It’s something that we have always done as physicians, and usually quite well at that. The treatment of chronic pain has attracted much in the way of media exposure during the last 10 years or so, and that increased public awareness has usually arisen out of news which has largely been negative.
The concern of punitive actions by law, licensing authorities, and — god forbid — the DEA have all placed undue gravity on a situation for prescribing physicians who have nothing but the best intentions for the care of their patients who suffer from chronic pain. Add to this the possibility of litigation for the undertreatment of chronic (nonmalignant) pain, and it is easy to see why — for many providers — the use of narcotics in these patients represents a futile ethical treatment quagmire.
The FDA is considering attacking this problem head on — but not without its share of criticism to come its way from concerned healthcare providers all over the country who contend that, at the very least, the FDA shouldn’t even venture into the land of the regulation of medical providers. | LINK
Huntington’s disease (HD) is a genetic neurological disorder characterized by abnormal body movements called chorea and a lack of coordination; it also affects a number of mental abilities and some aspects of behavior. In more advanced stages it can cause complications that significantly reduce life expectancy.
The disorder is named after George Huntington, the American physician who first described it in 1872. Just over 120 years later, the altered gene that causes HD was discovered, making it one of the first inherited genetic disorders for which an accurate test could be performed. Because of this, and because of the characteristics the disorder shares with some other neurological disorders, it has been extensively researched since then.
Now, you can count a drug for HD among the priorities of researchers. | LINK
Medicare officials have just announced rate increases in prescription drug premiums for beneficiaries in stand-alone Part D plans. Starting next year, the average monthly premium will mean $3 more per month for beneficiaries out of pocket. CMS is quick to buttress news of this increase with the acknowledgement that the popular program continues to function in the financial black.
There are three reasons behind the premium increase, [Kerry Weems, acting administrator of the U.S. Centers for Medicare and Medicaid Services] said.
“First, there is a trend in prescription drug cost growth generally — prices tend to increase because of price increases for existing drugs, the growth in the average number of prescriptions per person, and the introduction of new drugs,” he said.
Second, the 2008 premiums were calculated as part of a demonstration project that has now expired. This project resulted in premiums being 50 cents less in 2008 than had been projected.
“That change is now reflected in the 2009 premium,” Weems said.
Third, drug distributors participating in Part D have found coverage for catastrophic care to be higher than expected. “So they have adjusted their 2009 bids to reflect those higher-than-anticipated costs,” Weems said.
LINK
According to a recent poll commissioned by a prominent health insurance lobby, the percentage of Medicare beneficiaries satisfied with their Medicare Part D coverage approached 87%, and that 75% spent less on formulary drugs after Part D was enacted in 2006.
Did someone forget to tell Rep. Dennis Kucinich this?
Rep. Dennis Kucinich (D-Ohio) recently introduced a bill that would replace the Medicare prescription drug benefit with a new program in an effort to reduce costs, CQ HealthBeat reports. The legislation would require Medicare to negotiate directly with pharmaceutical companies for discounts on prescription drugs and eliminate copayments, premiums and deductibles for medications for beneficiaries.
The Kucinich bill is here. | LINK
- Federal panel: stop prostate exams at 75 years of age.
Most oncologists already argue against treating most men in that age group for prostate cancer because they are more likely to die from some other cause than from their tumor. The new guidelines go one step further, saying, in effect, why test if the patient is unlikely to be treated? The guidelines, published in the Annals of Internal Medicine, are only recommendations, but they are relied on by many physicians in determining patient care. The recommendations could therefore trigger a decline in prostate cancer testing in the elderly. The recommendations provoked a backlash from some experts.
- So much for privacy concerns. Apparently more UCLA Medical Center employees helped themselves to celebrities’ medical records.
- Can estrogens relieve psychosis in women with schizophrenia?
Schizophrenic women who get an estrogen patch along with their regular antipsychotic medications have fewer symptoms than women who get inactive placebo patches. The finding, from a four-week study of 102 women of childbearing age with schizophrenia, comes from Jayashri Kulkarni, MBBS, PhD, and colleagues at Monash University in Melbourne, Australia. During her psychiatric training, Kulkarni spoke with many schizophrenic women who kept telling her, “It’s my hormones, Doc.” They also told her, “No one takes any notice when I say that it’s to do with my hormones.” Kulkarni took notice. She and her colleagues have now completed a series of small studies showing that estrogen can be very effective in reducing symptoms such as delusions, hallucinations, and disordered thinking.
- What to the Democrats think of Obama’s message of healthcare reform? Why, they’re all for it.
- Since 2000, the World Bank has spent over $1.6B to combat AIDS-related illness in Africa. But is it enough?
- There’s a new technique for culturing neurons, the functional units of the nervous system; it may shed light on the origins of amyotrophic lateral sclerosis (Lou Gehrig’s disease).
The new cells were derived from 3-millimeter patches of skin removed from the arm of an 82-year-old woman and her 89-year-old sister, who share a rare genetic mutation that causes about 2% of ALS cases.
The scientists from Harvard University and Columbia University focused on the rare form of ALS in part to test whether cells from elderly patients could be reprogrammed, said biologist Kevin Eggan of the Harvard Stem Cell Institute.
“This opens the door to being able to make patient-specific stem cell lines from diseases which affect people very late in life, like Parkinson’s disease or Alzheimer’s disease,” said Eggan, the study’s senior author.
- The race to the finish line for anti-Alzheimer drug development may prove to be a risky proposition for pharma and its research.
- The House of Representatives moves to give the FDA power to regulate tobacco products. Great news.
- CMS: Medicare payment rates to long term care facilities to increase by over three quarters of a billion dollars next year.
Medicare payment rates to nursing homes will increase by $780 million next year, the Centers for Medicare & Medicaid Services (CMS) announced.
The boost in payments is the result of a 3.4 percent increase in the annual market basket calculation of the cost of goods and services included in a skilled nursing facility stay.
- Michigan physicians are upset over EPA’s decision to allow the state to use a certain antibiotic to “treat” diseased apples.
In an effort to assuage the increasing antipathy of medical lobbyists and physicians against the recent GOP-led campaign to enforce Medicare reimbursement cuts to healthcare providers, Republican leaders recently held a private meeting with top healthcare thought leaders to mend a relationship which has increasingly favored Democrats as of late. The last time Republicans seemed as though they were in the good graces of the medical leadership community was in 2003, when George W. Bush held his own against those in the medical provider cohort who were being bruised by unfair tort practices nationwide. That was also the year in which bold GOP initiatives were easily passed and yielded, among other things, a complete overhaul in how the government, Pharma, and patients later obtained prescription medications — under Medicare Part D.
However, recent spikes in the number of uninsured and a general sense of healthcare management malaise on the part of legislators on both sides of the ideological divide have made a tenuous relationship even more fragile. Can the Republicans make it up to physicians this time?
In the run-up to the 2006 midterm elections, doctors and the groups that represent them gave 62 percent of their combined $52.4 million war chest to Republicans, compared with 37 percent to Democrats, according to the Center for Responsive Politics. That breakdown mirrors previous cycles since Bush entered the White House. But since 2006, doctors and related groups have given Democrats 53 percent of their combined $53 million in campaign contributions, according to the watchdog group. The switch is even more stark for the AMA. In the run-up to the 2006 election, the AMA’s political action committee gave Republicans 70 percent of its campaign cash, according to the Center for Responsive Politics. In 2004, the AMA’s PAC contributed 80 percent of its total donations to Republican lawmakers and candidates. Since 2006, that PAC has directed 53 percent of its contributions to Democrats.
If the current state of re-election possibilities continues to wane for the GOP, don’t bet on it. | LINK
Ready for prime time by 2012? That’s what some researchers are saying about the anti-Alzheimer drug in the second stage of its development. The investigational drug is the first to attack the chronic degenerative disease at its core: the formation of proteinaceous neurotoxins (tau proteins) which are pathognomonic for the disorder. Early data show absolutely no decline in patients’ cognitive functioning over six months while on the drug — something not possible by the current crop of FDA approved agents for dementia (as cognitive decline is slowed, but not absolutely halted). | LINK
Early news from another trial involving former blockbuster drug Vytorin will not be good for investors and its parent Pharma company.
The combination was significantly more effective than placebo in reducing the risk of ischemic events, a secondary composite end point of nonfatal MI, coronary artery bypass graft (CABG) surgery, PCI, hospitalization for unstable angina, nonhemorrhagic stroke, and cardiovascular death. Vytorin failed to meet a secondary goal of improving aortic-valve disease events, which included valve-replacement surgery, hospitalization because of heart failure, and cardiovascular mortality.
“The SEAS study has given a clear-cut answer to the question of whether intensive lipid lowering will influence the course of aortic-stenosis disease. I think we can conclude that it does not,” announced Dr Terje Pedersen (Ulleval University Hospital, Oslo, Norway), chair of the steering committee, during a conference call today with the media. “We have also shown there is benefit in treating such patients with the study drug combination, as we saw a reduction in the risk of coronary artery disease.”
You may recall that Vytorin encountered hot water (and its market share took a big hit) when a previous scientific trial showed no difference between this combination drug and simvastatin (one of Vytorin’s component agents) alone in the treatment of coronary artery disease and prevention of its adverse outcomes. | LINK | Previous Doctor Pundit coverage here.
The American Academy of Pediatrics is now restating its earlier recommendations on when to appropriately give children anti-cholesterol drugs. Previously, the AAP stated such meds couldn’t be given to kids under 10 years of age. Buckling under pressure from Pharma (sell our drugs at any cost!), parents (do something, please!), and, perhaps among themselves (we have to do something!), the physician group released its new guidelines alongside those advocating lifestyle measures. | LINK
Here they are. Quick and dirty as I have a BBQ to attend!
The government’s main pharma regulatory agency will hear from cardiologists and biostatisticians today as it debates whether to adopt a strategy of studying cardiovascular risk as a provision of the future development of antidiabetes drugs. Under pressure from politicians who desire the approval of medications on more than just biochemical markers (Vytorin), the FDA is also aware of the costs that will be incurred if the inclusion of the study of cardiac risk (Avandia) for each novel drug becomes standard. The debate will begin today and should be very interesting. | LINK
