WASHINGTON — Many doctors may lose their ability to prescribe 24 popular narcotic medicines as part of a new effort to reduce the deaths and injuries that result from these medicines’ inappropriate use, federal drug officials announced Monday. (more…)
AUSTRALIAN couples are flocking to a US fertility clinic that allows them to chose not only the sex of their child, but “cosmetic” features such as hair and eye colour. (more…)
WASHINGTON (Reuters) - U.S. regulators need to improve lax oversight of the financial conflicts of doctors who test medicines before they are approved for sale, a government watchdog report said on Monday. (more…)
WASHINGTON—Health care continued to take up a greater share of the economy in 2007, as spending on hospitals, doctors and other services increased 6.1 percent to $2.2 trillion.
There was a silver lining in the numbers the government reported Monday: The increase in health spending was the smallest since 1998, thanks largely to the growing use of generic drugs.
Officials worry that devoting more resources to health care makes it harder for families to meet other priorities and for businesses to compete internationally.
Overall, health spending came to $7,421 per person for the year.
About 67 percent of medications dispensed in 2007 were generic drugs—up from 63 percent the year before. Generics can cost as little as one-third the price of brand-names.
Several factors helped drive the trend. First, insurers are steering consumers to lower-priced medicines by charging low co-payments for certain drugs. Meanwhile, they charge higher co-payments for medicines they want consumers to avoid for safety and financial reasons.
Large retailers and grocers are enticing consumers into their stores with low-priced generics.
Also, several blockbuster brand-name drugs lost their patent exclusivity in 2006, generating competition. Notable examples include Flonase, an allergy medicine; Zocor, a medicine used to lower cholesterol; and Zoloft, which is used to treat depression.
Federal officials said safety concerns also probably influenced spending on medicine as the Food and Drug Administration issued more of its most serious warnings than in previous years—68 in 2007 versus 58 the year before and 21 in 2003.
The overall spending slowdown in2007 came also from a decrease in administrative expenses for the new Medicare drug benefit. When the program kicked in during 2006, it generated a substantial uptick in administrative expenses.
Officials emphasized that the good news about slowing the increasing costs of health care extended only to prescription drugs. All other major health sectors—such as hospitals, physicians, nursing homes and home health—grew at the same rate or slightly faster than the year before.
Since prescription drugs generate only about 10 percent of all health spending, officials question how much longer the transition to generics would dampen the growth in health care costs.
“I wouldn’t expect the good news to continue,” said Richard Foster, chief actuary for the Centers for Medicare and Medicaid Services.
Historically, health spending has been somewhat insulated from the effects of a slowing economy, which means health care makes up an even greater share of the overall economy during recessions. In 2007, the health sector’s share came to 16.2 percent, up from 16 percent the year before.
Stop treating pregnancy as an illness and respect women’s birth choices.
That is one of the main messages to a Federal Government review of maternity services.
More than 400 of the 900 submissions to the review were made public today.
Key suggestions include:
- Establishing a one-off payment to expectant mothers, similar to the baby bonus, to help fund a woman’s chosen birthing option
- Giving midwives in private practice professional indemnity insurance, access to a Medicare number and allowing them to prescribe government subsidised drugs
- Appointing a national breastfeeding coordinator with authority to establish a committee of representatives from government and relevant organisations
- Establishing standards for rural maternity services that will be included in future health funding agreements between the Commonwealth and the states.
A national snapshot of mothers and their babies released this week showed caesarean sections made up almost one-third of births in 2006, compared with 20 per cent in 1997.
This increase in caesareans and other birth interventions has the potential to push down breastfeeding rates, the Australian Breastfeeding Association says in its submission.
“It is well accepted that breastfeeding within the first hour after birth is a vital link to the successful establishment of breastfeeding,” it says.
“However, birth by caesarean section often means that mothers and babies miss this vital first hour together.”
Homebirth Australia says a lack of funding and professional indemnity insurance for midwives means homebirth is available to very few women.
It has also received anecdotal evidence there has been a rise in the number of women giving birth at home without any medical assistance, referred to as free birth.
“The increase in freebirth is largely an indictment on a broken maternity system that is not based on evidence and is not woman centred,” the submission reads.
Future Families said the current structure of maternity services encourages birth to be treated purely as medical condition.
“In no other area of society are our women treated with such a lack of respect,” the group’s submission reads.
The same sentiment was echoed by consumer Melissa Graham, who said: “Reinstate birth as a normal function of life.”
Health Minister Nicola Roxon said most submissions are from individual consumers.
“Their personal accounts of experiences with maternity care sound a strong note of concern that our maternity system has become too focussed on medical intervention,” she said.
The government expects to release the Maternity Services Review report in the new year.
A conference taking place in Adelaide this week will focus on the pros and cons of different approaches to back care, an issue that affects more than 3 million Australians each year.
Medical researchers from Europe, North America and Australasia will attend the 1st Adelaide Spinal Research Symposium, to be held at the National Wine Centre on December 6.
Spinal surgeons will rub shoulders with chiropractors at the conference, which brings together global experts to discuss the latest trends in multidisciplinary care of the spine.
Says speaker Dr Chris Colloca: “The focus will be on assessing the best approaches to patient care. Only one in 400 patients with spine problems require surgery. Research will be presented regarding clinical decision making and prevention as well as fostering interprofessional relationships and case management.”
The pros and cons of conservative and surgical care including disc replacement surgery, diagnostic imaging and intervention for low back pain will also be reviewed. The symposium will be followed by a week of intensive research into spine care, conducted at the Adelaide Centre for Spinal Research.
A spine scientist, Dr Colloca is a chiropractor and member of the International Society for the Study of the Lumbar Spine* (ISSLS), an organisation composed mainly of orthopedic spine surgeons. The former president of the ISSLS, Dr Robert Fraser, an orthopaedic surgeon from Royal Adelaide Hospital, will also address the symposium.
The US-based Dr Colloca, who at the invitation of his Adelaide hosts has given talks at RAH about chiropractic research, said that the award-winning Adelaide Centre for Spine Research on North Terrace is globally recognised as a centre for excellence.
“The centre is closely affiliated with the ISSLS, which serves as an international forum for the exchange of information of both an investigative and clinical nature which relates to low back pain and disability.
“I have found that doctors are encouraged that chiropractors are demonstrating a scientific approach. Like any scientist, they don’t want to be just told something works, they want evidence. However, a lack of evidence is not a lack of effectiveness. There is a large body of evidence in support of the treatment of musculoskeletal conditions.”
Dr Zoe Love, President of the Chiropractors Association of South Australia, agreed with Dr Colloca’s view that scientific research provides the proof of the efficacy of manipulations.“As chiropractors, we closely follow developments in spinal research. We are pleased that this significant conference is taking place in Adelaide, bringing together the thought leaders in spinal care from around the world.”
Dr Colloca has visited Adelaide to conduct research at the ACSR every year for the past five years.
“One of our approaches is to use a disc degeneration model to research the impact of different interventions,” he explained. “We use this model to measure how the spine moves when the discs are normal and when there are abnormalities, how the muscles work and how the joints communicate with muscles through the nerves.”
Other research on the agenda includes:
• When will a patient benefit from conservative, biomechanical care rather than surgery?
• How can chiropractors and medical clinicians do a better job of referring between disciplines, according to what is best for the patient?
• Can a series of medical guidelines be developed to assist these referrals in cases of back pain, headaches and neck pain?
*The purpose of the International Society for the Study of the Lumbar Spine, a non-profit organization founded in 1974, is to bring together those individuals throughout the world, who, by their contributions and activities both in the area of research and clinical study, have, or are indicating interest in the lumbar spine in health and in disease.
For interviews or more information, please contact Leila Henderson 0414 69 70 71; leila@times8.com.au
Members of the Chiropractors Association of Australia SA (CAASA) are registered, primary contact health professionals who undertake a minimum of five years of university training across three government universities in Australia.
Chiropractors usually work in their own private practice or in clinics with other healthcare professionals. They may also act as allied health consultants in areas including occupational health and safety, sport, rehabilitation, health insurance assessment and medico-legal advising.
Their tenet is that “Wellness is an active, lifelong process of assuming personal responsibility that empowers one to become aware of choices, make decisions and take action towards a more balanced, dynamically sustainable and fulfilling existence.”
SOUTH Australian hospitals performing a high number of caesarean section births should be named and shamed, says Democrats MP Sandra Kanck.
SA’s official figures show more than 32 per cent of all babies born were delivered by caesarean section, which is more than double the recommended World Health Organisation standard, Ms Kanck said.
“WHO guidelines recommend 5 to 15 per cent of births as a safe level,” she said.
“Yet in SA the breakdown of caesarean rates are 28.4 per cent for all public hospitals, both metro and country, and 43.7 per cent for metro private hospitals.”
She said rates across five private metropolitan hospitals ranged from about 35 per cent to more than 54 per cent.
“Because choice in childbirth needs to be informed choice, I urge the minister for health (John Hill) to name and shame the worst-performing hospitals.”
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Rants and raves - Kanck’s colourful career
Ms Kanck said fear of pain should not a reason for having a caesarean.
Mothers must be informed of the risks involved with surgical deliveries and the circumstances in which they should be used.
“It is vital that a caesarean is not seen as an option of convenience for either obstetrician or mother,” she said.
AUSTRALIA’S hospitals operate on, X-ray or carry out other procedures on the wrong patient or body part every second day, an alarming new report into medical mistakes has found.
An Australian Commission on Safety and Quality in Health Care report released yesterday lists 187 cases of mistaken identity in private and public hospital operating theatres, laboratories and radiotherapy units in 2006-07 — up from 79 a year earlier. Another 55 patients had to undergo surgery to retrieve an instrument or other material left in them when they went under the knife.
While the effects on patients’ health are not recorded in these cases, other simpler errors — in medicine use or psychiatric supervision — proved fatal. Eleven people died in 2006-07 from incorrect administration of drugs, and another 45 committed suicide while in hospital.
The remainder of the 257 serious incidents recorded consisted of deaths, major injuries or illnesses associated with labour or delivery, reactions to transfusions with incompatible blood or air bubbles in the blood.
But the number of problems reported represents the tip of the iceberg, according to commission chief executive Chris Baggoley. “When some things are subject to self-reporting, we know they’re never going to be good or reliable data,” he said.
“Generally, it’s only about 1 to 4 per cent of matters that could be reported that are.”
Even the eight problems monitored nationally by the commission represent just 10 per cent of “serious adverse events” reported at state level. However, those statistics showed a 77per cent surge in the number of serious hospital mistakes between 2005-06 and 2006-07.
Professor Baggoley attributed much of the increases to changing definitions, noting the massive jump in procedures involving the wrong patient or body part came after NSW’s decision to count mistakes made in diagnostics, radiotherapy and other areas outside operating theatres.
Canberra will view the figures with interest, given its push to tie incentive payments to state health departments to progress against specific indicators.
It wants to see comparisons of such indicators — a campaign Professor Baggoley supports, within limits.
“You don’t want to be forever counting and doing nothing else. You’d want to be learning from this and making sure that learning is spread,” he said.
What gives placebos — substances with no known physiological effect on a medical condition — their power to alleviate symptoms and ease illness?
It’s not what they’re made of: the salt in saline injections, the sugar in dummy pills, or the nutrients in multi-vitamins. It’s their ability to inspire the placebo effect.
The distinction may seem like splitting hairs but it’s quite important, insists Dr. W. Grant Thompson, author of The Placebo Effect and Health and a professor emeritus at the University of Ottawa.
Placebos, whether nutritional supplements or sugar pills, are mere props in the medical drama that occurs between doctor and patient, he says.
The real action has to do with a patient’s willingness to believe that a doctor can help him and the impact that belief has, independent of the natural course of an illness or other physiological interventions, Thompson explains.
That’s the placebo effect. It’s essential to the very foundation of medicine — and a large part what made it possible for doctors to help patients before the mid-20th century, when treatments were largely ineffective.
Today, doctors tend to think that the placebo effect is activated by doing something — telling a patient to use an over-the-counter painkiller or take vitamins or try acupuncture. And, indeed, almost half of U.S. physicians recommend placebos to patients, according to a new survey in the BMJ published on Friday.
But Thompson thinks that all those pills are, for the most part, beside the point.
“The placebo effect can be engendered without any pill at all by the positivity and the personality of the physician…by simply talking to patients and reassuring them and empathizing with them,” he told me Thursday, during a phone conversation from his home in Canada.
“The mere handing of a pill to a patient is a shortcut for this and often, I believe, would not be necessary if physicians took time to communicate with patients about their experience of illness,” he continued.
In other words, it is the communication of caring, the feeling of being attended to, the transmission of confidence, the quality of the relationship between doctor and patient that holds the potential to ignite the placebo effect.
Of course, what is most lacking in doctor-patient encounters these days is time. So, as Grant notes, pills have become the medium of exchange in medical transactions, a symbol of the doctor’s power to heal and the patient’s willingness to be healed.
The problem is that this trains people to look to medication as the be-all and end-all. Which is why so many people want an antibiotic anyway, even when their doctors tell them they have a viral flu or respiratory infection and explain that antibiotics don’t work against those conditions.
The expectation that something will be done, some medication dispensed or some intervention tried, even when there is nothing to be done, really, ends up distorting the doctor-patient encounter, turning it into a transactional interaction.
The harm comes when antibiotics are dispensed needlessly, heightening the risk that bacteria will develop antibiotic resistance, one of the most dangerous medical phenomenon of our time. Or when patients are given sedatives — drugs that can have serious side-effects — only because the doctor wants to give something.
(Or, for that matter, when people demand interventions at the end of life that can’t really hold death at bay for more than a short time.)
The recent BMJ report documents that doctors are indulging in both practices, typically without fully disclosing to patients the fact that the medications are being given with the hopes of inciting the placebo effect.
Practically, the placebo effect may still underlie much of what’s done in day-to-day medical practice, Thompson notes.
“Evidence-based medicine only started in the 1930s, and it’s still the case that treatments subjected to clinical trials are almost always new drugs,” he said. “That leaves a whole host of things that we do for patients that we believe are important untested scientifically. It could be that the effects that have been observed have more to do with the placebo effect than any other factor.”
I’m curious what your thoughts are about this fascinating, important topic.
