Definition of Cancer Should Be Tightened, Scientists Say
By TARA PARKER-POPE
A group of experts advising the nation’s premier cancer research institution has recommended sweeping changes in the approach to cancer detection and treatment, including changes in the very definition of cancer and eliminating the word entirely from some common diagnoses.
The recommendations, from a working group of the National Cancer Institute, were published on Monday in the Journal of the American Medical Association. They say, for instance, that some premalignant conditions, like one that affects the breast called ductal carcinoma in situ, which many doctors agree is not cancer, should be renamed to exclude the word carcinoma so that patients are less frightened and less likely to seek what may be unneeded and potentially harmful treatments that can include the surgical removal of the breast.
The group, which includes some of the top scientists in cancer research, also suggested that many lesions detected during breast, prostate, thyroid, lung and other cancer screenings should not be called cancer at all but should instead be reclassified as IDLE conditions, which stands for “indolent lesions of epithelial origin.”
While it is clear that some or all of the changes may not happen for years, if it all, and that some cancer experts will profoundly disagree with the group’s views, the report from such a prominent group of scientists who have the clear backing of the National Cancer Institute brings the discussion to a much higher level and will most likely change the national conversation about cancer, its definition, its treatment and future research.
“We need a 21st-century definition of cancer instead of a 19th-century definition of cancer, which is what we’ve been using,” said Dr. Otis W. Brawley, the chief medical officer for the American Cancer Society, who was not directly involved in the report.
The impetus behind the call for change is a growing concern among doctors, scientists and patient advocates that hundreds of thousands of men and women are undergoing needless and sometimes disfiguring and harmful treatments for premalignant and cancerous lesions that are so slow growing they are unlikely to ever cause harm.
Tracing Germs Through the Aisles
By SABRINA TAVERNISE
Twice a month for a year, Lance Price, a microbiologist at George Washington University, sent his researchers out to buy every brand of chicken, turkey and pork on sale in each of the major grocery stores in Flagstaff, Ariz. As scientists pushed carts heaped with meat through the aisles, curious shoppers sometimes asked if they were on the Atkins diet.
In fact, Professor Price and his team are trying to answer worrisome questions about the spread of antibiotic-resistant germs to people from animals raised on industrial farms. Specifically, they are trying to figure out how many people in one American city are getting urinary infections from meat from the grocery store.
Professor Price describes himself as something of a hoarder. His own freezer is packed with a hodgepodge of samples swabbed from people’s sinuses and inner ears, and even water from a hookah pipe. But the thousands of containers of broth from the meat collected in Flagstaff, where his nonprofit research institute is based, are all neatly packed into freezers there, marked with bar codes to identify them.
He is now using the power of genetic sequencing in an ambitious attempt to precisely match germs in the meat with those in women with urinary infections. One recent day, he was down on his hands and knees in his university office in Washington, studying a family tree of germs from some of the meat samples, a printout of more than 25 pages that unfurled like a roll of paper towels. Its lines and numbers offered early clues to Professor Price’s central question: How many women in Flagstaff get urinary infections from grocery store meat? He expects preliminary answers this fall.
Researchers have been warning for years that antibiotics — miracle drugs that changed the course of human health in the 20th century — are losing their power. Some warn that if the trend isn’t halted, there could be a return to the time before antibiotics when people died from ordinary infections and children did not survive strep throat. Currently, drug resistant bacteria cause about 100,000 deaths a year, but mostly among patients with weakened immune systems, children and the elderly.
There is broad consensus that overuse of antibiotics has caused growing resistance to the medicines. Many scientists say evidence is mounting that heavy use of antibiotics to promote faster growth in farm animals is a major culprit, creating a reservoir of drug resistant bugs that are finding their way into communities. More than 70 percent of all the antibiotics used in the United States are given to animals.
Montana's State-Run Free Clinic Sees Early Success
A year ago, Montana opened the nation's first clinic for free primary healthcare services to its state government employees. The Helena, Mont., clinic was pitched as a way to improve overall employee health, but the idea has faced its fair share of political opposition.
A year later, the state says the clinic is already saving money.
Pamela Weitz, a 61-year-old state library technician, was skeptical about the place at first.
"I thought it was just the goofiest idea, but you know, it's really good," she says. In the last year, she's been there for checkups, blood tests and flu shots. She doesn't have to go; she still has her normal health insurance provided by the state. But at the clinic, she has no co-pays, no deductibles. It's free.
That's the case for the Helena area's 11,000 state workers and their dependents. With an appointment, patients wait just a couple minutes to see a doctor. Visitation is more than 75 percent higher than initial estimates.
"For goodness sakes, of course the employees and the retirees like it, it's free," says Republican State Sen. Dave Lewis.
He wonders what that free price tag is actually costing the state government as well as the wider Helena community.
"If they're taking money out of the hospital's pocket, the hospital's raising the price on other things to offset that," Lewis says.
He and others faulted then-Gov. Brian Schweitzer for moving ahead with the clinic last year without approval of the state legislature, although it was not needed.
Now, Lewis is a retired state employee himself. He says, personally, he does like going there, too.
"They're wonderful people, they do a great job, but as a legislator, I wonder how in the heck we can pay for it very long," Lewis says.
Lower Costs For Employees And Montana
The state contracts with a private company to run the facility and pays for everything — wages of the staff, total costs of all the visits. Those are all new expenses, and they all come from the budget for state employee healthcare.
Even so, division manager Russ Hill says it's actually costing the state $1,500,000 less for healthcare than before the clinic opened.
Wrinkle in Health Law Vexes Lawmakers’ Aides
By ROBERT PEAR
WASHINGTON — As President Obama barnstorms the country promoting his health care law, one audience very close to home is growing increasingly anxious about the financial implications of the new coverage: members of Congress and their personal staffs.
Under a wrinkle that dates back to enactment of the law, members of Congress and thousands of their aides are required to get their coverage through new state-based markets known as insurance exchanges.
But the law does not provide any obvious way for the federal government to continue paying its share of the premiums for the comprehensive coverage.
If the government cannot do so, it could mean an additional expense of $5,000 a year for individuals and $11,000 for families under some of the most popular plans.
Not surprisingly, that idea is unpopular on Capitol Hill.
“It’s a very serious concern,” said Representative Billy Long, a Missouri Republican who said staff members were “freaked out” at the prospect of paying the full cost of insurance out of their own pockets.
“They’re thinking about leaving government service,” said Mr. Long, noting that some staff members already lived in group houses and cramped apartments to make ends meet on Capitol Hill salaries. “They’re thinking about taking jobs other places. We have tried, and tried, and tried to get the answer on what they’re going to be paying. The Office of Personnel Management cannot tell us.”
The personnel office arranges health insurance benefits for federal employees.
The nonpartisan Congressional Research Service pinpointed the problem 10 days after President Obama signed the health care law in March 2010. Since then neither Congress nor the administration has addressed it.
With the exchanges scheduled to open in just nine weeks, the Obama administration is struggling to come up with a creative interpretation of the health care law that would allow the federal government to kick in for insurance as private employers do, but so far an answer has proved elusive.
The issue is politically charged because the White House and Congress are highly sensitive to any suggestion that lawmakers or their aides are getting special treatment under the health law. The administration is already under fire from Republicans for delaying a requirement that larger businesses offer insurance to their full-time employees.
Don’t Give Up on Health Care Cost Control
By EZEKIEL J. EMANUEL and TOPHER SPIRO
S.G.R. More than 99 percent of Americans have no idea what these three letters stand for. And yet they are extremely valuable: worth about $140 billion. This week, a House committee will finally take up the issue.
The S.G.R., or the Sustainable Growth Rate formula, was enacted as part of the Balanced Budget Act of 1997 to restrain the inevitable increase in Medicare’s annual spending on physician services. It set a reasonable target for each year’s increase, and Medicare was supposed to spend less than that amount. If it failed, then the per-service payments to physicians in the following year would be reduced to hit the target.
Nice idea in theory. Never worked out in practice.
Since 2002, the cost for physician services has consistently exceeded the S.G.R. target. Doctors have been delivering more services, and the services have become ever more complex and, therefore, expensive. But instead of enforcing the mandated cuts, every year Congress has passed a “doc fix,” coming up with billions to keep paying physicians the same amount and avert any reductions.
Strangely, despite never complying with the law, Congress has never seen fit to change the formula for calculating the target. Consequently, S.G.R. cuts have accumulated since 2002, to the extent that today the law ostensibly requires that physician payments be cut by 24.4 percent.
Everyone — Democrats and Republicans — agrees that the law is seriously flawed. Since the target level applies to total nationwide physician costs, there is no incentive for individual doctors to be more efficient. And the cuts are indiscriminate: they would hit high-quality, cost-effective doctors just as hard as inefficient free spenders, and underpaid primary-care doctors as much as overpaid specialists.
Everyone — Democrats and Republicans — agrees that the law is seriously flawed. Since the target level applies to total nationwide physician costs, there is no incentive for individual doctors to be more efficient. And the cuts are indiscriminate: they would hit high-quality, cost-effective doctors just as hard as inefficient free spenders, and underpaid primary-care doctors as much as overpaid specialists.
Physicians desperately want the S.G.R. repealed and replaced so they can charge what they want without the potential of massive cuts hanging over them each year. But according to the Congressional Budget Office, getting rid of it and simply letting payments increase would cost just under a projected $140 billion over 10 years. If Congress were to adhere to its “pay-as-you-go” principle of accounting for every new expenditure, it would have to find that money in either tax hikes or cuts in other programs — both nearly impossible in the current climate.
Enter the House Energy and Commerce Committee. This week, the committee is expected to begin marking up a bill that its subcommittee on healthapproved last Tuesday. The bill would repeal the S.G.R. formula and replace it with a stable annual 0.5 percent payment increase until 2018. Beginning in 2019, the bill would then link Medicare payments to the quality of care each physician provides, as measured by an enhanced quality reporting system.
Heart surgery in India for $1,583 costs $106,385 in US
Posted July 29, 2013, at 2:30 p.m.
MUMBAI, India — Devi Shetty is obsessed with making heart surgery affordable for millions of Indians. On his office desk are photographs of two of his heroes: Mother Teresa and Mahatma Gandhi.
Shetty is not a public health official motivated by charity. He’s a heart surgeon turned businessman who has started a chain of 21 medical centers around India. By trimming costs with such measures as buying cheaper scrubs and spurning air-conditioning, he has cut the price of artery-clearing coronary bypass surgery to 95,000 rupees ($1,583), half of what it was 20 years ago, and wants to get the price down to $800 within a decade. The same procedure costs $106,385 at Ohio’s Cleveland Clinic, according to data from the U.S. Centers for Medicare & Medicaid Services.
“It shows that costs can be substantially contained,” said Srinath Reddy, president of the Geneva-based World Heart Federation, of Shetty’s approach. “It’s possible to deliver very high-quality cardiac care at a relatively low cost.”
Medical experts like Reddy are watching closely, eager to see if Shetty’s driven cost-cutting can point the way for hospitals to boost revenue on a wider scale by making life- saving heart operations more accessible to potentially millions of people in India and other developing countries.
“The current price of everything that you see in health care is predominantly opportunistic pricing and the outcome of inefficiency,” Shetty, 60, said in an interview in his office in Bangalore.
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