By DONALD G. McNEIL Jr. (original article)
OCTOBER 20, 2014
Federal officials announced new guidelines on Monday evening for the protection of hospital workers caring for patients infected with Ebola — guidelines that might have prevented the infection of two nurses had they been in place a month ago.
The new guidelines, from the Centers for Disease Control and Prevention, follow broad revisions announced just last week. The new recommendations provide considerably more detail, however, and have been reviewed by specialists at American hospitals that have successfully cared for Ebola patients.
The procedures are based on the very strict protocols used for years by Doctors Without Borders, Dr. Thomas R. Frieden, the C.D.C.′s executive director, said during an unusual late-evening telephone news conference. That organization also reviewed the new guidelines, he said.
The Leukemia & Lymphoma Society (LLS) won’t rest until we find permanent cures for blood cancers. And to fortify that goal, LLS partners with both pharmaceutical and research organizations to fund promising studies that yield a strong chance of finding a therapy, a cure, or a vaccine. That’s right, a vaccine.
We are thrilled to report that LLS and OncoPep have entered a partnership to advance an experimental cancer vaccine to treat patients with smoldering multiple myeloma (SMM), an asymptomatic stage of myeloma. This breakthrough vaccine could save lives while preventing SMM from becoming a more aggressive disease.
Support from people like you will not only help LLS work towards cures but someday prevention of blood cancers as well.
Help us achieve our goal of a world without blood cancers.
Louis J. DeGennaro
Louis J. DeGennaro, Ph.D.
President and CEO
If you need help or to learn more about specific blood cancers: www.lls.org/diseaseinformation/
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RALEIGH, N.C. (AP) — A North Carolina inmate with mental illness who died of thirst was held in solitary confinement for 35 days and cited twice for flooding his cell, according to prison records.
Inmate Michael Anthony Kerr was found unresponsive in the back of a van March 12 after being driven three hours from Alexander Correctional Institution in Taylorsville to a mental hospital at Central Prison in Raleigh. An autopsy released earlier this week says the 54-year-old inmate, who had schizophrenia, died of dehydration. The report also said he was receiving no treatment for the symptoms of his mental illness.
A written policy at the North Carolina Department of Public Safety allows prison staff to respond to the “misuse of plumbing facilities” by turning off the water to an inmate’s sink and toilet. State prison officials did not respond Friday to questions about whether water to Kerr’s cell was cut off in the days before his death.
Health insurance companies are no longer allowed to turn away patients because of their pre-existing conditions or charge them more because of those conditions. But some health policy experts say insurers may be doing so in a more subtle way: by forcing people with a variety of illnesses — including Parkinson’s disease, diabetes and epilepsy — to pay more for their drugs.
Insurers have long tried to steer their members away from more expensive brand name drugs, labeling them as “non-preferred” and charging higher co-payments. But according to an editorial published Wednesday in the American Journal of Managed Care, several prominent health plans have taken it a step further, applying that same concept even to generic drugs.
The Affordable Care Act bans insurance companies from discriminating against patients with health problems, but that hasn’t stopped them from seeking new and creative ways to shift costs to consumers. In the process, the plans effectively may be rendering a variety of ailments “non-preferred,” according to the editorial.
“It is sometimes argued that patients should have ‘skin in the game’ to motivate them to become more prudent consumers,” the editorial said. “One must ask, however, what sort of consumer behavior is encouraged when all generic medicines for particular diseases are ‘non-preferred’ and subject to higher co-pays.”
Most news coverage of the new Kaiser Family Foundation annual survey on employer-sponsored health plans has focused on the fact that growth in premiums in 2013 was as low as it has ever been in the 16 years of the survey. But buried in the details of the report are some interesting insights into how employers think about controlling health care costs. One example is that they’re very fond of workplace wellness programs. This is surprising, because while such programs sound great, research shows they rarely work as advertised.
Wellness programs aim to encourage workers to be more healthy. Many use financial incentives to motivate workers to monitor and improve their health, sometimes through lifestyle-modification programs aimed at lowering cholesterol or blood pressure, for instance. Some programs offer a carrot, like discounts on health insurance to employees who complete health-risk assessments. Others use a stick, penalizing poor performance, or charging people more for smoking or having a high body mass index, for example.
Wellness programs are popular among employers. An analysis by the RAND Corporation found that half of all organizations with 50 or more employeeshave them. The new survey by the Kaiser Family Foundation found that 36 percent of firms with more than 200 workers, and 18 percent of firms over all, use financial incentives tied to health objectives like weight loss and smoking cessation. Even more large firms — 51 percent of those with 200 workers or more — offer incentives for employees to complete health risk assessments, intended to identify health issues.
Medium-to-large employers spent an average of $521 per employee on wellness programs last year, double the amount they spent five years ago, according to a February report by Fidelity Investments and the National Business Group on Health. The programs are generally offered not directly by insurance companies, but by specialist firms that tell employers they will reduce spending on employees’ care by encouraging the employees to take better care of their health.
PHILADELPHIA — McBaine, a bouncy black and white springer spaniel, perks up and begins his hunt at the Penn Vet Working Dog Center. His nose skims 12 tiny arms that protrude from the edges of a table-size wheel, each holding samples of blood plasma, only one of which is spiked with a drop of cancerous tissue.
The dog makes one focused revolution around the wheel before halting, steely-eyed and confident, in front of sample No. 11. A trainer tosses him his reward, a tennis ball, which he giddily chases around the room, sliding across the floor and bumping into walls like a clumsy puppy.
McBaine is one of four highly trained cancer detection dogs at the center, which trains purebreds to put their superior sense of smell to work in search of the early signs of ovarian cancer. Now, Penn Vet, part of the University of Pennsylvania’s School of Veterinary Medicine, is teaming with chemists and physicists to isolate cancer chemicals that only dogs can smell. They hope this will lead to the manufacture of nanotechnology sensors that are capable of detecting bits of cancerous tissue 1/100,000th the thickness of a sheet of paper. Continue reading →
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SPARTA, N.J. — When Gail Morris came home late one night after taking her daughter to college, she saw her teenage son, Alex, asleep on the sofa in the family room. Nothing seemed amiss. An unfinished glass of apple juice sat on the table. She tucked him in under a blanket and went to bed.
The next morning, he would not wake up. He was stiff and was hardly breathing. Over the next several hours, Ms. Morris was shocked to learn that her son had overdosed on heroin. She was told he would not survive.
He did survive, but barely. He was in a coma for six weeks. He went blind and had no function in his arms or legs. He could not speak or swallow. Hospitalized for 14 months, Alex, who is 6-foot-1, dropped to 90 pounds. One of his doctors said that Alex had come as close to dying as anyone he knew who had not actually died.
Most people who overdose on heroin either die or fully recover. But Alex plunged into a state that was neither dead nor functional. Continue reading →
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A new drug for the liver disease hepatitis C is scaring people. Not because the drug is dangerous — it’s generally heralded as a genuine medical breakthrough — but because it costs $1,000 a pill and about $84,000 for a typical person’s total treatment.
A Washington advocacy effort has sprung up overnight, largely devoted to objecting to the cost of this one medication, Sovaldi. Members of Congress have started a joint investigation into how its maker, Gilead Sciences, settled on its price.
“Clearly, $1,000 a pill strikes people as completely unreasonable,” said John Rother, president of the National Coalition on Health Care, an advocacy group that has been raising an outcry about the drug’s price as “unsustainable.” Gilead “stepped in it when they decided to go for that cost per pill, because people can’t imagine why that could be justified.”
But maybe we are looking at the costs of Sovaldi in the wrong way. One reason it is causing such angst among insurers and state Medicaid officials is that treatment costs are coming all at once.
Photo
Toyonnia Hodges at Central City Concern’s clinic in Portland, Ore. She recently learned she had hepatitis C, contracted from a blood transfusion.CreditThomas Patterson for The New York Times.
First of all, there is pent-up demand. There are a lot of people with hepatitis C — an estimated 3.2 million in the United States — many of whom have been waiting for a good treatment. Second, unlike drugs for most chronic diseases, like diabetes or H.I.V./AIDS, for which treatment continues over many years, Sovaldi can cure most patients’ hepatitis in just a few weeks, with the bill soon to follow. The lifetime cost of treating someone with an H.I.V. infection is around $380,000, according to estimates from the federal Centers for Disease Control and Prevention, but the annual bill is much smaller.
When cases of a potentially fatal strain of meningitis began cropping up at Princeton last year, university officials trying to stop its spread could recommend little beyond precautions like frequent handwashing and not sharing beverage containers.
Although a vaccine against the rare bacteria that was causing the illness on campus existed in much of the developed world, it was not available in the United States. Novartis, its Swiss-based manufacturer, had not applied here for licensure of the vaccine, called Bexsero, because it seemed unlikely to be used enough in the United States to offset the cost of entering the market.
In all, it took nine months after the first case was detected in March 2013 before Princeton students could be immunized and nearly a year before they had completed the two-shot course, and that happened only after extraordinary interventions from the Centers for Disease Control and the Food and Drug Administration to allow the vaccine into the country.
By the end of the outbreak, seven more students had contracted the disease on the Princeton campus, and a student at another university died after contact with Princeton students. In a second outbreak involving four students at the University of California, Santa Barbara, a lacrosse player had to have his feet amputated.
The episode highlights a drug approval process in the United States that experts say does not always take into account public health needs. Regulators typically do not seek out new treatments, but wait for pharmaceutical companies to apply for approval of new products. Drugmakers weigh their estimates of sales potential against the high costs of application. And that calculation is often more fraught in the United States than in other countries, in part because American regulators are historically loath to grant approval based solely on foreign trials, so they require expensive new studies.
The head of the Assembly Health Committee has blasted as unjustified the proposed double-digit rate increases New York insurers are requesting for new ObamaCare policies — and called for a probe into possible bait-and-switch tactics.
Manhattan Assemblyman Richard Gottfried on Thursday suggested that insurers low-balled prices in 2013 to lure in customers — before hammering them with an average 13 percent rate-hike request this year.
“The insurance carriers may have low-balled their premiums last year in order to grab market share on the health exchange. This is not unheard of. They should not be rewarded if that’s what’s going on,” Gottfried said.
“It’s hard to see how these increases are justified. Health-care costs have not increased that much.”
