Let’s Gang Up on Killer Bugs
By CARL F. NATHAN
I hope you never have this experience: a loved one is hospitalized. Her doctors tell you her infection is resistant to antibiotics. She dies. More than 60,000 American families go through that experience each year — and the number is almost certain to rise.
Multidrug-resistant organisms are showing up in top-flight hospitals — like the klebsiella found in the National Institutes of Health’s Clinical Center this year, which may have led to the deaths of seven patients. Even infections that used to be a breeze to treat, like gonorrhea, are becoming incurable.
In much of the world, of course, bacterial disease is a routine cause of tragedy. Tuberculosis alone kills 1.4 million people a year. One reason for this staggeringly high figure is that most people in the world are too poor to pay for most medicines. But another reason is that some strains of tuberculosis bacteria have become resistant to most of the drugs we have. Even after two years of toxic treatment, drug-resistant tuberculosis has a fatality rate of about 50 percent.
What makes the rapid loss of antibiotics to drug resistance particularly alarming is that we are failing to make new ones. We are emptying our medicine chest of the most important class of medicines we ever had. And the cause can be traced, for the most part, to two profound problems.
The first is economic. Historically, the drug industry thrived on antibiotics. But if an antibiotic is useful against only one type of bacterium, relatively few people need it during its patent life. And if an antibiotic is “broad spectrum,” meaning it works on many different types of bacteria, wider use shortens its commercial life because it quickens the pace at which bacteria develop resistance. Moreover, antibiotics are designed to cure an acute disease — not to palliate a chronic one — so people need them only for a limited time. Compared with drugs that are used for years to treat widespread conditions like high cholesterol or asthma, antibiotics pale as a corporate investment.
Worthy battle for homeless ends in victory
Bob Taube sounded like a man who had won a drawn-out battle he never really expected to fight, which is exactly who he is.
Taube runs Boston Health Care for the Homeless, a group that provides medical care in clinics and shelters across the city. It serves about 12,000 patients a year, and has won kudos for its service to a population that is beyond needy.
When the decision was made to renovate an old shelter in Jamaica Plain and turn it into permanent housing, the group thought it had lined up support in the places where it was most needed — the mayor’s office and the Boston Redevelopment Authority.
But Taube’s group ran into opposition from a pocket of well-heeled Jamaica Plain residents who tied the project up in court for two years. The long-running battle ended for good last week when the Supreme Judicial Court refused to take up an Appeals Court ruling backing the project. Finally, the legal battle is over.
Will national health reform close ethnic and racial disparities?
National health reform is designed to help everyone who lacks medical coverage, but minority groups stand to benefit most — simply because they have the farthest to go.
One-third of Hispanics and more than 20 percent of African-Americans nationwide lack health insurance. But the law’s provisions — most of which take effect in January 2014 — will effectively cut by half the number of African-Americans who are uninsured, and significantly improve coverage rates for Hispanics.
“I think it’ll have the biggest impact in terms of reducing disparities in this country of any piece of legislation since the Civil Rights Act,” says Robert Restuccia, executive director of Community Catalyst, a Boston consumer advocacy organization that operates in 40 states. “I’ve worked 30 years on this stuff and there’s not anything [else] that even comes close.”
The benefits go beyond basic coverage. The federal Affordable Care Act — unlike Massachusetts’ 2006 health overhaul — provides preventive measures for free. That means no out-of-pocket costs for diabetes, HIV, and cholesterol screening, dietary counseling, immunizations, and mammograms.
Lindsey Graham’s ‘bankruptcy’ trifecta
“I think we’re going over the cliff. It’s pretty clear to me they made a political calculation. This offer doesn’t remotely deal with entitlement reform in a way to save Medicare, Medicaid and Social Security from imminent bankruptcy. It raises $1.6 trillion on job creators that will destroy the economy and there are no spending controls.”
— Sen. Lindsey O. Graham (R-S.C.), on CBS’s “Face the Nation,” Dec. 2, 2012
In dismissing the administration’s offer to resolve the so-called “fiscal cliff,” Sen. Graham referred to the “imminent bankruptcy” of Medicare, Medicaid and Social Security.
We have warned before that politicians in both parties are guilty of misusing such phrases as “bankruptcy” or “broke” when talking about Medicare. But Graham hits the trifecta here — Medicare, Social Security and Medicaid. We take no position on whether the White House’s proposals are adequate, but what’s he talking about?
Healthcare law will have new California Legislature scrambling
Lawmakers will need to move quickly to clear the way for Californians' enrollment in a new state-run insurance market next fall in the run-up to the Affordable Care Act.
By Michael J. Mishak, Los Angeles Times10:40 PM PST, December 2, 2012
SACRAMENTO — When state lawmakers are sworn in Monday for the new legislative session, they will have little time to enjoy the pomp and circumstance.
Facing a federal deadline, the Legislature must move quickly to pass measures to implement President Obama's healthcare law and revamp the state's insurance market. New legislation will help extend coverage to millions of uninsured Californians and solidify the state's reputation as a key laboratory for the federal law.
Legislative leaders have said they also want to overhaul environmental regulations, curb soaring tuition at public colleges, and tweak the state's tax structure and ballot-initiative system.
But healthcare remains one of the largest and most immediate challenges.
The federal Affordable Care Act takes effect in January 2014, when most Americans face the requirement to buy health insurance or pay a penalty. State lawmakers must pass a series of rules to clear the way for enrollment in a new state-run insurance market next fall, including a requirement for insurers to cover consumers who have preexisting medical conditions and limits on how much they can charge based on age.
Gov. Jerry Brown is expected to call a special session of the Legislature next month — concurrent with the regular session — so healthcare bills that he signs can take effect within 90 days rather than the next year.
Appeals court puts 1st Amendment over public health
An appellate panel clears a man who pitched a drug for an unapproved use for it, saying he had a free-speech right to promote other uses. It's a blow to the FDA.
David LazarusDecember 7, 2012
The Food, Drug and Cosmetic Act makes it illegal to sell a prescription drug for any purpose other than what's listed on the label.
Nevertheless, a divided federal appeals court this week tossed out the conviction of a former drug sales rep who was recorded pitching a doctor on other uses of a medicine approved by regulators solely to treat the sleep disorder narcolepsy.
And here's the kicker: The court ruled that the sales rep had a free-speech right to promote the drug's unapproved uses.
I'm as big a fan of the 1st Amendment as anyone, but this decision strikes me as fundamentally flawed.
We're not talking about a right to express yourself. We're talking about selling stuff — stuff that could harm or even kill you if used improperly.
Moreover, it would seem that a serious blow has been dealt to the Food and Drug Administration's power to ensure the safety of prescription meds. The drug industry can now pitch any use for its products, regardless of what regulators say.
"This is a complete disgrace," said Steven Miles, a professor of medicine and bioethics at the University of Minnesota. "What this basically does is destroy drug regulation in the United States."
Felicia Cohn, director of medical bioethics for Kaiser Permanente Orange County, was more circumspect. But only slightly so.
"This completely undermines the FDA's authority over how drugs are marketed," she said. "I can't imagine that the marketing folks in the drug industry won't seize upon this as an excuse to sell almost all drugs beyond their approved usage."
http://www.latimes.com/business/la-fi-lazarus-20121207,0,4668058,print.column
Q&A: What would it mean to raise Medicare's eligibility age?
Raising the age for starting Medicare is among the leading proposals to slow the program's spending — key to a federal budget deal. But how would it work?
By Noam N. Levey, Washington BureauDecember 7, 2012
WASHINGTON — As they debate ways to control the federal deficit, President Obama and congressional Republicans have both acknowledged the need to rein in federal spending on healthcare programs such as Medicare, which provides health insurance to about 50 million elderly and disabled Americans.
Among the leading proposals to slow Medicare spending — a key ingredient of a budget deal — is to raise the eligibility age for the program, an option frequently championed by conservatives.
Here are answers to some basic questions about the concept and its potential effects:
How would raising the Medicare eligibility age work?
Most proposals envision gradually raising the eligibility age from 65 to 67 over a decade or longer. Lawmakers agreed in the 1980s to a similar phase-in to raise the Social Security eligibility age, a process that is still underway.
This idea was discussed during the 2011 budget negotiations between the president and congressional Republicans and was championed by former Massachusetts Gov. Mitt Romney, the 2012 GOP presidential nominee.
How much money would that save?
http://www.latimes.com/health/la-na-medicare-qa-20121207,0,6291485,print.story
Across nation, unsettling acceptance when mentally ill in crisis are killed
Even as they face a growing number of disturbed people, police often lack crisis training. And the leadership and data-gathering needed to stem the bloodshed are largely absent.
A few times each week, across the United States, police shoot and kill mentally ill people in complicated, often incredible circumstances.
In Houston, Texas, a pen-wielding, wheelchair-bound double amputee is fatally shot in the head when police are called to a group home for the mentally ill. In Saginaw, Mich., six police officers gun down a homeless, schizophrenic man in a vacant parking lot when he refuses to drop a small folding knife.
In Seattle, Wash., a police officer fatally shoots a mentally ill, chronic alcoholic as he crosses the street, carving a piece of wood with a pocket knife. In Portland, Ore., police check on a man threatening suicide and wind up killing him with a single gunshot in the back.
"Some of them, it seems the person is almost executed," said Ron Honberg, director of national policy and legal affairs at the National Alliance on Mental Illness, the country's premier mental health advocacy group
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