed on Wednesday with H1N1 swine flu and are recovering in their homes, the governor’s office said.

“It is important for the citizens of Maine to prepare for this as they would any other emergency situation,” Governor John Baldacci said in a statement.

(Reporting by Jason Szep)

APhA provides useful summary as number of cases jumps to 40.

The number of reported cases of swine influenza A (H1N1) has doubled to 40, CDC officials said during a news conference today. While more cases and involvement of more states are expected, agency personnel emphasized that these 20 new cases are the result of testing among students in a New York school who recently went to Cancun, Mexico, for spring break and not additional outbreaks of infection. APhA has compiled a useful summary of CDC announcements and clinical advice.

In response to the cases reported thus far in California, Texas, Kansas, Ohio, and New York, the CDC has mobilized 25% of its reserve of antiviral medications. A total of 11 million courses of agents for preventing and treating influenza are being shipped to those states and any others that report cases, CDC explained.

Over the weekend, CDC also issued several updates and recommendations to governmental authorities and clinicians. Patients with swine influenza are infectious from 1 day before to 7 days after onset of symptoms, CDC advised, and human-to-human transmission of the virus appears to be occurring. The possibility of swine influenza should be considered in those developing acute respiratory illness (defined as recent onset of at least two these symptoms—rhinorrhea or nasal congestion, sore throat, cough [with or without fever or feverishness]) after close contact with an identified case of swine influenza or after travel to affected areas (currently Mexico, southern California, San Antonio, Kansas, New York City) within 7 days of disease onset.

In infected patients, zanamivir (Relenza—GlaxoSmithKline) or oseltamivir (Tamiflu—Roche) can be used for 5 days of treatment. Those with suspected cases can receive either zanamivir alone or oseltamivir plus amantadine or rimantadine. Chemoprophylaxis with oseltamivir or zanamivir is recommended for health care workers with unprotected close contact with a case and several categories of patients who are at high risk of influenza complications, including close contacts and schoolmates of cases, those traveling to Mexico, and workers on the Mexican border.

CDC is recommending the usual common-sense precautions for Americans to take in stemming the transmission of this virus (cover nose and mouth with tissue during coughing and sneezing; throw tissue in trash after using; wash hands; avoid close contact with sick people; stay home when sick; and avoid touching eyes, nose, and mouth). It might be good time to skip the kiss and the handshake when greeting others, one CDC official said half-jokingly during the news conference, if people want to decrease their chances of getting swine influenza.

CORONA, Calif., April 22 /PRNewswire-FirstCall/ — Watson Pharmaceuticals, Inc. (NYSE: WPI), a leading specialty pharmaceutical company, today confirmed that it has filed two Abbreviated New Drug Applications (ANDAs) with the U.S. Food and Drug Administration seeking approval to market its guaifenesin extended-release 600mg and 1200mg tablets and its dextromethorphan HBr/guaifenesin extended-release 30mg/600mg and 60mg/1200mg tablets prior to the expiration of patents owned by Reckitt Benckiser Inc. Watson’s guaifenesin and dextromethorphan HBr/guaifenesin extended-release tablet products are the generic versions of Reckitt Benckiser Inc.’s Mucinex(R) and Mucinex(R) DM products which are indicated to help loosen phlegm (mucus) and thin bronchial secretions to rid the bronchial passageways of bothersome mucus and make coughs more productive.

Reckitt Benckiser filed suit against Watson on April 20, 2009 in the U.S. District Court for the Southern District of New York seeking to prevent Watson from commercializing its products prior to expiration of U.S. patent numbers 6,372,252 and 6,955,821. Reckitt Benckiser’s suit was filed under the provisions of the Hatch Waxman Act, resulting in a stay of final FDA approval of Watson’s ANDAs for up to 30 months or until final resolution of the matter before the court, whichever occurs sooner. Based on available information, Watson believes it may be the first applicant to file an ANDA for a generic version of Mucinex DM(R) and, should its product be approved, may be entitled to 180 days of generic market exclusivity.

For the twelve-months ended December 31, 2008, Mucinex(R) and Mucinex(R) DM products had total U.S. sales of approximately $106 million and $85 million respectively, according to IMS Health data.

Freedom 55 is a thing of the past, and many Canadians aren’t banking on Freedom 65, either.

This means a shift to an older workforce, and while it is creating challenges for everyone involved the trend is also benefiting employers by staving off an anticipated shortage of skilled workers as boomers age.

“That is really going to revolutionize the workforce,” says Barbara Jaworski, CEO of the Toronto-based Workplace Institute, which provides consultation and training on mature worker issues. “The challenge for employers is to accommodate new sorts of issues that perhaps they’ve never had to deal with in the past.”

The oldest baby boomers showed little interest in leaving the workforce even before the economic crisis gutted their investments and pension plans, she says. Financial necessity has made the option to stop working even less attractive.

Still, Jaworski and other experts believe deferred retirement is more about baby boomers wanting to stay engaged.

“While the financial impact is negative, the positive side is that 60 is the new 40, or whatever number you want to pick,” says Jim Thomson, vice-president human resources operations of Ceridian, a human resources services firm. “They feel like they can add value to companies, add value to society.”

Jean Brock took early retirement from the federal government in 1995 to look after her husband while he battled cancer. After his death in 2001, she moved from southern Ontario to Ottawa to help care for her grandchildren, but Brock, now 66, says she didn’t feel like she was giving back to society, so she applied for a job in the floral department of a grocery store.

“I really enjoy people and I help a lot of older ladies like myself select flowers for different occasions, and I make floral arrangements,” she says of her new career. “It’s just great, I’d never done anything like that in my life.”

The 10 hours a week she devotes to her job – between volunteering at the Legion, ballroom dance lessons and dart games – keeps her young, she says, and despite a stroke and two heart attacks, her 74-year-old partner continues to work as a stone mason for the same reason.

“I fully intend to work until I’m 90 if I last that long,” Brock says, laughing.

The “war for talent” among companies hoping to lure or retain experienced older workers will be waged not with higher salaries, Thomson says, but with fringe benefits like flexible scheduling and time off.

Experts agree flexibility will be the biggest demand of boomers staying on the job, whether it means telecommuting from the cottage or vacation property, working mornings only, flex-hours or a few months at a time as consultants.

“There’s a lot of tailoring you want to do to keep people engaged and productive,” says Lynn Palmer, CEO of the Canadian Council of Human Resources Associations.

That will require some pragmatic changes, she says, such as discarding the usual Monday morning meeting for a time when everyone is in the office and using technology to connect workers via teleconferencing and video.

HSBC Bank Canada got a “wake-up call” in 2005 when they realized 72 per cent of their senior managers would be eligible for retirement within a decade, says Pat Brosseau, vice-president human resources. In an effort to retain some of them, the company introduce a phased retirement program that lets experienced workers pass along their knowledge to younger successors, she says, as well as a roster of “returning retirees” who are hired for special projects.

“Most of the people we interviewed were interested in continuing to work or coming back to work after retirement, so the notion that at 55 they’d pack up their desk and start golfing really wasn’t there anymore,” Brosseau says.

But an older workforce could mean more health problems and higher benefit costs, says Jaworski, and employers may be compelled to confront the “very delicate” issue of dementia on the job. She recently worked with a company facing that situation with an employee who thought he was coming to work when he wasn’t, she says. The human resources manager ended up acting as “a bit of a social worker” because the man had no close family to help.

“Ideally, what you want is someone who’s got enough money to retire but wants to continue to work for you,” Jaworski says. “You don’t want an individual that just can’t afford to retire but can no longer do the job. That’s not going to be pretty.”

More people working later in life will also mean managing a workforce with an age gap of 40 years or more between the youngest employee and the oldest, says Palmer.

Boomers who are accustomed to working long hours may look askance at younger colleagues who dart out the door at 5 p.m. to play sports or otherwise guard their work-life balance, she says, but Thomson at Ceridian believes the older cohort will have more in common with their Millennial coworkers as time goes on.

“They’ve worked very hard for a long time and now it’s time to enjoy life,” he says.

MADRID – Young people largely drove the early stages of Internet growth but in recent years the sharpest rise in Web use in developed nations has been amongst people aged 70 and over, experts said Monday.

“Older adults are the fastest growing demographic on the Internet,” said Professor Vicki Hanson of the School of Computing at Scotland’s University of Dundee on the opening day of a global World Wide Web conference in Madrid.

While just over one-fourth, or 26 per cent, of 70-75 year olds went online in the United States in 2005, the proportion was 45 per cent last year, according to data from the Pew Internet & American Life Project, she said.

The percentage of those aged 76 years and over who surf the Web rose during the same period from 17 per cent to 27 per cent.

Britain has experienced similar sharp gains in Internet use by people in this age group, said Andrew Arch of the World Wide Web Consortium (W3C), the main international standards organization for the Web.

“They are basically doing the same things as everyone else. Using the Web for communication, then quickly moving to other activities like information seeking, online banking, shopping,” said Arch who works to boost Web accessibility for older and disabled users.

Sending and receiving e-mail is the most popular online activity for Internet users age 64 and older, according to the Pew study.

But older Internet users are less likely than younger Web surfers to do online banking and shopping — and far less likely to use social networking sites, it found.

“They are not on Twitter,” said Hanson, referring to the microblogging Web site whose popularity got a huge boost last week as U.S. talk show diva Oprah Winfrey became the latest big name celebrity to join the craze.

With the percentage of the population aged 60 and over expected to reach 20 per cent by 2050, experts said the numbers of older Web browsers is set to continue to rise.

And with many countries increasing the retirement age, being able to use the Web will become a requirement for an increasing number of older workers.

But the physical problems that come with old age still act as a barrier to getting online. Poor vision can make reading text on the screen a challenge. Arthritis and motor control problems can make manoeuvring a mouse difficult.

Web sites can make it easier for older surfers by using larger fonts, higher contrast and extra spaces at the end of sentences, said Arch.

“The typical web developer does not really understand that the world is aging the way it is,” he said, adding the changes he is suggesting would make it easier for people of all ages to use the Internet.

“It is like footpaths. They were initially set up for the disabled but then everyone found them very useful,” he said.

The number of people going online has surpassed one billion for the first time, according to online metrics company comScore.

It counts only unique users above the age of 15 and excludes access in Internet cafes and through mobile phones.

Total drug spending in Canada is estimated to have reached $29.8 billion, or $897 per Canadian, in 2008, according to figures released today by the Canadian Institute for Health Information (CIHI). This represents an estimated annual growth rate of 8.3%, an increase that exceeds other major health-spending categories, such as hospitals and physicians. In 2008, spending on drugs accounted for 17.4% of total health spending-nearly doubling since 1985 (9.5%). Spending on prescribed drugs continues to grow faster (9.0%) than spending on non-prescribed drugs (4.6%). Prescribed drugs are estimated to have accounted for 84% of total drug spending in 2008. 

“Over the last 20 years, drugs have consistently remained one of the major cost drivers in health care,” says Michael Hunt, Manager of Pharmaceutical Programs at CIHI. “Spending on pharmaceuticals has more than doubled over the past 10 years, outpacing growth in health spending by hospitals, physicians and other health professionals.” 

Spending on prescribed drugs growing faster in the private sector 

For the third consecutive year, private-sector spending on prescribed drugs grew at a faster rate than that in the public sector. Private-sector prescribed drug expenditure reached $12.6 billion in 2007, and is forecast to have reached $14.0 billion in 2008, representing annual growth rates of 11.4% and 11.0%, respectively. Public-sector expenditure on prescribed drugs reached $10.5 billion in 2007, and is forecast to have hit $11.2 billion in 2008, representing annual growth rates of 7.6% and 6.7%, respectively. 

The public-private split for total prescribed drug spending remained relatively stable over the past 20 years, with approximately 45% financed by the public sector and 55% financed by the private sector. However, among private-sector spending on prescribed drugs, the share of spending shifted from out-of-pocket spending to private insurers. Spending by private insurers is estimated to have accounted for 67% of private-sector drug spending in 2008, compared to 55% in 1989. 

“The economic downturn is resulting in many Canadians losing their jobs. Since many Canadians have private health insurance through their employment it may also mean a loss of private health insurance,” says Hunt. “In light of this situation, it will be important to document what the impact will be on both the public sector as well as out-of-pocket drug spending over the next few years.” 

Variation among provinces on prescribed drug spending 

Prescribed drug expenditure per person varies across Canada. In 2008, prescribed drug spending per person is estimated to have ranged from $651 in Alberta and $652 in British Columbia to $841 in Quebec and $865 in Nova Scotia. 

There is also variation among the provinces in terms of the source of funding for drugs. On average across Canada in 2008, 44% of total spending on prescribed drugs was publicly financed. The proportion of public spending on prescribed drugs ranged from 32% in New Brunswick and 34% in Prince Edward Island to 50% in Quebec and 54% in Saskatchewan. Public-sector spending per person on prescribed drugs ranged from $236 in B.C. and $253 in P.E.I. to $377 in Saskatchewan and $420 in Quebec. 

International comparison in drug spending 

When comparing 23 countries in the Organisation for Economic Co-operation and Development (OECD) with similar health-reporting systems as Canada’s in 2006 (latest available information), Canada had the second-highest level of total per capita drug spending (including prescribed and non-prescribed drugs). The United States had the highest level of 2006 per capita spending ($1,015) followed by Canada ($770) and Belgium ($703)-the position of Canada has been stable over the past few years. 

In 2006, Canada was below the OECD median in terms of what proportion of total drug spending was publicly financed. The public share of total drug spending in Canada was 39%, compared to the OECD median of 59%. Among the 23 OECD comparator countries, the share of total drug spending funded by the public sector ranged from 15% in Mexico to 84% in Luxembourg. 

Source
Angela Allain-LeVasseur
Administrative Assistant, Communications
CIHI, Ottawa
Canada

Drugmakers in 2008 reduced their spending on consumer advertising of prescription drugs by 8% to $4.4 billion, the first cutback since at least the late 1990s, the Wall Street Journal reports. Print advertising for pharmaceuticals declined by 18%, while television advertising declined by 4%, according to IMS Health.

Prescription drug advertisements “have surged” since 1997 when FDA relaxed restrictions on direct-to-consumer drug advertising, according to the Journal. Spending on such ads reached a high of $4.8 billion in 2007, compared with less than $1 billion in 1997, according to IMS data. 

The reduction in advertising spending can be attributed to fewer new drugs and heightened congressional scrutiny of drug marketing practices, experts said. For example, Merck and Schering-Plough, which jointly market the cholesterol drug Vytorin, reduced their overall consumer ad spending in 2008 to $47 million from $114 million following criticism from Reps. John Dingell (D-Mich.) and Bart Stupak (D-Mich.) over ads for Vytorin that ran while the companies delayedunfavorable study results, the Journal reports. 

According to IMS, which consults for drugmakers and investors, pharmaceutical companies went too far on print and TV advertising spending reductions. IMS researcher John Busbice said, “They should optimally be pushing back up again” (Winstein/Vranica, Wall Street Journal, 4/16). 

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.

1. First Neurons Created from ALS Patients

President-elect Obama has pledged to lift the seven-year ban on federal funding for embryonic stem-cell research — a boon for the field. But for some scientists, it almost doesn’t matter. Researchers at Harvard and Columbia reported a milestone experiment in July, using a new method — one that doesn’t require embryos at all — to generate the first motor neurons from stem cells in two elderly women with Lou Gehrig’s disease, or ALS. The technique, developed by Kyoto University scientist Shinya Yamanaka in 2006, involves reprogramming a patient’s ordinary skin cells to behave like stem cells, then coaxing them into the desired tissue-specific cells. Using the motor neurons created from ALS patients, scientists can now study the progress of the disease as the affected cells develop, degenerate and die in a dish — something researchers could never do before for such slow-moving conditions. Once scientists understand the development of ALS, they may be able to create more effective treatments, or perhaps even a cure.

2. Inflammation vs. Cholesterol

Half of all heart attacks in the U.S. occur in people with normal cholesterol levels. Baffled? So were doctors, until November. That’s when Dr. Paul Ridker at Boston’s Brigham and Women’s Hospital confirmed a separate, perhaps equally powerful, risk factor for heart disease: inflammation, the same culprit behind arthritis and other autoimmune diseases. Smaller studies had hinted at the link in the past, but Ridker’s recent research, published in the New England Journal of Medicine, showed that when people with normal cholesterol and high levels of CRP — a protein marker for inflammation in the blood — took statins, their CRP levels plummeted and their heart attack risk fell 54%. Compare that to the 20% reduced risk in people who take statins to lower cholesterol alone. Doctors say cholesterol and fatty plaques are still the main indicators of heart disease, but inflammation may be just as important, playing a key role as a trigger: It increases the instability of plaques, making them more likely to rupture, block heart vessels and cause a heart attack.

3. Scarless Surgery

4. Genomes for the Masses

James Watson, co-discoverer of the structure of DNA, did it. So did Craig Venter, co-mapper of the human genome. Now you, too, can map your entire genome and reveal some of its many secrets — for just $399 and a little spit. Scientists debate whether that information is really worth anything at the moment — in many cases, there isn’t enough scientific knowledge to interpret what it really means to have this gene variant or that one — but companies like 23 and Me at least make it possible for you to take a gander at your genetic data. (Although the service was available previously, until this year, it’s been prohibitively expensive.) You provide a sample of saliva, from which your DNA is extracted, copied and combed for the presence of 90 known genetic variations that code for different traits or conditions, from lactose intolerance (though you could probably drink a glass of milk and find out for far cheaper) to prostate cancer. Right now, there’s no way to know whether you’ll get cancer just because you have the gene, but once the science has advanced, the hope is that such genetic mining will predict disease, giving people the option of seeking treatment before they get sick.

5. New Genes for Alzheimer’s

There is no cure, no vaccine and no way to diagnose Alzheimer’s disease without an autopsy. But there may be hope in the discovery of four new genes that contribute to the most common form of the disease. The genes emerged from a study of over 1,300 families, and although the genes’ exact role in Alzheimer’s isn’t known yet, researchers think they may contribute to the death of nerve cells. As the disease progresses, fatty plaques and fibrous tangles of protein build up in the brain, ensnaring nerve cells and eventually strangling them to death. The newly identified genes may shed light on how to keep those nerves alive, which may be an important target for future therapies. Even more exciting is that one of the genes produces a protein that nerve cells use to communicate, another function that declines when Alzheimer’s sets in. Dozens of genes have already been linked to Alzheimer’s, but each newly discovered gene represents a new target and new hope for future drug treatment.

6. A Five-in-One Vaccine

Any parent can appreciate how much babies hate shots. So, welcome Pentacel, the first vaccine to immunize against five diseases at once — diphtheria, tetanus, pertussis, polio and haemophilus influenzae type B. The vaccine was studied in more 5,000 infants, who showed only minor side effects, including fever, redness and swelling at the injection site. Pentacel still has to be administered in four separate doses, three times between the ages of 2 and 6 months, then again between 15 and 18 months — but it cuts down by 30% on the 23 injections toddlers under 18 months normally receive. Telescoping immunizations may help to get more kids up to date on their immunizations; so far, 77.4% of kids aged 19 to 35 months have received all of their vaccinations, which is just shy of the government’s goal of 80% by 2010.

7. Gene Screens for Breast Cancer

Gene screens are fast becoming a powerful tool, not just for diagnosing cancer but for treating it as well. Joining the growing pool of genetic tests for breast cancer, SPOT-Light mines patients’ genes to determine who will respond best to the cancer drug Herceptin, which is effective against tumors that release an abundance of the HER2 protein. The SPOT-Light test can measure how many HER2 genes are present in a sample of breast tumor; the more genes there are, the more likely the tumor will respond to treatment with Herceptin. Breast cancer patients are also increasingly relying o n another gene test, OncotypeDx, which can determine the risk of breast cancer recurrence and which chemotherapy agents will work best against a particular tumor.

8. Blood Test for Down Syndrome

One of the best ways to confirm Down syndrome before birth is by amniocentesis, which uses a needle to remove a sample of the amniotic fluid surrounding a fetus. But needles can be nerve-wracking, especially when they’re aimed at a growing baby in the womb, and the procedure carries a 1 in 200 risk of miscarriage. Now, a new genetic test may be able to pick up the disease with a simple blood sample from the mom-to-be. Because small amounts of fetal DNA enter the mother’s bloodstream, the test is designed to detect abnormally elevated levels of chromosome 21 (an extra copy of it causes Down) in the mother’s blood, which would indicate a baby with the disease. The test is still in the development stages, but could herald a new way to identify certain genetic conditions.

9. Seasick Patch for Cancer Patients

Those motion-sickness patches can really help calm a churning stomach on a boat. So, someone decided to apply the same idea to deliver anti-nausea drugs to cancer patients after chemotherapy. In September, the FDA approved Sancuso, a patch that releases a continuous dose of the drug granisetron, which blocks serotonin receptors and reduces queasiness. The prescription drug is already available to cancer patients in solution, tablet or injection form, but the patch makes delivery easier and more convenient. Once on, the Sancuso patch quells nausea and vomiting for about five days.

 10. Stem-Cell Trachea Transplant

In a transplant first, doctors in Spain gave Claudia Lorena Castillo Sanchez, 30, a new windpipe, constructed from a donor trachea lined with Sanchez’s own stem cells. It’s the first time a patient’s adult stem cells, extracted from bone marrow, have been used to seed a new tissue or organ for transplant. Because the donor trachea was stripped of cells that could cause rejection, Sanchez, who suffered from tuberculosis and lost function of one branch of her trachea, avoided having to take the powerful immunosuppressant drugs that transplant patients normally require. Doctors expect that this type of transplant, which is still experimental, will need several more years of study before it becomes widely used. But Sanchez, for one, is happy she didn’t have to wait that long; the mother of two is already back to work and enjoying dancing six months after her operation.

It may sound outlandish, but doctors are increasingly experimenting with “natural orifice” surgery, a new technique in which surgeons enter the body through existing openings such as the mouth, vagina and colon, instead of cutting through the skin. A team at the University of California at San Diego performed the first such appendectomy in the U.S. in March, using camera-fitted scopes to guide the removal of a woman’s appendix through her vagina. The technique is also helping some gastric bypass patients whose stomach tissue has stretched out post-surgery; doctors insert a scope through the mouth and gather up the stretched folds to shrink the stomach back to a smaller size. The technique isn’t completely incision-free — surgeons make small cuts through tissue inside the body — but by reducing incisions through the skin, it could reduce pain and infection and promote faster recovery for some common surgical procedures.

The original version of this story misstated that the first natural orifice surgery was performed at the University of California at San Diego this year. In fact, the first procedure was performed at NewYork-Presbyterian Hospital/Columbia in 2007, to remove a gallbladder. The UCSD procedure was the first such appendectomy.

The art and practice of pharmacy has never been more relevant and valuable than today. Lives are saved, diseases are closely monitored, and the pharmacist-patient relationship is more vital than ever in keeping patients safe and producing the best healthcare outcomes. Several pharmacists were honored for the meaningful and important contributions they make to the profession of pharmacy at Outlook 2009, the Annual Meeting and Education Faire for the California Pharmacists Association (CPhA) and the Pharmacy Foundation of California, which was recently held in Anaheim, February 19-22. This year’s honorees exemplify the best pharmacists in the State of California. They join an elite group of past winners who have gone above and beyond to serve their patients and profession with excellence. 

George Yasutake, PharmD, Pharmacist of the Year 

Taking top honors for Pharmacist of the Year, was George Yasutake, PharmD. In order to be nominated for this award, a pharmacist must be a leader at all levels and stimulate others to actively participate in all aspects of the profession. George Yasutake has gone above and beyond these criteria. He has been involved at every level of pharmacy leadership including local, state and national organizations. He serves as an inspiration and a sound voice of reason and responsibility. 

George is an energetic leader who has encouraged many others to get involved in pharmacy and speaks to pharmacy students, residents, and fellow pharmacist-colleagues about the importance of involvement, membership, and community activities in professional pharmacy organizations. His continued activities for the betterment of pharmacy are appreciated universally. He has worked tirelessly with fellow health care providers and patients to provide state-of- the-art clinical services as a Pediatric Clinical Pharmacist and a Drug Information/Drug Usage Evaluation/Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) Pharmacist also. 

Additionally, George has served as CPhA President, CPhA Speaker of the House, American Pharmacists Association (APhA) Chairman of the Academy of Pharmacy Practice & Management (APPM), President of Hollywood-Wilshire Pharmacists Association, on the APhA Nominations Committee, and many more leadership roles. George is well recognized by pharmacists and others in California and nationally. 

Chester Yee, PharmD, Bowl of Hygeia Award 

The Bowl of Hygeia award recognizes a pharmacist for outstanding involvement both in and outside the profession of pharmacy by demonstrating how pharmacists can elevate themselves and the profession in the eyes of the public. Chet Yee has been active since his graduation from pharmacy school, where he served as Editor for the School Newsletter and APhA Student Chapter President. Chet, along with other pharmacists, banded together to form the San Mateo County Pharmacists Association and affiliated with CPhA as a local association. He has served in numerous capacities on the San Mateo County Pharmacists Association Board but most notably, as Chair of the “Talk with a Pharmacist Day.” Chet has also served as President of CPhA in 1978 and received the CPhA Pharmacist of the Year Award in 1985. During Chet’s CPhA Presidency, he started the Task Force for Pharmacy. In addition to the multiple leadership roles with CPhA, Chet was nominated and elected to the APhA Board of Trustees. Chet not only spends many hours promoting the profession but is actively involved in his community, including the local Lions Club and in his church. 

Eric Gupta, PharmD, Distinguished New Practitioner of the Year 

This award recognizes a new practitioner who has demonstrated energetic leadership at multiple levels, someone who is an energetic leader, who stimulates others to actively participate in the profession, and finally, someone who is well recognized by their peers. In his letter of support, Mike Pastrick stated, “I am hard pressed to think of someone more deserving than Eric Gupta.” Eric has demonstrated a high level of professional involvement since the day he entered pharmacy school, contributing to the good and welfare of the profession. He continues his involvement today as an educator at Western University of Health Sciences and as a leader on CPhA’s Board of Trustees as the Speaker of the House. Eric actively participates in a number of professional organizations such as CPhA, APhA, American Society of Health System Pharmacists (ASHP), American Association of Colleges of Pharmacy (AACP), and American College of Clinical Pharmacy (ACCP). In addition to state and national organizations, Eric is President of the Southeast Los Angeles Pharmacists Association, CE Coordinator for Kappa Psi Pharmaceutical Fraternity, served as the 2008 Chair for the Pharmacy Foundation’s Educational Advisory Committee, and more. Most recently, the members of CPhA elected Eric to serve as President-Elect. 

Dana Nelson, RPh, 2009 Innovative Pharmacist 

Creative, ingenious, novel, fresh, original, unprecedented: these are just a few words that define innovative. The 2009 Innovative Pharmacist, Dana Nelson, describes an innovator as a trend-setter in the profession of pharmacy. In order to quality for this award, a pharmacy must demonstrate the ability to significantly improve patient care. Dana has a highly imaginative and innovative clinical pharmacy practice where he is typically the first to set the stage for improved patient care and outcomes. Along with his wife, Dana purchased a pharmacy in San Luis Obispo and instantly became one of the top compounding pharmacies in the nation. Dana’s scope of services includes long-term care, durable medical equipment supplies, compounding, and assisting patients in managing chronic disease states. He is a national leader in bioidentical hormone replacement therapy using a cutting-edge rhythmic hormone replacement system, which ensures standardized product production and accurate and consistent patient dosing. Dana also serves as the Chief Pharmacist, Pharmacist Clinical Trainer and Standardized Transdermal Hormone Cream Production Trainer for the Wiley Protocol. Dana is a true stalwart for the practice of pharmacy, a patient advocate, and a tireless provider for his patients, practice, staff, and family. 

Heather Duffer, Pharmacy Technician of the Year 

Heather Duffer was given the CPhA 2009 Technician of the Year Award in recognition of her exemplary work with Inland Compounding Pharmacy in Loma Linda, California. Heather understands and clearly exemplifies the role and importance of being a pharmacy technician. In the words of her employers, Gordon & Raylene Mote, “She is a great asset to our practice – compassionate, caring and always wanting to learn.” Heather began working in the pharmacy profession in 1994 and is now pursuing a pharmacy degree. In addition to her work in the pharmacy, Heather also serves on the CPhA Academy of Pharmacy Technicians Board and has participated on the Technician Task Force for the State of California. 

Vi Li, CPhA Pharmacy Student of the Year 

Western University of Health Sciences, College of Pharmacy 

Vi Le has shown dedication to the profession of pharmacy through her continuous involvement with local, state, national and student organizations. Vi became involved during her first year at Western University and immediately started making an impact. She increased the number of and participation in health fairs, and implemented new programs that increased the visibility and stature of the Academy of Student Pharmacists Chapter on campus. All of Vi’s activities and ideas saw a dramatic increase in student members, earning the WesternU Chapter a national award at the APhA national meeting. In addition to programs on campus, Vi reached out to the CPhA local associations in the area and created a strong relationship between them and the school. Her desire to create a foundation for greatness, dedication to the profession of pharmacy and genuine personality are testimony to the title Student Pharmacist of the Year. 

Chapter of Excellence Awards 

In addition to the individual honors listed above, CPhA recognized many of its local pharmacist associations who have achieved a high level of excellence through their activities and contributions to their local communities over the previous year. The Chapter of Excellence Awards were given to the Alameda County Pharmacists Association, the Orange County Pharmacists Association, the Pharmacists’ Professional Society of the San Fernando Valley, the San Diego County Pharmacists Association, the San Joaquin Pharmacists Association, the San Mateo County Pharmacists Association, and the South Bay Pharmacists Association. 

About CPhA 

The California Pharmacists Association is the largest state pharmacy association in the nation and the professional society representing all pharmacists in California. The mission of the Association is to act as the leader in advocating the role of the pharmacist as an essential provider of health care and to support pharmacists in providing optimal patient care. 

For more information on the CPhA Awards Criteria please visit the Membership page of the CPhA website at http://www.cpha.com. 

California Pharmacists Association

Apr 13, 2009 at 8:00am ET by Alex Porter

The U.S. Food and Drug Administration (FDA) has sent letters to a number of pharmaceutical manufacturers to alert them that they were in violation of acceptable marketing practices in relation to their paid search marketing campaigns.

The basic gist of the letter is that when these pharmaceutical companies advertise on Google they are a.) not providing the risks associated with the drugs and b.) not including their “established name.” Basically, the FDA is stating that pharmaceutical ads must provide adequate explanation of the risks associated with the drug and provide the full name of the drug. Think of the wonderful television ads that always list the full name of the drugs and provide a plethora of horrible sounding side effects. Or just watch this hilarious SNL spoof.

In all seriousness, these new regulations raise a couple questions: What is Google’s reaction? At this time, they have not made a statement about the FDA’s ruling. Google is currently falling back on their canned guidelines set forth some time ago and has not yet let on when they might address the issue. Will the FDA address how the pharmaceutical companies can fit all the required information into the extremely limited, two 35-character lines of search advertisements? After speaking at length with an FDA representative, I learned that they also have no official response to the issue; however, I was told to keep an eye on their press center. So, I have a hunch that they will be releasing some official guidelines in the near future.

The FDA set a final deadline of April 9 for pharmaceutical manufacturers to change their ads. Since the first day the letters were sent, I have bided my time before commenting, anxiously watching the changes happening across the search results landscape. So far, everyone is complying, but there are several problems with the results that are now available as a consequence of these changes.

To understand what the landscape currently looks like, do a search for “plavix” a very popular and heavily-advertised drug. Results should look something like this:

I doubt the FDA intended for the beneficiary of this policy to be Canadian online pharmacies, who have the top listings in paid search results. However, to be fair, all Plavix has to do is file the trademark paperwork with Google and this issue is resolved. This typically is done at day one of the paid search process, but must be initiated by the brand and/or agency.

Outside of online pharmacies, the other folks that will benefit are homeopathic remedies and health portals (like an AOL health), who can now buy this traffic with less competition and receive a better ROI.

The parties that do not benefit from the FDA’s new regulations are Google, the consumer and pharma companies. Google does not benefit because they are getting lower CPCs for pharma traffic. The consumer does not benefit because they very well may not get the information they are looking for. And the pharma companies do not benefit because they are unable to reach the consumer.

I see only a few possible solutions to the issues caused by this regulation:

New pharma ad text guidelines. The FDA, Google and pharma must agree on ad copy requirements that make sense for everyone. Perhaps the second line of every text ad must be “Side effects may occur.” Additionally, if a website specifically and prominently mentions the “established name” on the landing page, that name can be used in the ad.

Viewing the issue from Google’s perspective (i.e., providing the quickest and simplest searcher experience) it does not make sense for two-thirds of a text ad to display a name that has no meaning to the consumer and the rest be canned disclaimers. Would you click on an ad that read: Rosiglitazone maleate / Use with Nitrates Not Recommended? Who would even know what that means?! Ads of this nature are not good for the consumer nor for the manufacturer (not to mention the hit taken by Google in CTR and revenue).

Search engine optimization. Always a recommended strategy; however, depending on long-term FDA regulations, SEO becomes even more important. Long-tail keywords, high-volume phrases, etc.—the value is immense. To do this well, though, takes a great deal of time and concentrated efforts.

Unbranded URLs that redirect to the branded website. You might be thinking, doesn’t this violate Google’s policies? The answer is, yes and no.

Take a look at this search result for “depression medication:”

Looks pretty innocuous right? Yet, if you click on the top result, you go to the following page:

Wait—this isn’t a site discussing treatment options—it’s a pharma site talking about a drug that you take when you are already on depression medication. As a consumer, I’m not very happy about where I am and I do not think this is what the FDA or Google desires. It seemingly violates Google’s pharma policy; however, upon closer inspection that is not the case. The following is Google’s official pharma exemption policy:

• Pharma advertisers are allowed to use an unbranded URL that redirects to their branded website
• Pharma advertisers must own this unbranded URL and it must be working (if a user were to enter it directly into their browser, it must redirect to the advertiser’s branded or working URL)

Please note that the above is a Google editorial guideline and not that of the FDA.

I would hazard to guess that the FDA is not fully aware of this policy, and I’m somewhat surprised that Google allows it. The chance for consumer confusion is much greater chance with this type of bait–and-switch than with not listing risks associated with the medication in search ad copy.

Essentially, the FDA has ceased all pharmaceutical pay per click advertising by severely handcuffing advertisers with regards to writing FDA compliant ad copy, thus opening the door for foreign drug suppliers and homeopathic treatments to increase market share. And as it stands at this time, a pharma marketer can only do the last two solutions mentioned above: increase their focus on SEO or use redirects.

What needs to happen? Google, the FDA and a consortium of pharma emarketers need to lock themselves in a room and not come out until a reasonable agreement is made, one that allows the consumers to find the information they are seeking, without causing confusion about the products.

Alex Porter is vice president of Location3 Media, a Denver-based technology driven direct marketing company that delivers internet marketing solutions for businesses targeting consumers on local to global scales.

Today U.S. Senate Special Committee on Aging Chairman Herb Kohl (D-WI), Senate Majority Whip Dick Durbin (D-IL), Senate Committee on Health, Education, Labor, and Pensions (HELP) Committee Chairman Ted Kennedy (D-MA), and Senator Bob Casey (D-PA) were joined by House Committee on Energy and Commerce Chairman Henry A. Waxman (D-CA), House Energy and Commerce Subcommittee on Health Chairman Frank Pallone (D-NJ), House Committee on Ways and Means Chairman Charles Rangel (D-NY), and House Ways and Means Subcommittee on Health Chairman Pete Stark (D-CA) in introducing a bill in both chambers to provide doctors with unbiased information on prescription drugs. This federal “academic detailing” program would provide physicians and other prescribers with an objective source of information on all prescription drugs, based on independent, scientific research. 

A study in the New England Journal of Medicine projected that for every dollar spent on academic detailing, two dollars can be saved in drug costs. When doctors are better informed about the full range of drugs available on the market, they are more likely to prescribe the most effective treatment, as opposed to the latest brand-name blockbuster drug. The result is also lower health care costs, as generic drugs are more likely to be prescribed. Last year, the Journal of the American Medical Association (JAMA) published an editorial underscoring the need for physician access to unbiased research about the drugs available on the market. 

“This bill will provide an important alternative to the way doctors currently get their information about drugs-from the drug companies themselves-a practice that seems to be fraught with conflicts of interest,” said Kohl. “By providing physicians with thorough, independent research on all the drugs available to them, we believe we can improve the quality of health care and reduce the cost of prescription drugs in America.” 

“Many doctors learn about new drugs from drug company salespersons who may not be objective,” Durbin said. “Studies confirm that when unbiased health professionals, armed with educational materials, provide guidance to doctors, they are more likely to purchase the best drug for the patient instead of the best deal for the pharmaceutical company.” 

“This bill will provide for objective, scientific reviews of the available evidence on the safety and effectiveness of drugs, and will get this information to the physicians who need it, so they and their patients can make more informed decisions about what is best for their care,” said Kennedy. 

“This legislation is a cost-effective, common sense and practical solution to a serious problem – it is exactly the kind of support the federal government should be providing the states,” said Casey. “I’m proud to note that Pennsylvania has one of the best and most innovative academic detailing programs in the country, with documented and measurable cost savings.” 

“For far too long, most of the information physicians receive to make prescribing decisions has come from the drug companies marketing reps, not independent experts,” said Waxman. “This important legislation will help provide doctors with the best objective information to help them make better clinical decisions in partnership with their patients.” 

“Quality health care includes the best use of all available medications,” said Pallone. “Pharmaceutical companies have produced medicines that save lives and improve the quality of life but doctors need the best, objective information about prescriptions if they are to be used properly and effectively. This bill is good for health care in America, good for the medical profession and, most importantly, good for consumers and patients.” 

“Providing doctors and patients with direct access to objective, comprehensive information on prescription drugs can help save lives and money,” said Stark. “This legislation will test ways to help doctors and patients make medication decisions based on facts, not manufacturer propaganda.” 

The Independent Drug Education and Outreach Act of 2009 would provide grants to produce educational materials for doctors on the safety, efficacy, and cost of prescription drugs, including generic and over-the-counter drugs. A second set of up to ten grants would be made available in order to dispatch trained medical staff (such as pharmacists, nurses, and other health care professionals) into physicians’ offices to distribute and discuss the independent information. To ensure their neutrality, grant recipients may not receive financial support from any drug manufacturers whose products they are reviewing. The recently-passed stimulus package designates $400 million dollars to the Department of Health and Human Services to accelerate the development and dissemination of comparative effectiveness research, which could be used to fund grants like those included in the Independent Drug Education and Outreach Act. 

Currently, pharmaceutical sales representatives are one of the most common ways doctors learn about new drugs on the market, and evidence has shown that interaction with them can impact doctors’ prescribing patterns. At an Aging Committee hearing on academic detailing in March 2008, a former sales representative for the pharmaceutical company Eli Lilly shared with the committee his experiences as a drug detailer and discussed the techniques sales representatives employ when marketing drugs to doctors. Other witnesses, including Dr. Jerry Avorn from Harvard’s School of Medicine, outlined the concept of academic detailing, shared success stories from state and international programs already underway, and discussed both the documented cost savings of academic detailing programs and how patients stand to benefit when doctors have access to unbiased information. 

The academic detailing legislation is part of a larger effort to change the way the pharmaceutical industry interacts with doctors. In January, Kohl and Finance Committee Ranking Member Charles Grassley (R-IA) reintroduced the Physician Payment Sunshine Act (S. 301) to require manufacturers of pharmaceutical drugs, medical devices, and biologics to disclose the amount of money they give to doctors through payments, gifts, honoraria, travel and other means. 

BILL SUMMARY

– Fund grants or contracts through the HHS Agency for Health Care Research and Quality (AHRQ) to develop educational materials. 

- The grantee or contractor would develop educational materials showing the relative safety, effectiveness, and cost of prescription drugs, including generic and over the counter alternatives and non-drug treatments for selected conditions. These materials would include brochures, handouts, and electronic information accessible to both patients and doctors. 

- Entities that can demonstrate clinical expertise in pharmaceutical research, such as medical and pharmacy schools and academic medical centers, would be eligible to apply. 

- Applicants may not receive financial support from any manufacturer of the drugs being reviewed. 

- AHRQ will review and approve the accuracy and effectiveness of the materials on a bi-yearly basis. 

– Fund ten grants or contracts through AHRQ to dispatch trained medical professionals into physicians’ offices to discuss and disseminate the unbiased educational materials. 

- Public entities and nonprofit groups are eligible to apply for the grant or contract, as are other entities that can demonstrate the capacity to train and deploy the medical professionals to disseminate and discuss the materials. 

- Applicants may not receive financial support from any manufacturer of the products being discussed. 

- The grant or contract recipients will hire and train appropriate staff, identify health care providers who will be the recipients of the outreach, and evaluate the effectiveness of the program on both cost and prescribing behavior. 

- Regulations will also be in place to ensure the accuracy and timeliness of the information being distributed, to prevent conflicts of interest, and to promote the effectiveness of the program. 

FULL LIST OF SUPPORTERS

“Patients are safer when doctors receive good, unbiased drug information,” said Allan Coukell, director of the Pew Prescription Project. “Programs like this already exist in other countries and in several states, and they’ve been shown to improve care and generate savings.” 

The Prescription Project / Community Catalyst
HealthPartners Health Plan, MN
HealthPartners Medical Group, MN
Gray Panthers
American Medical Student Association (AMSA) 
Consumers Union
Health Care for All (Massachusetts) 
Medicare Rights Center
Mississippi Human Services Coalition
Minnesota Senior Federation
National Physicians Alliance
No Free Lunch
Tennessee Health Care Campaign
National Legislative Association on Prescription Drug Prices (NLARX) 
American Association of Colleges of Pharmacy
UMass Memorial Medical Center
US PIRG
The Harvard Interfaculty Initiative on Medications and Society
The Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital / Harvard Medical School 
The Leapfrog Group
BlueCross BlueShield Association
The Marshfield Clinic
Prescription Policy Choices

Ashley Glacel
Press Secretary
Special Committee on Aging
Senator Herb Kohl, Chair