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"disqusTitle": "Are Poor Neighborhoods Really Food Deserts?",
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"content": "\u003cfigure id=\"attachment_3539\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/FoodDesert_BurgerKing_JohnHenryMostyn_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-3539\" title=\"(John Henry Mostyn: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/FoodDesert_BurgerKing_JohnHenryMostyn_Flickr-300x225.jpg\" alt=\"(John Henry Mostyn: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(John Henry Mostyn: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Proponents of public health have long worried about \"food deserts\"-- but it took First Lady Michelle Obama to put the expression on the map when she launched her \"\u003ca title=\"http://www.letsmove.gov/\" href=\"http://www.letsmove.gov/\" target=\"_blank\">Let's Move\u003c/a>\" campaign. A food desert brings to mind an impoverished neighborhood where the main streets are lined with fast-food outlets or convenience stores with nary a full-scale supermarket to be found. \"Lack of access contributes to poor diet and can lead to higher levels of obesity and other diet-related diseases, such as diabetes and heart disease. But, this is a solvable problem,\" it says on the\u003ca title=\"http://www.letsmove.gov/healthy-communities\" href=\"http://www.letsmove.gov/healthy-communities\" target=\"_blank\"> Let's Move\u003c/a> website.\u003c/p>\n\u003cp>And to solve the problem the Administration has pledged to end food deserts within seven years by helping communities invest in healthier food outlets.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"I never bought into the 'supermarkets make you thinner' story.\"\u003c/aside>\n\u003cp>It sounds laudable, but new research finds that food deserts may not be so barren after all. \u003ca title=\"http://www.ppic.org/main/bio.asp?i=270\" href=\"http://www.ppic.org/main/bio.asp?i=270\" target=\"_blank\">Helen Lee\u003c/a> at the Public Policy Institute of California, set out to look at food deserts, expecting to find that they were the widespread problem they've been reported to be. Instead she found something very different.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>By looking at national records of businesses across the country, she could compare more disadvantaged neighborhoods to their wealthier counterparts. Yes, poorer neighborhoods had more fast-food outlets, but she also found they had more grocery stores. \"So the picture I came away with ... is they don't have worse access to healthier food stores, it's more a picture of food diversity,\" she said in an interview. \"That was a surprise to me. I did not expect to find that.\" She says she crunched the data in different ways. \"It came out consistently.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In her \u003ca title=\"http://www.sciencedirect.com/science/article/pii/S0277953612000810\" href=\"http://www.sciencedirect.com/science/article/pii/S0277953612000810\" target=\"_blank\">study,\u003c/a> \"The Role of Local Food Availability in Explaining Obesity Risk among Young School-Aged Children,\" Lee then turned to obesity rates among children. \"That was the second question,\" she said. \"Does what families have access to, does it even matter for explaining who becomes obese over time and who doesn't? ... It has no relation to obesity outcomes.\"\u003c/p>\n\u003cp>As a researcher, Lee believes it's time to reflect on policies that focus on grocery stores. \"We all like a silver bullet,\" she told me, \"but this is not it.\"\u003c/p>\n\u003cp>A second\u003ca title=\"https://riskfactor.cancer.gov/mfe/search-publications/School-and-residential-neighborhood-food\" href=\"https://riskfactor.cancer.gov/mfe/search-publications/School-and-residential-neighborhood-food\" target=\"_blank\"> study\u003c/a> from the Rand Corporation reinforces Lee's findings. The study could not find a \"robust relationship between food environment and consumption.\" Co-author Roland Sturm cautioned there were limitations of the study, but nonetheless added, \"I never bought into the 'supermarkets make you thinner' story.\"\u003c/p>\n\u003cp>Part of the problem is what happens when an individual enters a supermarket. \"I challenge you to go to a grocery store and walk around and for every healthy food you can find, you can find an unhealthy counterpart,\" Lee says. \"For everything you can think of. There's whole milk and fat free milk. You can buy fresh broccoli or broccoli with cheese sauce in the frozen food aisle.\"\u003c/p>\n\u003cp>But as a sociologist, Lee did not want her research to be taken as fodder to \"blame the individual.\" People's social situation drives health. \"These things we know,\" she says, \"Education, economic mobility, they are so predictive of your health. ... At the end of the day what drives obesity is choices we make, shaped by our environment.\"\u003c/p>\n\u003cp>That environment still has to do with what's actually in a grocery store, insist some advocates. \u003ca title=\"http://www.phlpnet.org/php/staff/laurison\" href=\"http://www.phlpnet.org/php/staff/laurison\" target=\"_blank\">Hannah Burton Laurison\u003c/a> is with Public Health Law and Policy. While she says she agrees that access to grocery stores with fresh foods may not help to alleviate childhood obesity, she says the issue of food outlet availability is much more nuanced than 'is there a supermarket in the neighborhood?' \"We're trying to understand a complicated food retail environment where there are good options available and unhealthy options available, but pricing and quality and marketing are huge factors in how we make decisions,\" she said. \"You have to have access. It is not a single solution and I would agree with that finding in each of these studies, but you do have to have access, ... access to healthy foods matters quite a lot.\"\u003c/p>\n\u003cp>Laurison points to a specific example in San Francisco's Bayview Hunters Point, a largely poor and minority neighborhood in San Francisco, with few grocery stores. In 1998, when the current owner purchased the store, alcohol sales accounted for 55 percent of revenue and and produce was less than two percent. In other words, more of a liquor store than a grocery store. Over the next 12 years, a community group worked with the store to improve the variety and quality of its produce. The store more than doubled its gross revenue. By 2010 produce sales were 17 percent of revenue and alcohol sales were down to 14 percent of revenue.\u003c/p>\n\u003cp>It would be hard for anyone to disagree that the improvement of this store's produce offerings is not worthwhile. But a healthier diet does not necessarily affect obesity. \"How can we improve diet to become healthier AND lose weight?\" Sturm muses. \"It's not necessarily the same thing. You can have a really good diet in many ways, but still be heavy.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A key component of the Let's Move! campaign was the establishment of the \u003ca title=\"http://www.whitehouse.gov/the-press-office/childhood-obesity-task-force-unveils-action-plan-solving-problem-childhood-obesity-\" href=\"http://www.whitehouse.gov/the-press-office/childhood-obesity-task-force-unveils-action-plan-solving-problem-childhood-obesity-\" target=\"_blank\">White House Childhood Obesity Task Force\u003c/a>. The Task Force explicitly promotes supermarkets and based its recommendation on \u003ca title=\"https://riskfactor.cancer.gov/mfe/search-publications/Associations-between-access-to-food-stores-and\" href=\"https://riskfactor.cancer.gov/mfe/search-publications/Associations-between-access-to-food-stores-and\" target=\"_blank\">a single study\u003c/a> that found an association between supermarkets in a ZIP code and lower body weight among adolescents. But, as Sturm details in his study, the Task Force did not cite two other studies (\u003ca title=\"https://riskfactor.cancer.gov/mfe/search-publications/Neighborhood-playgrounds-fast-food-restaurants-and\" href=\"https://riskfactor.cancer.gov/mfe/search-publications/Neighborhood-playgrounds-fast-food-restaurants-and\" target=\"_blank\">here\u003c/a> and \u003ca title=\"https://riskfactor.cancer.gov/mfe/search-publications/Body-mass-index-in-elementary-school-children\" href=\"https://riskfactor.cancer.gov/mfe/search-publications/Body-mass-index-in-elementary-school-children\" target=\"_blank\">here\u003c/a>) that found no connection.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_3539\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/FoodDesert_BurgerKing_JohnHenryMostyn_Flickr.jpg\">\u003cimg class=\"size-medium wp-image-3539\" title=\"(John Henry Mostyn: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/FoodDesert_BurgerKing_JohnHenryMostyn_Flickr-300x225.jpg\" alt=\"(John Henry Mostyn: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(John Henry Mostyn: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Proponents of public health have long worried about \"food deserts\"-- but it took First Lady Michelle Obama to put the expression on the map when she launched her \"\u003ca title=\"http://www.letsmove.gov/\" href=\"http://www.letsmove.gov/\" target=\"_blank\">Let's Move\u003c/a>\" campaign. A food desert brings to mind an impoverished neighborhood where the main streets are lined with fast-food outlets or convenience stores with nary a full-scale supermarket to be found. \"Lack of access contributes to poor diet and can lead to higher levels of obesity and other diet-related diseases, such as diabetes and heart disease. But, this is a solvable problem,\" it says on the\u003ca title=\"http://www.letsmove.gov/healthy-communities\" href=\"http://www.letsmove.gov/healthy-communities\" target=\"_blank\"> Let's Move\u003c/a> website.\u003c/p>\n\u003cp>And to solve the problem the Administration has pledged to end food deserts within seven years by helping communities invest in healthier food outlets.\u003c/p>\n\u003caside class=\"pullquote alignleft\">\"I never bought into the 'supermarkets make you thinner' story.\"\u003c/aside>\n\u003cp>It sounds laudable, but new research finds that food deserts may not be so barren after all. \u003ca title=\"http://www.ppic.org/main/bio.asp?i=270\" href=\"http://www.ppic.org/main/bio.asp?i=270\" target=\"_blank\">Helen Lee\u003c/a> at the Public Policy Institute of California, set out to look at food deserts, expecting to find that they were the widespread problem they've been reported to be. Instead she found something very different.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>By looking at national records of businesses across the country, she could compare more disadvantaged neighborhoods to their wealthier counterparts. Yes, poorer neighborhoods had more fast-food outlets, but she also found they had more grocery stores. \"So the picture I came away with ... is they don't have worse access to healthier food stores, it's more a picture of food diversity,\" she said in an interview. \"That was a surprise to me. I did not expect to find that.\" She says she crunched the data in different ways. \"It came out consistently.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In her \u003ca title=\"http://www.sciencedirect.com/science/article/pii/S0277953612000810\" href=\"http://www.sciencedirect.com/science/article/pii/S0277953612000810\" target=\"_blank\">study,\u003c/a> \"The Role of Local Food Availability in Explaining Obesity Risk among Young School-Aged Children,\" Lee then turned to obesity rates among children. \"That was the second question,\" she said. \"Does what families have access to, does it even matter for explaining who becomes obese over time and who doesn't? ... It has no relation to obesity outcomes.\"\u003c/p>\n\u003cp>As a researcher, Lee believes it's time to reflect on policies that focus on grocery stores. \"We all like a silver bullet,\" she told me, \"but this is not it.\"\u003c/p>\n\u003cp>A second\u003ca title=\"https://riskfactor.cancer.gov/mfe/search-publications/School-and-residential-neighborhood-food\" href=\"https://riskfactor.cancer.gov/mfe/search-publications/School-and-residential-neighborhood-food\" target=\"_blank\"> study\u003c/a> from the Rand Corporation reinforces Lee's findings. The study could not find a \"robust relationship between food environment and consumption.\" Co-author Roland Sturm cautioned there were limitations of the study, but nonetheless added, \"I never bought into the 'supermarkets make you thinner' story.\"\u003c/p>\n\u003cp>Part of the problem is what happens when an individual enters a supermarket. \"I challenge you to go to a grocery store and walk around and for every healthy food you can find, you can find an unhealthy counterpart,\" Lee says. \"For everything you can think of. There's whole milk and fat free milk. You can buy fresh broccoli or broccoli with cheese sauce in the frozen food aisle.\"\u003c/p>\n\u003cp>But as a sociologist, Lee did not want her research to be taken as fodder to \"blame the individual.\" People's social situation drives health. \"These things we know,\" she says, \"Education, economic mobility, they are so predictive of your health. ... At the end of the day what drives obesity is choices we make, shaped by our environment.\"\u003c/p>\n\u003cp>That environment still has to do with what's actually in a grocery store, insist some advocates. \u003ca title=\"http://www.phlpnet.org/php/staff/laurison\" href=\"http://www.phlpnet.org/php/staff/laurison\" target=\"_blank\">Hannah Burton Laurison\u003c/a> is with Public Health Law and Policy. While she says she agrees that access to grocery stores with fresh foods may not help to alleviate childhood obesity, she says the issue of food outlet availability is much more nuanced than 'is there a supermarket in the neighborhood?' \"We're trying to understand a complicated food retail environment where there are good options available and unhealthy options available, but pricing and quality and marketing are huge factors in how we make decisions,\" she said. \"You have to have access. It is not a single solution and I would agree with that finding in each of these studies, but you do have to have access, ... access to healthy foods matters quite a lot.\"\u003c/p>\n\u003cp>Laurison points to a specific example in San Francisco's Bayview Hunters Point, a largely poor and minority neighborhood in San Francisco, with few grocery stores. In 1998, when the current owner purchased the store, alcohol sales accounted for 55 percent of revenue and and produce was less than two percent. In other words, more of a liquor store than a grocery store. Over the next 12 years, a community group worked with the store to improve the variety and quality of its produce. The store more than doubled its gross revenue. By 2010 produce sales were 17 percent of revenue and alcohol sales were down to 14 percent of revenue.\u003c/p>\n\u003cp>It would be hard for anyone to disagree that the improvement of this store's produce offerings is not worthwhile. But a healthier diet does not necessarily affect obesity. \"How can we improve diet to become healthier AND lose weight?\" Sturm muses. \"It's not necessarily the same thing. You can have a really good diet in many ways, but still be heavy.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>A key component of the Let's Move! campaign was the establishment of the \u003ca title=\"http://www.whitehouse.gov/the-press-office/childhood-obesity-task-force-unveils-action-plan-solving-problem-childhood-obesity-\" href=\"http://www.whitehouse.gov/the-press-office/childhood-obesity-task-force-unveils-action-plan-solving-problem-childhood-obesity-\" target=\"_blank\">White House Childhood Obesity Task Force\u003c/a>. The Task Force explicitly promotes supermarkets and based its recommendation on \u003ca title=\"https://riskfactor.cancer.gov/mfe/search-publications/Associations-between-access-to-food-stores-and\" href=\"https://riskfactor.cancer.gov/mfe/search-publications/Associations-between-access-to-food-stores-and\" target=\"_blank\">a single study\u003c/a> that found an association between supermarkets in a ZIP code and lower body weight among adolescents. But, as Sturm details in his study, the Task Force did not cite two other studies (\u003ca title=\"https://riskfactor.cancer.gov/mfe/search-publications/Neighborhood-playgrounds-fast-food-restaurants-and\" href=\"https://riskfactor.cancer.gov/mfe/search-publications/Neighborhood-playgrounds-fast-food-restaurants-and\" target=\"_blank\">here\u003c/a> and \u003ca title=\"https://riskfactor.cancer.gov/mfe/search-publications/Body-mass-index-in-elementary-school-children\" href=\"https://riskfactor.cancer.gov/mfe/search-publications/Body-mass-index-in-elementary-school-children\" target=\"_blank\">here\u003c/a>) that found no connection.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Medicare Quality Ratings: No Effect on Patient Deaths",
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"content": "\u003cp>By Jordan Rau, \u003ca title=\"http://capsules.kaiserhealthnews.org/index.php/2012/03/study-medicare-quality-ratings-didnt-reduce-patient-deaths/\" href=\"http://capsules.kaiserhealthnews.org/index.php/2012/03/study-medicare-quality-ratings-didnt-reduce-patient-deaths/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/Screen-Shot-2012-03-05-at-3.14.04-PM.png\">\u003cimg class=\"alignleft size-medium wp-image-3499\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/Screen-Shot-2012-03-05-at-3.14.04-PM-300x233.png\" alt=\"\" width=\"300\" height=\"233\">\u003c/a>Medicare’s seven-year effort to spur quality improvements in hospital care by publishing key performance metrics on its \u003ca href=\"http://www.hospitalcompare.hhs.gov/\" target=\"_blank\">Hospital Compare website\u003c/a> has not resulted in fewer patient deaths, according to\u003ca href=\"http://content.healthaffairs.org/content/31/3/585.abstract\" target=\"_blank\"> a new Health Affairs study\u003c/a>.\u003c/p>\n\u003cp>In 2005, Hospital Compare started rating more than 3,000 hospitals on how well they adhere to basic guidelines for clinical care, such as giving flu vaccinations to pneumonia patients. Over time, Hospital Compare \u003ca href=\"http://www.hospitalcompare.hhs.gov/staticpages/for-consumers/for-consumers.aspx\" target=\"_blank\">has added\u003c/a> the results of patient experience scores, readmission and mortality rates, and, most recently, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2011/October/17/Medicare-Releases-Patient-Safety-Ratings-For-Hospitals.aspx\" target=\"_blank\">rates of complications and other patient safety mishaps\u003c/a>.\u003c/p>\n\u003cp>There’s been little evidence that consumers use the site in choosing hospitals. Still, health policy experts \u003ca href=\"http://www.commonwealthfund.org/Blog/2011/Oct/New-Hospital-Compare-Measures.aspx\" target=\"_blank\">have hoped \u003c/a>poor performing hospitals would nonetheless be embarrassed enough by their public scores to make changes. Indeed, scores on many of the measures have improved over time.\u003c/p>\n\u003cp>But the new study questions whether any of this was actually leading to better outcomes for patients, such as their chance of survival in the month after they were discharged. The study found that at the time Hospital Compare was launched, mortality rates for patients with three common ailments — heart attacks, heart failure and pneumonia — were already decreasing. After those trends were taken into account, Hospital Compare was found to have no effect on the 30-day survival rate of heart attack and pneumonia patients, according to the study.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>There was only a “modest” reduction in death rates for heart failure, and that could have been due to something other than Hospital Compare, the study said. “Hospital Compare did not result in patients’ shifting toward high-quality hospitals, and led to little or no reduction in mortality rates within hospitals beyond existing trends,” the paper concludes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Starting in October 2013, hospitals will have an added reason to improve their mortality rates. As part of the health law’s \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2011/April/29/medicare-rules-for-hospital-quality.aspx\" target=\"_blank\">value-based purchasing program\u003c/a>, \u003ca href=\"http://www.hospitalcompare.hhs.gov/staticpages/for-consumers/ooc/death-mortality-measures.aspx\" target=\"_blank\">mortality rates \u003c/a>will added to the factors Medicare uses in determining how much to reimburse hospitals.\u003c/p>\n\n",
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"excerpt": "Medicare’s seven-year effort to spur quality improvements in hospital care by publishing key performance metrics on its Hospital Compare website has not resulted in fewer patient deaths, according to a new Health Affairs study.\r\n\r\nIn 2005, Hospital Compare started rating more than 3,000 hospitals on how well they adhere to basic guidelines for clinical care, such as giving flu vaccinations to pneumonia patients. Over time, Hospital Compare has added the results of patient experience scores, readmission and mortality rates, and, most recently, rates of complications and other patient safety mishaps.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Jordan Rau, \u003ca title=\"http://capsules.kaiserhealthnews.org/index.php/2012/03/study-medicare-quality-ratings-didnt-reduce-patient-deaths/\" href=\"http://capsules.kaiserhealthnews.org/index.php/2012/03/study-medicare-quality-ratings-didnt-reduce-patient-deaths/\" target=\"_blank\">Kaiser Health News\u003c/a>\u003c/p>\n\u003cp>\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/Screen-Shot-2012-03-05-at-3.14.04-PM.png\">\u003cimg class=\"alignleft size-medium wp-image-3499\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/Screen-Shot-2012-03-05-at-3.14.04-PM-300x233.png\" alt=\"\" width=\"300\" height=\"233\">\u003c/a>Medicare’s seven-year effort to spur quality improvements in hospital care by publishing key performance metrics on its \u003ca href=\"http://www.hospitalcompare.hhs.gov/\" target=\"_blank\">Hospital Compare website\u003c/a> has not resulted in fewer patient deaths, according to\u003ca href=\"http://content.healthaffairs.org/content/31/3/585.abstract\" target=\"_blank\"> a new Health Affairs study\u003c/a>.\u003c/p>\n\u003cp>In 2005, Hospital Compare started rating more than 3,000 hospitals on how well they adhere to basic guidelines for clinical care, such as giving flu vaccinations to pneumonia patients. Over time, Hospital Compare \u003ca href=\"http://www.hospitalcompare.hhs.gov/staticpages/for-consumers/for-consumers.aspx\" target=\"_blank\">has added\u003c/a> the results of patient experience scores, readmission and mortality rates, and, most recently, \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2011/October/17/Medicare-Releases-Patient-Safety-Ratings-For-Hospitals.aspx\" target=\"_blank\">rates of complications and other patient safety mishaps\u003c/a>.\u003c/p>\n\u003cp>There’s been little evidence that consumers use the site in choosing hospitals. Still, health policy experts \u003ca href=\"http://www.commonwealthfund.org/Blog/2011/Oct/New-Hospital-Compare-Measures.aspx\" target=\"_blank\">have hoped \u003c/a>poor performing hospitals would nonetheless be embarrassed enough by their public scores to make changes. Indeed, scores on many of the measures have improved over time.\u003c/p>\n\u003cp>But the new study questions whether any of this was actually leading to better outcomes for patients, such as their chance of survival in the month after they were discharged. The study found that at the time Hospital Compare was launched, mortality rates for patients with three common ailments — heart attacks, heart failure and pneumonia — were already decreasing. After those trends were taken into account, Hospital Compare was found to have no effect on the 30-day survival rate of heart attack and pneumonia patients, according to the study.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>There was only a “modest” reduction in death rates for heart failure, and that could have been due to something other than Hospital Compare, the study said. “Hospital Compare did not result in patients’ shifting toward high-quality hospitals, and led to little or no reduction in mortality rates within hospitals beyond existing trends,” the paper concludes.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Starting in October 2013, hospitals will have an added reason to improve their mortality rates. As part of the health law’s \u003ca href=\"http://www.kaiserhealthnews.org/Stories/2011/April/29/medicare-rules-for-hospital-quality.aspx\" target=\"_blank\">value-based purchasing program\u003c/a>, \u003ca href=\"http://www.hospitalcompare.hhs.gov/staticpages/for-consumers/ooc/death-mortality-measures.aspx\" target=\"_blank\">mortality rates \u003c/a>will added to the factors Medicare uses in determining how much to reimburse hospitals.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "How \"Pay-for-Delay\" Adds to Drug Prices",
"title": "How \"Pay-for-Delay\" Adds to Drug Prices",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_3456\" class=\"wp-caption alignleft\" style=\"max-width: 276px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty.jpg\">\u003cimg class=\"size-medium wp-image-3456\" title=\"(Jupiter Images: Getty)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty-300x326.jpg\" alt=\"(Jupiter Images: Getty)\" width=\"276\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Jupiter Images: Getty)\u003c/figcaption>\u003c/figure>\n\u003cp>Americans spent more than $300 billion on prescription drugs in 2010. As most consumers know, generic drugs are cheaper than their brand name counterparts. A\u003ca title=\"http://www.gao.gov/products/GAO-12-371R\" href=\"http://www.gao.gov/products/GAO-12-371R\" target=\"_blank\"> federal report \u003c/a>found consumers saved more than $1 \u003cem>trillion \u003c/em>between 1999 and 2010 by using generic drugs. Generic drugs can't be made or sold until the patent on the original drug expires, usually after 20 years.\u003c/p>\n\u003cp>But what you might not know is that pharmaceutical companies have long engaged in \u003cem>pay-for-delay. \u003c/em>These are payments to generic manufacturers to stay out of the market--to not\u003cem> \u003c/em>sell cheaper versions of the drug. According to a \u003ca title=\"http://www.ftc.gov/os/testimony/100727antitrustoversight.pdf\" href=\"http://www.ftc.gov/os/testimony/100727antitrustoversight.pdf\" target=\"_blank\">Federal Trade Commission report\u003c/a> [PDF], these deals have cost consumers $3.5 billion \u003cem>each year\u003c/em> in higher prescription drug costs.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“These agreements are instrumental in keeping [drug prices] enormously high.”\u003c/aside>\n\u003cp>Today, \u003ca title=\"http://californiawatch.org/dailyreport/state-court-examine-pay-delay-deals-drugmakers-15133\" href=\"http://californiawatch.org/dailyreport/state-court-examine-pay-delay-deals-drugmakers-15133\" target=\"_blank\">California Watch\u003c/a> reports that the California Supreme Court has agreed to take up the issue of pay-for-delay by reviewing a decade old class-action lawsuit having to do with the antibiotic\u003ca title=\"http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000878/\" href=\"http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000878/\" target=\"_blank\"> Cipro\u003c/a>, originally manufactured by Bayer.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>From California Watch:\u003c/p>\n\u003cblockquote>\u003cp>The suit argues that it was illegal for Bayer to pay a competitor to stay out of the market as part of a settlement in a legal dispute over the Cipro patent.\u003c/p>\n\u003cp>The deal forced hundreds of thousands of Californians to collectively overpay millions of dollars for the drug, the lawsuit claimed.\u003c/p>\n\u003cp>“Without generic competition, drug prices are enormously high,” said Joseph Saveri, an attorney with Lieff Cabraser Heimann & Bernstein, who is representing California consumers in the case. “These agreements are instrumental in keeping them enormously high.”\u003c/p>\n\u003cp>The class-action case stems from a 1996 settlement of a patent dispute over Cipro between Bayer and Barr Laboratories, which was planning to sell a generic version of the antibiotic. After five years of litigation – and in light of projections that Bayer could lose about $1 billion in profits over several years if a generic were to step into the market – the companies settled the case.\u003c/p>\n\u003cp>The terms of the agreement involved Bayer paying Barr nearly $400 million to delay making or selling the generic until after the expiration of the patent in December 2003. Between 1997 and the end of 2003, Bayer raised the price of Cipro by 16 percent and made a profit of about $5 billion, according to court documents.\u003c/p>\u003c/blockquote>\n\u003cp>There is an apparent tension between federal and state law on the pay-for-delay issue. Bayer has already won cases at the lower court level, by relying on federal case law. They believe they will also prevail before the California Supreme Court.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Again, from California Watch:\u003c/p>\n\u003cblockquote>\u003cp>“Bayer believes that the decisions of the trial and appellate courts are correct and will vigorously defend those decisions before the Supreme Court of California,” Bayer spokeswoman Marcy Funk wrote in an e-mail. ...\u003c/p>\n\u003cp>In making the recent argument for California Supreme Court review, attorneys representing the state's consumers argued that while some federal courts may find these payment settlements permissible, they’re ultimately illegal under California antitrust law.\u003c/p>\n\u003cp>“California law does \u003cem>not\u003c/em> authorize or condone settlements that violate public policy, particularly a settlement where competitors are paid off to prevent competition,” stated \u003ca href=\"http://www.scribd.com/doc/83404594/Cipro-petition-for-CA-Supe-Ct-Review\" target=\"_blank\">documents\u003c/a> filed by attorneys for consumers. ...\u003c/p>\n\u003cp>Given this general split between state and federal courts on antitrust law, the Cipro case is “potentially very significant,” Mark A. Lemley, a law professor at Stanford University, wrote in an e-mail.\u003c/p>\n\u003cp>“If reverse payments are declared illegal in California, it may affect the behavior of pharmaceutical companies nationwide, because they will face liability in California if they continue to enter into such agreements,” wrote Lemley, who wrote an \u003ca href=\"http://www.scribd.com/doc/83404664/Amicus-Cipro\" target=\"_blank\">amicus brief\u003c/a> on behalf of 78 law professors arguing that the settlements are illegal.\u003c/p>\u003c/blockquote>\n\n",
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"excerpt": "Americans spent more than $300 billion on prescription drugs in 2010. As most consumers know, generic drugs are cheaper than their brand name counterparts. A federal report found consumers saved more than $1 trillion between 1999 and 2010 by using generic drugs. Patents on pharmaceutical drugs typically run 20 years. When the patent expires, generic drugs--usually significantly cheaper--can be marketed.",
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"description": "Americans spent more than $300 billion on prescription drugs in 2010. As most consumers know, generic drugs are cheaper than their brand name counterparts. A federal report found consumers saved more than $1 trillion between 1999 and 2010 by using generic drugs. Patents on pharmaceutical drugs typically run 20 years. When the patent expires, generic drugs--usually significantly cheaper--can be marketed.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_3456\" class=\"wp-caption alignleft\" style=\"max-width: 276px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty.jpg\">\u003cimg class=\"size-medium wp-image-3456\" title=\"(Jupiter Images: Getty)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/Cropped_DrugsMoneyGeneric_Getty-300x326.jpg\" alt=\"(Jupiter Images: Getty)\" width=\"276\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Jupiter Images: Getty)\u003c/figcaption>\u003c/figure>\n\u003cp>Americans spent more than $300 billion on prescription drugs in 2010. As most consumers know, generic drugs are cheaper than their brand name counterparts. A\u003ca title=\"http://www.gao.gov/products/GAO-12-371R\" href=\"http://www.gao.gov/products/GAO-12-371R\" target=\"_blank\"> federal report \u003c/a>found consumers saved more than $1 \u003cem>trillion \u003c/em>between 1999 and 2010 by using generic drugs. Generic drugs can't be made or sold until the patent on the original drug expires, usually after 20 years.\u003c/p>\n\u003cp>But what you might not know is that pharmaceutical companies have long engaged in \u003cem>pay-for-delay. \u003c/em>These are payments to generic manufacturers to stay out of the market--to not\u003cem> \u003c/em>sell cheaper versions of the drug. According to a \u003ca title=\"http://www.ftc.gov/os/testimony/100727antitrustoversight.pdf\" href=\"http://www.ftc.gov/os/testimony/100727antitrustoversight.pdf\" target=\"_blank\">Federal Trade Commission report\u003c/a> [PDF], these deals have cost consumers $3.5 billion \u003cem>each year\u003c/em> in higher prescription drug costs.\u003c/p>\n\u003caside class=\"pullquote alignleft\">“These agreements are instrumental in keeping [drug prices] enormously high.”\u003c/aside>\n\u003cp>Today, \u003ca title=\"http://californiawatch.org/dailyreport/state-court-examine-pay-delay-deals-drugmakers-15133\" href=\"http://californiawatch.org/dailyreport/state-court-examine-pay-delay-deals-drugmakers-15133\" target=\"_blank\">California Watch\u003c/a> reports that the California Supreme Court has agreed to take up the issue of pay-for-delay by reviewing a decade old class-action lawsuit having to do with the antibiotic\u003ca title=\"http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000878/\" href=\"http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000878/\" target=\"_blank\"> Cipro\u003c/a>, originally manufactured by Bayer.\u003c/p>\n\u003cp>\u003c!--more-->\u003c/p>\n\u003cp>From California Watch:\u003c/p>\n\u003cblockquote>\u003cp>The suit argues that it was illegal for Bayer to pay a competitor to stay out of the market as part of a settlement in a legal dispute over the Cipro patent.\u003c/p>\n\u003cp>The deal forced hundreds of thousands of Californians to collectively overpay millions of dollars for the drug, the lawsuit claimed.\u003c/p>\n\u003cp>“Without generic competition, drug prices are enormously high,” said Joseph Saveri, an attorney with Lieff Cabraser Heimann & Bernstein, who is representing California consumers in the case. “These agreements are instrumental in keeping them enormously high.”\u003c/p>\n\u003cp>The class-action case stems from a 1996 settlement of a patent dispute over Cipro between Bayer and Barr Laboratories, which was planning to sell a generic version of the antibiotic. After five years of litigation – and in light of projections that Bayer could lose about $1 billion in profits over several years if a generic were to step into the market – the companies settled the case.\u003c/p>\n\u003cp>The terms of the agreement involved Bayer paying Barr nearly $400 million to delay making or selling the generic until after the expiration of the patent in December 2003. Between 1997 and the end of 2003, Bayer raised the price of Cipro by 16 percent and made a profit of about $5 billion, according to court documents.\u003c/p>\u003c/blockquote>\n\u003cp>There is an apparent tension between federal and state law on the pay-for-delay issue. Bayer has already won cases at the lower court level, by relying on federal case law. They believe they will also prevail before the California Supreme Court.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Again, from California Watch:\u003c/p>\n\u003cblockquote>\u003cp>“Bayer believes that the decisions of the trial and appellate courts are correct and will vigorously defend those decisions before the Supreme Court of California,” Bayer spokeswoman Marcy Funk wrote in an e-mail. ...\u003c/p>\n\u003cp>In making the recent argument for California Supreme Court review, attorneys representing the state's consumers argued that while some federal courts may find these payment settlements permissible, they’re ultimately illegal under California antitrust law.\u003c/p>\n\u003cp>“California law does \u003cem>not\u003c/em> authorize or condone settlements that violate public policy, particularly a settlement where competitors are paid off to prevent competition,” stated \u003ca href=\"http://www.scribd.com/doc/83404594/Cipro-petition-for-CA-Supe-Ct-Review\" target=\"_blank\">documents\u003c/a> filed by attorneys for consumers. ...\u003c/p>\n\u003cp>Given this general split between state and federal courts on antitrust law, the Cipro case is “potentially very significant,” Mark A. Lemley, a law professor at Stanford University, wrote in an e-mail.\u003c/p>\n\u003cp>“If reverse payments are declared illegal in California, it may affect the behavior of pharmaceutical companies nationwide, because they will face liability in California if they continue to enter into such agreements,” wrote Lemley, who wrote an \u003ca href=\"http://www.scribd.com/doc/83404664/Amicus-Cipro\" target=\"_blank\">amicus brief\u003c/a> on behalf of 78 law professors arguing that the settlements are illegal.\u003c/p>\u003c/blockquote>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Healthy San Francisco: Snapshot of Universal Care",
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"content": "\u003cfigure id=\"attachment_3433\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/HealthySF_Jack-Snook_Credit_KamalMenghrajani_02.jpg\">\u003cimg class=\"size-medium wp-image-3433\" title=\"Jack Snook expresses his appreciation for Healthy San Francisco in a panel discussion last night. (Photo: Kamal Menghrajani)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/HealthySF_Jack-Snook_Credit_KamalMenghrajani_02-300x224.jpg\" alt=\"Jack Snook expresses his appreciation for Healthy San Francisco in a panel discussion last night. (Photo: Kamal Menghrajani)\" width=\"300\" height=\"224\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jack Snook expresses his appreciation for Healthy San Francisco in a panel discussion last night. (Photo: Kamal Menghrajani)\u003c/figcaption>\u003c/figure>\n\u003cp>It's been almost five years since San Francisco launched its innovative, universal health plan--\u003ca title=\"http://www.healthysanfrancisco.org/\" href=\"http://www.healthysanfrancisco.org/\" target=\"_blank\">Healthy San Francisco\u003c/a>--and last night a panel of public health experts and care providers gathered at the Tenderloin's \u003ca title=\"https://www.glide.org/sslpage.aspx\" href=\"https://www.glide.org/sslpage.aspx\" target=\"_blank\">Glide Foundation\u003c/a> to provide a snapshot of how the program is faring.\u003c/p>\n\u003cp>Glide has a long history of providing services to the poor and marginalized--and advocating on their behalf. Glide's Freedom Hall was packed, with a smattering of people who indicated they were participants in Healthy San Francisco. Tangerine Brigham, director of the program, spoke first and described the program's goals: to provide improved access to care through a network of community clinics and hospitals. Of primary importance is for people to have a relationship with a doctor or clinic so they don't resort to the emergency room for what are essentially primary care problems.\u003c/p>\n\u003caside class=\"pullquote alignright\">Healthy San Francisco has enrolled 80 percent of San Francisco's uninsured--about 55,000 adults.\u003c/aside>\n\u003cp>Since its inception in 2007, Healthy San Francisco has enrolled 80 percent of San Francisco's uninsured--about 55,000 adults. And people are using the primary care benefits. \"Over 70 percent of the people in Healthy SF are getting a primary care visit at least once a year,\" Brigham said. \"Because they're using primary care, we saw a reduction in emergency room utilization at \u003ca title=\"http://sfghed.ucsf.edu/\" href=\"http://sfghed.ucsf.edu/\" target=\"_blank\">San Francisco General Hospital\u003c/a>. We compared that to other public hospitals in California and what that analysis showed was that San Francisco emergency utilization was declining while others' was rising.\"\u003c!--more-->\u003c/p>\n\u003cp>Healthy San Francisco is not health insurance. Participants pay a quarterly fee--on a sliding scale--for care at the clinics and hospitals that participate in the program, which are in San Francisco only\u003cstrong>.\u003c/strong> But people don't seem to be bothered by the geographic constraints. A \u003ca title=\"http://www.kff.org/kaiserpolls/kaiserpolls082609nr.cfm\" href=\"http://www.kff.org/kaiserpolls/kaiserpolls082609nr.cfm\" target=\"_blank\">2009 survey\u003c/a> by the Kaiser Family Foundation found that 94 percent of participants were at least \"somewhat satisfied\" with the program and 92 percent would recommend to a friend.\u003c/p>\n\u003cp>\u003ca title=\"http://futurehealth.ucsf.edu/Public/Leadership-Programs/MiniProfile.aspx?pid=33&asuid=8814\" href=\"http://futurehealth.ucsf.edu/Public/Leadership-Programs/MiniProfile.aspx?pid=33&asuid=8814\" target=\"_blank\">Karen Hill\u003c/a> is the clinic manager at \u003ca title=\"http://glide.org/health\" href=\"http://glide.org/health\" target=\"_blank\">Glide Health Services\u003c/a>. As a provider, she is also highly satisfied with Healthy San Francisco. \"From a clinic manager's perspective,\" she says, \"I don't have to worry about where I need to send someone for specialty care. I know they have a place to go. ... We are going to be able to get those specialty tests they need. We have access for blood tests and for medications.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As part of San Francisco's health care overhaul, businesses with more than 20 employees are \u003ca title=\"http://www.healthysanfrancisco.org/employers/HCSO_Compliance.aspx\" href=\"http://www.healthysanfrancisco.org/employers/HCSO_Compliance.aspx\" target=\"_blank\">required to provide health insurance\u003c/a> to their employees. Before implementation of the plan, employers--especially restaurant owners--had worried that this requirement would cost jobs, since businesses in surrounding cities and counties might not bear the same health insurance costs. \u003ca title=\"http://sph.berkeley.edu/faculty/dow.php\" href=\"http://sph.berkeley.edu/faculty/dow.php\" target=\"_blank\">William Dow\u003c/a>, Professor of Health Economics at UC Berkeley, has looked at this issue extensively. \"Were there fewer jobs in the City after this happened?\" he asked, in reference to the implementation of Healthy San Francisco. \"The answer is no.\" You can read his full analysis \u003ca title=\"http://www.nber.org/papers/w16179.pdf\" href=\"http://www.nber.org/papers/w16179.pdf\" target=\"_blank\">here\u003c/a>.\u003c/p>\n\u003cp>The discussion was peppered with comments and questions from the audience. Many spoke in favor of Healthy SF, including Jack Snook. \"I think Healthy San Francisco is the best thing that ever happened to me other than being a teacher for 20 years,\" he said. \"I'm able to easily attain care through Healthy SF. ... It's been a big blessing in my life.\"\u003c/p>\n\u003cp>Looking ahead to the rollout of federal health care reform in 2014, panelists agreed that San Francisco's near-universal health coverage makes the upcoming change easier. \"We will be in a very unique position as a provider community in 2014,\" said Tangerine Brigham, \"because we will be far better prepared with our residents in Healthy San Francisco to transition either from Medicaid or into another program.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The panel unfortunately ended before any discussion of cost of the program could be addressed. \u003ca title=\"http://sfpublicpress.org/\" href=\"http://sfpublicpress.org/\" target=\"_blank\">The San Francisco Public Press\u003c/a>--sponsor of last night's event--featured an \u003ca title=\"http://sfpublicpress.org/news/healthy-sf\" href=\"http://sfpublicpress.org/news/healthy-sf\" target=\"_blank\">in-depth special report\u003c/a> last November. The entire edition is worth a read, but \u003ca title=\"http://sfpublicpress.org/news/2011-11/san-franciscos-universal-health-plan-reaches-tens-of-thousands-rests-on-unstable-funding\" href=\"http://sfpublicpress.org/news/2011-11/san-franciscos-universal-health-plan-reaches-tens-of-thousands-rests-on-unstable-funding\" target=\"_blank\">one ominous parting note\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>The employer contribution raised relatively modest revenues. Of Healthy San Francisco’s total $177 million budget in the last fiscal year, businesses covered just $12.9 million, or about 7 percent. When city officials created the program they envisioned businesses covering $30 million to $40 million, or at least 15 percent of the cost.\u003c/p>\n\u003cp>The city’s General Fund picked up nearly eight times that amount — $99.7 million. The contributions of individuals opting to buy Healthy San Francisco for themselves contribute just $5.9 million or a bit more than 3 percent of total costs.\u003c/p>\u003c/blockquote>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_3433\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/HealthySF_Jack-Snook_Credit_KamalMenghrajani_02.jpg\">\u003cimg class=\"size-medium wp-image-3433\" title=\"Jack Snook expresses his appreciation for Healthy San Francisco in a panel discussion last night. (Photo: Kamal Menghrajani)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/03/HealthySF_Jack-Snook_Credit_KamalMenghrajani_02-300x224.jpg\" alt=\"Jack Snook expresses his appreciation for Healthy San Francisco in a panel discussion last night. (Photo: Kamal Menghrajani)\" width=\"300\" height=\"224\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Jack Snook expresses his appreciation for Healthy San Francisco in a panel discussion last night. (Photo: Kamal Menghrajani)\u003c/figcaption>\u003c/figure>\n\u003cp>It's been almost five years since San Francisco launched its innovative, universal health plan--\u003ca title=\"http://www.healthysanfrancisco.org/\" href=\"http://www.healthysanfrancisco.org/\" target=\"_blank\">Healthy San Francisco\u003c/a>--and last night a panel of public health experts and care providers gathered at the Tenderloin's \u003ca title=\"https://www.glide.org/sslpage.aspx\" href=\"https://www.glide.org/sslpage.aspx\" target=\"_blank\">Glide Foundation\u003c/a> to provide a snapshot of how the program is faring.\u003c/p>\n\u003cp>Glide has a long history of providing services to the poor and marginalized--and advocating on their behalf. Glide's Freedom Hall was packed, with a smattering of people who indicated they were participants in Healthy San Francisco. Tangerine Brigham, director of the program, spoke first and described the program's goals: to provide improved access to care through a network of community clinics and hospitals. Of primary importance is for people to have a relationship with a doctor or clinic so they don't resort to the emergency room for what are essentially primary care problems.\u003c/p>\n\u003caside class=\"pullquote alignright\">Healthy San Francisco has enrolled 80 percent of San Francisco's uninsured--about 55,000 adults.\u003c/aside>\n\u003cp>Since its inception in 2007, Healthy San Francisco has enrolled 80 percent of San Francisco's uninsured--about 55,000 adults. And people are using the primary care benefits. \"Over 70 percent of the people in Healthy SF are getting a primary care visit at least once a year,\" Brigham said. \"Because they're using primary care, we saw a reduction in emergency room utilization at \u003ca title=\"http://sfghed.ucsf.edu/\" href=\"http://sfghed.ucsf.edu/\" target=\"_blank\">San Francisco General Hospital\u003c/a>. We compared that to other public hospitals in California and what that analysis showed was that San Francisco emergency utilization was declining while others' was rising.\"\u003c!--more-->\u003c/p>\n\u003cp>Healthy San Francisco is not health insurance. Participants pay a quarterly fee--on a sliding scale--for care at the clinics and hospitals that participate in the program, which are in San Francisco only\u003cstrong>.\u003c/strong> But people don't seem to be bothered by the geographic constraints. A \u003ca title=\"http://www.kff.org/kaiserpolls/kaiserpolls082609nr.cfm\" href=\"http://www.kff.org/kaiserpolls/kaiserpolls082609nr.cfm\" target=\"_blank\">2009 survey\u003c/a> by the Kaiser Family Foundation found that 94 percent of participants were at least \"somewhat satisfied\" with the program and 92 percent would recommend to a friend.\u003c/p>\n\u003cp>\u003ca title=\"http://futurehealth.ucsf.edu/Public/Leadership-Programs/MiniProfile.aspx?pid=33&asuid=8814\" href=\"http://futurehealth.ucsf.edu/Public/Leadership-Programs/MiniProfile.aspx?pid=33&asuid=8814\" target=\"_blank\">Karen Hill\u003c/a> is the clinic manager at \u003ca title=\"http://glide.org/health\" href=\"http://glide.org/health\" target=\"_blank\">Glide Health Services\u003c/a>. As a provider, she is also highly satisfied with Healthy San Francisco. \"From a clinic manager's perspective,\" she says, \"I don't have to worry about where I need to send someone for specialty care. I know they have a place to go. ... We are going to be able to get those specialty tests they need. We have access for blood tests and for medications.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As part of San Francisco's health care overhaul, businesses with more than 20 employees are \u003ca title=\"http://www.healthysanfrancisco.org/employers/HCSO_Compliance.aspx\" href=\"http://www.healthysanfrancisco.org/employers/HCSO_Compliance.aspx\" target=\"_blank\">required to provide health insurance\u003c/a> to their employees. Before implementation of the plan, employers--especially restaurant owners--had worried that this requirement would cost jobs, since businesses in surrounding cities and counties might not bear the same health insurance costs. \u003ca title=\"http://sph.berkeley.edu/faculty/dow.php\" href=\"http://sph.berkeley.edu/faculty/dow.php\" target=\"_blank\">William Dow\u003c/a>, Professor of Health Economics at UC Berkeley, has looked at this issue extensively. \"Were there fewer jobs in the City after this happened?\" he asked, in reference to the implementation of Healthy San Francisco. \"The answer is no.\" You can read his full analysis \u003ca title=\"http://www.nber.org/papers/w16179.pdf\" href=\"http://www.nber.org/papers/w16179.pdf\" target=\"_blank\">here\u003c/a>.\u003c/p>\n\u003cp>The discussion was peppered with comments and questions from the audience. Many spoke in favor of Healthy SF, including Jack Snook. \"I think Healthy San Francisco is the best thing that ever happened to me other than being a teacher for 20 years,\" he said. \"I'm able to easily attain care through Healthy SF. ... It's been a big blessing in my life.\"\u003c/p>\n\u003cp>Looking ahead to the rollout of federal health care reform in 2014, panelists agreed that San Francisco's near-universal health coverage makes the upcoming change easier. \"We will be in a very unique position as a provider community in 2014,\" said Tangerine Brigham, \"because we will be far better prepared with our residents in Healthy San Francisco to transition either from Medicaid or into another program.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The panel unfortunately ended before any discussion of cost of the program could be addressed. \u003ca title=\"http://sfpublicpress.org/\" href=\"http://sfpublicpress.org/\" target=\"_blank\">The San Francisco Public Press\u003c/a>--sponsor of last night's event--featured an \u003ca title=\"http://sfpublicpress.org/news/healthy-sf\" href=\"http://sfpublicpress.org/news/healthy-sf\" target=\"_blank\">in-depth special report\u003c/a> last November. The entire edition is worth a read, but \u003ca title=\"http://sfpublicpress.org/news/2011-11/san-franciscos-universal-health-plan-reaches-tens-of-thousands-rests-on-unstable-funding\" href=\"http://sfpublicpress.org/news/2011-11/san-franciscos-universal-health-plan-reaches-tens-of-thousands-rests-on-unstable-funding\" target=\"_blank\">one ominous parting note\u003c/a>:\u003c/p>\n\u003cblockquote>\u003cp>The employer contribution raised relatively modest revenues. Of Healthy San Francisco’s total $177 million budget in the last fiscal year, businesses covered just $12.9 million, or about 7 percent. When city officials created the program they envisioned businesses covering $30 million to $40 million, or at least 15 percent of the cost.\u003c/p>\n\u003cp>The city’s General Fund picked up nearly eight times that amount — $99.7 million. The contributions of individuals opting to buy Healthy San Francisco for themselves contribute just $5.9 million or a bit more than 3 percent of total costs.\u003c/p>\u003c/blockquote>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Heart Disease Treatment: Is Less ... More?",
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"content": "\u003cfigure id=\"attachment_3367\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/EKG_Rosmary_Flickr_02282012.jpg\">\u003cimg class=\"size-medium wp-image-3367\" title=\"(Rosmary: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/EKG_Rosmary_Flickr_02282012-300x247.jpg\" alt=\"(Rosmary: Flickr)\" width=\"300\" height=\"247\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Rosmary: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>It's practically gospel in American health care--the more expensive and the more invasive a treatment is, the more people seem to believe it is the best option. But is it? A new study looks at America's number 1 killer -- heart disease -- and finds that a regimen of fairly inexpensive pills works just as well as an expensive surgical procedure to implant a stent. Oh, and drug treatment has fewer risks in this case, too.\u003c/p>\n\u003cp>The study is published in this week's \u003ca title=\"http://archinte.ama-assn.org/cgi/content/abstract/172/4/312\" href=\"http://archinte.ama-assn.org/cgi/content/abstract/172/4/312\" target=\"_blank\">Archives of Internal Medicine\u003c/a> and it looks at \u003cem>stable\u003c/em> coronary artery disease. In stable heart disease, patients experience angina --chest pain -- at times of \"high demand\" such as during exercise or stress.\u003c!--more-->\u003c/p>\n\u003cp>This study is a new review of a group of randomized trials which had compared medication treatment with the surgical option, called percutaneous coronary intervention, or PCI. In PCI, a surgeon threads a narrow tube through an artery to a point where there is blockage in the heart and inserts a stent--a mesh tube--against the walls of the artery to hold it open.\u003c/p>\n\u003cp>While it certainly sounds like a good idea, researchers found no benefit over drug therapy. As the authors write:\u003c/p>\n\u003cblockquote>\u003cp>The significant finding of this analysis is that compared with a strategy of initial medical therapy alone, coronary stent implantation in combination with medical therapy for stable CAD [coronary artery disease] is not associated with a significant reduction in mortality, nonfatal MI ... or angina.\u003c/p>\u003c/blockquote>\n\u003cp>\"MI\" is shorthand for myocardial infarction--a heart attack. So, in other words, if you have stable heart disease, you will do just as well with the less expensive pills and you will not bear the risks of surgery. But PCI is a popular procedure. The researchers report that more than 400,000 Americans a year have PCI with a stent implanted every year.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The \u003ca title=\"http://www.nytimes.com/2012/02/28/health/stents-show-no-extra-benefits-for-coronary-artery-disease.html?scp=1&sq=Percutaneous&st=cse\" href=\"http://www.nytimes.com/2012/02/28/health/stents-show-no-extra-benefits-for-coronary-artery-disease.html?scp=1&sq=Percutaneous&st=cse\" target=\"_blank\">New York Times\u003c/a> took a detailed look at this study today and reported that one of the drivers for PCI over medications could be money, The Times reports the cost of PCI ranges from $30,000 to $50,000 and interviewed Dr. David Brown, an author of the study:\u003c/p>\n\u003cblockquote>\u003cp>More than half of patients with stable coronary artery disease are now implanted with stents without even trying drug treatment, Dr. Brown said. The reason, he believes, is financial.\u003c/p>\n\u003cp>“In many hospitals, the cardiac service line generates 40 percent of the total hospital revenue, so there’s incredible pressure to do more procedures,” he said.\u003c/p>\n\u003cp>“When you put in a stent, everyone is happy — the hospital is making more money, the doctor is making more money — everybody is happier except the health care system as a whole, which is paying more money for no better results.”\u003c/p>\u003c/blockquote>\n\u003cp>The study reviewed 7,229 patients who had a been enrolled in eight different trials. Of those patients, 3,617 received stents and medication while 3,612 received just the medications. There were 649 total deaths during the trials, 322 in the stent group and 327 in the medication group. Some doctors argued that certain patients do not tolerate the drugs well and they could still be candidates for PCI and stent treatment.\u003c/p>\n\u003cp>In an \u003ca title=\"http://archinte.ama-assn.org/cgi/content/full/172/4/319\" href=\"http://archinte.ama-assn.org/cgi/content/full/172/4/319\" target=\"_blank\">accompanying editorial \u003c/a>in the Archives, Dr. William Boden writes about doctors who outwardly \"worship at the altar of evidence-based medicine\" as long as studies or trials reinforce what they already believe, \"while we ignore or disdain the results of studies with results that are unpopular ... or collide with the conventional wisdom.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And where does this collision with conventional wisdom leave the patient? \u003cem>The Times \u003c/em>concludes with an explanation of the current understanding of heart disease. Patients, take heed:\u003c/p>\n\u003cblockquote>\u003cp>These results support the current concept of coronary artery disease, the authors wrote — that it is a systemic inflammatory disease of the arteries that cannot be successfully treated by surgical intervention at a particular site on one artery.\u003c/p>\n\u003cp>According to Dr. Brown, a professor of medicine at Stony Brook University, many doctors cannot accept this. Instead, he said, “interventional cardiologists use the analogy of a pipe blocked in a house — it’s a terrible analogy, but patients accept it. It’s simplistic and erroneous.”\u003c/p>\u003c/blockquote>\n\n",
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"excerpt": "It's practically gospel in American health care--the more expensive and the more invasive a treatment is, the more people seem to believe it is the best option. But is it? A new study looks at America's number 1 killer--heart disease--and finds that a regimen of fairly inexpensive pills works just as well as an expensive surgical procedure to implant a stent. Oh, and, drug treatment has fewer risks in this case, too.\r\n\r\nThe study is published in this week's Archives of Internal Medicine and it looks at stable coronary artery disease. In stable heart disease, patients experience angina--chest pain--at times of \"high demand\" such as during exercise or stress.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_3367\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/EKG_Rosmary_Flickr_02282012.jpg\">\u003cimg class=\"size-medium wp-image-3367\" title=\"(Rosmary: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/EKG_Rosmary_Flickr_02282012-300x247.jpg\" alt=\"(Rosmary: Flickr)\" width=\"300\" height=\"247\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Rosmary: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>It's practically gospel in American health care--the more expensive and the more invasive a treatment is, the more people seem to believe it is the best option. But is it? A new study looks at America's number 1 killer -- heart disease -- and finds that a regimen of fairly inexpensive pills works just as well as an expensive surgical procedure to implant a stent. Oh, and drug treatment has fewer risks in this case, too.\u003c/p>\n\u003cp>The study is published in this week's \u003ca title=\"http://archinte.ama-assn.org/cgi/content/abstract/172/4/312\" href=\"http://archinte.ama-assn.org/cgi/content/abstract/172/4/312\" target=\"_blank\">Archives of Internal Medicine\u003c/a> and it looks at \u003cem>stable\u003c/em> coronary artery disease. In stable heart disease, patients experience angina --chest pain -- at times of \"high demand\" such as during exercise or stress.\u003c!--more-->\u003c/p>\n\u003cp>This study is a new review of a group of randomized trials which had compared medication treatment with the surgical option, called percutaneous coronary intervention, or PCI. In PCI, a surgeon threads a narrow tube through an artery to a point where there is blockage in the heart and inserts a stent--a mesh tube--against the walls of the artery to hold it open.\u003c/p>\n\u003cp>While it certainly sounds like a good idea, researchers found no benefit over drug therapy. As the authors write:\u003c/p>\n\u003cblockquote>\u003cp>The significant finding of this analysis is that compared with a strategy of initial medical therapy alone, coronary stent implantation in combination with medical therapy for stable CAD [coronary artery disease] is not associated with a significant reduction in mortality, nonfatal MI ... or angina.\u003c/p>\u003c/blockquote>\n\u003cp>\"MI\" is shorthand for myocardial infarction--a heart attack. So, in other words, if you have stable heart disease, you will do just as well with the less expensive pills and you will not bear the risks of surgery. But PCI is a popular procedure. The researchers report that more than 400,000 Americans a year have PCI with a stent implanted every year.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The \u003ca title=\"http://www.nytimes.com/2012/02/28/health/stents-show-no-extra-benefits-for-coronary-artery-disease.html?scp=1&sq=Percutaneous&st=cse\" href=\"http://www.nytimes.com/2012/02/28/health/stents-show-no-extra-benefits-for-coronary-artery-disease.html?scp=1&sq=Percutaneous&st=cse\" target=\"_blank\">New York Times\u003c/a> took a detailed look at this study today and reported that one of the drivers for PCI over medications could be money, The Times reports the cost of PCI ranges from $30,000 to $50,000 and interviewed Dr. David Brown, an author of the study:\u003c/p>\n\u003cblockquote>\u003cp>More than half of patients with stable coronary artery disease are now implanted with stents without even trying drug treatment, Dr. Brown said. The reason, he believes, is financial.\u003c/p>\n\u003cp>“In many hospitals, the cardiac service line generates 40 percent of the total hospital revenue, so there’s incredible pressure to do more procedures,” he said.\u003c/p>\n\u003cp>“When you put in a stent, everyone is happy — the hospital is making more money, the doctor is making more money — everybody is happier except the health care system as a whole, which is paying more money for no better results.”\u003c/p>\u003c/blockquote>\n\u003cp>The study reviewed 7,229 patients who had a been enrolled in eight different trials. Of those patients, 3,617 received stents and medication while 3,612 received just the medications. There were 649 total deaths during the trials, 322 in the stent group and 327 in the medication group. Some doctors argued that certain patients do not tolerate the drugs well and they could still be candidates for PCI and stent treatment.\u003c/p>\n\u003cp>In an \u003ca title=\"http://archinte.ama-assn.org/cgi/content/full/172/4/319\" href=\"http://archinte.ama-assn.org/cgi/content/full/172/4/319\" target=\"_blank\">accompanying editorial \u003c/a>in the Archives, Dr. William Boden writes about doctors who outwardly \"worship at the altar of evidence-based medicine\" as long as studies or trials reinforce what they already believe, \"while we ignore or disdain the results of studies with results that are unpopular ... or collide with the conventional wisdom.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>And where does this collision with conventional wisdom leave the patient? \u003cem>The Times \u003c/em>concludes with an explanation of the current understanding of heart disease. Patients, take heed:\u003c/p>\n\u003cblockquote>\u003cp>These results support the current concept of coronary artery disease, the authors wrote — that it is a systemic inflammatory disease of the arteries that cannot be successfully treated by surgical intervention at a particular site on one artery.\u003c/p>\n\u003cp>According to Dr. Brown, a professor of medicine at Stony Brook University, many doctors cannot accept this. Instead, he said, “interventional cardiologists use the analogy of a pipe blocked in a house — it’s a terrible analogy, but patients accept it. It’s simplistic and erroneous.”\u003c/p>\u003c/blockquote>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Proposed Ballot Measure Seeks Tougher Health Insurance Rate Regulation",
"title": "Proposed Ballot Measure Seeks Tougher Health Insurance Rate Regulation",
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"content": "\u003cfigure id=\"attachment_3342\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/healthinsuranceclaimsform-thinkstock.jpg\">\u003cimg class=\"size-medium wp-image-3342 \" title=\"The ballot initiative would grant California's Insurance Commissioner the authority to reject health insurance rate increases. (Photo: Thinkstock)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/healthinsuranceclaimsform-thinkstock-300x200.jpg\" alt=\"The ballot initiative would grant California's Insurance Commissioner the authority to reject health insurance rate increases. (Photo: Thinkstock)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The ballot initiative would grant California's Insurance Commissioner the authority to reject health insurance rate increases. (Photo: Thinkstock)\u003c/figcaption>\u003c/figure>\n\u003cp>In more than 30 states, government insurance departments have the authority to reject what they determine to be excessive rate hikes for health insurance. But not in California. Earlier this month, consumer advocates launched a drive to put an initiative on the November ballot to let voters decide if California's Insurance Commissioner should have this power.\u003c/p>\n\u003cp>\"Right now, my sole authority over rates, if I find a rate to be unreasonable, is to sentence a health insurer to my website,\" joked \u003ca title=\"http://insurance.ca.gov/0500-about-us/0200-commissioner/\" href=\"http://insurance.ca.gov/0500-about-us/0200-commissioner/\" target=\"_blank\">Dave Jones\u003c/a>, California's Insurance Commissioner, in an interview.\u003c/p>\n\u003cp>That's a bit of an overstatement, as his department does review rates, making sure the math is right and ensuring there are no inaccuracies. Still, what the Department is left with is \"whatever element of the bully pulpit we have to try to rein those rates in,\" Jones says.\u003c!--more-->\u003c/p>\n\u003cp>Before he was Insurance Commissioner, Jones served as an Assemblyman. He says he introduced legislation in the State Assembly every year for seven years to give the Insurance Commissioner more authority over health insurance rates. But his bills never passed. When he was sworn in as Insurance Commissioner a year ago, he again authored legislation. It went through the House, but is a handful of votes short in the Senate, he says.\u003c/p>\n\u003cp>\"After having tried to accomplish this through the legislature for the last seven years,\" Jones says, \"I know only too well how influential the HMOs and the health insurers are in the state legislature. Time and time again, they've been able to block this legislation, so I think it's time we took this issue to the voters of California.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Enter \u003ca title=\"http://www.consumerwatchdog.org/\" href=\"http://www.consumerwatchdog.org/\" target=\"_blank\">Consumer Watchdog\u003c/a>--the Santa Monica advocacy group that in 1988 backed \u003ca title=\"http://www.insurance.ca.gov/0500-about-us/0500-organization/0400-rate-regulation/prop-103.cfm\" href=\"http://www.insurance.ca.gov/0500-about-us/0500-organization/0400-rate-regulation/prop-103.cfm\" target=\"_blank\">Proposition 103\u003c/a>. While most Californians associate Prop. 103 with auto insurance rate reform, the law also gives the Insurance Commissioner the right to reject rate hikes in property and casualty insurance. Now Consumer Watchdog is \u003ca title=\"http://www.justifyrates.org/\" href=\"http://www.justifyrates.org/\" target=\"_blank\">behind an effort\u003c/a> to give the Insurance Commissioner the same level of authority over health insurance rates. To quality for the November ballot, the group needs 505,000 valid signatures by May.\u003c/p>\n\u003cp>\"We're trying to get on the November ballot and we're doing it with as much volunteer energy as we can,\" said \u003ca title=\"http://www.consumerwatchdog.org/about/our-team\" href=\"http://www.consumerwatchdog.org/about/our-team\" target=\"_blank\">Jamie Court\u003c/a>, President of Consumer Watchdog. \"This is basically about making sure health insurance companies publicly justify their rates under penalty of perjury before they take effect. It's all about getting approval from the government.\"\u003c/p>\n\u003cp>U.S. Senator Dianne Feinstein has long backed this increased regulatory control. Today her office provided an email where the Senator says she was the first person to sign Consumer Watchdog's initiative. \"Consumer Watchdog's ballot measure would require health insurance companies to publicly justify their rates before rate hikes take effect,\" Feinstein wrote in the email.\u003c/p>\n\u003cp>In an opinion piece in the Sacramento Bee last summer, Feinstein wrote:\u003c/p>\n\u003cblockquote>\u003cp>Since 1999, average health insurance premiums for family policies have risen 138 percent, while medical inflation rose just 31 percent, putting insurance out of reach for millions of Californians.\u003c/p>\u003c/blockquote>\n\u003cp>For Valerie Burchfield-Rhodes of Laguna Niguel health insurance is still within reach, but at tremendous cost. She says health insurance is her family's biggest household expense each month, \"substantially more\" than their mortgage. In 2010, her family was paying $1,053 monthly, but in 2011 their premium jumped 36 percent to $1,434 a month with the highest deductible available to them--$7,000.\u003c/p>\n\u003cp>\"I flipped out,\" she told me. \"I was writing letters and contacting people and calling reporters and freaking out because it was so expensive.\" She estimates her family is currently paying $24,000 annually between premiums, the deductible and co-pays for some of her husband's treatment for diabetes.\u003c/p>\n\u003cp>But health insurers say additional regulation is unlikely to be a panacea. \"Rate regulation may sound appealing,\" said Steve Shivinsky, a spokesman for Blue Shield said last week in the\u003ca title=\"http://www.latimes.com/business/la-fi-0223-health-insurance-rate-hikes-20120223,0,7634380.story\" href=\"http://www.latimes.com/business/la-fi-0223-health-insurance-rate-hikes-20120223,0,7634380.story\" target=\"_blank\"> L.A. Times\u003c/a>, but \"It will layer in another complex bureaucratic level of rate review that will gum up the system.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Insurance Commissioner Jones anticipates a different response from health insurance companies. \"Now what the insurers argue [is] 'oh my gosh, if we give the Insurance Commissioner that authority, it's going to be the end of the world as we know it, and we're all going to stop writing insurance. We're going to leave the State of California.' In fact, they made that argument in 1988,\" Jones says in a reference to the Proposition 103 campaign. \"But in truth what happened was they continued to write insurance in California, we continue to have all of the major national insurers still writing insurance in all these product lines and they make a reasonable profit. But what was the best thing about Prop. 103, it saved consumers and business tens of billions of dollars.\"\u003c/p>\n\n",
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"excerpt": "In more than 30 states, Insurance Commissioners have the authority to reject what they determine to be excessive rate hikes for health insurance. But not in California. Earlier this month, consumer advocates launched a drive to put an initiative on the November ballot to let voters decide if the commissioner should have this power.\r\n\r\n\"Right now, my sole authority over rates, if I find a rate to be unreasonable, is to sentence a health insurer to my website,\" joked Dave Jones, California's Insurance Commissioner, in an interview.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_3342\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/healthinsuranceclaimsform-thinkstock.jpg\">\u003cimg class=\"size-medium wp-image-3342 \" title=\"The ballot initiative would grant California's Insurance Commissioner the authority to reject health insurance rate increases. (Photo: Thinkstock)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/healthinsuranceclaimsform-thinkstock-300x200.jpg\" alt=\"The ballot initiative would grant California's Insurance Commissioner the authority to reject health insurance rate increases. (Photo: Thinkstock)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">The ballot initiative would grant California's Insurance Commissioner the authority to reject health insurance rate increases. (Photo: Thinkstock)\u003c/figcaption>\u003c/figure>\n\u003cp>In more than 30 states, government insurance departments have the authority to reject what they determine to be excessive rate hikes for health insurance. But not in California. Earlier this month, consumer advocates launched a drive to put an initiative on the November ballot to let voters decide if California's Insurance Commissioner should have this power.\u003c/p>\n\u003cp>\"Right now, my sole authority over rates, if I find a rate to be unreasonable, is to sentence a health insurer to my website,\" joked \u003ca title=\"http://insurance.ca.gov/0500-about-us/0200-commissioner/\" href=\"http://insurance.ca.gov/0500-about-us/0200-commissioner/\" target=\"_blank\">Dave Jones\u003c/a>, California's Insurance Commissioner, in an interview.\u003c/p>\n\u003cp>That's a bit of an overstatement, as his department does review rates, making sure the math is right and ensuring there are no inaccuracies. Still, what the Department is left with is \"whatever element of the bully pulpit we have to try to rein those rates in,\" Jones says.\u003c!--more-->\u003c/p>\n\u003cp>Before he was Insurance Commissioner, Jones served as an Assemblyman. He says he introduced legislation in the State Assembly every year for seven years to give the Insurance Commissioner more authority over health insurance rates. But his bills never passed. When he was sworn in as Insurance Commissioner a year ago, he again authored legislation. It went through the House, but is a handful of votes short in the Senate, he says.\u003c/p>\n\u003cp>\"After having tried to accomplish this through the legislature for the last seven years,\" Jones says, \"I know only too well how influential the HMOs and the health insurers are in the state legislature. Time and time again, they've been able to block this legislation, so I think it's time we took this issue to the voters of California.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Enter \u003ca title=\"http://www.consumerwatchdog.org/\" href=\"http://www.consumerwatchdog.org/\" target=\"_blank\">Consumer Watchdog\u003c/a>--the Santa Monica advocacy group that in 1988 backed \u003ca title=\"http://www.insurance.ca.gov/0500-about-us/0500-organization/0400-rate-regulation/prop-103.cfm\" href=\"http://www.insurance.ca.gov/0500-about-us/0500-organization/0400-rate-regulation/prop-103.cfm\" target=\"_blank\">Proposition 103\u003c/a>. While most Californians associate Prop. 103 with auto insurance rate reform, the law also gives the Insurance Commissioner the right to reject rate hikes in property and casualty insurance. Now Consumer Watchdog is \u003ca title=\"http://www.justifyrates.org/\" href=\"http://www.justifyrates.org/\" target=\"_blank\">behind an effort\u003c/a> to give the Insurance Commissioner the same level of authority over health insurance rates. To quality for the November ballot, the group needs 505,000 valid signatures by May.\u003c/p>\n\u003cp>\"We're trying to get on the November ballot and we're doing it with as much volunteer energy as we can,\" said \u003ca title=\"http://www.consumerwatchdog.org/about/our-team\" href=\"http://www.consumerwatchdog.org/about/our-team\" target=\"_blank\">Jamie Court\u003c/a>, President of Consumer Watchdog. \"This is basically about making sure health insurance companies publicly justify their rates under penalty of perjury before they take effect. It's all about getting approval from the government.\"\u003c/p>\n\u003cp>U.S. Senator Dianne Feinstein has long backed this increased regulatory control. Today her office provided an email where the Senator says she was the first person to sign Consumer Watchdog's initiative. \"Consumer Watchdog's ballot measure would require health insurance companies to publicly justify their rates before rate hikes take effect,\" Feinstein wrote in the email.\u003c/p>\n\u003cp>In an opinion piece in the Sacramento Bee last summer, Feinstein wrote:\u003c/p>\n\u003cblockquote>\u003cp>Since 1999, average health insurance premiums for family policies have risen 138 percent, while medical inflation rose just 31 percent, putting insurance out of reach for millions of Californians.\u003c/p>\u003c/blockquote>\n\u003cp>For Valerie Burchfield-Rhodes of Laguna Niguel health insurance is still within reach, but at tremendous cost. She says health insurance is her family's biggest household expense each month, \"substantially more\" than their mortgage. In 2010, her family was paying $1,053 monthly, but in 2011 their premium jumped 36 percent to $1,434 a month with the highest deductible available to them--$7,000.\u003c/p>\n\u003cp>\"I flipped out,\" she told me. \"I was writing letters and contacting people and calling reporters and freaking out because it was so expensive.\" She estimates her family is currently paying $24,000 annually between premiums, the deductible and co-pays for some of her husband's treatment for diabetes.\u003c/p>\n\u003cp>But health insurers say additional regulation is unlikely to be a panacea. \"Rate regulation may sound appealing,\" said Steve Shivinsky, a spokesman for Blue Shield said last week in the\u003ca title=\"http://www.latimes.com/business/la-fi-0223-health-insurance-rate-hikes-20120223,0,7634380.story\" href=\"http://www.latimes.com/business/la-fi-0223-health-insurance-rate-hikes-20120223,0,7634380.story\" target=\"_blank\"> L.A. Times\u003c/a>, but \"It will layer in another complex bureaucratic level of rate review that will gum up the system.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Insurance Commissioner Jones anticipates a different response from health insurance companies. \"Now what the insurers argue [is] 'oh my gosh, if we give the Insurance Commissioner that authority, it's going to be the end of the world as we know it, and we're all going to stop writing insurance. We're going to leave the State of California.' In fact, they made that argument in 1988,\" Jones says in a reference to the Proposition 103 campaign. \"But in truth what happened was they continued to write insurance in California, we continue to have all of the major national insurers still writing insurance in all these product lines and they make a reasonable profit. But what was the best thing about Prop. 103, it saved consumers and business tens of billions of dollars.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "High-Risk Insurance Pool Helps ... But What About Cost?",
"title": "High-Risk Insurance Pool Helps ... But What About Cost?",
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"content": "\u003cp>\u003cstrong>By: Kamal Menghrajani\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_3303\" class=\"wp-caption alignleft\" style=\"max-width: 245px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Man_HospitalBed_DSharonPruitt_Flickr_02242012.jpg\">\u003cimg class=\"size-medium wp-image-3303 \" title=\"Because many people who enroll in the pool have been uninsured, there is pent-up demand for health care, experts say. (D. Sharon Pruitt: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Man_HospitalBed_DSharonPruitt_Flickr_02242012-300x366.jpg\" alt=\"Because people who enroll in the pool have been uninsured, there is pent-up demand for health care, experts say. (D. Sharon Pruitt: Flickr)\" width=\"245\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Because people who enroll in the pool have been uninsured, there is pent-up demand for health care, experts say. (D. Sharon Pruitt: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Thousands of California’s sickest residents are already benefitting from the federal health care law. The Affordable Care Act says that people cannot be denied health insurance for a pre-existing condition. Until the law goes into full effect in 2014, the government has created a bridge program to help--the \u003ca title=\"https://pcip.gov/\" href=\"https://pcip.gov/\" target=\"_blank\">Pre-Existing Condition Insurance Plan\u003c/a>, or PCIP. But this high-risk insurance program is proving to be much more expensive than expected.\u003c/p>\n\u003cp>California is spending three times more than anticipated to insure the people who have enrolled in this program. Before the program launched in 2010, California projected that the program would cost about $12,000 a year for each member. But a year later the administrators of the program determined it was costing more than $37,000 per patient.\u003c/p>\n\u003cp>According to \u003ca title=\"http://www.cciio.cms.gov/resources/files/Files2/02242012/pcip-annual-report.pdf\" href=\"http://www.cciio.cms.gov/resources/files/Files2/02242012/pcip-annual-report.pdf\" target=\"_blank\">a report\u003c/a> [PDF] from the White House, the cost of care for PCIP patients across the country is twice as much as originally projected.\u003c!--more-->\u003c/p>\n\u003cp>As the \u003ca title=\"http://www.washingtonpost.com/national/health-science/per-person-cost-of-federal-high-risk-medical-plan-doubles/2012/02/23/gIQAX3xVWR_story.html\" href=\"http://www.washingtonpost.com/national/health-science/per-person-cost-of-federal-high-risk-medical-plan-doubles/2012/02/23/gIQAX3xVWR_story.html\" target=\"_blank\">Washington Post \u003c/a>reports:\u003c/p>\n\u003cblockquote>\u003cp>Those who have enrolled in the program are projected to have significantly higher medical costs than the government initially expected. Each participant is expected to average $28,994 in medical costs in 2012, according to the report, more than double what government-contracted actuaries predicted in November 2010. Then, the analysts expected that the program would cost $13,026 per enrollee.\u003c/p>\u003c/blockquote>\n\u003cp>Looking beyond costs, thousands of people across California are being helped by this plan. Some had been denied coverage because they carry a diagnosis of cancer, heart disease, or kidney failure. Others found that the only insurance they could get was excessively costly, with rates of thousands of dollars per month.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When Gabe Chavez, a 39-year-old father of two from Alameda, was first diagnosed with Type II diabetes, he was only worried about treatment, because he had health insurance.\u003c/p>\n\u003cp>“All the horrible stories hit your mind. I’m going to die. I’m going to lose a leg.” He knew it would be important to change his lifestyle and felt comforted by his doctor’s support. “You know, it’s treatable,” he told me.\u003c/p>\n\u003cp>But then Chavez’s company was sold, and the new owners did not provide health insurance. So he went looking for coverage on his own, making innumerable phone calls to insurance providers. “I would say, on a daily basis, I spent two to three hours.”\u003c/p>\n\u003cp>He went on like this for eight months.\u003c/p>\n\u003cp>“Everyday, I would call and see if I could get insurance. I even tried to get it from another state. I exhausted every avenue I could find.”\u003c/p>\n\u003cp>But nobody would provide insurance at a reasonable price. He was paying around $160 to cover his wife and two kids under Blue Cross. To get coverage for himself would have cost an additional $1,200.\u003c/p>\n\u003cp>Finally, Chavez heard about \u003ca title=\"http://www.pcip.ca.gov/\" href=\"http://www.pcip.ca.gov/\" target=\"_blank\">California's Pre-Existing Condition Insurance Plan\u003c/a> and after going for months without insurance, he was able to get coverage for doctor visits and the medications he needed.\u003c/p>\n\u003cp>Currently, 6,861 Californians are enrolled in the program. By law, they must have been previously uninsured for 6 months or more. This gap in coverage might be the reason why insuring them is so costly.\u003c/p>\n\u003cp>“Because they haven’t had health care for a while, they have this pent-up demand,” says Jeanie Esajian, a spokesperson for the\u003ca title=\"http://www.mrmib.ca.gov/\" href=\"http://www.mrmib.ca.gov/\" target=\"_blank\"> state governmental group\u003c/a> that runs PCIP here.\u003c/p>\n\u003cp>“They need medical tests, have surgeries they put off, maybe they have a chronic condition they couldn’t quite get under control,\" Esajian told me.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In a sense, Chavez dodged a bullet. He was able to maintain his health during the time he did not have insurance. He now pays $350 a month for coverage, a rate he says he can afford. For him, though, a psychic burden is eased. He had been worried about all kinds of complications--including a diabetic coma. \"I just didn’t want to die,\" he says. \"Health is probably one of the most important things, next to marriage and family. And you want to say healthy for them.\"\u003c/p>\n\n",
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"excerpt": "Thousands of California’s sickest residents are already benefitting from the federal health care law. The Affordable Care Act says that people cannot be denied health insurance for a pre-existing condition. Until the law goes into full effect in 2014, the government has created a bridge program to help--the Pre-Existing Condition Insurance Plan, or PCIP. But this high-risk insurance program is proving to be much more expensive than expected.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By: Kamal Menghrajani\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_3303\" class=\"wp-caption alignleft\" style=\"max-width: 245px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Man_HospitalBed_DSharonPruitt_Flickr_02242012.jpg\">\u003cimg class=\"size-medium wp-image-3303 \" title=\"Because many people who enroll in the pool have been uninsured, there is pent-up demand for health care, experts say. (D. Sharon Pruitt: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Man_HospitalBed_DSharonPruitt_Flickr_02242012-300x366.jpg\" alt=\"Because people who enroll in the pool have been uninsured, there is pent-up demand for health care, experts say. (D. Sharon Pruitt: Flickr)\" width=\"245\" height=\"300\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Because people who enroll in the pool have been uninsured, there is pent-up demand for health care, experts say. (D. Sharon Pruitt: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Thousands of California’s sickest residents are already benefitting from the federal health care law. The Affordable Care Act says that people cannot be denied health insurance for a pre-existing condition. Until the law goes into full effect in 2014, the government has created a bridge program to help--the \u003ca title=\"https://pcip.gov/\" href=\"https://pcip.gov/\" target=\"_blank\">Pre-Existing Condition Insurance Plan\u003c/a>, or PCIP. But this high-risk insurance program is proving to be much more expensive than expected.\u003c/p>\n\u003cp>California is spending three times more than anticipated to insure the people who have enrolled in this program. Before the program launched in 2010, California projected that the program would cost about $12,000 a year for each member. But a year later the administrators of the program determined it was costing more than $37,000 per patient.\u003c/p>\n\u003cp>According to \u003ca title=\"http://www.cciio.cms.gov/resources/files/Files2/02242012/pcip-annual-report.pdf\" href=\"http://www.cciio.cms.gov/resources/files/Files2/02242012/pcip-annual-report.pdf\" target=\"_blank\">a report\u003c/a> [PDF] from the White House, the cost of care for PCIP patients across the country is twice as much as originally projected.\u003c!--more-->\u003c/p>\n\u003cp>As the \u003ca title=\"http://www.washingtonpost.com/national/health-science/per-person-cost-of-federal-high-risk-medical-plan-doubles/2012/02/23/gIQAX3xVWR_story.html\" href=\"http://www.washingtonpost.com/national/health-science/per-person-cost-of-federal-high-risk-medical-plan-doubles/2012/02/23/gIQAX3xVWR_story.html\" target=\"_blank\">Washington Post \u003c/a>reports:\u003c/p>\n\u003cblockquote>\u003cp>Those who have enrolled in the program are projected to have significantly higher medical costs than the government initially expected. Each participant is expected to average $28,994 in medical costs in 2012, according to the report, more than double what government-contracted actuaries predicted in November 2010. Then, the analysts expected that the program would cost $13,026 per enrollee.\u003c/p>\u003c/blockquote>\n\u003cp>Looking beyond costs, thousands of people across California are being helped by this plan. Some had been denied coverage because they carry a diagnosis of cancer, heart disease, or kidney failure. Others found that the only insurance they could get was excessively costly, with rates of thousands of dollars per month.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When Gabe Chavez, a 39-year-old father of two from Alameda, was first diagnosed with Type II diabetes, he was only worried about treatment, because he had health insurance.\u003c/p>\n\u003cp>“All the horrible stories hit your mind. I’m going to die. I’m going to lose a leg.” He knew it would be important to change his lifestyle and felt comforted by his doctor’s support. “You know, it’s treatable,” he told me.\u003c/p>\n\u003cp>But then Chavez’s company was sold, and the new owners did not provide health insurance. So he went looking for coverage on his own, making innumerable phone calls to insurance providers. “I would say, on a daily basis, I spent two to three hours.”\u003c/p>\n\u003cp>He went on like this for eight months.\u003c/p>\n\u003cp>“Everyday, I would call and see if I could get insurance. I even tried to get it from another state. I exhausted every avenue I could find.”\u003c/p>\n\u003cp>But nobody would provide insurance at a reasonable price. He was paying around $160 to cover his wife and two kids under Blue Cross. To get coverage for himself would have cost an additional $1,200.\u003c/p>\n\u003cp>Finally, Chavez heard about \u003ca title=\"http://www.pcip.ca.gov/\" href=\"http://www.pcip.ca.gov/\" target=\"_blank\">California's Pre-Existing Condition Insurance Plan\u003c/a> and after going for months without insurance, he was able to get coverage for doctor visits and the medications he needed.\u003c/p>\n\u003cp>Currently, 6,861 Californians are enrolled in the program. By law, they must have been previously uninsured for 6 months or more. This gap in coverage might be the reason why insuring them is so costly.\u003c/p>\n\u003cp>“Because they haven’t had health care for a while, they have this pent-up demand,” says Jeanie Esajian, a spokesperson for the\u003ca title=\"http://www.mrmib.ca.gov/\" href=\"http://www.mrmib.ca.gov/\" target=\"_blank\"> state governmental group\u003c/a> that runs PCIP here.\u003c/p>\n\u003cp>“They need medical tests, have surgeries they put off, maybe they have a chronic condition they couldn’t quite get under control,\" Esajian told me.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In a sense, Chavez dodged a bullet. He was able to maintain his health during the time he did not have insurance. He now pays $350 a month for coverage, a rate he says he can afford. For him, though, a psychic burden is eased. He had been worried about all kinds of complications--including a diabetic coma. \"I just didn’t want to die,\" he says. \"Health is probably one of the most important things, next to marriage and family. And you want to say healthy for them.\"\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "New Supply of Cancer Drugs ... from Abroad",
"title": "New Supply of Cancer Drugs ... from Abroad",
"headTitle": "State of Health | KQED News",
"content": "\u003cfigure id=\"attachment_3247\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Vials_Zaldylmg_Flickr_02222012.jpg\">\u003cimg class=\"size-medium wp-image-3247\" title=\"(Zaldylmg: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Vials_Zaldylmg_Flickr_02222012-300x225.jpg\" alt=\"(Zaldylmg: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Zaldylmg: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Stories of critical drug shortages--including cancer drugs--have been \u003ca title=\"http://www.npr.org/blogs/health/2011/10/04/140958404/shortages-lead-doctors-to-ration-critical-drugs\" href=\"http://www.npr.org/blogs/health/2011/10/04/140958404/shortages-lead-doctors-to-ration-critical-drugs\" target=\"_blank\">making news\u003c/a> for months. Now the Food and Drug Administration is \u003ca title=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm292658.htm\" href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm292658.htm\" target=\"_blank\">announcing\u003c/a> that replacement supplies of two of those drugs, Doxil and methotrexate, should be available within weeks.\u003c/p>\n\u003cp>Both drugs are used to treat cancer. Methotrexate is used for many conditions, but of particular concern is its use for a type of childhood leukemia. If a child does not get the drug, the cancer can easily recur.\u003c/p>\n\u003cp>As the \u003ca title=\"http://www.nytimes.com/2012/02/22/health/policy/fda-approves-imports-amid-shortage-of-2-cancer-drugs.html?ref=health\" href=\"http://www.nytimes.com/2012/02/22/health/policy/fda-approves-imports-amid-shortage-of-2-cancer-drugs.html?ref=health\" target=\"_blank\">New York Times reports\u003c/a>, some experts say the new supplies are only a temporary solution:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>Dr. Peter C. Adamson, chairman of the \u003ca title=\"Web site\" href=\"http://www.childrensoncologygroup.org/\">Children’s Oncology Group\u003c/a>, which is financed by the \u003ca title=\"Web site\" href=\"http://cancer.gov/\">National Cancer Institute\u003c/a>, said he was pleased that the immediate threat of a methotrexate shortage had passed. “But this is at best a Band-Aid approach to the problem,” he said.\u003c/p>\n\u003cp>Shortages of both drugs developed when \u003ca title=\"Message about shortage\" href=\"http://www.benvenue.com/\">Ben Venue Laboratories\u003c/a> temporarily closed its manufacturing facility in Bedford, Ohio, because it could not guarantee product safety.\u003c/p>\n\u003cp>In the case of Doxil, which is used to treat \u003ca title=\"In-depth reference and news articles about Ovarian Cancer.\" href=\"http://health.nytimes.com/health/guides/disease/ovarian-cancer/overview.html?inline=nyt-classifier\">ovarian cancer\u003c/a>, \u003ca title=\"In-depth reference and news articles about Multiple myeloma.\" href=\"http://health.nytimes.com/health/guides/disease/multiple-myeloma/overview.html?inline=nyt-classifier\">multiple myeloma\u003c/a> and \u003ca title=\"In-depth reference and news articles about AIDS/H.I.V..\" href=\"http://health.nytimes.com/health/guides/disease/aids/overview.html?inline=nyt-classifier\">AIDS\u003c/a>-related Kaposi’s sarcoma, the F.D.A. has decided to allow temporary shipments from India of Lipodox, which is similar to Doxil and is made by Sun Pharma Global.\u003c/p>\u003c/blockquote>\n\u003cp>The FDA says it is also permitting the pharmaceutical company \u003ca title=\"http://www.hospira.com/Products/pharmaceuticals.aspx\" href=\"http://www.hospira.com/Products/pharmaceuticals.aspx\" target=\"_blank\">Hospira\u003c/a> to ship 31,000 vials of methotrexate from its overseas facilities to hospitals and treatment centers across the U.S. This quantity of vials is enough to meet U.S. demand for one month.\u003c/p>\n\u003cp>At UC San Francisco, oncologist \u003ca title=\"http://cancer.ucsf.edu/people/venook_alan.php\" href=\"http://cancer.ucsf.edu/people/venook_alan.php\" target=\"_blank\">Alan Venook\u003c/a>, said drug shortages have affected his practice as well. But he expressed concern about drugs coming from overseas. \"You do worry about quality assurance, this is a real issue,\" he told me. \"is it a good solution? I don't think so, but it probably will be fine.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Venook treats patients with gastrointestinal cancers. Last summer, his group experienced a shortage of a chemotherapy drug. \"We didn't have enough drug for all 40 patients we would have treated,\" he said. \"Each week we would have a conference call on Thursday where we would decide who we were going to treat next week.\"\u003c/p>\n\u003cp>One of those 40 patients was Jay Cuetara who was being treated for stage 4 rectal cancer. One day last August he came to the clinic, only to discover there was no drug for him. \"I was shocked,\" he said. \"I wasn't angry. I was shocked. How can we not have the drug I need in the United States? How does that work?\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Ultimately, that one session was the only one he missed. But that was all it took. He has become an activist on the issue and has testified before Congress. There are bills before both the House and the Senate to give the FDA more legal authority to prevent drug shortages.\u003c/p>\n\n",
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"excerpt": "Stories of critical drug shortages--including cancer drugs--have been making news for months. Now the Food and Drug Administration is announcing that replacement supplies of two of those drugs, Doxil and methotrexate, should be available within weeks.\r\n\r\nBoth drugs are used to treat cancer. Methotrexate is used for many conditions, but of particular concern is its use for a type of childhood leukemia. If a child does not get the drug, the cancer can easily recur.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_3247\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Vials_Zaldylmg_Flickr_02222012.jpg\">\u003cimg class=\"size-medium wp-image-3247\" title=\"(Zaldylmg: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Vials_Zaldylmg_Flickr_02222012-300x225.jpg\" alt=\"(Zaldylmg: Flickr)\" width=\"300\" height=\"225\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Zaldylmg: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Stories of critical drug shortages--including cancer drugs--have been \u003ca title=\"http://www.npr.org/blogs/health/2011/10/04/140958404/shortages-lead-doctors-to-ration-critical-drugs\" href=\"http://www.npr.org/blogs/health/2011/10/04/140958404/shortages-lead-doctors-to-ration-critical-drugs\" target=\"_blank\">making news\u003c/a> for months. Now the Food and Drug Administration is \u003ca title=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm292658.htm\" href=\"http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm292658.htm\" target=\"_blank\">announcing\u003c/a> that replacement supplies of two of those drugs, Doxil and methotrexate, should be available within weeks.\u003c/p>\n\u003cp>Both drugs are used to treat cancer. Methotrexate is used for many conditions, but of particular concern is its use for a type of childhood leukemia. If a child does not get the drug, the cancer can easily recur.\u003c/p>\n\u003cp>As the \u003ca title=\"http://www.nytimes.com/2012/02/22/health/policy/fda-approves-imports-amid-shortage-of-2-cancer-drugs.html?ref=health\" href=\"http://www.nytimes.com/2012/02/22/health/policy/fda-approves-imports-amid-shortage-of-2-cancer-drugs.html?ref=health\" target=\"_blank\">New York Times reports\u003c/a>, some experts say the new supplies are only a temporary solution:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>Dr. Peter C. Adamson, chairman of the \u003ca title=\"Web site\" href=\"http://www.childrensoncologygroup.org/\">Children’s Oncology Group\u003c/a>, which is financed by the \u003ca title=\"Web site\" href=\"http://cancer.gov/\">National Cancer Institute\u003c/a>, said he was pleased that the immediate threat of a methotrexate shortage had passed. “But this is at best a Band-Aid approach to the problem,” he said.\u003c/p>\n\u003cp>Shortages of both drugs developed when \u003ca title=\"Message about shortage\" href=\"http://www.benvenue.com/\">Ben Venue Laboratories\u003c/a> temporarily closed its manufacturing facility in Bedford, Ohio, because it could not guarantee product safety.\u003c/p>\n\u003cp>In the case of Doxil, which is used to treat \u003ca title=\"In-depth reference and news articles about Ovarian Cancer.\" href=\"http://health.nytimes.com/health/guides/disease/ovarian-cancer/overview.html?inline=nyt-classifier\">ovarian cancer\u003c/a>, \u003ca title=\"In-depth reference and news articles about Multiple myeloma.\" href=\"http://health.nytimes.com/health/guides/disease/multiple-myeloma/overview.html?inline=nyt-classifier\">multiple myeloma\u003c/a> and \u003ca title=\"In-depth reference and news articles about AIDS/H.I.V..\" href=\"http://health.nytimes.com/health/guides/disease/aids/overview.html?inline=nyt-classifier\">AIDS\u003c/a>-related Kaposi’s sarcoma, the F.D.A. has decided to allow temporary shipments from India of Lipodox, which is similar to Doxil and is made by Sun Pharma Global.\u003c/p>\u003c/blockquote>\n\u003cp>The FDA says it is also permitting the pharmaceutical company \u003ca title=\"http://www.hospira.com/Products/pharmaceuticals.aspx\" href=\"http://www.hospira.com/Products/pharmaceuticals.aspx\" target=\"_blank\">Hospira\u003c/a> to ship 31,000 vials of methotrexate from its overseas facilities to hospitals and treatment centers across the U.S. This quantity of vials is enough to meet U.S. demand for one month.\u003c/p>\n\u003cp>At UC San Francisco, oncologist \u003ca title=\"http://cancer.ucsf.edu/people/venook_alan.php\" href=\"http://cancer.ucsf.edu/people/venook_alan.php\" target=\"_blank\">Alan Venook\u003c/a>, said drug shortages have affected his practice as well. But he expressed concern about drugs coming from overseas. \"You do worry about quality assurance, this is a real issue,\" he told me. \"is it a good solution? I don't think so, but it probably will be fine.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Venook treats patients with gastrointestinal cancers. Last summer, his group experienced a shortage of a chemotherapy drug. \"We didn't have enough drug for all 40 patients we would have treated,\" he said. \"Each week we would have a conference call on Thursday where we would decide who we were going to treat next week.\"\u003c/p>\n\u003cp>One of those 40 patients was Jay Cuetara who was being treated for stage 4 rectal cancer. One day last August he came to the clinic, only to discover there was no drug for him. \"I was shocked,\" he said. \"I wasn't angry. I was shocked. How can we not have the drug I need in the United States? How does that work?\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Ultimately, that one session was the only one he missed. But that was all it took. He has become an activist on the issue and has testified before Congress. There are bills before both the House and the Senate to give the FDA more legal authority to prevent drug shortages.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_3185\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Aging_Healthy_Patrick_Flickr_02212012.jpg\">\u003cimg class=\"size-medium wp-image-3185\" title=\"(Patrick: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Aging_Healthy_Patrick_Flickr_02212012-300x240.jpg\" alt=\"(Patrick: Flickr)\" width=\"300\" height=\"240\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Patrick: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Researchers and health advocates have long been encouraging people to make their end-of-life wishes known. While most people say they want to die a natural death at home, \u003ca title=\"http://ww2.kqed.org/stateofhealth/2012/02/14/disparity-between-preferences-and-actions-in-end-of-life-care/\" href=\"http://ww2.kqed.org/stateofhealth/2012/02/14/disparity-between-preferences-and-actions-in-end-of-life-care/\" target=\"_blank\">few actually put those wishes into writing\u003c/a>.\u003c/p>\n\u003cp>But at least equally important is thinking about how to enjoy quality of life while aging. A new book seeks to help people address these questions. \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/February/21/nortin-hadler-q-and-a.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/February/21/nortin-hadler-q-and-a.aspx\" target=\"_blank\">Kaiser Health News\u003c/a> interviewed \u003ca title=\"http://tarc.med.unc.edu/facultymem.php?id=25\" href=\"http://tarc.med.unc.edu/facultymem.php?id=25\" target=\"_blank\">Nortin Hadler\u003c/a>, the author of “\u003ca title=\"http://uncpress.unc.edu/books/T-9195.html\" href=\"http://uncpress.unc.edu/books/T-9195.html\" target=\"_blank\">Rethinking Aging\u003c/a>.”\u003c/p>\n\u003cp>I especially like the book's tagline: \"Growing Old and Living Well in an Overtreated Society.\" Hadler is concerned about the medicalization of aging. “We’re taught and marketed that all changes in appearance and in function in older people are forms of disease that demand treatment,\" he told Kaiser Health News. \"But often, that isn’t true. Much that is termed a disease is a normal aspect of this time of life and needs to be viewed as such.”\u003c!--more-->\u003c/p>\n\u003cp>The Kaiser Health News interview goes on:\u003c/p>\n\u003cblockquote>\u003cp>\u003cstrong>Q: You talk a lot about the importance of older people making informed medical decisions.\u003c/strong>\u003c/p>\n\u003cp>A: For the first time in the history of medicine, we have a tremendous amount of information about efficacy: what makes sense to do medically and what doesn’t.\u003c/p>\n\u003cp>What I want to teach people is that it's perfectly appropriate for patients to ask their doctors, \"How certain are you that what you are offering me will produce meaningful benefits? What does the evidence show about the possibility of harm?\"\u003c/p>\n\u003cp>\u003cstrong>Q: Can you suggest some other questions people might ask?\u003c/strong>\u003c/p>\n\u003cp>A: People should want to know the likelihood that death will be postponed by doing something. What is the likelihood of the same outcome, or close to the same, if one doesn’t have the treatment? Out of every 100 people, how many are helped by this intervention?\u003c/p>\u003c/blockquote>\n\u003cp>This last point--how many are helped by an intervention--is particularly relevant. The doctor is referring to \u003ca title=\"http://ww2.kqed.org/stateofhealth/2011/11/08/5-things-to-know-before-starting-a-new-drug/\" href=\"http://ww2.kqed.org/stateofhealth/2011/11/08/5-things-to-know-before-starting-a-new-drug/\" target=\"_blank\">relative risk\u003c/a>. You might hear a drug ad claim that “twice as many people” avoided a heart attack, stroke or some other dire health consequence. But if the likelihood of that dire thing happening to you was only one in 100 to begin with, do you really want to try an intervention and risk the side effects that go along with it?\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In the interview, Hadler also puts the issue of informed medical decision making into context for people with a serious, life threatening illness:\u003c/p>\n\u003cblockquote>\u003cp>You want to know whether a proposed intervention will be effective given your context: your age, your degree of frailty, other illnesses that you have. How much benefit will you get: an extra three months, an extra year? If it’s a year, what kind of year will it be? Will I feel absolutely awful? What will the quality of my life be?\u003c/p>\n\u003cp>I once took care of a very, very famous physician. He was an octogenarian with heart disease, but he was very active and sharp as a tack. Well, he found out that in his belly was an expanding aortic aneurism – a surgically treatable potential killer. He and I had multiple conversations about what to do and each time he would say, “I’ll be damned if I let them do surgery on me.” He knew there was a high risk of surgical mortality because of his age and his frailty. He knew that urological complications were almost guaranteed and cardiac complications were probable. He didn’t want to try to live through that. And he didn’t have to because he died of a stroke, unrelated to the aneurism, several years later.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>You can read the entire interview \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/February/21/nortin-hadler-q-and-a.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/February/21/nortin-hadler-q-and-a.aspx\" target=\"_blank\">here\u003c/a>.\u003c/p>\n\n",
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"excerpt": "Researchers and health advocates have long been encouraging people to make their end-of-life wishes known. While most people say they want to die a natural death at home, few actually put those wishes into writing.\r\n\r\nBut at least equally important is thinking about how to enjoy quality of life while aging. A new book seeks to help people address these questions. Kaiser Health News interviewed Nortin Hadler, the author of “Rethinking Aging.” I especially like the book's tagline: \"Growing Old and Living Well in an Overtreated Society.\"",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_3185\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Aging_Healthy_Patrick_Flickr_02212012.jpg\">\u003cimg class=\"size-medium wp-image-3185\" title=\"(Patrick: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Aging_Healthy_Patrick_Flickr_02212012-300x240.jpg\" alt=\"(Patrick: Flickr)\" width=\"300\" height=\"240\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Patrick: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Researchers and health advocates have long been encouraging people to make their end-of-life wishes known. While most people say they want to die a natural death at home, \u003ca title=\"http://ww2.kqed.org/stateofhealth/2012/02/14/disparity-between-preferences-and-actions-in-end-of-life-care/\" href=\"http://ww2.kqed.org/stateofhealth/2012/02/14/disparity-between-preferences-and-actions-in-end-of-life-care/\" target=\"_blank\">few actually put those wishes into writing\u003c/a>.\u003c/p>\n\u003cp>But at least equally important is thinking about how to enjoy quality of life while aging. A new book seeks to help people address these questions. \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/February/21/nortin-hadler-q-and-a.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/February/21/nortin-hadler-q-and-a.aspx\" target=\"_blank\">Kaiser Health News\u003c/a> interviewed \u003ca title=\"http://tarc.med.unc.edu/facultymem.php?id=25\" href=\"http://tarc.med.unc.edu/facultymem.php?id=25\" target=\"_blank\">Nortin Hadler\u003c/a>, the author of “\u003ca title=\"http://uncpress.unc.edu/books/T-9195.html\" href=\"http://uncpress.unc.edu/books/T-9195.html\" target=\"_blank\">Rethinking Aging\u003c/a>.”\u003c/p>\n\u003cp>I especially like the book's tagline: \"Growing Old and Living Well in an Overtreated Society.\" Hadler is concerned about the medicalization of aging. “We’re taught and marketed that all changes in appearance and in function in older people are forms of disease that demand treatment,\" he told Kaiser Health News. \"But often, that isn’t true. Much that is termed a disease is a normal aspect of this time of life and needs to be viewed as such.”\u003c!--more-->\u003c/p>\n\u003cp>The Kaiser Health News interview goes on:\u003c/p>\n\u003cblockquote>\u003cp>\u003cstrong>Q: You talk a lot about the importance of older people making informed medical decisions.\u003c/strong>\u003c/p>\n\u003cp>A: For the first time in the history of medicine, we have a tremendous amount of information about efficacy: what makes sense to do medically and what doesn’t.\u003c/p>\n\u003cp>What I want to teach people is that it's perfectly appropriate for patients to ask their doctors, \"How certain are you that what you are offering me will produce meaningful benefits? What does the evidence show about the possibility of harm?\"\u003c/p>\n\u003cp>\u003cstrong>Q: Can you suggest some other questions people might ask?\u003c/strong>\u003c/p>\n\u003cp>A: People should want to know the likelihood that death will be postponed by doing something. What is the likelihood of the same outcome, or close to the same, if one doesn’t have the treatment? Out of every 100 people, how many are helped by this intervention?\u003c/p>\u003c/blockquote>\n\u003cp>This last point--how many are helped by an intervention--is particularly relevant. The doctor is referring to \u003ca title=\"http://ww2.kqed.org/stateofhealth/2011/11/08/5-things-to-know-before-starting-a-new-drug/\" href=\"http://ww2.kqed.org/stateofhealth/2011/11/08/5-things-to-know-before-starting-a-new-drug/\" target=\"_blank\">relative risk\u003c/a>. You might hear a drug ad claim that “twice as many people” avoided a heart attack, stroke or some other dire health consequence. But if the likelihood of that dire thing happening to you was only one in 100 to begin with, do you really want to try an intervention and risk the side effects that go along with it?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In the interview, Hadler also puts the issue of informed medical decision making into context for people with a serious, life threatening illness:\u003c/p>\n\u003cblockquote>\u003cp>You want to know whether a proposed intervention will be effective given your context: your age, your degree of frailty, other illnesses that you have. How much benefit will you get: an extra three months, an extra year? If it’s a year, what kind of year will it be? Will I feel absolutely awful? What will the quality of my life be?\u003c/p>\n\u003cp>I once took care of a very, very famous physician. He was an octogenarian with heart disease, but he was very active and sharp as a tack. Well, he found out that in his belly was an expanding aortic aneurism – a surgically treatable potential killer. He and I had multiple conversations about what to do and each time he would say, “I’ll be damned if I let them do surgery on me.” He knew there was a high risk of surgical mortality because of his age and his frailty. He knew that urological complications were almost guaranteed and cardiac complications were probable. He didn’t want to try to live through that. And he didn’t have to because he died of a stroke, unrelated to the aneurism, several years later.\u003c/p>\u003c/blockquote>\n\u003cp>\u003c/p>\n\u003cp>You can read the entire interview \u003ca title=\"http://www.kaiserhealthnews.org/Stories/2012/February/21/nortin-hadler-q-and-a.aspx\" href=\"http://www.kaiserhealthnews.org/Stories/2012/February/21/nortin-hadler-q-and-a.aspx\" target=\"_blank\">here\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Law Seeks to Stop Fake Prescription Drugs",
"title": "Law Seeks to Stop Fake Prescription Drugs",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cstrong>By: Sarah Varney\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_3146\" class=\"wp-caption aligncenter\" style=\"max-width: 597px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/ArtyPills_Eric_Flickr_02202012.jpg\">\u003cimg class=\"size-full wp-image-3146\" title=\"(Eric: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/ArtyPills_Eric_Flickr_02202012.jpg\" alt=\"(Eric: Flickr)\" width=\"597\" height=\"457\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2012/02/ArtyPills_Eric_Flickr_02202012.jpg 597w, https://ww2.kqed.org/app/uploads/sites/27/2012/02/ArtyPills_Eric_Flickr_02202012-400x306.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2012/02/ArtyPills_Eric_Flickr_02202012-320x245.jpg 320w\" sizes=\"(max-width: 597px) 100vw, 597px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Eric: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The \u003ca title=\"http://www.fda.gov/Drugs/DrugSafety/ucm291960.htm?utm_source=fda&utm_medium=website&utm_term=Aspirin&utm_content=f1&utm_campaign=HomePageSpotlight\" href=\"http://www.fda.gov/Drugs/DrugSafety/ucm291960.htm?utm_source=fda&utm_medium=website&utm_term=Aspirin&utm_content=f1&utm_campaign=HomePageSpotlight\" target=\"_blank\">announcement\u003c/a> by the \u003ca title=\"http://www.fda.gov/\" href=\"http://www.fda.gov/\" target=\"_blank\">Food and Drug Administration\u003c/a> last week that \u003ca title=\"http://ww2.kqed.org/stateofhealth/2012/02/16/fda-warns-california-clinics-of-fake-avastin/\" href=\"http://ww2.kqed.org/stateofhealth/2012/02/16/fda-warns-california-clinics-of-fake-avastin/\" target=\"_blank\">sixteen California clinics and physicians were sold bogus vials\u003c/a> of the cancer drug Avastin did not surprise regulators and researchers who study the counterfeit drug trade.\u003c/p>\n\u003cp>Indeed, it was after fake AIDS drugs were discovered in California that state legislators passed the \"\u003ca title=\"http://www.pharmacy.ca.gov/about/e_pedigree.shtml\" href=\"http://www.pharmacy.ca.gov/about/e_pedigree.shtml\" target=\"_blank\">e-pedigree law\u003c/a>\" mandating that all prescription drugs carry an electronic tag. The tag could be scanned to show where the drug was first manufactured and every stop along its way to market.\u003c/p>\n\u003cp>Since the law passed in 2004, biotech and pharmaceutical trade groups fought to delay its implementation. They argued, successfully, that the electronic track-and-trace system would up-end global drug manufacturing.\u003c!--more-->\u003c/p>\n\u003cp>Finally the system is going into effect, says \u003ca title=\"http://www.pharmacy.ca.gov/about/executive_staff.shtml\" href=\"http://www.pharmacy.ca.gov/about/executive_staff.shtml\" target=\"_blank\">Virginia Herold\u003c/a>, head of the state Board of Pharmacy. But it will still be awhile. \"In January 2015, 50 percent of a manufacturer’s products that will be sold into California have to have this unique serialized number of each container,\" she says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The remaining half must have the serialized numbers by the following year -- and in subsequent years the system will become more robust. Herold says the the electronic tags can stop incidents like the recent sale of the adulterated Avastin.\u003c/p>\n\u003cp>\"The wholesaler, when it purchased the product would have had to certify, 'Yes, I just bought this from Roche.' Well, Roche didn’t manufacture the product. Somebody else did.\"\u003c/p>\n\u003cp>But \u003ca title=\"http://anesthesia.ucsd.edu/research/faculty-research/Pages/bryan-liang.aspx\" href=\"http://anesthesia.ucsd.edu/research/faculty-research/Pages/bryan-liang.aspx\" target=\"_blank\">Brian Liang\u003c/a>, Director of the Center for Patient Safety at UC San Diego, says electronic tags won’t end the fake drug business, because counterfeiters often avoid wholesalers. \"These are people who are coming at it from a completely different underground approach,\" he says.\u003c/p>\n\u003cp>Liang says counterfeiters will try to sell directly to clinics and doctors by bombarding them with faxes advertising cheap drugs. But there are resources available now, he says, that clinics and patients can turn to.\u003c/p>\n\u003cp>\"We have authorized wholesalers who are in fact listed by the government and \u003ca title=\"http://www.nabp.net/\" href=\"http://www.nabp.net/\" target=\"_blank\">National Association of Boards of Pharmacy\u003c/a>, they also list wholesalers. If it’s a source you’re not familiar with you really should find out: Is this source legitimate?\"\u003c/p>\n\u003cp>State regulators say about 1 percent of the 400 million prescriptions dispersed in California each year are fake. That’s about four million prescriptions that have too little or too much of the right active ingredients or no active ingredients at all.\u003c/p>\n\u003cp>\u003cstrong>Listen to the Story:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\">\u003cparam name=\"movie\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201202200850a.xml\">\u003cembed src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" type=\"application/x-shockwave-flash\" width=\"335\" height=\"85\" flashvars=\"file=http://www.kqed.org/radio/archives/R201202200850a.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n",
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"excerpt": "The announcement by the Food and Drug Administration last week that sixteen California clinics and physicians were sold bogus vials of the cancer drug Avastin did not surprise regulators and researchers who study the counterfeit drug trade.\r\n\r\nIndeed, it was after fake AIDS drugs were discovered in California that state legislators passed a law mandating that all prescription drugs carry an electronic tag. The tag could be scanned to show where the drug was first manufactured and every stop along its way to market.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By: Sarah Varney\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_3146\" class=\"wp-caption aligncenter\" style=\"max-width: 597px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/ArtyPills_Eric_Flickr_02202012.jpg\">\u003cimg class=\"size-full wp-image-3146\" title=\"(Eric: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/ArtyPills_Eric_Flickr_02202012.jpg\" alt=\"(Eric: Flickr)\" width=\"597\" height=\"457\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2012/02/ArtyPills_Eric_Flickr_02202012.jpg 597w, https://ww2.kqed.org/app/uploads/sites/27/2012/02/ArtyPills_Eric_Flickr_02202012-400x306.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2012/02/ArtyPills_Eric_Flickr_02202012-320x245.jpg 320w\" sizes=\"(max-width: 597px) 100vw, 597px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Eric: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The \u003ca title=\"http://www.fda.gov/Drugs/DrugSafety/ucm291960.htm?utm_source=fda&utm_medium=website&utm_term=Aspirin&utm_content=f1&utm_campaign=HomePageSpotlight\" href=\"http://www.fda.gov/Drugs/DrugSafety/ucm291960.htm?utm_source=fda&utm_medium=website&utm_term=Aspirin&utm_content=f1&utm_campaign=HomePageSpotlight\" target=\"_blank\">announcement\u003c/a> by the \u003ca title=\"http://www.fda.gov/\" href=\"http://www.fda.gov/\" target=\"_blank\">Food and Drug Administration\u003c/a> last week that \u003ca title=\"http://ww2.kqed.org/stateofhealth/2012/02/16/fda-warns-california-clinics-of-fake-avastin/\" href=\"http://ww2.kqed.org/stateofhealth/2012/02/16/fda-warns-california-clinics-of-fake-avastin/\" target=\"_blank\">sixteen California clinics and physicians were sold bogus vials\u003c/a> of the cancer drug Avastin did not surprise regulators and researchers who study the counterfeit drug trade.\u003c/p>\n\u003cp>Indeed, it was after fake AIDS drugs were discovered in California that state legislators passed the \"\u003ca title=\"http://www.pharmacy.ca.gov/about/e_pedigree.shtml\" href=\"http://www.pharmacy.ca.gov/about/e_pedigree.shtml\" target=\"_blank\">e-pedigree law\u003c/a>\" mandating that all prescription drugs carry an electronic tag. The tag could be scanned to show where the drug was first manufactured and every stop along its way to market.\u003c/p>\n\u003cp>Since the law passed in 2004, biotech and pharmaceutical trade groups fought to delay its implementation. They argued, successfully, that the electronic track-and-trace system would up-end global drug manufacturing.\u003c!--more-->\u003c/p>\n\u003cp>Finally the system is going into effect, says \u003ca title=\"http://www.pharmacy.ca.gov/about/executive_staff.shtml\" href=\"http://www.pharmacy.ca.gov/about/executive_staff.shtml\" target=\"_blank\">Virginia Herold\u003c/a>, head of the state Board of Pharmacy. But it will still be awhile. \"In January 2015, 50 percent of a manufacturer’s products that will be sold into California have to have this unique serialized number of each container,\" she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The remaining half must have the serialized numbers by the following year -- and in subsequent years the system will become more robust. Herold says the the electronic tags can stop incidents like the recent sale of the adulterated Avastin.\u003c/p>\n\u003cp>\"The wholesaler, when it purchased the product would have had to certify, 'Yes, I just bought this from Roche.' Well, Roche didn’t manufacture the product. Somebody else did.\"\u003c/p>\n\u003cp>But \u003ca title=\"http://anesthesia.ucsd.edu/research/faculty-research/Pages/bryan-liang.aspx\" href=\"http://anesthesia.ucsd.edu/research/faculty-research/Pages/bryan-liang.aspx\" target=\"_blank\">Brian Liang\u003c/a>, Director of the Center for Patient Safety at UC San Diego, says electronic tags won’t end the fake drug business, because counterfeiters often avoid wholesalers. \"These are people who are coming at it from a completely different underground approach,\" he says.\u003c/p>\n\u003cp>Liang says counterfeiters will try to sell directly to clinics and doctors by bombarding them with faxes advertising cheap drugs. But there are resources available now, he says, that clinics and patients can turn to.\u003c/p>\n\u003cp>\"We have authorized wholesalers who are in fact listed by the government and \u003ca title=\"http://www.nabp.net/\" href=\"http://www.nabp.net/\" target=\"_blank\">National Association of Boards of Pharmacy\u003c/a>, they also list wholesalers. If it’s a source you’re not familiar with you really should find out: Is this source legitimate?\"\u003c/p>\n\u003cp>State regulators say about 1 percent of the 400 million prescriptions dispersed in California each year are fake. That’s about four million prescriptions that have too little or too much of the right active ingredients or no active ingredients at all.\u003c/p>\n\u003cp>\u003cstrong>Listen to the Story:\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cobject width=\"335\" height=\"85\">\u003cparam name=\"movie\" value=\"http://www.kqed.org/assets/flash/kqedplayer.swf\">\u003cparam name=\"flashvars\" value=\"file=http://www.kqed.org/radio/archives/R201202200850a.xml\">\u003cembed src=\"http://www.kqed.org/assets/flash/kqedplayer.swf\" type=\"application/x-shockwave-flash\" width=\"335\" height=\"85\" flashvars=\"file=http://www.kqed.org/radio/archives/R201202200850a.xml\">\u003c/embed>\u003c/object>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Lack of Primary and Preventive Care Sends Thousands to Hospital",
"title": "Lack of Primary and Preventive Care Sends Thousands to Hospital",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cstrong>By Bernice Yeung, \u003ca href=\"http://californiawatch.org/dailyreport/lack-primary-and-preventative-care-sends-thousands-hospitals-14935\" title=\"http://californiawatch.org/dailyreport/lack-primary-and-preventative-care-sends-thousands-hospitals-14935\" target=\"_blank\">California Watch\u003c/a>\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_3133\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Hand_Bandage_PreventableHospitalization_Bastian_Flickr_022021012.jpg\">\u003cimg class=\"size-medium wp-image-3133\" title=\"(Bastian: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Hand_Bandage_PreventableHospitalization_Bastian_Flickr_022021012-300x200.jpg\" alt=\"(Bastian: Flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Bastian: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Better access to primary health care and prevention programs could have kept thousands of California adults out of hospitals, according to a new statewide analysis.\u003c/p>\n\u003cp>According to \u003ca href=\"http://www.oshpd.ca.gov/HID/Products/PatDischargeData/AHRQ/\" target=\"_blank\">new data\u003c/a> released last week by the Office of Statewide Health Planning and Development, there were more than 335,000 adult hospitalizations in California that could have been avoided if the patient had seen a doctor sooner.\u003c/p>\n\u003cp>According to the state agency, so-called “preventable hospitalizations” are an indication of systemic shortcomings related to access to quality primary care.\u003c!--more-->\u003c/p>\n\u003cp>“These are people going into the hospital that probably shouldn’t be if they were getting good primary care up front,” said Michael Kassis, a research specialist with the office.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Poor environmental factors and a failure to follow medical treatment also could prompt these avoidable hospital stays, the agency said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The latest figures are based on an \u003ca href=\"http://www.oshpd.ca.gov/HID/Products/PatDischargeData/AHRQ/pqi_overview.html\" target=\"_blank\">analysis\u003c/a> of 2009 hospital inpatient discharges by state-licensed facilities of 13 “prevention quality indicators,” or readily treatable medical conditions such as chest pains and dehydration.\u003c/p>\n\u003cdiv>There’s been a slight uptick in preventable hospitalizations in California since 2008, when there were 317,050 cases. In 1999, there were 399,113 cases.The financial implications of these avoidable hospitalizations can be significant. A \u003ca href=\"http://www.cms.gov/reports/downloads/Segal_Policy_Insight_Report_Duals_PAH_June_2011.pdf\" target=\"_blank\">report [PDF]\u003c/a> published last year by the Centers for Medicare & Medicaid Services noted that 26 percent of all patients who are dually eligible for Medicare and Medicaid had avoidable hospitalizations – at a cost of more than $7 billion to taxpayers in 2011.\u003c/div>\n\u003cdiv>\u003c/div>\n\u003cdiv>\n\u003cp>California had fewer preventable hospitalizations among this population than the national average, and based on the new state data, avoidable hospitalizations cost the California-based health care system an estimated $3.6 billion per year.\u003c/p>\n\u003cp>Although these costs are associated with patients who are both publicly and privately insured, the state agency said avoidable hospitalizations ultimately affect all Californians.\u003c/p>\n\u003cp>“Outpatient care costs less than hospital care, resulting in significant cost savings for health plans/insurers, employers, government and the ultimate payer – all of us,” according to a 2010 report on preventable hospitalizations published by the office.\u003c/p>\n\u003cp>The new California data is also available by county, with rural counties like Del Norte, Glenn and San Joaquin experiencing among the highest five-year averages of preventable hospitalizations for bacterial pneumonia, diabetes-related amputations and chronic obstructive pulmonary disease.\u003c/p>\n\u003cp>Los Angeles residents had rates of preventable hospitalizations above the state average for conditions such as long-term complications of diabetes, hypertension, congestive heart failure and adult asthma.\u003c/p>\n\u003cp>“The reason it’s good to have this data is that it forces us to look upstream and understand where there are missed opportunities to address these events and think about how we can develop systemic approaches to reducing them,” said Dr. Jonathan E. Fielding, director of the Los Angeles County Department of Public Health and the county's health officer.\u003c/p>\n\u003cp>Los Angeles is home to about \u003ca href=\"http://www.healthpolicy.ucla.edu/pubs/files/twothirdspb-2-2011.pdf\" target=\"_blank\">2.2 million [PDF]\u003c/a> uninsured non-elderly adults and children, which Fielding said contributes to the area’s preventable hospitalizations.\u003c/p>\n\u003cp>“I think there needs to be more emphasis on primary care, but you can’t emphasize that unless you have the means to access it,” he said. “In the state as a whole, and particularly in Los Angeles County, there are too many adults who lack health insurance and don’t get the care they need in a timely fashion, so they result in preventable hospitalizations. Good access to primary care can help avert these hospitalizations.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.oshpd.ca.gov/HID/Products/PatDischargeData/AHRQ/pdi_overview.html\" target=\"_blank\">Among children\u003c/a>, there were an additional 53,897 preventable hospitalizations in 2009 related to five medical conditions, such as low birth weight and short-term complications from diabetes. Imperial County had high rates of pediatric gastroenteritis and urinary tract infections.\u003c/p>\n\u003cp>Jeremy Cantor of the Oakland-based Prevention Institute said these statistics illustrates the importance of prevention programs.\u003c/p>\n\u003cp>“All of these things are preventable to some extent, so the fact that the numbers are above zero means that there needs to be more focus on prevention,” he said. “What this means – not just in terms of health care costs, but also productivity and days that people have to take off work – has a huge impact on the state.”\u003c/p>\n\u003cp>But funds for prevention programs recently have become more scarce. Last week, Congress passed a \u003ca href=\"http://thomas.loc.gov/cgi-bin/query/z?c112:H.R.3630:\" target=\"_blank\">bill\u003c/a> that extends the payroll tax cut and forestalls payment cuts to doctors who accept Medicare by trimming about $5 billion from the federal Prevention and Public Health Fund over the next decade. In 2010, California received about \u003ca href=\"http://wwwn.cdc.gov/fundingprofiles/FundingProfilesRIA/Report_Docs/PDFDocs/California-2010-CDC-Grants-Profile-Report.pdf\" target=\"_blank\">$12 million [PDF]\u003c/a> from the fund, which was created under the federal health reform law.\u003c/p>\n\u003cp>Cantor added that environmental and social factors that affect health can’t be overlooked.\u003c/p>\n\u003cp>“What can be misleading is that the implication is that these rates are determined by a patient’s experience in clinical settings,” he said. “That is far from the case. Part of the picture is access to quality clinical care. But it’s also related to exposures to toxins, and economic and educational opportunities, the lack of access to places to be physically active and a whole spectrum of factors that shape health outcomes.”\u003c/p>\n\u003cp>The data on preventable hospitalizations is not an indication of poor hospital care. But the 2009 data recently released by the Office of Statewide Health Planning and Development also examined \u003ca href=\"http://www.oshpd.ca.gov/HID/Products/PatDischargeData/AHRQ/PSI/AL_PSI_2009.pdf\" target=\"_blank\">patient safety [PDF]\u003c/a> and found 334 incidents in which gauze or other surgical equipment was left inside the body during an operation and 8,230 cases in which patients were accidentally cut or punctured during their hospital stay.\u003c/p>\n\u003c/div>\n\n",
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"excerpt": "Better access to primary health care and prevention programs could have kept thousands of California adults out of hospitals, according to a new statewide analysis.\r\n\r\nAccording to new data released last week by the Office of Statewide Health Planning and Development, there were more than 335,000 adult hospitalizations in California that could have been avoided if the patient had seen a doctor sooner.",
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"description": "Better access to primary health care and prevention programs could have kept thousands of California adults out of hospitals, according to a new statewide analysis.\r\n\r\nAccording to new data released last week by the Office of Statewide Health Planning and Development, there were more than 335,000 adult hospitalizations in California that could have been avoided if the patient had seen a doctor sooner.",
"title": "Lack of Primary and Preventive Care Sends Thousands to Hospital | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cstrong>By Bernice Yeung, \u003ca href=\"http://californiawatch.org/dailyreport/lack-primary-and-preventative-care-sends-thousands-hospitals-14935\" title=\"http://californiawatch.org/dailyreport/lack-primary-and-preventative-care-sends-thousands-hospitals-14935\" target=\"_blank\">California Watch\u003c/a>\u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_3133\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Hand_Bandage_PreventableHospitalization_Bastian_Flickr_022021012.jpg\">\u003cimg class=\"size-medium wp-image-3133\" title=\"(Bastian: Flickr)\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/Hand_Bandage_PreventableHospitalization_Bastian_Flickr_022021012-300x200.jpg\" alt=\"(Bastian: Flickr)\" width=\"300\" height=\"200\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Bastian: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>Better access to primary health care and prevention programs could have kept thousands of California adults out of hospitals, according to a new statewide analysis.\u003c/p>\n\u003cp>According to \u003ca href=\"http://www.oshpd.ca.gov/HID/Products/PatDischargeData/AHRQ/\" target=\"_blank\">new data\u003c/a> released last week by the Office of Statewide Health Planning and Development, there were more than 335,000 adult hospitalizations in California that could have been avoided if the patient had seen a doctor sooner.\u003c/p>\n\u003cp>According to the state agency, so-called “preventable hospitalizations” are an indication of systemic shortcomings related to access to quality primary care.\u003c!--more-->\u003c/p>\n\u003cp>“These are people going into the hospital that probably shouldn’t be if they were getting good primary care up front,” said Michael Kassis, a research specialist with the office.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Poor environmental factors and a failure to follow medical treatment also could prompt these avoidable hospital stays, the agency said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The latest figures are based on an \u003ca href=\"http://www.oshpd.ca.gov/HID/Products/PatDischargeData/AHRQ/pqi_overview.html\" target=\"_blank\">analysis\u003c/a> of 2009 hospital inpatient discharges by state-licensed facilities of 13 “prevention quality indicators,” or readily treatable medical conditions such as chest pains and dehydration.\u003c/p>\n\u003cdiv>There’s been a slight uptick in preventable hospitalizations in California since 2008, when there were 317,050 cases. In 1999, there were 399,113 cases.The financial implications of these avoidable hospitalizations can be significant. A \u003ca href=\"http://www.cms.gov/reports/downloads/Segal_Policy_Insight_Report_Duals_PAH_June_2011.pdf\" target=\"_blank\">report [PDF]\u003c/a> published last year by the Centers for Medicare & Medicaid Services noted that 26 percent of all patients who are dually eligible for Medicare and Medicaid had avoidable hospitalizations – at a cost of more than $7 billion to taxpayers in 2011.\u003c/div>\n\u003cdiv>\u003c/div>\n\u003cdiv>\n\u003cp>California had fewer preventable hospitalizations among this population than the national average, and based on the new state data, avoidable hospitalizations cost the California-based health care system an estimated $3.6 billion per year.\u003c/p>\n\u003cp>Although these costs are associated with patients who are both publicly and privately insured, the state agency said avoidable hospitalizations ultimately affect all Californians.\u003c/p>\n\u003cp>“Outpatient care costs less than hospital care, resulting in significant cost savings for health plans/insurers, employers, government and the ultimate payer – all of us,” according to a 2010 report on preventable hospitalizations published by the office.\u003c/p>\n\u003cp>The new California data is also available by county, with rural counties like Del Norte, Glenn and San Joaquin experiencing among the highest five-year averages of preventable hospitalizations for bacterial pneumonia, diabetes-related amputations and chronic obstructive pulmonary disease.\u003c/p>\n\u003cp>Los Angeles residents had rates of preventable hospitalizations above the state average for conditions such as long-term complications of diabetes, hypertension, congestive heart failure and adult asthma.\u003c/p>\n\u003cp>“The reason it’s good to have this data is that it forces us to look upstream and understand where there are missed opportunities to address these events and think about how we can develop systemic approaches to reducing them,” said Dr. Jonathan E. Fielding, director of the Los Angeles County Department of Public Health and the county's health officer.\u003c/p>\n\u003cp>Los Angeles is home to about \u003ca href=\"http://www.healthpolicy.ucla.edu/pubs/files/twothirdspb-2-2011.pdf\" target=\"_blank\">2.2 million [PDF]\u003c/a> uninsured non-elderly adults and children, which Fielding said contributes to the area’s preventable hospitalizations.\u003c/p>\n\u003cp>“I think there needs to be more emphasis on primary care, but you can’t emphasize that unless you have the means to access it,” he said. “In the state as a whole, and particularly in Los Angeles County, there are too many adults who lack health insurance and don’t get the care they need in a timely fashion, so they result in preventable hospitalizations. Good access to primary care can help avert these hospitalizations.\"\u003c/p>\n\u003cp>\u003ca href=\"http://www.oshpd.ca.gov/HID/Products/PatDischargeData/AHRQ/pdi_overview.html\" target=\"_blank\">Among children\u003c/a>, there were an additional 53,897 preventable hospitalizations in 2009 related to five medical conditions, such as low birth weight and short-term complications from diabetes. Imperial County had high rates of pediatric gastroenteritis and urinary tract infections.\u003c/p>\n\u003cp>Jeremy Cantor of the Oakland-based Prevention Institute said these statistics illustrates the importance of prevention programs.\u003c/p>\n\u003cp>“All of these things are preventable to some extent, so the fact that the numbers are above zero means that there needs to be more focus on prevention,” he said. “What this means – not just in terms of health care costs, but also productivity and days that people have to take off work – has a huge impact on the state.”\u003c/p>\n\u003cp>But funds for prevention programs recently have become more scarce. Last week, Congress passed a \u003ca href=\"http://thomas.loc.gov/cgi-bin/query/z?c112:H.R.3630:\" target=\"_blank\">bill\u003c/a> that extends the payroll tax cut and forestalls payment cuts to doctors who accept Medicare by trimming about $5 billion from the federal Prevention and Public Health Fund over the next decade. In 2010, California received about \u003ca href=\"http://wwwn.cdc.gov/fundingprofiles/FundingProfilesRIA/Report_Docs/PDFDocs/California-2010-CDC-Grants-Profile-Report.pdf\" target=\"_blank\">$12 million [PDF]\u003c/a> from the fund, which was created under the federal health reform law.\u003c/p>\n\u003cp>Cantor added that environmental and social factors that affect health can’t be overlooked.\u003c/p>\n\u003cp>“What can be misleading is that the implication is that these rates are determined by a patient’s experience in clinical settings,” he said. “That is far from the case. Part of the picture is access to quality clinical care. But it’s also related to exposures to toxins, and economic and educational opportunities, the lack of access to places to be physically active and a whole spectrum of factors that shape health outcomes.”\u003c/p>\n\u003cp>The data on preventable hospitalizations is not an indication of poor hospital care. But the 2009 data recently released by the Office of Statewide Health Planning and Development also examined \u003ca href=\"http://www.oshpd.ca.gov/HID/Products/PatDischargeData/AHRQ/PSI/AL_PSI_2009.pdf\" target=\"_blank\">patient safety [PDF]\u003c/a> and found 334 incidents in which gauze or other surgical equipment was left inside the body during an operation and 8,230 cases in which patients were accidentally cut or punctured during their hospital stay.\u003c/p>\n\u003c/div>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cfigure id=\"attachment_3106\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/REV_BikeRider_Sunset_Moyan_Brenn_02162012-copy.jpg\">\u003cimg class=\"size-medium wp-image-3106\" title=\"REV_BikeRider_Sunset_Moyan_Brenn_02162012 copy\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/REV_BikeRider_Sunset_Moyan_Brenn_02162012-copy-300x197.jpg\" alt=\"Building bike & pedestrian paths saves almost $3 in medical costs for every dollar spent in building the trails. (Moyan Brenn: Flickr)\" width=\"300\" height=\"197\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Building bike & pedestrian paths saves almost $3 in medical costs for every dollar spent in building the trails. (Moyan Brenn: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The debate over the extension of the payroll tax break has dominated headlines. But as part of the same package deal was an agreement on the so-called \"\u003ca title=\"http://www.kaiserhealthnews.org/stories/2011/december/15/faq-doc-fix.aspx?referrer=search\" href=\"http://www.kaiserhealthnews.org/stories/2011/december/15/faq-doc-fix.aspx?referrer=search\" target=\"_blank\">Doc Fix.\u003c/a>\" That's the Washington shorthand for finding a way to avoid a 27.4 percent cut in fees to doctors who see Medicare patients. Naturally, doctors were not enthusiastic about having their fees cut so drastically.\u003c/p>\n\u003cp>Lawmakers figured out a \"Doc Fix\" but at the cost of the \u003ca title=\"http://www.healthcare.gov/news/factsheets/2011/02/prevention02092011a.html\" href=\"http://www.healthcare.gov/news/factsheets/2011/02/prevention02092011a.html\" target=\"_blank\">Prevention and Public Health Fund\u003c/a>--part of the \u003ca title=\"http://www.healthcare.gov/law/full/index.html\" href=\"http://www.healthcare.gov/law/full/index.html\" target=\"_blank\">health care reform law\u003c/a>. The deal is not yet final, but it looks like lawmakers will slice $5 billion--or about one-third of its total funding. Public health advocates had fought hard against these cuts, but to no avail.\u003c/p>\n\u003cp>\"I know we're at a place where difficult decisions have to be made,\" said \u003ca title=\"http://www.phi.org/people_programs/people-bio.cfm?AG=A547\" href=\"http://www.phi.org/people_programs/people-bio.cfm?AG=A547\" target=\"_blank\">Mary Pittman,\u003c/a> President of the Oakland-based Public Health Institute, \"but it just doesn't make sense that all of the difficult decisions end up focused on prevention. If we're to change the way we think about health and we're trying to find a way to reduce cost, all directions point to prevention.\"\u003c/p>\n\u003cp>The goal of the Prevention Fund is to provide communities around the country with billions of dollars over the next ten years to invest in effective prevention efforts against heart attacks, cancer and strokes and to reduce tobacco use as well as prevent obesity.\u003c/p>\n\u003cp>\u003c!--more-->And if you're wondering if prevention money is well spent, the most recent research says it is. The American Heart Association\u003ca title=\"http://circ.ahajournals.org/content/early/2011/07/25/CIR.0b013e3182285a81.full.pdf\" href=\"http://circ.ahajournals.org/content/early/2011/07/25/CIR.0b013e3182285a81.full.pdf\" target=\"_blank\"> reported\u003c/a> [PDF] in 2011 that money spent on prevention can yield a dramatic return on investment:\u003c/p>\n\u003cul>\n\u003cli>Community programs to increase physical activity, improve nutrition and prevent smoking save more than $5 on every dollar spent within five years\u003c/li>\n\u003cli>Building bike and pedestrian paths saves almost $3 in medical costs for every dollar spent in building the trails\u003c/li>\n\u003cli>Lifestyle changes reduced the incidence of diabetes by 58 percent, versus 31 percent for drug therapy\u003c/li>\n\u003c/ul>\n\u003cdiv>\n\u003cp>\"It costs each and every one of us every day as taxpayers, as residents of communities, when we say we're going to let people get sick first and then deal with it afterwards,\" says \u003ca title=\"http://www.preventioninstitute.org/about-us/our-staff.html\" href=\"http://www.preventioninstitute.org/about-us/our-staff.html\" target=\"_blank\">Sana Chehimi\u003c/a>, Program Director of the Prevention Institute. She adds that the prevention approach says \"'that's unnecessary--we know how to prevent illness.' If we do that, we're making sure that people don't have to go to the doctor or emergency room. So it makes our healthcare system that much more efficient.\"\u003c/p>\n\u003cp>But the reason prevention program ends up on the chopping block is not only that its impact tends to happen over years, but also because it's hard to see the results. The \u003ca title=\"http://www.washingtonpost.com/blogs/ezra-klein/post/why-congress-cuts-prevention-funds/2012/02/15/gIQAxiSBGR_blog.html\" href=\"http://www.washingtonpost.com/blogs/ezra-klein/post/why-congress-cuts-prevention-funds/2012/02/15/gIQAxiSBGR_blog.html\" target=\"_blank\">Washington Post\u003c/a> talked to the University of Richmond's Rick Mayes, who \u003ca title=\"http://jhppl.dukejournals.org/content/early/2011/12/05/03616878-1538593.abstract?papetoc\" href=\"http://jhppl.dukejournals.org/content/early/2011/12/05/03616878-1538593.abstract?papetoc\" target=\"_blank\">has written\u003c/a> about the political hurdles prevention efforts face. Mayes refers to the \"Prevention Paradox\":\u003c/p>\n\u003cblockquote>\u003cp>“If public health measures are effective, the problems they are aimed at are often solved or never even materialize, thereby making them virtually invisible. ... When individuals are spared from a disease because the air in their office building is clean, it is not immediately clear whom to thank or if thanks are even necessary. As a consequence, public health professionals, programs, and policies are largely invisible to the public and taken for granted.”\u003c/p>\u003c/blockquote>\n\u003c/div>\n\u003cp>Prevention Funds for this year were just awarded. California received 20 percent of the total nationally--more than $22 million. These \"Community Transformation Grants\" will fund healthier eating policies, programs to increase walking and weight loss, and the creation of safe routes to schools--to name just a few grants awarded at the local level. This line of funding is secure. But if the $5 billion in cuts become law, the grants will likely be reduced in the coming years, making the work of public health advocates harder.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "The debate over the extension of the payroll tax break has dominated headlines. But as part of the same package deal was an agreement on the so-called \"Doc Fix.\" That's the Washington shorthand for finding a way to avoid a 27.4 percent cut in fees to doctors who see Medicare patients. Doctors were not enthusiastic about having their fees cut so drastically. Lawmakers figured out a \"Doc Fix\" but at the cost of the Prevention and Public Health Fund--part of the health care reform law. The deal is not yet final, but it looks like lawmakers will slice $5 billion--or about one-third of its total funding. Public health advocates had fought hard against these cuts, but to no avail. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_3106\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/REV_BikeRider_Sunset_Moyan_Brenn_02162012-copy.jpg\">\u003cimg class=\"size-medium wp-image-3106\" title=\"REV_BikeRider_Sunset_Moyan_Brenn_02162012 copy\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/02/REV_BikeRider_Sunset_Moyan_Brenn_02162012-copy-300x197.jpg\" alt=\"Building bike & pedestrian paths saves almost $3 in medical costs for every dollar spent in building the trails. (Moyan Brenn: Flickr)\" width=\"300\" height=\"197\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Building bike & pedestrian paths saves almost $3 in medical costs for every dollar spent in building the trails. (Moyan Brenn: Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>The debate over the extension of the payroll tax break has dominated headlines. But as part of the same package deal was an agreement on the so-called \"\u003ca title=\"http://www.kaiserhealthnews.org/stories/2011/december/15/faq-doc-fix.aspx?referrer=search\" href=\"http://www.kaiserhealthnews.org/stories/2011/december/15/faq-doc-fix.aspx?referrer=search\" target=\"_blank\">Doc Fix.\u003c/a>\" That's the Washington shorthand for finding a way to avoid a 27.4 percent cut in fees to doctors who see Medicare patients. Naturally, doctors were not enthusiastic about having their fees cut so drastically.\u003c/p>\n\u003cp>Lawmakers figured out a \"Doc Fix\" but at the cost of the \u003ca title=\"http://www.healthcare.gov/news/factsheets/2011/02/prevention02092011a.html\" href=\"http://www.healthcare.gov/news/factsheets/2011/02/prevention02092011a.html\" target=\"_blank\">Prevention and Public Health Fund\u003c/a>--part of the \u003ca title=\"http://www.healthcare.gov/law/full/index.html\" href=\"http://www.healthcare.gov/law/full/index.html\" target=\"_blank\">health care reform law\u003c/a>. The deal is not yet final, but it looks like lawmakers will slice $5 billion--or about one-third of its total funding. Public health advocates had fought hard against these cuts, but to no avail.\u003c/p>\n\u003cp>\"I know we're at a place where difficult decisions have to be made,\" said \u003ca title=\"http://www.phi.org/people_programs/people-bio.cfm?AG=A547\" href=\"http://www.phi.org/people_programs/people-bio.cfm?AG=A547\" target=\"_blank\">Mary Pittman,\u003c/a> President of the Oakland-based Public Health Institute, \"but it just doesn't make sense that all of the difficult decisions end up focused on prevention. If we're to change the way we think about health and we're trying to find a way to reduce cost, all directions point to prevention.\"\u003c/p>\n\u003cp>The goal of the Prevention Fund is to provide communities around the country with billions of dollars over the next ten years to invest in effective prevention efforts against heart attacks, cancer and strokes and to reduce tobacco use as well as prevent obesity.\u003c/p>\n\u003cp>\u003c!--more-->And if you're wondering if prevention money is well spent, the most recent research says it is. The American Heart Association\u003ca title=\"http://circ.ahajournals.org/content/early/2011/07/25/CIR.0b013e3182285a81.full.pdf\" href=\"http://circ.ahajournals.org/content/early/2011/07/25/CIR.0b013e3182285a81.full.pdf\" target=\"_blank\"> reported\u003c/a> [PDF] in 2011 that money spent on prevention can yield a dramatic return on investment:\u003c/p>\n\u003cul>\n\u003cli>Community programs to increase physical activity, improve nutrition and prevent smoking save more than $5 on every dollar spent within five years\u003c/li>\n\u003cli>Building bike and pedestrian paths saves almost $3 in medical costs for every dollar spent in building the trails\u003c/li>\n\u003cli>Lifestyle changes reduced the incidence of diabetes by 58 percent, versus 31 percent for drug therapy\u003c/li>\n\u003c/ul>\n\u003cdiv>\n\u003cp>\"It costs each and every one of us every day as taxpayers, as residents of communities, when we say we're going to let people get sick first and then deal with it afterwards,\" says \u003ca title=\"http://www.preventioninstitute.org/about-us/our-staff.html\" href=\"http://www.preventioninstitute.org/about-us/our-staff.html\" target=\"_blank\">Sana Chehimi\u003c/a>, Program Director of the Prevention Institute. She adds that the prevention approach says \"'that's unnecessary--we know how to prevent illness.' If we do that, we're making sure that people don't have to go to the doctor or emergency room. So it makes our healthcare system that much more efficient.\"\u003c/p>\n\u003cp>But the reason prevention program ends up on the chopping block is not only that its impact tends to happen over years, but also because it's hard to see the results. The \u003ca title=\"http://www.washingtonpost.com/blogs/ezra-klein/post/why-congress-cuts-prevention-funds/2012/02/15/gIQAxiSBGR_blog.html\" href=\"http://www.washingtonpost.com/blogs/ezra-klein/post/why-congress-cuts-prevention-funds/2012/02/15/gIQAxiSBGR_blog.html\" target=\"_blank\">Washington Post\u003c/a> talked to the University of Richmond's Rick Mayes, who \u003ca title=\"http://jhppl.dukejournals.org/content/early/2011/12/05/03616878-1538593.abstract?papetoc\" href=\"http://jhppl.dukejournals.org/content/early/2011/12/05/03616878-1538593.abstract?papetoc\" target=\"_blank\">has written\u003c/a> about the political hurdles prevention efforts face. Mayes refers to the \"Prevention Paradox\":\u003c/p>\n\u003cblockquote>\u003cp>“If public health measures are effective, the problems they are aimed at are often solved or never even materialize, thereby making them virtually invisible. ... When individuals are spared from a disease because the air in their office building is clean, it is not immediately clear whom to thank or if thanks are even necessary. As a consequence, public health professionals, programs, and policies are largely invisible to the public and taken for granted.”\u003c/p>\u003c/blockquote>\n\u003c/div>\n\u003cp>Prevention Funds for this year were just awarded. California received 20 percent of the total nationally--more than $22 million. These \"Community Transformation Grants\" will fund healthier eating policies, programs to increase walking and weight loss, and the creation of safe routes to schools--to name just a few grants awarded at the local level. This line of funding is secure. But if the $5 billion in cuts become law, the grants will likely be reduced in the coming years, making the work of public health advocates harder.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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