The blog will be on hold for a few days over the holidays. But first, here is my list of the top ten stories in health, health care, medicine and science over this past year.
1. Conflicts of interest in health care, medicine, research (just one example: the recent news from the Cleveland Clinic)
2. Avian flu (including hype of unproven Tamiflu)
3. Medicare’s prescription drug benefit – “greatest advance for seniors in 40 years” or “a boondoggle”?
4. Medicaid cuts – impact on states
5. Fallout from aggressive marketing of Cox-2 inhibitors
6. Science stifled by Bush administration
7. Drug prices continue to outpace inflation
8. Continued cost-shifting to employees (AKA consumer-driven health plans)
9. What’s going on at the FDA?
10. Lots of news about two people – Terri Schiavo and Peter Jennings – but relatively little news about 45-million Americand who are uninsured and perhaps twice that number who are under-insured.
A year from now, it would be terrific if the contents of this list would be markedly different.
Watch this showdown in the Senate. They're bringing in the big guns.
The AP reports that "A Senate vote on a deficit-reduction bill looks to be so tight that Vice President Dick Cheney was rushing home from an overseas diplomatic mission to be the tiebreaker for saving one of the Bush administration's top priorities."
The AP further reports that "drug companies won a last-minute break against cuts to their Medicaid payments at the expense of beneficiaries, who face higher co-payments that advocates for the poor say will drive people out of the program. Regional health insurance companies, another powerful lobby, stopped a Senate bid to cut a subsidy fund designed to entice them into the Medicare market."
AARP chief William Novelli said, "It protects the pharmaceutical industry, the managed care industry and other providers at the expense of low-income Medicaid beneficiaries and Medicare beneficiaries who will foot the bill."
A special tip of the hat to ABC News for last night's one-hour special, "Peter Jennings Reporting: Breakdown — America's Health Insurance Crisis." It was the last report Jennings worked on before he died.
"Over the course of Peter's long career at ABC News he made more than 60 prime-time documentaries, many of them covering public health issues. He had planned for this broadcast to be the first of a series confronting the problems in the American health-care system — a subject he believed was critical to all Americans," said Tom Yellin, executive producer of Peter Jennings Reporting.
With an estimated 45-million Americans without health insurance, it should not be unusual to see such primetime coverage of an embarrassing national issue -- but it is unusual.
While the report was not perfect (it lacked continuity, appeared to be glued together somewhat hastily after Jennings' death, and relied too much on too few interviewees), it was still television worth watching. Especially since the other networks at that time were airing "The Apprentice," and "Without a Trace."
President Bush this week told seniors that help is available to those who are confused by the number of choices for the new Medicare drug plan. Bush said, "Ask your son or daughter, ask people in your church, ask people in AARP, ask people in your community center to help you look at what's available for you." Bush said.
Note how suddenly it is non-government sources who are supposed to solve the confusion caused by a government program that some have called a boondoggle.
Meantime, the South Florida Sun-Sentinel reports that delegates at the 2005 White House Conference on Aging on Tuesday "sharply criticized" the new Medicare prescription drug benefit and suggested that it be "completely revised and administered by the government, not private companies." The delegates also said the federal government should negotiate directly with pharmaceutical companies to obtain discounts on prescription drugs, saying the resulting savings would eliminate the doughnut hole in coverage.
According to the Sun-Sentinel, Bush is the first president in the conference's history not to address delegates. Perhaps he didn't want to see how many of them were wearing buttons that read, "Fix Medicare RX."
The PSA (or prostate specific antigen) test for prostate cancer isn't the most reliable test. It finds cancers that might otherwise not kill men, but sends them down a pathway of treatments that carry considerable risks.
One idea that's been promoted to improve the test is a so-called "PSA velocity test," which, in simple terms, measures how fast the PSA rises over time.
But the Seattle Times reports that researchers at the Fred Hutchinson Cancer Research Center in Seattle say the PSA velocity test is not reliable because it can be affected by age, race, diet and even calcium supplements. The Times reports:
"Relying on the velocity calculations could lead to unnecessary biopsies — testing tissue from the prostate — and stress for the patient, said Dr. Alan Kristal, lead scientist in the study, published today in the online version of the journal Cancer.
The velocity test had been an attempt to make better sense of the commonly used PSA test, which has already been shown to have problems.
"This is not going to be the solution. It's not going to save the whole screening process from the problems of PSA," Kristal said."
The Wall Street Journal today has an excellent, although troubling look at ghostwriting. That is, researchers who do the work don't actually write the research results in papers submitted to journals.
Sometimes the "ghostwriting" is not disclosed. Oftentimes the ghostwriter is hired by a drug company whose product is the subject of the research.
One journal editor tells the story of a paper that was submitted but the "track changes" function of Word was still in place. It showed that the "author" really didn't write the article. And a telltale note was in the text: "Marketing approval required."
This is an ethical issue that journals and the scientific community must deal with.
The latest evidence of the rampant conflicts of interest in big monied big American health care is in the Wall Street Journal today.
The Cleveland Clinic for years has touted a procedure for atrial fibrillation, calling it the "AtriCure procedure," after the maker of the equipment used in the surgery. But the Journal reports:
"The Clinic's relationship with AtriCure, however, goes deeper. A venture-capital partnership that the Clinic helped found and invested in owns about 4.1% of AtriCure's stock, valued at about $7 million. The Clinic's chief executive, heart surgeon Delos "Toby" Cosgrove, sat on AtriCure's board of directors until March. He also invested personally in the fund and was one of the general partners managing it until, according to a Clinic spokeswoman, he cut his ties to the fund at the end of October.
In addition, Dr. Cosgrove will be entitled to royalties for a medical device he developed that AtriCure plans to begin selling next year. Marc Gillinov, another Clinic surgeon who performs the AtriCure procedure, is a paid consultant to the company, as is another doctor who recently left the Clinic.
The Clinic didn't disclose these ties to AtriCure to the patients on whom it performed the AtriCure procedure. The venture fund the Clinic helped found has also invested in two other medical companies conducting clinical trials at the Clinic."
In addition, the Journal reports that one of the Clinic physicians who questioned the ties -- famed cardiologist Eric Topol -- was told last week that he would be removed from the Clinic medical school's top post and from the conflict-of-interests committee.
Wow.
The Washington Post reports on a national science advisory panel recommendation that food and beverage companies produce more healthful products and shift their advertising emphasis from enticing kids to massive amounts of unhealthful food. If the companies do not do so within two years, Congress should mandate changes, especially for broadcast and cable television ads, the Institute of Medicine said.
The Post article states: "The report said most of the food and beverage products promoted to children are high in calories, sugar, salt and fat and low in nutrients.
Many are promoted with popular cartoon characters. There are, for example, SpongeBob SquarePants cereal, Pop-Tarts, cookies and candy and Scooby-Doo fruit snacks and crackers. The institute said such characters should be used to promote only products that support healthful diets. ...
The institute found that children and other young people spend $200 billion a year. In 2004, children ages 2 to 15 influenced about $500 billion worth of purchases a year, compared with $295 billion in 1993. Of the things that children buy -- or have their parents buy for them -- food and beverages, especially candy, carbonated soft drinks and salty snacks, are the top categories.
The number of new food products aimed at children is growing at a far faster rate than new food products in general, and for the most part, new children's products were high in total calories, sugar or fat, the report found.
In 2004, marketers spent an estimated $10 billion to market products to children, the report said. But, it said, only 20 percent of that was for traditional TV, radio, print and billboard marketing. Marketing dollars are instead going to product placement, in-school marketing, special-event marketing and licensing popular characters. Manufacturers also are turning to Internet marketing, mobile phone ads, product placement in movies and video games, and viral marketing to create a buzz about their goods."
Marketing can only take a product so far, and then market realities set in.
Could that be happening with drugs for impotence, or erectile dysfunction, or ED (as marketing types prefer to call it)?
The New York Times reports: "Seven years after Pfizer made Viagra a cultural touchstone and commercial blockbuster, the market for impotence medicines appears to have fallen well short of what was once predicted.
Heavy advertising to consumers, totaling more than $400 million in 2004, has made Viagra and its newer competitors, Cialis and Levitra, among the best-known drug brands in the United States, and their combined global sales reached about $2.5 billion last year. But the number of new prescriptions for the drugs has fallen steadily this year. Doctors wrote about 10 percent fewer new prescriptions in October than they did in October of 2004. ... The drop in prescriptions comes as sales of other heavily marketed medicines, like antidepressants, are also stalling, and it may be another sign of the limits of consumer advertising to drive demand for drugs. In the late 1990's, drug makers used television advertising to introduce treatments for chronic conditions like arthritis and heartburn. But today, with many patients angry about drug prices and worried that companies are downplaying side effects, drug advertising seems to have lost some of its power. "
The safety questions about Vioxx and other Cox-2 drugs are now well known.
But one of the selling points that helped launch these drugs to begin with was that they were supposedly easier on the stomach than other anti-inflammatory drugs.
A study in last week's BMJ punches more holes in that argument as well.
A large British case-control study found "no strong evidence of enhanced gastrointestinal safety with any of the new cyclo-oxygenase-2 inhibitors compared with non-selective non-steroidal anti-inflammatory drugs.... and that these drugs may not be as safe as originally thought. Given that enhanced gastrointestinal safety has been one of the main justifications for these drugs, this finding is important."
The authors cautioned: "This is an observational study and may be subject to residual confounding that cannot be fully corrected for."
But with more evidence accumulating, and with safety and efficacy and cost (they cost much more) in question, consumers have reason to question why they should be taking a Cox-2 drug.
That troublesomely fuzzy TV ethics line just keeps getting fuzzier.
The Star Tribune reports on Minneapolis station KARE joining a list of other Gannett-owned stations around the country that charge advertisers to talk about their products on a talk show. Advertisers will pay KARE $2,000 to $2,5000 for 5-minute segments on the show. Station news veterans will host the paid-for appearances. My University of Minnesota colleague Jane Kirtley calls this a "logical extension of the whole pernicious practice of infomercials."
The Washington Times reports on that same Gannett trend and on an even more troublesome practice. The Times reports that WUSA in Washington charged the D.C. government as much as $100,000 a year to promote breast cancer awareness during the station's newscasts. So here's a station wrapping itself in the pink ribbon of breast cancer awareness while demanding a premium fee to do so.
Let me remind you: the Radio-Television News Directors Association code of ethics has clauses that dictate that professional electronic journalists should: "Not accept gifts, favors, or compensation from those who might seek to influence coverage; Determine news content solely through editorial judgment and not as the result of outside influence; Recognize that sponsorship of the news will not be used in any way to determine, restrict, or manipulate content; Refuse to allow the interests of ownership or management to influence news judgment and content inappropriately."