Health Policy News and Views
Compiled by Benita M. Dodd
Fighting tooth and nail: At least 30 states have tried to shut down teeth-whitening businesses, according to a new study by the Institute for Justice. It’s usually because licensed dentists and hygienists have tried to corner the market on these services. As the teeth-whitening industry has exploded in recent years, so too has the push for laws and regulations that enable licensed dentists and hygienists to capture a greater share of that market by banning anyone else from offering teeth-whitening services. The study investigates this expansion of dental licensing as a form of economic protectionism, where industry insiders agitate for laws that limit competition. The institute points out that scholarly research and consumer complaint data reviewed for this report show that teeth whitening is safe wherever it is done. Outlawing teeth-whitening entrepreneurs serves only to raise prices for consumers and protect dentists from honest competition. Legislators and dental boards should resist protectionist calls to expand dental licensing and instead legalize teeth whitening to allow new businesses to flourish, The Institute for Justice maintains.
ObamaCare update: Middle income families are about to encounter some real surprises as a result of the Affordable Care Act, John Goodman reports in his Health Policy Blog. For example, many workers will soon discover that when they earn more money, they end up with less take-home pay. Others will discover that they are worse off if their employer offers them “affordable coverage” than if there is no health insurance offer. Under the IRS final rule, the affordable coverage requirements in the ObamaCare law apply only to single coverage for each employee. No matter how high the premium for family coverage, it is not counted in the affordability calculation. Even so, an employee’s family members will not be eligible for health exchange premium subsidies as long as they are eligible to enroll in an employer plan that is deemed “affordable.” Firms with more than 50 employees must offer coverage for dependents, but not for spouses.
Britain’s woes signal ours: The number of emerging problems with the British health care system suggests that the Affordable Care Act may fall short of its goal of reducing the cost of health care, according to Diana Furchtgott-Roth, a senior fellow with the Manhattan Institute. From 2005 to 2012, the population grew only 4 percent but British hospital emergency room visits rose 22 percent, from 18 million to 22 million. This should concern those who claim the U.S. federal health care mandate will reduce the number of hospital emergency room visits and lower the national cost of health care. The increased visits in Britain are due to fewer physicians, an aging population and increased patient demand, all problems America is currently facing. Source: RealClearMarkets.com
Growing dem bones: Human bone grown in a laboratory dish has been successfully transplanted into living mice, according to a study published Monday in the Proceedings of the National Academy of Sciences. As the population ages, bone repair using stem cells is expected to become increasingly important. In the past, scientists have approached the problem of repairing human bones by using synthetic materials or bone transplants, techniques that so far have produced limited results. Recent research has grown more ambitious, however, as scientists have increasingly experimented with stem cells, including successfully growing arteries and windpipes. Source: MedicalDaily.com
Alzheimer’s disappointment: Baxter International said it is stopping Phase III Alzheimer’s disease trials of Gammagard after the intravenous immunoglobulin failed to enhance mental decline and functional ability in patients. Gammagard, also known as intravenous immunoglobulin, is the only Alzheimer’s treatment currently in Phase III development. The firm said it will re-evaluate its Alzheimer’s program and make a decision after analyzing the trial’s full results. Phase III studies are randomized, controlled clinical trials on large patient groups (300–3,000 or more) to assess the drug’s effectiveness. Phase III is the most expensive, time-consuming and difficult trial to design and run.
Best-selling prescription drugs: AstraZeneca’s acid blocker Nexium, or esomeprazole, and Otsuka Pharmaceutical’s antipsychotic drug Abilify, or aripiprazole, were the best-selling prescription drugs in the first quarter of 2013. Eli Lilly & Co.’s Cymbalta, or duloxetine, AstraZeneca’s Crestor, or rosuvastatin, and GlaxoSmithKline’s Advair Diskus, or salmeterol-fluticasone propionate, rounded out the top five, according to Drugs.com, which released a list of the 100 top-selling drugs.
Cause of death? A lie: Some 48.6-58.4 percent of medical residents from more than half of the residency programs in New York City have knowingly entered the incorrect cause of death on death certificates, according to a recent study. With death certificates being relied on more and more instead of autopsies, this revelation has implications for epidemiology, public health research and disease surveillance. Almost half of all respondents (48.6 percent) reported they had identified a cause of death on a death certificate that did not represent the true cause of death. More than half of the residents (54.0%) reported they were unable to list what they felt to be the correct cause of death “after guidance from the admitting department in their hospital,” the researchers wrote. Of all respondents, 70 percent believed they were forced to identify an alternate cause of death when the patient died of septic shock and 34.2 percent believed they were forced to identify an alternate cause when the patient died of acute respiratory distress syndrome, the researchers noted. Source: Medscape.com
Making the case for transparency: The odds of misdiagnosis are shockingly high. An estimated 10-20 percent of cases are misdiagnosed, according to a report from Kaiser Health News. That exceeds drug errors and surgery on the wrong patient or body part, both of which receive considerably more attention. One report found that 28 percent of 583 diagnostic mistakes were life threatening or had resulted in death or permanent disability. Another study estimated that fatal diagnostic errors in U.S. intensive care units equal the number of breast cancer deaths each year: 40,500. A survey found that 96 percent of physicians felt that diagnostic errors are preventable while half said they encountered at least one per month.
Nanotechnology plays no small part: As biotechnology companies focus on nanotechnology to treat and diagnose cancer, experts believe the industry may be at a turning point. The ability to encapsulate potent drugs in such tiny particles is opening up new options for super-accurate drug delivery, increasing precision hits at the site of disease with, hopefully, fewer side effects. “We have been hearing about the promise of nanomedicine for a long time, but it is now really starting to move,” said Dan Peer, head of a nanomedicine laboratory at Tel Aviv University. “We will see more and more products in clinical testing over the next few years.”
Less addictive painkillers: In the wake of a key decision by the Food and Drug Administration, more than a dozen pharmaceutical companies are vying to create painkilling drugs that are difficult to abuse, The Wall Street Journal reports. The FDA moved last month to block the manufacture and sale of generic versions of the original OxyContin, which has gone off patent but which is easier to abuse than the current version. A newer version of OxyContin introduced in 2010, contains an infusion of polymer that makes the pill difficult to crush, meaning addicts can’t get all of the extended-release ingredients at once to get high.
Allergy pill offers more than temporary relief: The Food and Drug Administrationhas accepted Merck’s license application for a dissolvable immunotherapy pill for ragweed pollen allergy. The FDA is expected to release its decision in the first half of next year.
New life in drug industry: The pharmaceutical industry is invigorated by the promise of quicker regulatory decisions, more targeted treatments and a pickup in new drug approvals as the effect of a major wave of patent expiries subsides, Reuters reports. “It’s a very exciting time in terms of advances in science and technology,” FDA Commissioner Dr. Margaret Hamburg told the Reuters Health Summit. After approvals last year from the FDA for 39 novel medicines, a record only beaten in 1996, the healthy pace has continued into 2013. Signs of renewed investor confidence are reflected in stock prices.
Quotes of Note
“Isn’t it a bit unnerving that doctors call what they do ‘practice’?” – George Carlin
“We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.” – Atul Gawande, “Complications: A Surgeon’s Notes on an Imperfect Science”