Drug Companies: H1N1 and a New Spin

The advent of the H1N1 swine flu virus is temporarily changing the spin on drug companies. The demand for life-saving remedies is getting more play than the call for cost-cutting reform.

Drug Companies as Heroes

• A vaccine for H1N1 swine flu may be in clinical trials within "a couple of months" as development is accelerated. (Bloomberg)

• The World Health Organization raised the level of alert to phase 5 and expects to reach the maximum of phase 6 soon indicating that a "pandemic is imminent." (NYTimes.com)

• On average, newer medicines increased drug costs by an average of $18, but they reduced hospital and other non-drug costs by $129. (Study by Frank Lichtenberg, Professor of Business, Columbia University, cited on the Pfizer website)

Drug Companies as Villains

• The cost of prescription drugs increased by 89 percent between 2000 and 2007, although they continue to account for approximately 10 percent of America's healthcare expenditures. (Kaiser Family Foundation)

• Expenditures on prescriptions are projected to increase to $515.7 billion, or 12 percent of America's healthcare spending by 2017. (U.S. Department of Health and Human Services)

• One crusader's Internet thread promulgates a common view. It provided a list of prescription drugs and their alleged mark-up. For example, Paxil® was claimed to have a consumer price (100 tablets) of $220.27, a cost of active ingredients of $7.60 and resultant markup of 2,898 percent.

My Spin

The current situation with H1N1 underscores the heroic innovation and productivity we all need from drug companies. As healthcare reform progresses, we must guard against a possible epidemic of drug-company vilification that could prove fatal.

—Tom DeSanto

End-of-Life Medical Decisions

A friend told me that his active, healthy mother dropped dead of a heart attack at age 85. He was shocked and sad, but over time took comfort that his mother "went out at the top of her game." It struck a chord with me.

My active, healthy father was so robust that at 90 he underwent surgery to repair an aortic aneurysm. The procedure was successful, although the surgeon said that repairing his artery was like "stitching leather." My father lived until 94, finally falling victim to Alzheimer's.

What did we gain by repairing my father's aorta? We enjoyed his company for a few more years, which was priceless. He went through the transition to assisted living and then an Alzheimer's unit and finally hospice care, which exacted a huge price.

In retrospect, was taking the extra medical measures to prolong his life at age 90 worth the emotional and financial cost? Was it really what my father wanted? Maybe not. What if we had discussed it with him, far in advance and knew how to proceed?

A recent study led by Harvard researchers at Dana-Farber Cancer Institute suggests that end-of-life conversations between physicians, patients and families can be linked to better quality of life for patients with advanced cancers and lower costs for their medical care. 

My father didn't have cancer, but a candid discussion about how his life might end would have provided invaluable wisdom and guidance.

Advanced directives have been around for many years, but they are not very effective. Studies by the Agency for Healthcare Research and Quality have shown that less than 50 percent of severely or terminally ill had an advance directive in their medical record. Even if they did, more than 65 percent of their physicians were unaware of it. An existing advanced directive actually made a difference in only half the cases.

It's well known that Americans spend a disproportionate amount of resources on end-of-life care. It's easy to understand why. But researchers in that recent Dana-Farber study demonstrated that end-of-life conversations could lower national expenditures for cancer care by tens of millions of dollars annually—and that's solely for cancer care.

Having those difficult conversations could improve life for the dying and preserve precious resources for the living, such as lowering America's shameful infant mortality.

My father, who was pragmatic, kind and brave, would have approved of the idea. He chose to fight in World War II and came out alive. But he had no choice in his final battle with death.

—Tom DeSanto

Falling Between the Cracks

As the recession strips people of jobs and health insurance, they are forgoing vital preventive care. Recent data estimates that more than 3.7 million working-age Americans have lost their health insurance since the recession began. 500,000 of them are here in California.

The Los Angeles Times recently cited studies that estimate:

• 47 percent of Californians postponing care are considered to be in fair or poor health.

• 33 percent of Californians with chronic conditions have postponed care or prescriptions because of cost.

• 25 percent of California's uninsured have diabetes, emphysema and other chronic conditions that are not being managed.

A New England Journal of Medicine study showed that a co-pay of as little as $10 can dissuade a woman from getting a mammogram. An increase of $5 in a drug co-pay can cause older patients not to refill their prescriptions. 

When people forgo or postpone medical care, they are more likely to show up in emergency rooms with severe conditions that could have been prevented. It damages their health and drives up healthcare costs.

In the long term, the prognosis is even worse. Approximately 23.6 million Americans have diabetes and the number is growing. Type 2 diabetes is already linked with higher possibility of heart attack and stroke. A new study published in the Journal of the American Medical Association links diabetes with a higher risk of dementia.

Too many people are falling between the cracks. America is only as strong as its weakest citizens. For the medical and financial health of our nation, we must find a way to care for all of us.

—Tom DeSanto

Image: www.phoenixrealestateguy.com

Nurses Needed for Healthcare Reform

The prognosis for America's chronic nursing shortage remains grim. 

More than 216,000 registered nursing positions remain unfilled at U.S. hospitals and nursing homes. 

The nationwide nursing shortage could grow to 275,000 by 2010 and one million by 2020.

Nearly 50,000 qualified applicants were turned away from U.S. nursing schools in 2008 because of insufficient resources to educate them.

New possibilities bring some hope for resolution.

The recently enacted economic stimulus bill includes $500 million to address shortages of healthcare workers. Approximately $100 million may be dedicated to nursing.

The Nurse Education, Expansion, and Development (NEED) Act was introduced in Congress in February 2009. It would authorize capitated grants to nursing schools for much-needed nurse educators, infrastructure improvements, laboratory enhancement and equipment purchase.

In a recession, nursing offers the assurance of eventual employment opportunity. A 2006 study projected nursing employment  to rise an average of 23 percent by 2016. Nursing positions in physicians' offices and home health each led the way with a predicted increase of 39 percent. 

America's healthcare system cannot be reformed or realize its full potential unless we have sufficient nursing staff to care for the growing number of patients requiring treatment. An estimated 6,700 patient deaths and 4 million days of hospital care could be averted annually by increasing the number of nurses. Now is the time to take action to alleviate the nursing shortage. My wife is. She's planning a second career in nursing.

—Tom DeSanto

Image: www.reachingallyouth.org