Eye Catching Statistic

From today's Wall Street Journal (p. A7),

Americans spent $1.58 trillion on medical care over the past year -- the highest category of personal consumption expenditure. Americans spent $1.37 trillion on housing and $1.27 trillion on food.

2007 HSA Inflation Adjustments Projected

The federal law governing the consumer driven option known as a health savings account (HSA) coupled with a high deductible health plan (HDHP) provides for annual inflation adjustments to the minimum and maximum health plan deductible, the out-of-pocket expense maximum, etc. The inflation adjustment for the next year is computed based on the change in the consumer price index (urban or CPI-U) from August of the prior year to August of the current year -- the same adjustment that is used for income tax factors that are inflation adjusted.

After the Department of Labor recently released the August 2006 CPI-U data, the HSA mavens quickly performed the calculation and projected the inflation adjusted HSA/HDHP factors for 2007. The IRS will release the official adjustments later this fall.

CMS Makes Medicare Part D Open Season Announcement

The Centers for Medicare and Medicaid Services (CMS) provided details on 2007 Medicare Part D plan options today. Medicare Part D is Medicare's prescription drug coverage program with coverage offered to Medicare eligible beneficiaries by regional prescription drug plans and Medicare Advantage Plans with prescription drug coverage. The open enrollment period begins November 15. (Medicare Part D intentionally is structured similar to the FEHB Program.)

CMS announced that

The monthly premium beneficiaries will pay in 2007 will average $24 if they stay in their current plan -- about the same as in 2006. While some people will see an increase in their current plan premiums, they have the option to switch plans. Nationally, 83 percent of beneficiaries will have access to plans with premiums lower than they are paying this year, and beneficiaries will also have access to plans with premiums of less than $20 a month.

Beneficiaries will have more plan options that offer enhanced coverage, including zero deductibles and coverage in the gap for both generics and preferred brand name drugs. Plans are adding drugs to their formularies. Nationwide the average number of drugs included on a plan formulary will increase by approximately 13 percent, and plans will also use utilization management tools at a lower rate.

CMS also noted that "In addition to prescription drug plans, Medicare beneficiaries in 39 states will have access to the first Medical Savings Account plans and related consumer-directed plans ever available in Medicare." Of course, 2007 will only be the second year of operation for Medicare Part D, which was created by the Medicare Modernixation Act of 2003.

Executive Order Update

On August 22, 2006, President Bush issued an executive order that directs certain federal agencies, including the U.S. Office of Personnel Management to

1. Increase Transparency In Pricing and Quality.

2. Encourage Adoption Of Health Information Technology (IT) Standards.

3. Provide Options That Promote Quality And Efficiency In Health Care.

HHS Secretary Michael Leavitt continues to push forward these Presidential initiatives according to a GCN.com report.

Secretary Leavitt reported that last week the Healthcare Information Technology Standards Panel, (HITSP) a unit of the American National Standards Institute, issued its first set of HIT interoperability standards. HITSP will be issuing additional standards every eight to ten weeks. These are the standards referenced in the Executive Order.

Another organization the Certification Commission for Healthcare Information Technology (CCHIT) which also operates under an HHS contract is responsible for accrediting HIT for

Functionality – setting features and functions to meet a basic set of requirements. (For additional details, see the CCHIT Functionality Criteria.)

Interoperability – enabling standards-based data exchange with other sources of healthcare information when they are established by HITSP. (For additional details, see the CCHIT Interoperability Criteria.)

Security – ensuring data privacy and robustness to prevent data loss. (For additional details, see the CCHIT Security Criteria.)

CCHIT already has accredited 22 ambulatory electronic health record products. HITSP and CCHIT recently created a working group to coordinate their activities.

Secretary Leavitt also announced the creation of an additional American Health Information Community workgroup focused on quality. This workgroup will make "that specify how certified health information technology should capture, aggregate and report data for a core set of ambulatory and inpatient quality measures."

Kaiser Foundation Survey Released

One week after OPM announced a 1.8% increase in Federal Employees Health Benefit plan premiums for 2007, the Kaiser Family Foundation and the Health Educational and Reseach Trust released their 2006 Employer Health Benefits Survey, the key findings of which are feaured in a publically available Health Affairs report. The Survey reports that "premiums for employer-sponsored health coverage rose an average 7.7 percent in 2006, less than the 9.2 percent increase recorded in 2005 and the recent peak of 13.9 percent in 2003" The KFF press release and other press accounts note that the 2006 increase, while low compared to other recent years, is more than double the rate of inflation. FEHBP premiums rose 6.6% for 2006, which suggests that the 2007 survey will report significantly lower premium increases.

Other survey findings include the following:

• An estimated 4 percent of covered workers are enrolled in high-deductible plans with a savings option, compared with 60 percent in preferred provider organizations (PPOs), 20 percent in health maintenance organizations, 13 percent in point-of-service plans, and 3 percent in conventional indemnity plans. Among the 2.7 million workers estimated to be enrolled in HSAs or HRAs this year, 1.4 million are in HSA-qualified plans (up from 0.8 million estimated last year) and 1.3 million are in plans with HRAs (statistically unchanged from last year’s 1.6 million estimate).
• About 61 percent of firms nationally offer health benefits to at least some of their workers, statistically unchanged from last year’s offer rate (60 percent). While nearly all large businesses (with at least 200 workers) offer health benefits to their workers, fewer than half of the smallest firms (with three to nine workers) do.
• On average, workers are paying $259 more this year than they did last year toward the cost of family health coverage.Workers at small firms (with three to 199 employees) on average contribute significantly more to their premiums ($3,550 for family coverage) than workers at larger companies ($2,658 for family coverage). On average, workers this year are paying about 16 percent of premiums for single coverage and 27 percent of premiums for family coverage, with their employers paying the rest. That share is essentially unchanged in recent years.
• In 2006, the average in-network PPO deductible for workers facing a deductible reached $473 for single coverage. Average co-payments for drugs across plan types were $11 for generic drugs, $24 for preferred drugs and $38 for non-preferred drugs.
• Few employers have a lot of confidence in strategies to contain rising health-care costs. For example, only 17 percent of small employers and 28 percent of large employers say that they consider disease management programs “very effective” at controlling health-care costs. Employers were less likely to rate other strategies as very effective, including consumer-directed health plans (16 percent of small and 13 percent of large employers), higher employee cost sharing (15 percent of small and 13 percent of large firms), and tighter managed-care networks (9 percent of small and 4 percent of large firms).
  

The last finding is worth further investigation.

Leslie Norwalk named Acting CMS Administrator

Leslie V. Norwalk has been named Acting Administrator of the Centers for Medicare and Medicaid Services effective October 15, 2006. Ms. Norwalk who currently is Deputy CMS Administrator replaces Dr. Mark McClellan, who recently resigned as CMS Administrator. So a lawyer is replacing a doctor in this very important job.

IOM Releases Studies on Drug Safety, Pay for Performance

The presitigious Institute of Medicine released a report yesterday on the "Future of Drug Safety. Action Steps for Congress." Among the IOM recommendations are two that make perfect sense to me in the wake of the Vioxx and similar flawed drug releases: restrict direct to consumer advertising for the first two years following a new drug release and conduct a follow-up efficacy and safety study five years after the new drug release. The drug manufacturers may not be crazy about the first recommendation because they appear to rely on the blockbuster release approach in order to recoup their investment in new drugs. But an ounce of prevention is worth a pound of cure. The 110th Congress will take up the IOM recommendations next year when Congress must reconsider the user fees that pharmceutical manufacturers pay the FDA for running the new drug approval process.

On Thursday, the IOM released a study on "Rewarding Provider Performance. Aligning Incentives in Medicare." The report finds that pay for performance programs are one of several tools for improving health care quality in the traditional Medicare program. The report recommends that pay for performance program be used to incent improvements not only the quality of care in a particular health care facility but also the in the coordination of care among health care providers. The report offers guidance for pay for performance programs in all payer settings.

Reaction to Walmart's move

Target has decided to match Walmart's price in Tampa - St. Petersburg, Florida, where the $4 generic drug price pilot begins today. CVS and Walgreen's, drugstore chains which have the most to lose from Walmart's move, seek to minimize the move claiming that the price cut extends only to a subset of older generics. Here's the drug list.

Marketwatch reports that analysts do not see the move hurting PBMs or generic drug manufacturers. The Washington Post provides an interesting overview of the move, observing that

Tovar, the Wal-Mart spokesman, said that the $4 price is available to anyone, but that Wal-Mart will try to collect insurance on prescriptions for people with prescription-drug coverage. However, some insurance contracts stipulate that pharmacies will not be paid the full cost of a drug unless customers pay the full co-payment the insurer requires.

Tovar said Wal-Mart will still allow insured customers to pay $4 per prescription, even if that is less than the co-payment required and even if that means Wal-Mart will not be paid any money by insurance companies.

Mohit Ghose, a spokesman for America's Health Insurance Plans, which represents providers of insurance of all types, including for prescription-drug coverage, said the typical co-payment for a generic prescription is $5 to $15. He said it is unclear how the Wal-Mart plan will affect insurance coverage.

The Post also had an illuminating report on the government's regulatory reaction to the e. coli outbreak in packaged spinach.
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Drug Reimportation Compromise

The Republican leadership in Congress reportedly has agreed on a compromise that would allow Americans to bring a 90 day supply of prescription drugs back from Canada, where retail brand name drug prices are significantly lower. Mail order and internet purchases from Canada would remain prohibited. The Food and Drug Administration will not guarantee the safety of reimported drugs (or American grown spinach, although the FDA is now considering a spinach labelling plan.).

CDC Recommends Routine HIV Testing

The U.S. Centers for Disease Control is now recommending routine HIV tests for all American aged 13 to 64. Of course, HIV is the virus which can lead to AIDS. The American Medical Association has endorsed this action. The CDC believes that catching the virus earlier will improve patient outcomes.

Interim ONCHIT Director Named

Dr. Robert Kolodner, the Veterans Affairs Department's chief health care infomatics officer, has been named interim national coordinator of health information technology at the Department of Health and Human Services, succeeding Dr. David Brailer who resigned last May.

Walmart's generic drug pricing innovation

The blog has followed the trend of blockbluster prescription drugs that have lost their patent protection, such as Merck's Zocor and Pfizer's Zoloft. The leading discount store chain Walmart announced today that

Its pharmacies will make nearly 300 generic drugs available for only $4 per prescription for up to a 30-day supply at commonly prescribed dosages. The program, to be launched on Friday [Sept. 22], will be available to customers and associates of the 65 Wal-Mart, Neighborhood Market and Sam's Club pharmacies in Tampa Bay, Fla. area, and will be expanded to the entire state in January 2007 [and to as many states as possible next year].

The program is available to all customers, whether insured or uninsured. On average, generic drugs cost consumers $10 to $30 for a month's supply. The announcement caused drug wholesalers and drugstore company stock prices to fall.

Transparency Update

Health care provider price and quality transparency is a major Administration goal and a component of the President's August 22, 2006, Executive Order. The U.S. Office of Personnel Management which administers the Federal Employees Health Benefits Program has explained its Executive Order implementation approach:

Transparency in pricing. OPM will work with carriers to make available to
FEHBP enrollees information about the cost of services delivered by various
providers. This information will be combined with quality information so that
enrollees can see quality and price information together in single, easy-to-use
sources.

Transparency in quality. OPM will work with carriers to make available
information on the performance of doctors, hospitals and other health care
providers. They will use quality measures that have been developed
collaboratively with the health care sector, to help ensure accuracy and
fairness.

OPM announced this week the FEHB plans which were the first to meet its transparency standards:

Aetna Health Plans, American Postal Workers Union consumer-driven, Av-Med,
Blue Choice for Ohio and Missouri, Blue HMO of Ohio, CaliforniaCare,
CareFirst BlueChoice, Foreign Service Benefit Plan, HealthNet of California,
HMO Health of Ohio, Humana Health Plans, Independent Health, Kaiser for
California, Colorado and Northwest regions, M-Care, Rural Letter Carriers
Health Plan, SuperMed HMO and United Healthcare.

Give me the details

As you know, OPM released 2007 FEHBP, supplemental dental, and supplemental vision premiums yesterday. Many more details about 2007 premiums are now available on OPM’s website – www.opm.gov and www.opm.gov/insure

More on the press release

Naturally, there are several news articles on the 2007 FEHBP premiums press release this morning, including the Washington Post, the Federal Times, and Govexec.com .

New Evidence Based Medicine Payment Model Proposed

A multi-disciplinary group organized as Prometheus Payment Reform, Inc. is proposing a new health care provider payment model using "Evidence-Based Case Rates" that seek to tie the payment to compliance with evidence based medical guidelines. "The initial focus of the model is on five specific clinical areas: cancer care (starting with lung and colon cancers), chronic care (starting with diabetes, depression, hypertension and hyperlipidemia), interventional cardiology, orthopedic care (in particular joint replacements) and routine and preventive care." The group which includes executives from Bridges to Excellence, the Leapfrog Group, the Blue Cross and Blue Shield Association, and the American Hospital Association, currently is preparing to conduct pilot tests of the model in several regions.

OPM plans E-prescribing pilot

As I earlier blogged, the U.S. Institute of Medicine strongly recommends electronic prescribing to reduce medication errors and related health care costs. In his September 1, 2006, testimony before the House Federal Workforce and Agency Organization Subcommittee, OPM Deputy Associate Director Dan Green advised the members of OPM's plan to conduct an e-prescribing pilot program in the Federal Employees Health Benefits Program. More details are to follow.

OPM Releases 2007 FEHBP Premiums

Today is a big day in the Federal Employees Health Benefits Program (FEHBP) contract cycle, which began when OPM released its 2007 benefit and rate proposal call letter in April 2006. OPM announced 2007 FEHBP premiums!

The average premium increase is 1.8%, the lowest increase in a decade. "On average, employees will contribute 2.3 percent more to their health care, while the government contribution (roughly 72 percent) will increase by 1.6 percent." 63% of enrollees will see no increase at all.

"The FEHBP will offer 284 plan choices in 2007, up from 279 in 2006; 29 HDHPs will be offered, an increase of two over 2006. Similarly, the number of Health Maintenance Organizations increases to 209, up from 205."

For the first time, OPM also announced premiums for the new enrollee-pay-all supplemental dental and vision programs. "Three enrollment categories are available for dental and vision coverage: self only, self plus one, and self and family. Bi-weekly dental premiums, based on the employee's place of residence, range from $7.29 for self coverage, to $56.77 for self and family coverage; bi-weekly vision premiums range from $2.63 for self coverage, to $16.21 for self and family coverage."

The next step in the cycle is the Open Season.

A single Open Season for the FEHB Program, FSAFEDS Program and Dental/Vision coverage will be held governmentwide from November 13 through December 11. During this period, individuals can review printed and online materials to compare the coverage and costs of each program, as well as enroll or make changes based on their personal needs. Current FSAFEDS enrollees must re-enroll for 2007 if they wish to continue coverage. Additional information on FEDVIP benefits and costs, along with health plan brochures, will be available at agencies for review by employees; employees and retirees can view the information online at www.opm.gov/insure/health/index.asp. Information on FEDVIP can be obtained online at www.opm.gov/insure/dentalvision; information on FSAFEDS can be found at www.fsafeds.com.

Maybe next year.

It's a reoccuring story. My name never shows up in the annual list of MacArthur "genius" grants. Then again, I don't see any lawyers in this year's list.

When It Rains, it pours

Bristol Myers Squibb took another one in the chops yesterday when a federal judge in New York City invalidated a key Imclone System's patent associated with its colon cancer drug Erbitux (in favor of three Israeli scientists). BMS is the co-marketer of Erbitux, sales of which are expected to be around $1 billion this year. (It is worse news for Imclone as Erbitux is its only marketed drug, and Amgen is poised to receive FDA approval of a competitor drug. Which company is more snake bit -- BMS or Imclone (founder Sam Waksal in prison for securities fraud, etc.)?

Happy Constitution Day!

September 17 is Constitution Day, the day on which in 1787 the members of the Constitutional Convention, chaired by George Washington, signed our Constitution, subject of course to ratification by the states. OPM has produced a website about its Constitution Initiative project to educate federal employees about the Constitution. I would like to have Constitution Day capped off with a Redskins win over the Cowboys.

Glaxo drug may prevent Type 2 Diabetes

According to a study published in the New England Journal of Medicine and its UK cousin The Lancet, a large clinical trial called DREAM indicates that a GlaxoSmithKline drug called Avandia (rosiglitazone) may prevent Type 2 diabetes in high risk individuals. Avandia is labeled for use to treat Type 2 diabetes, which is considered an epidemic in the U.S. and many other parts of the world. However, the study also raised a concern that preventive use of Avandia may cause heart failure. A Lancet editorial cautioned that "The high cost of therapy and the lack of long-term data mean that healthcare funders are unlikely to see rosiglitazone as an appropriate agent" particularly when diet and exercise programs also are effective prophylatics for this population.

The study also revealed that another drug thought to prevent Type 2 diabetes -- ramipril -- has a minimal impact on the disease.

Forbes.com observes that

Still, the results are a scientific win because they show that it is possible to develop drugs that prevent diabetes. An entirely new class of treatments is racing to market in the form of Januvia and Galvus, experimental pills developed by Merck and Novartis, which work in a new way. The FDA is expected to approve or reject Januvia in mid-October and Galvus in November. It's possible that Merck and Novartis could find a way to walk through the door that Glaxo has already opened.

Blue Cross Survey Discloses HSA Popularity

"The popularity of health savings accounts (HSAs) coupled with high-deductible health plans is equally distributed across consumers aged 25 to 54, with demand also coming from all income and education segments of the population, according to a new survey released today by the Blue Cross and Blue Shield Association (BCBSA)."

Welcome back DDT!

According to the Wall Street Journal and other press reports, "The World Health Organization, conceding that widely used malaria-fighting methods have failed to bring the catastrophic disease under control, plans to announce Friday that it will encourage the use of DDT even though the pesticide has been banned or tightly restricted in many parts of the world." According to MSNBC.com, "the U.S. government already has decided to pay for DDT and other indoor insecticide use as part of President Bush’s $1.2 billion, five-year initiative to control malaria in Africa." (It's interesting to note on the WHO web site that European countries are experiencing "epidemics" of heart disease and diabetes similar to the U.S.)

CMS Announces 2007 Medicare Deductibles and Premiums

The Centers for Medicare and Medicaid Services ("CMS") have announced the 2007 Medicare deductibles and premiums for Parts A and B. The monthly Medicare Part B premium will increase $5.00 from $88.50 to $93.50 and for the first time the premium amounts will be higher for Medicare beneficiaries with over $80,000 in taxable income (single taxpayer) or $160,000 for those filing jointly. Part B covers physician's and related medical services and supplies, such as diagnostic testing.

CMS explains that

The single most important factor driving the 5.6 percent Part B premium increase is the growth in traditional fee-for-service Part B spending per capita, as opposed to spending growth in Medicare Advantage. The phase-out of “budget neutrality” adjustments in Medicare Advantage payments helps account for the limited Medicare Advantage payment increase. The largest contributors to the 2007 premium increase by type of service are outpatient hospital services, physician-administered drugs, and ambulatory surgical center (ASC) services. Spending for outpatient hospital prospective payment services is growing rapidly and is projected to increase by 11.6 percent per capita in 2007. This is mainly due to an expected 7.9 percent increase in the volume and intensity of these services. In addition to the higher premium costs caused by this growth, it also results in a projected 6.5 percent increase in per capita beneficiary coinsurance payments (beneficiary coinsurance for hospital outpatient services can be as high as 40 percent).

However, the 2007 premium increase is held down by a provision in current law that, if unchanged, will require a reduction in fees paid by Medicare to physicians of about 5 percent. Congress has acted to prevent such physician fee reductions from occurring in each of the last four years. Even with the fee reduction, however, the volume and intensity of physicians’ services is projected to increase by 4.9 percent in 2007, resulting in projected continuing pressure toward rising costs.

As CMS has said repeatedly, the rapid growth in utilization of services and the wide variation across providers and geographic areas in the use of these services shows that Medicare needs to move away from a system that pays simply for more services, regardless of the quality of those services or their impact on beneficiary health. Medicare payments should provide better financial support to doctors and other health professionals in their efforts to achieve better health outcomes for Medicare beneficiaries at a lower cost. CMS is working closely with medical professionals and Congress to increase the effectiveness of how Medicare compensates physicians and other health care providers. CMS is also conducting demonstrations and pilot programs that pay providers more for better quality, better patient satisfaction, and lower overall health care costs

Of course, the medical community is fighting to restore the fee reduction that helps to control the Psrt B premium.

The Medicare Part B deductible will increase from $124 to $131, the same percentage as the premium increase.

Finally CMS explains that

Medicare Part A pays for inpatient hospital, skilled nursing facility, hospice, and certain home health care. The $992 deductible, paid by the beneficiary when admitted as a hospital inpatient, is an increase of $40 from $952 in 2006. The Part A deductible is the beneficiary’s only cost for up to 60 days of Medicare-covered inpatient hospital care in a benefit period. Beneficiaries must pay an additional $248 per day for days 61 through 90 in 2007, and $496 per day for hospital stays beyond the 90th day for lifetime reserve days. This compares with $238 and $476 in 2006. The daily coinsurance for the 21st through 100th day in a skilled nursing facility will be $124 in 2007, up from $119 in 2006.

House Subcommittee Sends H.R. 4859 to the Full Committee

On September 13, the House Federal Workforce and Agency Organization subcommittee approved by voice vote the Manager's amended version of H.R. 4859, the Federal Family Health Information Technology Act, and sent it on to the full Government Reform Committee for its consideration. As previously reported in the blog, this bill would require Federal Employees Health Benefit Plans to provide their menbers with electronic health records. According to press reports, America's Health Insurance Plans , a major industry trade association, had asked the Subcommittee chairman, Rep. Jon Porter (R-NV) to delay the legislation until health insurers develop standards for EHRs and the systems used to store and transmit them."

H.R. 4859 Update

Following up on his September 1 subcommittee hearing, Rep. Jon Porter (R Nev) will hold a meeting of his House Federal Workforce and Agency Organization subcommittee to markup and vote on H.R. 4859, the Federal Family Health Information Technology Act. The meeting will be held tomorrow at 2 pm. The Federal Times reported on the meeting earlier today.

Drug Wars Update 9

Embattled Bristol Myers Squibb CEO Peter Dolan and (gasp) his company's general counsel Richard Willard were terminated today based on the recommendation of retired Federal Judge Frederick B. Lacey who is monitoring the company's compliance with its deferred prosecution agreement with the federal government. Mr. Dolan was under shareholder fire for his mishandling of the Plavix patent dispute discussed in the Drug Wars Updates, among other issues. The Wall Street Journal notes that Mr. Dolan is the third major U.S. drug company CEO to be shown the door in the past 16 months.

Merck & Co., Whitehouse Station, N.J., last year pushed then-CEO Raymond Gilmartin into early retirement after withdrawing the painkiller Vioxx from the market in 2004. Pfizer Inc., the world's biggest drug maker, ousted Henry McKinnell in late July, replacing him with a former lawyer. As at Bristol-Myers, the stocks of both companies have been battered in the past two years.

HIT Tidbits

• The Houston Chronicle reports that "A national survey of about 1,100 adults that Harris Interactive conducted in July found that 7 percent of U.S. adults use online personal health records. The poll also found that 35 percent of those surveyed were unaware that the technology exists. The survey's margin of error was plus or minus 3 percentage points."
• The New York Times reports on a new twist to the myspace.com and Facebook fads -- web pages such as thestatus.com where hospital patients and chronically ill people can update their friends and family on their condition and receive notes of support. Because the trick with these ventures is to figure out how to monetize the site, the Times notes that carepages.com which was created by the Mayo Clinics, the Cleveland Clinic, and Massachusetts General Hospital, among other care providers, "offers newsletters; educational materials specific to the patient’s illness; links to the hospital florist, gift shop or medical foundation."
  

Wall Street Jounral's 2006 Technology Awards

Here are The Wall Street Journal's 2006 Technology Award winners for Biotech-Medicine and Medical Devices:

Biotech-Medicine
Pfizer/Nektar Therapeutics, U.S.
Nominees: Both companies say too many individuals were involved to single out individuals.
Innovation; Exubera, a powdered inhalable insulin for the treatment of diabetes.

Medical Devices
Incisive Surgical, U.S.
Nominee: John L. Shannon, Jr., President and CEO
Innovation: Insorb, a mechanical skin stapler that places absorbable staples underneath the skin.

Very cool.

Cracking Cancer's Genetic Code

More encouraging news was released today in the public health campaign against cancer, the second deadliest disease in America after heart disease. According to a report in the most recent issue of the journal Science, researchers from Howard Hughes Medical Institute (HHMI), Johns Hopkins University, Case Western Reserve University School of Medicine, and a team of researchers from The Kimmel Cancer Center at Johns Hopkins have identified 189 genetic mutations that play a major role in the development of breast cancer and colorectal cancer.

Foodconsumer.org reports that

"Only by understanding this blueprint of cancer will we be fully able to understand the mechanism of what makes a cancer a cancer and to think about strategies for diagnosis, prevention and therapy," said Dr. Victor Velculescu, senior researcher on the project and an assistant professor of oncology at [the] Kimmel Cancer Center.

The [research] team found far more mutated genes in tumor cells than they had expected. They found 189 genetic mutations in the tumors, which are suspected to be involved in causing cancer. The main point was that these genes were never implicated in cancer previously.

“Scientists who have seen these data have told us that it keeps them up all night thinking,” said Bert Vogelstein, a co-researcher in the study. “It will hopefully open up a large number of opportunities in many areas of cancer research.”

The researchers had theorized that they would find a maximum of 90 mutations that alter protein structure. Through crosschecking, the researchers identified an average of 11 genes in each cancer that were most likely involved in how the cancer presented itself. Approximating this to the human genome, the researchers say an average of about 17 genes are expected to have critical involvement in the development of each cancer.

The researchers found another startling fact. No two cancers were similar even if the genes were the same, meaning that different genes presented in different ways for the same type of cancer in different individuals. The genes contributing to breast cancer were different from those mutated in colorectal cancers.

This is just the beginning of a federally financed effort, called the Cancer Genome Atlas, to map the genetic mututations that cause the various forms of cancer. It is hoped that the effort will lead to the development of new drug treatments for this terrible disease.

Drug formulary changes

Nexium is the purple pill that you've seen on TV, a proton pump inhibitor to treat acid reflux disease. AstraZeneca sold $4.6 billion dollars worth of this medication in 2005. In July 2005, TRICARE, the Defense Department's health care program for military retirees and active duty dependents, reclassified Nexium as a non-formulary drug on the ground that cost effective alternatives like now over the counter Prilosec were readily available.

Today UnitedHealthcare, the Nation's second largest health insurance company, announced that it will stop covering Nexium on the same ground. According to the Associated Press report, UnitedHealthcare took the action because it "had expected costs in the category to slow after generic and over-the-counter versions of Prilosec, the predecessor drug to Nexium, became available in 2003. But that didn't happen" -- possibly because of aggressive advertising of the drug particularly at the time when Prilosec, another AstraZeneca product, lost its patent protection. UnitedHealthcare expects to cut its proton pump inhibitor expenses in half as a result of this and related actions.

Senator Carper introduces FEHBP electronic health records bill

Following up on Sen. George Voinovich's (R - Ohio) August 22 announcement, Senator Tom Carper (D Del.) and Sen. Voinovich yesterday introduced the Federal Employees' Electronic Personal Health Records Act of 2006, S. 3846. According to Senator Carper's press release, "The legislation would require all insurance carriers that contract with the Federal Employees Health Benefits Program to make an electronic health record available for every FEHBP enrollee."

National Cancer Institute Reports Drop in Cancer Death Rates

The National Cancer Institute has released its annual cancer status report with these significant findings:

The long-term decline in overall cancer death rates continued through 2003 for all races and both sexes combined. The declines were greater among men (1.6 percent per year from 1993 through 2003) than women (0.8 percent per year from 1992 through 2003), although rates for men remain 46 percent higher than for women.

Death rates decreased for 11 of the 15 most common cancers in men and for 10 of the 15 most common cancers in women. The authors attribute the decrease in death rates, in part, to successful efforts to reduce exposure to tobacco, earlier detection through screening, and more effective treatment, saying that continued success will depend on maintaining and enhancing these efforts.

“The greater decline in cancer death rates among men is due in large part to their substantial decrease in tobacco use. We need to enhance efforts to reduce tobacco use in women so that the rate of decline in cancer death rates becomes comparable to that of men,” said Betsy A. Kohler, President of the North American Association of Central Cancer Registries, Inc (NAACCR).

Other noteworthly findings were a leveling off of the breast cancer incidence rate over the period 2001 - 2003, ending a string of increases that began in the 1980s and an increase female thyroid cancer incidence rates.

McClellan Resignation

Dr. Mark McClellan, the Adminstrator of the federal government's Centers of Medicare and Medicaid Services, announced that he is resigning his position in October. No successor has yet been announced.

More on the HIT Hearing

The Federal Workforce and Agency Organization Subcommittee has posted complete information about Friday's health information technology hearing on its website. This is the Subcommittee's fourth hearing on this topic since July 2005. Steve Barr reports in his Federal Diary column of today's Washington Post that Subcommittee Chair Jon "Porter [R Nev.] also hopes to mark up a bill [H.R. 4859] that would create electronic health records for the 8 million Americans covered by the federal employee health insurance program."

HIT Hearing Held in St. Louis

The House Federal Workforce and Agency Organization subcommittee held a special hearing in St. Louis, Missouri, yesterday. At the hearing, OPM Deputy Associate Director Daniel A. Green informed the attendees that "OPM's chief priority in the health care arena was to work to implement the President's recent executive order to expand the information and options available to federal employees." OPM has posted its executive order implementation steps on its website, which recently received a facelift.

More on Gene Therapy

I watched Dr. Stephen Rosenberg of the National Cancer Institute on Good Morning America today. As I noted in the blog yesterday, Dr. Rosenberg's miraculous gene therapy cured two out of seventeen potentially fatal melanoma cases. In his interview this morning, Dr. Rosenberg explained that the treatment was administered two years ago, and since then his team has strengthened the treatment and moreover has adapted the therapy to fight other potentially fatal cancers. He is waiting for Food and Drug Administration approval to test the therapy on other types of cancer.