India’s Efforts to Aid Poor Worry Drug Makers
By GARDINER HARRIS
NEW DELHI — Alka Kudesia needs an expensive drug to treat her breast cancer, but refuses to tell her children for fear they will take out loans to buy the medicine and spend the rest of their lives in debt.
“We’re barely able to afford the treatment I’m already getting,” Ms. Kudesia, 48, said with quiet defiance. “My kids are just starting out in life. There is no way I’m going to be a burden to them.”
The drug, Herceptin, is one of the most effective treatments for an aggressive form of breast cancer. But in India, at a cost of at least $18,000 for one course of treatment, only a small fraction of the women who need it get it.
The Indian government last year threatened to allow production of less costly, generic versions of Herceptin. Its maker, Roche Holdings of Switzerland, initially resisted, but surrendered its patent rights this year in large measure because it concluded that it would lose a legal contest in Indian courts.
The skirmishing over Herceptin and other cancer medicines is part of a new and critical phase in a struggle to make drugs affordable to the world’s poorest people, one that began in earnest more than a decade ago when advocates campaigned successfully to make AIDS medicines accessible to millions of Africans.
“Cancer is the next H.I.V./AIDS issue, and the fight has only begun,” said Shamnad Basheer, a professor of law at West Bengal National University of Juridical Sciences in Kolkata.
American trade officials have voiced concerns about India’s treatment of drug patents, including its reasons for sometimes overriding them. President Obama discussed the issue this year with Prime Minister Manmohan Singh of India in the Oval Office, administration officials said.
Executives in the international pharmaceutical industry, increasingly dependent on drug sales in emerging markets like India, China and Brazil, contend that India’s efforts to cancel patents threaten the global system for discovering cures while doing little to resolve the health challenges most patients here face.
“We are open to discussing what the best way is to bring innovative medicines to patients,” said Daniel Grotzky, a spokesman for Roche, which has a large portfolio of cancer medicines. “But a society that wants to develop new medicines and technology must reward innovation through a solid protection of intellectual property.”
Breast Cancer Screenings: What We Still Don’t Know
By H. GILBERT WELCH
HANOVER, N.H. — A COUPLE of months ago, JAMA Internal Medicine, a journal of the American Medical Association, published the findings of a brief online survey of middle-aged Americans.Most had previously been screened for either breast or prostate cancer. But the study found that about half said they would not choose to start screening if the test resulted in more than one overtreated person per one cancer death averted.
Wow. That implies that millions of Americans might choose not to be screened if they knew the whole story — that overtreatment is typically more common than avoiding a cancer death.
Is the survey right? Honestly, I have no idea. Different surveys get different answers. According to surveys, most of us hate Obamacare. But a number of us like the Affordable Care Act (another name for the same thing). And most of us like the bulk of the individual components of the law. How you ask the question matters.
Similarly, how Americans feel about screening is obviously related to what they are told about screening. Most of the time they get a simple message: It’s the most important thing they can do to stay healthy. Occasionally, they may hear just the opposite: It’s dangerous. The truth is, it’s neither.
Instead, it’s a close call. Different people in the same situation can rationally make different choices. But first, patients need some quantification of the benefits and harms.
In a study to be published Monday, Dec. 30 in JAMA Internal Medicine, a colleague and I attempt to provide that data for women making the choice about screening mammography. Let’s be clear at the outset: There is a lot of uncertainty — and professional disagreement — about what the data are. So we provide a range of estimates, from optimistic to pessimistic.
A.D.H.D. Experts Re-evaluate Study’s Zeal for Drugs
By ALAN SCHWARZ
Twenty years ago, more than a dozen leaders in child psychiatry received $11 million from the National Institute of Mental Health to study an important question facing families with children with attention deficit hyperactivity disorder: Is the best long-term treatment medication, behavioral therapy or both?
The widely publicized result was not only that medication like Ritalin or Adderall trounced behavioral therapy, but also that combining the two did little beyond what medication could do alone. The finding has become a pillar of pharmaceutical companies’ campaigns to market A.D.H.D. drugs, and is used by insurance companies and school systems to argue against therapies that are usually more expensive than pills.
But in retrospect, even some authors of the study — widely considered the most influential study ever on A.D.H.D. — worry that the results oversold the benefits of drugs, discouraging important home- and school-focused therapy and ultimately distorting the debate over the most effective (and cost-effective) treatments.
The study was structured to emphasize the reduction of impulsivity and inattention symptoms, for which medication is designed to deliver quick results, several of the researchers said in recent interviews. Less emphasis was placed on improving children’s longer-term academic and social skills, which behavioral therapy addresses by teaching children, parents and teachers to create less distracting and more organized learning environments.
Recent papers have also cast doubt on whether medication’s benefits last as long as those from therapy.
“There was lost opportunity to give kids the advantage of both and develop more resources in schools to support the child — that value was dismissed,” said Dr. Gene Arnold, a child psychiatrist and professor at Ohio State University and one of the principal researchers on the study, known as the Multimodal Treatment Study of Children With A.D.H.D.
Another co-author, Dr. Lily Hechtman of McGill University in Montreal, added: “I hope it didn’t do irreparable damage. The people who pay the price in the end is the kids. That’s the biggest tragedy in all of this.”
Obama's healthcare law takes full effect this week
The total of those who have signed up appears to be about 2 million, short of the goal but a recovery from the enrollment system's disastrous debut.
By Noam N. Levey and Chad Terhune
9:21 PM PST, December 29, 2013
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WASHINGTON — Nearly four years after it was signed and after months of scrambling and uncertainty, President Obama's landmark bid to guarantee Americans health security takes full effect Wednesday as the Affordable Care Act begins delivering healthcare coverage to millions nationwide.
Administration officials reported Sunday that about 1.1 million people had enrolled in health plans using the federal website, HealthCare.gov, the main entry point for coverage in 36 states. Nearly all the enrollments came in the last couple of weeks as the deadline approached for coverage that would take effect Jan. 1.
Several hundred thousand people have enrolled on separate sites run by 14 states and the District of Columbia, with the largest figure coming from California, where more than 400,000 have signed up.
An exact count nationwide is not yet available because not all states have tallied their figures, but the total appears to be about 2 million. That remains short of the administration's original goal of 3 million by this point, but marks a significant recovery from the system's disastrous debut in October.
More than 4 million additional people have been found eligible for coverage under the law's expansion of Medicaid and the Children's Health Insurance Program.
How the law will ultimately work and whether it can endure remain unclear, though the fact that coverage will now be real for several million people will almost certainly change the debate over Republican efforts to repeal it.
While that broader political fight plays out, doctors, hospitals and pharmacies across the country are bracing for more confusion as patients struggle to understand their new coverage.
Some may show up at physicians' offices without insurance cards, victims of the error-plagued enrollment process that bedeviled the initial rollout.
Others may discover that although they're properly enrolled in a health plan, the doctor or hospital they visit or the prescription they want to fill won't be covered by the plan they have selected.
Still other patients, including many who have never had insurance before, may be shocked to learn they have to pay thousands of dollars out of pocket before their coverage kicks in. Like employer-provided health plans, many insurance plans set up under the health law come with low premiums and high deductibles.
Surveys indicate that many Americans have little understanding of basic insurance concepts such as co-pays and deductibles.
"We still have a lot of education to do for the average man on the street who doesn't really understand the Affordable Care Act," said J. Mario Molina, chief executive of Molina Healthcare Inc., a California-based insurer that is selling policies in nine states.
http://www.latimes.com/nation/la-na-obamacare-20131230,0,2110955,print.story
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As critics gain, ALEC gives ground
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ALEC is putting 2013 in its rearview mirror.
The American Legislative Exchange Council, a conservative group of state lawmakers and corporations that, among other things, drafts model legislation, saw an exodus of members and a sharp decline in fundraising after it was tied to controversial “stand your ground laws” like the one made infamous following the shooting death of Florida teen Trayvon Martin.
ALEC has denied being the source of Florida’s law and says it has no model policy today bearing resemblance to it. But the group says its practice of keeping draft bills secret has allowed opponents to pin the organization unfairly to such measures.
So now, ALEC’s leaders say they are putting in place a key change that will make sure that never happens again. As part of what it calls a move toward more transparency, the group has decided to post online all the “model legislation” it develops so that lawmakers, the public and the press will be able to see exactly where ALEC stands.
“We all acknowledge there were challenges in our past, but challenge oftentimes gives you the opportunity to be introspective and see what you can do differently, what you can do better, how you can better serve your constituents and your community,” said Bill Meierling, senior director of communications and public affairs.
It’s the draft bills where the group has run into the most trouble. Opponents charge that the model legislation is written in secret, then translated into real bills — sometimes word for word — and passed by lawmakers as if it were their own work and with scant understanding of the implications.
The move toward greater openness comes in the wake of dozens of corporate members pulling out earlier this year after ALEC was drawn into the Martin case. By some estimates, as many as 400 lawmakers and 60 companies, including brand names like Coca-Cola, Pepsi and McDonald’s, bolted.
But critics say the transparency effort is a smokescreen, and they charge that ALEC remains the same corporate-driven “bill mill” designed to push right-wing business interests in statehouses with as little notice as possible.
HealthCare.gov Enrolls 1.1 Million by Year-End––Cause For Celebration or Worry?
After the disastrous launch of Obamacare the enrollment of 1.1 million people in the 36 state exchanges run by the feds is a major accomplishment. It is likely that the enrollment in the 14 state-run exchanges will take total Obamacare's private insurance enrollment to near 2 million for the year.
Does this mean that Obamacare is finally on track and moving toward success? At least the front-end of HealthCare.gov is now clearly working. I will suggest there are still some very important questions for Obamacare that need to be answered. First, how many of these new enrollments are people whose policies have been cancelled under Obamacare? As I have said on this blog before, I expect at least 80% of those in the existing individual health insurance market to lose their coverage by the end of 2014. Half of the market bought their coverage after March 2010 and therefore cannot continue while most of the other half of the market will not qualify under the Obama administration's stringent grandfather rules. What we don't know is just how many of these people had to buy new coverage on January 1 given the widespread offers by carriers to "early renew" their coverage into late 2014. Then the President asked insurers and states to allow people to keep their coverage another year. It appears about two-thirds of the states went along with that request. Then many of the cancellations won't occur until they renew throughout calendar year 2014. We do know that California did not allow insurers to continue coverage for another year leading to 800,000 cancellations on January 1 and 200,000 cancellations by March. The state exchange has said that 300,000 of these are subsidy eligible and they can only get a subsidized policy on the exchange. California will likely announce they have signed-up about 600,000 people this year. But given the cancellations that are occurring by January 1, is this a big accomplishment? Washington State cancelled 260,000 policies and also did not allow the cancelled policies to continue past January 1. Half of these polices are subsidy eligible and can only get a subsidized policy in the state insurance exchange. Washington State might report 100,000 private plan enrollments by year-end. But if they cancelled 130,000 people who can only get a subsidized policy in their exchange, is this a big accomplishment? The good news is that Obamacare will likely enroll almost 2 million people in 2013. Even if we ignore that fact that many of these people were previously insured and had to replace cancelled policies (there were more than 400,000 subsidy eligible cancellations in California and Washington alone), 2 million people are only 10% of the 20 million uninsured in the U.S. who are eligible to buy coverage in the health insurance exchanges.
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