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March 2015 Archives

Oncologists Reveal Reasons for High Cost of Cancer Drugs, Recommend Solutions

Increasingly high prices for cancer drugs are affecting patient care in the U.S. and the American health care system overall, say the authors of a special article published online in the journal Mayo Clinic Proceedings.

“Americans with cancer pay 50 percent to 100 percent more for the same patented drug than patients in other countries,” says S. Vincent Rajkumar, M.D., of Mayo Clinic Cancer Center, who is one of the authors. “As oncologists we have a moral obligation to advocate for affordable cancer drugs for our patients.”

Dr. Rajkumar and his colleague, Hagop Kantarjian, M.D., of MD Anderson Cancer Center, say the average price of cancer drugs for about a year of therapy increased from $5,000 to $10,000 before 2000 to more than $100,000 by 2012. Over nearly the same period the average household income in the U.S. decreased by about 8 percent.

In the paper, the authors rebut the major arguments the pharmaceutical industry uses to justify the high price of cancer drugs, namely, the expense of conducting research and drug development, the comparative benefits to patients, that market forces will settle prices to reasonable levels, and that price controls on cancer drugs will stifle innovation.

“One of the facts that people do not realize is that cancer drugs for the most part are not operating under a free market economy,” says Dr. Rajkumar. “The fact that there are five approved drugs to treat an incurable cancer does not mean there is competition. Typically, the standard of care is that each drug is used sequentially or in combination, so that each new drug represents a monopoly with exclusivity granted by patent protection for many years.”

Drs. Rajkumar and Kantarjian say other reasons for the high cost of cancer drugs include legislation that prevents Medicare from being able to negotiate drug prices and a lack of value- based pricing, which ties the cost of a drug to its relative effectiveness compared to other drugs.
Their recommendations include:
  • Allow Medicare to negotiate drug prices.
  • Develop cancer treatment pathways/guidelines that incorporate the cost and benefit of cancer drugs.
  • Allow the Food and Drug Administration or physician panels to recommend target prices based on a drug’s magnitude of benefit (value-based pricing).
  • Eliminate “pay-for-delay” strategies in which a pharmaceutical company with a brand name drug shares profits on that drug with a generic drug manufacturer for the remainder of a patent period, effectively eliminating a patent challenge and competition.
  • Allow the importation of drugs from abroad for personal use.
  • Allow the Patient-Centered Outcomes Research Institute and other cancer advocacy groups to consider cost in their recommendations.
  • Create patient-driven grassroots movements and organizations to advocate effectively for the interests of patients with cancer to balance advocacy efforts of pharmaceutical companies, insurance companies, pharmacy outlets and hospitals.
Read about this at the Mayo Clinic News Network in an article written by Joe Dangor

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
 
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The Trouble With Advance Directives

Ever since Congress passed the Patient Self-Determination Act in 1990, health professionals and consumer advocates have urged Americans, especially older adults, to draw up advance directives and distribute them to families and doctors. The documents allow people with terminal illnesses to accept or reject medical interventions and to appoint surrogate decision makers if they become incapacitated.

The campaign does seem to have paid off in one sense: Among Americans over age 60, the proportion who had advance directives when they died rose to 72 percent in 2010 from 47 percent in 2000, according to data from the national Health and Retirement Study.

Too often, though, an advance directive hardly seems to matter. Stories abound of documents misplaced, stashed in safe deposit boxes, filed in lawyers’ offices. 

Frequently, “the directive never gets to the right place, or isn’t referred to when a decision needs to be made,” said David M. English, chairman of the American Bar Association’s Commission on Law and Aging. Emergency medical personnel operate under standing orders to attempt resuscitation, whatever an advance directive says. (Only a state do-not-resuscitate or Polst form can prevent that.)

The Polst form does a better job than advance directivesof keeping dying people out of hospitals, research has shown. Completed by health care professionals in consultation with patients, this document can stipulate that only comfort measures be applied, or full life-prolonging interventions — or various options in between.

But a Polst can’t always substitute for an advance directive. It is meant for people with with serious illnesses that could result in their death within a year. Most people over 65 are still too healthy to have a Polst.

My advice is to always start by giving a copy of your Power of Attorney to your primary care physician. If you have a very serious illness consider a Polst.

Read about this in a New York Times article on March 13, 2015 written by Paula Span at http://nyti.ms/18Hg8hP

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
 
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.


Still problems at the VA

Now, patients, veterans groups and doctors say delays in receiving care are still common, and they accuse department officials of failing to provide opportunities to see private doctors. Critics, including Republican lawmakers on Capitol Hill, say far too few senior managers have been held accountable for mismanagement at the hospital in Phoenix and at others around the country.

“Very little has changed,” Dr. Sam Foote, an internist who was one of the first whistle-blowers to reveal problems with wait times at the Phoenix hospital, said in an interview on Thursday.

The continued problems at the hospitals underscore the grim reality that overhauling a federal department with almost 300,000 employees scattered across the country is a difficult and tedious process. That truth will almost certainly ensure that Mr. Obama fails to make good on his 2008 campaign promise to fix the “broken bureaucracy of the V.A.” before he leaves office.

 Revelations about widespread problems at the hospitals started in Phoenix with the reports that 40 veterans had died while they were stuck on waiting lists to see doctors. The department’s inspector general later said that at least 1,700 veterans in Phoenix were “at risk of being forgotten or lost” in the hospital’s convoluted scheduling process.

Read about this in the New York Times in an article written by Michael Shears and Dave Philipps on March 13, 2015. 

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
 
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.

New Dietary Guidelines, Better Science-Low Fat-Low Salt Diets Don't Prove Up

For decades, many dietary recommendations have revolved around consuming a low percentage of your daily calories from fat. It has been widely thought that doing so would reduce your chance of having coronary heart disease. Most of the evidence for that recommendation has come from epidemiologic studies, which can be flawed.

But last week, the government started to address that problem, proposing new guidelines that in some cases are more in line with evidence from randomized controlled trials, a more rigorous form of scientific research.

Just recently, a study was published in the journal Open Heart in which researchers performed a systematic review and meta-analysis of the randomized controlled trials that were available when those guidelines were announced. They wanted to explore what evidence those creating the guidelines might have been able to consider at the time. The study did show that cholesterol levels went down more in the groups that ate low-fat diets. Some have used this as justification for a low-fat diet. But the difference between them was small. And these groups didn’t have different clinical outcomes, and that’s what we really care about.

Small changes in cholesterol levels from dietary changes also aren’t surprising to those who follow the research. About 70 percent of people are thought to be “hyporesponders” to dietary cholesterol. This means that after consuming three eggs a day for 30 days, they would see no increase in their plasma cholesterol ratios. Their cholesterol levels have almost no relationship to what they eat.

In 2013, researchers published a systematic review of all studies from 2003 or after. In most studies, all people didn’t respond. In the rest, only a minority of patients responded to changes in dietary cholesterol. A government committee urged repeal of the guideline that Americans limit their cholesterol intake to 300 milligrams a day, saying, “Cholesterol is not a nutrient of concern for overconsumption.

Then there is the issue of salt. A systematic review of randomized controlled trials of salt intake was published last year. Eight trials involving more than 7,200 participants looked at whether advising patients to cut down on salt, or reducing sodium intake, affected outcomes. None of the trials, including ones involving people with both normal and high blood pressure, showed a reduction in all-cause mortality.

Since pretty much all calories come from fat, protein or carbohydrates, reducing your consumption of one means that you have to increase your consumption of another. So, as the guidelines have recommended cutting down on meat, especially red meat, this meant that many people began to increase their consumption of carbohydrates. Many now believe that excessive carbohydrate consumption may be contributing to the obesity and diabetes epidemics. A Cochrane Review of all randomized controlled trials of reduced or modified dietary fat interventions found that replacing fat with carbohydrates does not protect even against cardiovascular problems, let alone death.

Read about this in the New York Times on February 23, 2015 in an article written by Dr. Aaron Carroll. Aaron E. Carroll is a professor of pediatrics at Indiana University School of Medicine. He blogs on health research and policy at The Incidental Economist, and you can follow him on Twitter at @aaronecarroll.

William Wombacher, your Central Illinois Certified Elder Law Attorney (CELA) and Social Security Disability Specialist. I'll help you!   http://www.wombacherlaw.com
 
Serving Peoria, East Peoria, Peoria Heights, Pekin, Dunlap, Chillicothe, Morton, Washington, Metamora, Canton, Galesburg, Lacon, Henry, Bloomington, Normal and surrounding cites and counties of Peoria, Tazewell, Woodford, Fulton and  Knox Counties in Central Illinois.