Expansion of Medicaid may prevent future tragedies
IT’S TOO soon to know what drove Adam Lanza to massacre 26 children and adults at Sandy Hook Elementary School in Newtown, Conn. But early signs suggest that serious mental illness played a role. If so, that — alongside another arsenal — would be a thread connecting last week’s atrocity with the recent mass killings in Aurora, Colo.; Phoenix; and Blacksburg, Va.
Since Friday, a wave of outrage and a renewed desire for gun-control laws have swept the country, including Washington. “Enough is enough,” Senator Mark Warner, a Virginia Democrat with an “A” rating from the National Rifle Association, said on Monday. “I think most of us realize that there are ways to get to rational gun control.”
Limiting the availability of assault weapons is an obvious and necessary step to reducing the future likelihood of mass shootings like the one in Connecticut. But so is maintaining and improving mental health care services, which have been severely strained in recent years (and in some areas reduced) and are further threatened by the fallout from a recent Supreme Court decision and the incipient deal to avert the fiscal cliff.
The linchpin is Medicaid. Though mainly thought of as a safety-net program for the poor, Medicaid provides about half of state mental-health budgets. “Medicaid is hands down the most important source of funding for public mental health services,” says Ron Honberg, the director for policy and legal affairs at the National Alliance on Mental Illness. But the recession and the Republican-led effort to slash social spending have put enormous pressure on those budgets.
Amgen Agrees to Pay $762 Million for Marketing Anemia Drug for Off-Label Use
By ANDREW POLLACK and MOSI SECRET
The biotechnology giant Amgen marketed its anemia drug Aranesp for unapproved uses even after the Food and Drug Administration explicitly ruled them out, federal prosecutors said on Tuesday.
The federal charges were made public as Amgen pleaded guilty to illegally marketing the drug and agreed to pay $762 million in criminal penalties and settlements of whistle-blower lawsuits.
Amgen was “pursuing profits at the risk of patient safety,” Marshall L. Miller, acting United States attorneyin Brooklyn, said in a telephone news briefing on Tuesday.
David J. Scott, Amgen’s general counsel, entered the guilty plea at the United States District Court in Brooklyn to a single misdemeanor count of misbranding the drug, Aranesp, meaning selling it for uses not approved by the F.D.A.
Amgen agreed to pay $136 million in criminal fines and forfeit $14 million, with about $612 million going to settle civil litigation.
The presiding judge, Sterling Johnson Jr., scheduled a hearing for Wednesday to announce whether he will accept the agreement. If he does, a broader settlement and as many as 11 whistle-blower lawsuits would be made public, some containing accusations beyond those to which Amgen pleaded guilty.
In court on Tuesday, prosecutors charged that Amgen had promoted the use of Aranesp to treat anemia in cancer patients who were not undergoing chemotherapy, even though the drug’s approval was only for patients receiving chemotherapy.
A subsequent study sponsored by Amgen showed that use of Aranesp by those nonchemotherapy cancer patients had actually increased the risk of death, and the off-label use diminished.
The federal charges also say Amgen promoted using larger but less frequent injection of Aranesp than stated in the label as a way of making the drug more attractive to doctors and patients than Procrit, a rival anemia drug from Johnson & Johnson.
Amgen eventually tried to obtain approval for the less frequent dose, but the F.D.A. turned down its requests, saying the company’s studies were inadequate. Nonetheless, according to the federal charges, Amgen continued to promote the off-label dosing, relying on the same studies the F.D.A. had deemed inadequate.
Roger Burlingame, a federal prosecutor, told the judge Tuesday that “in certain instances, Amgen employees were so thoroughly indoctrinated to sell the drug for off-label uses that they did not, in fact, know that the drug had not been approved for the use for which they were selling it.”
Aspirin Use Tied to Rare Eye Disorder
By ANAHAD O'CONNOR
Regularly taking aspirin may slightly raise the likelihood of developing a degenerative eye condition, a new study found.
Though the increase in the risk of developing the disease, a rare form of macular degeneration, was slight, it may be a potential concern because about one in five adults nationwide take low doses of aspirin regularly, mostly to ward off heart disease. Some doctors have recently started recommending aspirin for theprevention of some types of cancer as well.
The new study, which was published in The Journal of the American Medical Association, found that routinely using aspirin doubled the odds of developing neovascular macular degeneration, the most severe form of the disease. Nonetheless, the condition is rare enough that the increase translated into a negligible risk, rising from about 1 in 200 among older Americans in general to roughly 1 in 100 among older aspirin users.
A major cause of blindness in people over the age of 50, macular degeneration is a disease of the retina that slowly blurs central vision, making it difficult to read or see fine detail. Neovascular macular degeneration accounts for about 10 percent of cases but causes most of the vision loss associated with the disease.
The authors of the new report were quick to point out that for most middle-aged and older adults, any potential concerns about visual decline would not be enough to outweigh the heart-healthy benefits of a daily aspirin. Instead, it should be something to keep in mind should any problems with eyesight start to arise, said Dr. Barbara Klein, the lead author of the study and a professor of ophthalmology and visual sciences at the University of Wisconsin, Madison.
"If you're an aspirin user and your doctor put you on it for cardioprotective reasons, this is not a reason to stop it," she said. "It's better to have blurry vision but still be here to complain about it than it is to die of a heart attack."
Dietary Seat Belts
By MARK BITTMAN
Here's some good news: Seat belts save lives[1] . So do vaccinations. The world's population is living longer. The childhood obesity rate has declined[2] in parts of the United States.
That's miraculous, because the policies for food, energy, climate change and health care are, effectively, "let's help big producers make as much money as they can regardless of the consequences."
Except for just after the most visible tragedies, public health and welfare are barely part of the daily conversation. When New York is flooded, climate change dominates TV news - for a week. When innocents are slaughtered with weapons designed for combat, gun control is a critical topic - for a week. When 33 people die violent, painful deaths from eating cantaloupe, food safety is in the headlines - for a week. When nearly 70,000 people die a year, from mostly preventable diabetes, most media ignore it.
Forget the fiscal cliff: we've long since fallen off the public health cliff. We need consistent policies that benefit a majority of our citizens, even if it costs corporations money.
And guns are just the bloodiest public health menace to go virtually unregulated. [3] Preventable, chronic disease - to a large extent brought about by diet - is now the biggest killer on the planet. Soda kills more people than guns - more people than car wrecks - only less dramatically. What we need is the equivalent of a dietary seat belt.
And guns are just the bloodiest public health menace to go virtually unregulated. [3] Preventable, chronic disease - to a large extent brought about by diet - is now the biggest killer on the planet. Soda kills more people than guns - more people than car wrecks - only less dramatically. What we need is the equivalent of a dietary seat belt.
When we hear about extended life expectancy on a global scale[4] , we're hearing about the triumph of public health policies - from municipal water treatment and delivery to sewer systems and immunizations. We're also hearing about health care that extends lives despite chronic disease, a triumph of expensive technology over thoughtful, less expensive planning.
And we're hearing about the failure of policy to address the leading public health challenge of the 21st century: not finding a "cure" for our leading killers -
http://opinionator.blogs.nytimes.com/2012/12/18/dietary-seat-belts/?ref=global-home&pagewanted=print
aine's debt to hospitals approaches $500 million
Hospitals are urging the state to begin making overdue Medicaid payments so they can also collect the much bigger federal match.
By Kelley Bouchard kbouchard@mainetoday.com
Staff Writer
Staff Writer
Owed $484 million in overdue Medicaid reimbursements, Maine's 39 hospitals are pushing state lawmakers to find a way to start paying off a debt that's forcing some hospitals to reduce staffing, delay capital improvements and borrow money to pay bills.
Their lobbying effort -- advertisements in newspapers and meetings with lawmakers -- comes as the Legislature prepares to deal with a projected $120 million revenue shortfall in Maine's current budget for MaineCare, the state's version of Medicaid.
The reimbursement debt affects hospitals large and small across the state, from Maine Medical Center in Portland ($67.7 million), to Central Maine Medical Center in Lewiston ($50.2 million), to Aroostook Medical Center in Presque Isle ($12.4 million).
Central Maine Medical Center is leaving jobs unfilled, including a vice president's position, and delaying all but emergency capital spending, including long-planned building projects for obstetrical and primary care services.
"This can't continue," said Chuck Gill, the hospital's spokesman. "When you have a bill, you have to pay it. We provided care two or three years ago, in some cases, and we're still waiting for payment."
A few blocks away at St. Mary's Regional Medical Center in Lewiston, officials announced this month that they plan to restructure and eliminate as many as 25 positions if they don't get their Medicaid reimbursements, which now total $28.8 million.
http://www.pressherald.com/politics/MaineCare-Settlements-TK.html
Philanthropy group headed by Eliot Cutler offers money to save Portland clinic
Posted Dec. 18, 2012, at 11:24 a.m.
PORTLAND, Maine — The Portland Community Free Clinic may keep its doors open a little longer, thanks to a $25,000 challenge grant from the Emanuel and Pauline A. Lerner Foundation.
Mayor Michael Brennan and Eliot Cutler, chairman of the Portland-based philanthropy, announced the grant Dec. 14, and called upon other organizations and individuals to match it.
By Sunday, $5,000 had already been pledged in response, according to an email from the clinic.
The clinic, at 103 India St., provides no-cost primary and specialty care to Cumberland County residents who earn too much to qualify for public programs such as Medicaid, but not enough to afford health care on their own. The clinic, which provides evening hours, is often the only possible source of care for the area’s working poor.
An average of more than 500 patients rely on the clinic for care, according to the city.
For nearly two decades, the clinic was supported by a partnership between Mercy Hospital and the city. But as reported earlier this month, Mercy stopped its contribution of about $200,000 a year in 2011, and emergency funding from the city ended in September.
Both Mercy and the city continue to provide in-kind support, including office space. The clinic has tightened its budget, and more than 100 physicians, nurses, counselors and others volunteer to keep it operating.
Next Challenge for the Health Law: Getting the Public to Buy In
By ABBY GOODNOUGH
On its face, the low-key discussion around a conference table in Miami last month did not appear to have national implications. Eight men and women, including a diner owner, a chef and a real estate agent, answered questions about why they had no health insurance and what might persuade them to buy it.
But this focus group, along with nine others held around the country in November, was an important tool for advocates coming up with a campaign to educate Americans about the new health care law. The participants were among millions of uninsured people who stand to benefit from the law. With incomes below 400 percent of the poverty level, or $92,200 for a family of four this year, the focus group members will qualify for federal subsidies to help cover the cost of private insurance starting in 2014.
The sessions confirmed a daunting reality: Many of those the law is supposed to help have no idea what it could do for them. In the Miami focus group, a few participants knew only that they could face a fine if they did not buy coverage.
“It’s another forced bill,” said Christopher Pena, 24, who works in customer service.
There lies the challenge for Enroll America, a nonprofit group formed last year to get the word out to the uninsured and encourage them get coverage, providing help along the way. With the election over and the law almost certain to survive, the group is honing its fund-raising and testing strategies for persuading people to sign up for health insurance — a process that will begin in less than a year.
Starting next October, people will be able to shop for coverage, or find out if they are eligible for Medicaid, through online markets known as insurance exchanges.
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