September 06, 2007
Today's Health Care In-Box . . .
Where I read the papers so you don't have to (but include links so you can if you want):
Health Insurance Reform in Holland
The health insurance revamp in Holland, which last year transformed its state-run health care system into one that is based on insurance companies selling individual plans, gets an intriguing review in this morning's Wall Street Journal. Key component: Insurance companies must take all comers, and are prohibited from discriminating against anyone with pre-existing conditions or easily foreseeable health care problems.
EPO Fails in ICU Trial
A Johnson & Johnson-funded study that administered EPO (Procrit) in emergency room and intensive care unit settings to reduce blood transfusions failed. Not only did it fail to reduce the need for blood transfusions, but patients in the Procrit arm of the trial suffered 40 percent more heart attacks -- another sign that overuse of EPO raises cardiovascular risk. While there was a non-statistically significant reduction in mortality in the Procrit arm of the trial, an accompanying editorial in the New England Journal of Medicine warns doctors not to prescribe the drug for critically ill patients. J&J tells the Wall Street Journal that it is cancelling plans to seek Food and Drug Administration approval for emergency room and ICU use of the drug.
NEJM Bashes Bush on Kids Insurance
The nation's leading medical journal also weighs in this morning with a hard-hitting editorial slamming the president's opposition to the expansion of the children's health insurance program. Noting that organizations as diverse as the American Medical Association, the Pharmaceutical Research and Manufacturers Association, the AARP and the Children's Defense Fund have endorsed the bill, the NEJM intones: "If the president is sincere in his commitment to leave no child behind, he must begin by leaving no child uncovered."
The editorial accompanies an overview of "The Battle over SCHIP", written by John K. Iglehart, the former editor of Health Affairs who is now a national correspondent for NEJM. While the article mentions that physicians will get their scheduled fee-cuts restored in the bill, it skates over the fact that the increase in physician payments costs almost as much as what the legislation spends on kids' health insurance.
FDA Fails to Follow Through on IOM Report
The NEJM also contains a thorough review of the Food and Drug Administration's response to the Institute of Medicine's 2006 report on drug safety, which faulted the agency for emphasizing getting new drugs approved over protecting the public from unsafe drugs. While good as far as it went, the review made no mention of the FDA reform legislation attached to the Prescription Drug User Fee Act reauthorization now before Congress. An independent review of how well those reforms will succeed at correcting the problems identified in the IOM report is sorely needed. Sheila Weiss Smith's review (she's a long-time ad hoc member of FDA advisory panels and consulted with the IOM on its report) suggests the legislation has severe shortcomings, especially its failure to establish an independent safety department within the agency.
Study Shows Teen Suicides Rise After Anti-Depressant Warnings
The Washington Post carries a front page story on a new study showing an increase in teenage suicides the year after the FDA warned that use of anti-depressants increases the risk of suicide in youths. Prescriptions for the drugs declined sharply after the warning. David Healy is the only critic quoted in the story. He suggests an increase in atypical anti-psychotic drug use among the young may be responsible for the increase -- not a decline in the use of anti-depressants. No one in the story addresses the issue of talk therapy and its declining use in America because insurance companies won't pay for it. Many studies show this is a critical element in any program to decrease teen suicide. And then there's gun control. Far more boys than girls succeed at killing themselves because they're much more likely to use guns, while girls tend to use easily obtainable household poisons, which are much less effective. Eighty percent of teenage male suicide attempts succeed; 60 percent of teenage female suicide attempts fail.