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Research shows manipulation superior to acupuncture, drugs

A randomized, controlled clinical trial published in Spine Journal reveals that chiropractic "manipulation" is superior to both drugs and acupuncture in the treatment of chronic spinal pain (pain lasting more than 13 weeks). The study, conducted at a multidisciplinary spinal pain outpatient unit (MSPU) in an Australian public hospital, involved 115 patients randomly assigned to receive one of three interventions: medication, needle acupuncture, or chiropractic manipulation.

Giles LGF, Muller R. Chronic spinal pain a randomized clinical trial comparing medication, acupuncture, and spinal manipulation. Spine 2003; 28:1490-1503.

Big increase seen in people lacking health insurance

The number of people without health insurance shot up last year by 2.4 million, the largest increase in a decade, raising the total to 43.6 million. This occurred as health costs soared and many workers lost coverage provided by employers, the Census Bureau reported. The increase brought the proportion of people who were uninsured to 15.2 percent, up from 14.6 percent in 2001. The New York Times, front page, September 30, 2003.

Medical injuries kill 32,000 annually

A new study of hospital-related injuries suggests worries about patient safety have been well founded: Injuries ranging from post-surgical infections to re-opening wounds kill about 32,000 Americans every year. These injuries add more than $9 billion to the nation's health care bill. Moreover, those numbers are "just the tip of the iceberg," Dr. Chunliu Zhan, a research fellow at the Agency for Healthcare Research and Quality (AHRQ) in Rockville, Md., told United Press International. The findings are based on analyses of almost 7.5 million hospital discharge records. Dr. Saul Weingart, director of patient safety at Boston's Beth Israel Medical Center, suspects the study "grossly underestimates both the occurrence of injury and the cost of these injuries." One basic suggestion AHRQ makes to help with the problem is that "patients should ask all health care workers with whom they have direct contact whether they have washed their hands." One reason for this underestimation, he said, is the decision by Zhan and Miller to omit all injuries caused by medication errors, which many experts claim is the largest single factor in patient injury. Peggy Peck, UPI Science News, October 7, 2003. DHIPS Network, PRNewswire, October 27, 2003.

Preferred Provider Organizations now the first choice for health care

Almost half of all Americans are now enrolled in a PPO. They have grown faster than any other type of health plan over the last seven years. PPOs are now the first choice for health care, according to a recent report by the American Association of Preferred Provider Organizations. Consumer demand also has led to the growth of specialty health organizations, including specialty dental, vision, chiropractic, and radiology PPOs, according to the report. Peggy Peck, UPI Science News, October 7, 2003. DHIPS Network, PRNewswire, October 27, 2003.

Benefits offered by managed care plans nationwide*

*Total Number of Plans - 1,412 (Includes HMOs, PPOs, specialty HMOs, specialty PPOs, and point-of-service providers). Managed Care Information Center, 2003. Directions: Looking Ahead in Healthcare.

The conflict of financial interests in clinical trials

To advance scientific discovery and expedite the development of new treatments, many researchers accept funding from private industry (usually the biotechnology and pharmaceutical industries). The drawback is that these "partnerships" create complex relationships involving researchers, private industry, and academic institutions. Some of these relationships have raised serious concerns about conflicts of interest and liability for errors, omissions, or adverse outcomes. Over the last few years, a number of research studies failed to disclose investigators' and institutions' financial stakes, often in cases where the research has led to death or serious injury. Some in the industry even believe that disclosure alone is no longer an adequate safeguard for conflicts of interest in clinical trials. Recent initiatives - both private and governmental - demonstrate the attention being paid to the issue of clinical trials and conflict of interest. Perhaps most importantly, they send a strong message that the need for innovative, cutting-edge research will not come at the cost of endangering the safety or the lives of the human volunteers participating in such studies. Susan W. Berson, J.D., Medscape, October 1, 2003.

Long-term aspirin use tied to cancer

Long-term use of aspirin was linked to an increased risk of pancreatic cancer in an 18-year study of more than 88,000 women, researchers reported on October 27, 2003. An author of the study said she and her colleagues had expected to find that aspirin lowered the risk of pancreatic cancer and were surprised to come up with the opposite result. In a telephone interview, she said further studies were needed to see whether the connection between aspirin and the cancer was real. The New York Times, October 28, 2003.

Stopping aspirin use may lead to heart attacks

Heart patients who take an aspirin a day to prevent heart attacks may put themselves at risk if they stop, an early study hints. Aspirin helps prevent blood clots that can trigger a heart attack. But if patients stop, blood may clot more easily, French researchers say. A team studied 1,236 people hospitalized after a heart attack or other heart trouble; 500 had already had a heart attack and had been taking aspirin regularly. Of those 500, 51 suffered a heart attack an average of 10 days after stopping aspirin. This study doesn't prove it is dangerous for heart patients to stop taking aspirin, says the American College of Chest Physicians president. USA Today, October 30, 2003.

FDA warns patients with heart stents

More than 60 patients who received a popular new drug-coated heart stent have died, the government disclosed on October 29. The stent doesn't prevent a risk posed by all stents: blood clots that form around the device and can cause a heart attack. The FDA now has more than 290 reports of blood clots from recipients of the stents. In more than 60 recipients, the device was associated with the patient's death. USA Today, October 30, 2003.

Widespread pessimism: Large majority of U.S. think health care system will get worse

Most Americans are profoundly pessimistic about the future of the American health care system, according to a recent national survey of U.S. adults. One reason for this pessimism may be the rapid increase in health care costs, a substantial part of which is now being passed on to those with health insurance and to patients. The Harris survey was conducted online with a cross section of 2,306 adults between September 16 and 23, 2003, and found that a lopsided 62 percent to 25 percent of the public are more pessimistic than optimistic about the likelihood that the health care system will improve in the next five years. CHIPS Network, PRNewswire, October 27, 2003

Consumer-driven health plans penetrating market

Consumer-driven plan over 4 years

How a consumer-driven health plan works, based on a policy with a $1,000 allowance and a $2,000 deductible:

Year 1: You spend $600 on routine medical expenses. You pay nothing out-of-pocket and carry over $400 to the next year.

Year 2: You spend $800 out of your new allowance of $1,400 on medical expenses. You pay nothing out-of-pocket and carry over $600 to the next year.

Year 3: You fall off your skateboard and incur $15,000 in medical expenses. Your annual allowance and what you've carried over from previous years covers the first $1,600, leaving a deductible of $400. You pay $400 out-of-pocket. Your traditional insurance policy kicks in for all or part of the remaining expenses. You pay only up to your annual out-of-pocket maximum, which varies.

Year 4: Because you exhausted the balance in your allowance in Year 3, you start over with a $1,000 allowance.

(Some workers who enroll in Humana's consumer-driven plan pay 50 percent less than those who sign up for its standard preferred provider plan.) About 17 percent of U.S. companies with 5,000 workers or more offer high-deductible policies, which often include consumer-driven health plans. Another 40 percent of big companies said they're likely to offer the plan next year (Kaiser Family Foundation). USA Today, October 31, 2003.

Groups aim to thwart drug importation bill

The pharmaceutical industry's trade group spent $8.5 million in lobbying this year as it worked against a bill to allow importation of government-approved drugs. This is the most the group has ever spent in a reporting period. Lobbying totals cover expenses such as salaries and mailings but not campaign contributions. "It was the most intense full-court press," said Rep. Gil Gutkecht, a Minnesota Republican. The pharmaceutical trade group, known as PhRMA, represents major drug companies. A PhRMA spokesman refused to comment because he said the organization does not discuss its lobbying. Associated Press, October 12, 2003.

FDA eases stance on importing medicines

Softening a hard-line stance against the illegal importation of lower-priced prescription drugs from Canada, a senior Food and Drug Administration official said on October 23 that the agency won't sue cities and states that set up plans to bring in the unapproved drugs. www.boston.com/business, October 24, 2003.

Some in Congress seek inquiry over drug supply to Canada

Twenty-two members of Congress have signed a letter asking Attorney General John Ashcroft to investigate whether the pharmaceutical industry has violated antitrust laws by restricting sales to Canadian wholesalers and pharmacies that export to the United States. "We must not allow pharmaceutical companies to abuse American consumers and place lives at risk by illegally manipulating supply," the letter concludes. nytimes.com, by Gardiner Harris, November 1, 2003.

100 patients a day wake up during surgery, study finds

Anesthesia failure that allows a patient to wake up during surgery, paralyzed and unable to cry for help, occurs 100 times a day in the United States. Many doctors have long questioned the prevalence of this occurring. "They have their head in the sand," says the study's lead investigator, Peter Sebel, professor of anesthesiology at the Emory University School of Medicine. The figures indicate that at least 1,000 of 1 million surgical patients awaken during surgery. USA Today, October 13, 2003.

Massage therapy increasingly sought for pain relief

Many people already know that massage therapy helps relieve muscle soreness. But a new consumer survey released on October 15 by the American Massage Therapy Association (AMTA) reveals that more people than ever seek massage specifically to manage and relieve pain. The survey shows that nearly half (47 percent) of those polled have had a massage at some time specifically for pain relief and/or pain management. The percentage is even higher (58 percent) among 18-24 years olds as well as those ages 35-44. What's more, 91 percent of adults polled agreed that massage therapy can be effective in reducing pain. Two other national surveys reinforce these findings. PRNewswire, Evanston, Ill., October 15, 2003.

Medicare deductibles and premiums are updated annually in accordance with formulas set by law

The Department of Health and Human Services (HHS) announced on October 17 the Medicare premium, deductible, and coinsurance amounts to be paid by Medicare beneficiaries in 2004. For Medicare Part A, which pays for inpatient hospital, skilled nursing facility, and some home health care, the deductible paid by the beneficiary will be $76 in 2004. This is an increase of $36 from this year's $840 deductible. The monthly premium paid by beneficiaries enrolled in Medicare Part B, which covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and other items, will be $66.60, an increase of 13.5 percent - or $7.90 - over the $58.70 premium for 2003. The CHIPS Network, Daily News Headlines, October 17, 2003.

The number of health insurance complaints logged against Anthem, Inc. (aka Trigon) in its home state of Indiana doubled from 535 in 2001 to 1,123 last year

Anthem's complaint index for 2002 of 1.51 means the company received about 1.5 times more complaints than would be expected for its share of business in Indiana, according to the state's Department of Insurance. Managed Care Week, October 20, 2003.

Connecticut attorney general launches investigation into alleged pharmaceutical industry collusion

Connecticut Attorney General Richard Blumenthal on Monday announced that he has launched an investigation into possible collusion among U.S. drug companies to reduce drug supplies sent to Canada. Blumenthal said that Pfizer, GlaxoSmithKline, Wyeth, and AstraZeneca are among the companies being investigated. He said that efforts to reduce supplies sent to Canada would violate antitrust laws. Kaiser Daily Health Policy Report, November 6, 2003.

Poll: Public supports health care for all

The public's growing unease with the current health care system has built support for a new approach that would mean care for all Americans and changes in laws governing prescription drugs, a poll suggests. A sizable majority, 70 percent, said it should be legal for Americans to buy prescription drugs outside the United States, according to the ABC News-Washington Post poll. The poll, released October 19, found that more than half of Americans, 54 percent, are dissatisfied with the overall quality of health care in the United States. Associated Press, October 20, 2003.

How nonretired Americans feel about their employer-provided health care benefits

Source: Stony Brook University, "Health Pulse of America," August 19, 2003, Medical Benefits, September 15, 2003.

Consumers propose plan to make U.S. health care system safe, compassionate, and just

Two co-founders of Consumers Advancing Safety, a collective voice for patients and their lay caregivers, presented a proposed plan to make the U.S. health care system safer at the 2nd National Summit on Patient Safety Research. The plan was sponsored by the Agency for Healthcare Research and Quality in Washington, DC, on November 7, 2003. CHIPS Network, November 6, 2003.

Aetna $470 million settlement approved

The managed care judge on October 24 granted final approval to Aetna's estimated $470 million settlement with the nation's physicians. "This court has determined that the settlement is fair, reasonable, and adequate and should therefore be approved," U.S. Judge Federico A. Moreno of the Southern District of Florida ruled. "The Court is also satisfied that the amount to be received by physicians, $100 million, plus the changes in [Aetna's] procedures to pay doctors' claims ... are of substantial value to the class," he said. The settlement resolves claims that Aetna violated the Racketeer Influenced and Corrupt Organizations Act and state and federal statutes by engaging in a scheme to "systematically reduce, deny, and delay" payments owed to physicians who provide medical services to Aetna's insureds. Mealey's Managed Care Liability Report, October 2, 2003.

Pharmaceuticals learn of government's plan to investigate sales

With the help of whistleblowers, federal prosecutors and Office of Inspector General investigators are writing a prescription for scrutiny. Pharma companies are coming under fire for illegal continuing medical education, kickbacks, improper consulting arrangements, and illegal off-label promotion practices. Last year brought sweeping changes to the way the pharmaceutical sales representatives do their jobs. Press release, HCPro, Inc., Medical Industry e-mail news service (TM), October 29, 2003.

U.S. warned drug makers of illegal sales practices in April of 2003

The Bush Administration told drug companies on April 27 that many of the techniques they use to sell their drugs run a high risk of violating federal fraud and abuse laws. The warning included telling manufacturers of drugs that they must not offer any financial incentives to doctors, hospitals, insurers, or pharmacists to encourage or reward the prescribing of particular drugs. www.nytimes.com by Robert Pear, Washington, April 27, 2003.

Report shows strong faculty institutional review board ties to drug firms

Almost half of the medical school faculty who staff institutional review boards (IRBs) overseeing the safety of humans involved in clinical research also serve as consultants to biomedical industry companies. According to a report published in August in Academic Medicine of the 2,989 faculty IRB members surveyed, 47 percent had recently served as industry consultants. "People who have relations with industry form a potential conflict of interest," said the study's lead author, Eric G. Campbell, PhD, assistant professor in medicine at the Institute for Health Policy and the Department of Medicine at Massachusetts General Hospital and Harvard Medical School. In her May 18, 2003, New England Journal of Medicine editorial, "Is Academic Medicine for Sale?" Marcia Angell, MD, senior lecturer in the Department of Social Medicine at Harvard Medical School and former editor-in-chief of the NEJM, described how she believes institutions are encouraged by law to obtain patents, license new products, and share the wealth with faculty researchers. "They're merely describing [these relationships] as a fact of life, but the next question is 'Is it a good thing?'" Dr. Angell said, "I think it's a terrible thing. It's one more indication that the boundaries between investor-owned industry and academia have broken down ... It's letting the fox guard the chicken coop." AMNews, September 22/29, 2003.

The National Center for Complementary and Alternative Medicine (CAM) is forging new partnerships

The first two Developmental Centers for Research on Complementary and Alternative Medicine (DCRC) will help to build a collaborative CAM research community that will enhance the scientific rigor in the field. "These new centers provide a vehicle for scientists in CAM institutions to partner with established investigators in conventional research institutions to conduct rigorous exploratory and developmental research projects on CAM." One of the first two 3-year grants has been awarded to:

Palmer Center for Chiropractic Research, Davenport, Iowa - Principle investigator: William Meeker, D.C., M.P.H. Developmental Centers for Research on CAM (DCRC), specifically for CAM institutions, October 30, 2003.

Road less traveled

The number of applicants to U.S. medical schools fell for the sixth year running in 2002-2003. Lower reimbursements, higher medical school tuition, and perceptions that physician autonomy is declining likely contributed to the slide. Since 1997, the number of people applying to medical school has dropped nearly 22 percent. Medical education experts are reluctant to speculate, but a past standard explanation has been that the medical field has lost prestige. Rising tuition and the threat of government regulation also have been cited as deterrents. Developmental Centers for Research on CAM (DCRC), specifically for CAM institutions, October 30, 2003.

However, a later report by the Association of American Medical Colleges shows ...

Applications to medical schools in the United States rose slightly for the first time since 1996, and women applicants out-numbered men for the first time. The number of applicants fell steadily after 1996 until last year, the association says.

USA Today, November 6, 2003.

Drug profits and the free market

To the Editor:

"... But we should not assume that the cost of research and development is the engine that drives price inflation (in the pharmaceutical industry). Many medications in a given class are duplicates of each other, and millions of dollars of drug research money are spent creating new competing chemicals only slightly different from already effective medicines." From a medical doctor

"...But newspapers, magazines, and television are filled with advertisements for medications that are surely extremely costly. And pharmaceutical companies invest large sums of money in expensive dinners and various perks for physicians provided by the drug representatives. Now that is a bitter pill for Americans to swallow." From a clinical instructor at Harvard Medical School

"... It is not the free market that causes drug prices to be high in the United States, it is patent protection - a government-granted monopoly ... With all drugs sold in a free market, there would be enormous gains for everyone, except the pharmaceutical industry." From the co-director, Center for Economic and Policy Research, Washington

The New York Times, Editorials/Letters, October 28, 2003.

FDA warns of possible drug-suicide link

Some anti-depressant drugs undergoing trials in children may be associated with suicides, the Food and Drug Administration said on October 27. The agency said reports in the press and medical journals describe suicide attempts and suicides in children receiving antidepressants. Many such reports also have been submitted to the FDA. Health News, Associated Press, October 28, 2003.

Campaign for medical device bypasses doctors

Taking a page from the drug industry, two medical device makers are going head to head with national campaigns that advertise hip-replacement implants to consumers. Jack Nicklaus, on CBS' "60 Minutes" urged patients to ask about the new device he had implanted. Until now, manufacturers of medical devices that "require" surgery or other complex procedures have largely focused promotional efforts on doctors. A growing number have now turned their attention to consumers "This is not how people should be making important decisions on procedures that can help them, but also come at great risk as well," said Arthur A. Levin, director of the Center for Medical Consumers in Manhattan. Mr. Levin said that such surgeries can also lead to life-threatening complications, especially in the elderly, and can require repeated operations on young patients. But analysts say the ads may be only the beginning. And while pharmaceutical companies must follow strict advertising rules set by the FDA, few rules apply to device makers. Such ads include no information on risks other than making it clear that a hip replacement involves surgery and rehab. The New York Times, October 30, 2003.

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