30 April 2010

Health Notes from St. Louis


Vitamin E, Fetal Care, and Virtual Colonoscopy

Daily doses of vitamin E can boost liver function in patients with nonalcoholic steatohepatitis (NASH), according to new research at St. Louis University.

"Fatty liver disease is a growing problem in the U.S., and we currently have no approved medication to offer patients," said Dr. Brent Tetri, a hepatologist at the school's liver center. "With this study, we're pleased to find that vitamin E should help some of our patients.

Increasingly common, NASH is characterized by excessive fat that causes inflammation and damage in the liver. Linked to weight gain and obesity, it affects 3 percent to 4 percent of all American adults and can lead to cirrhosis, liver cancer and death.

During 96 weeks of treatment, patients with NASH were given either 800 International Units (IU) of vitamin E or a placebo. Nearly half -- 43 percent -- of those who took the vitamin E showed significant improvement of the liver compared to 19 percent of those who took the placebo.

In a separate part of the study, researchers also found that patients who took the drug pioglitazone also improved, although it was associated with weight gain. Researchers caution that neither treatment improved liver disease in all patients and that diabetic patients were not included.

New Fetal Care Center

Countless babies born throughout the Midwest each year may have a better chance of survival thanks to the new Fetal Care Center in St. Louis.

The center was launched earlier this month as a collaboration of Barnes-Jewish Hospital, St. Louis Children's Hospital and Washington University. It is targeted at the nearly 10,000 babies born with serious medical conditions requiring every year in Missouri and eight surrounding states.

"We don't think a mother-to-be should wait for answers," said Dr. Anthony Odibo, the center's co-director. "That's why we've designed our program to provide results, develop a plan -- even begin treatment, if necessary -- right on the spot."

The goal is to provide pregnant women facing the birth of a baby with major health problems to have all necessary tests done at one time and provide answers and options before the end of the day.

"Delivering at a hospital that doesn't have the capacity to address some of these really important things then mandates the baby be transported from one facility to another," said Dr. Brad Warner, the surgical director. "That can sometimes make the difference between life or death"

Alzheimer's conference Saturday

St. Louis University will share the latest information on preventing Alzheimer's disease during an all-day conference Saturday at the Doisy Learning Resources Center, 3545 Vista Ave., St. Louis.

Open to the public, the program will explore such topics as the role of exercise and diet in promoting brain health, drug therapies in the pipeline, the importance of sleep and such alternative therapies as yoga, mediation and herbs.

"The brain has a tremendous capacity to change," said Dr. Abhilash Desai, director of the school's Center for Health Brain Aging. "We believe that exercise, nutrition, stress management and healthy habits can help postpone dementia."

For more information, consult an Alzheimer's specialist in St. Louis
Virtual colonoscopy study

A new, large study of virtual colonoscopy has uncovered a pleasant surprise: Of the more than 10,000 people without symptoms tested, more than one out of every 200 had malignant cancer -- and most of those cancers were outside the colon.

"We are finding that virtual colonoscopy screening actually identifies more unsuspected cancer outside of the colon than within it," said Dr. Perry J. Pickhardt, the chief of GI Imaging at the University of Wisconsin and the study's lead author. "As with asymptomatic colorectal cancers identified by virtual colonoscopy, these cancers are often detected at an early, curable stage.

Virtual colonoscopy uses CT scans to examine the entire length of the colon, making it quicker than the standard test while essentially removing the risk of bleeding or colon perforation. Now, doctors are finding its ability to assess nearby structures in the abdomen and pelvis is reaping additional benefits.

"Optical colonoscopy cannot provide for any assessment beyond the colon itself," Pickhardt said. "Virtual colonoscopy can detect a wide array of unsuspected extracolonic disease, most notably cancers and aortic aneurysms.

The study, reported in this month's issue of Radiology, found cancer in 58 patients -- 22 inside the colon and 36 outside. Of those, 31 cases were stage 1, the most curable.

Recording surgical consultations

If you ever need to talk to a heart surgeon in St. Louis, you may want to take along a tape recorder. A new Scottish study has found that patients who taped surgical consultations were better informed and had less anxiety.

"Patients facing heart surgery are understandably anxious ... and, as a consequence, are unlikely to absorb all the information presented to them," the study authors noted. "They also find it difficult to remember the various percentage figures quoted for risk of complications, success rate of alternative therapeutic options and other pertinent facts."

But in a study of 84 patients at the Glasgow Royal Infirmary, those who taped their conversations with their surgeon wound up much more informed, reported a greater sense of control over their health, and scored lower on measurements of anxiety and depression.

New program at Touchette

Touchette Regional Hospital in Centreville recently launched its Complete Care Program to help patients battling chronic diseases.

The initial focus of the program will be on diabetes with hospital staff offering education on ways to better manage the disease and prevent complications. The goal is to provide a better quality of life while reducing the need for health care services.

Lester Johnson, who has had trouble for a decade controlling his blood sugar, said the program already has helped him.

"The diabetes educators were very helpful," said Johnson, of East St. Louis. "They showed me what foods I should eat, the benefits of exercise and how to properly test my blood sugar. I feel much better now, and my blood sugar is testing much lower."

Beta blockers may be underused

New research at St. Louis University suggests that beta blockers are underused in heart failure patients who receive implantable cardiac devices.

Consuming too much "added sugar" not only can make you fat, it also may play havoc with your cholesterol levels.

That's the conclusion of a new study of 6,100 adults, which found that those with higher intakes of added sugars were more likely to have lower levels of high-density lipoproteins (the good cholesterol) and higher levels of triglycerides (blood fats).

"Added sugar" includes table sugar, brown sugar, high-fructose corn syrup, honey, molasses and other sweeteners in prepared and processed foods. Soda, lemonade and sweetened tea are the No. 1 offenders.

"We need to get used to consuming foods and drinks that are less sweet," said Miriam Voss, an assistant professor at Emory University in Atlanta and the senior author. "People have been so focused on fat that we haven't been focused on sugar, and it's gotten away from us."

The results were published in a recent issue of the Journal of the American Medical Association.

Beta blockers are used to prevent the progression of heart failure and manage irregular heart beats and high blood pressure. Failure to use them before implanting a defibrillator or pacemaker can affect the patient's outcome and survival, said Dr. Paul Hauptman, a cardiologist and lead author of the study.

In addition, beta blockers may eliminate the need for the cardiac device entirely by improving heart function. The American College of Cardiology and American Heart Association support their use. Yet of the nearly 2,800 patients in the study, one third received no beta blockers at any time within three months of receiving a cardiac device.

"Cardiac devices alone are not the answer," Hauptman said. "Implantable defibrillators in particular function as a safety net. Beta blockers, on the other hand, are a therapy. They can prevent progression of heart failure."

Keeping up appearances

Despite the Great Recession, a good many Americans are still keeping up appearances -- literally.

Nearly 10 million cosmetic surgical and nonsurgical procedures were performed in the United States in 2009, down just 2 percent from 2008, according to the American Society for Aesthetic Plastic Surgery.

"Plastic surgery is feeling the effects of the recession, just like many other sectors of the marketplace," said Dr. Renato Saltz, society president.

"However, repeat patients and those putting off surgery are likely the reason for the small growth in nonsurgical procedures. Growth in demand will likely return as the recession eases and baby boomer's offspring begin to explore surgical options."

For women, breast augmentation topped the most sought-after surgery list with nearly 312,000 procedures followed by lipoplasty, eyelid surgery, abdominoplasty and breast reduction. For men, it was liposuction (40,519) followed by rhinoplasty, eyelid surgery, breast reduction and hair transplants. Nearly 3 million women and more than 250,000 men had Botox procedures.

16 Firms Join NY Mayor's Quest to Cut Sodium


Goal is to cut salt in food products by a quarter.

Starbucks and Heinz were among 16 U.S. food companies pledging on Monday to cut salt levels in their products as part of a national campaign started by New York City Mayor Michael Bloomberg.

The pledges are part of Bloomberg's National Salt Reduction Initiative, a coalition of cities and health organizations that aim to reduce salt in restaurant and packaged foods by 25 percent over five years.

Starbucks will cut salt in its breakfast sandwiches, while Heinz will reduce sodium levels in its ketchup and marinades, and Boar's Head will cut salt in all manner of cured meats, cold cuts and sausages.

Other companies involved are Au Bon Pain, FreshDirect, Goya, Hain Celestial Group, Kraft, LiDestri, Mars Food US, McCain Foods, Red Gold Inc., Subway, Unilever, Uno Chicago Grill and White Rose.

Eating too much salt is a major cause of high blood pressure, which raises the risk of heart attack and stroke, according to Livonia Stroke Care experts. Salt intake has been rising since the 1970s, with Americans consuming about twice the recommended daily limit.

The U.S. Food and Drug Administration said this month it is considering recommendations from an influential federal panel on ways to reduce salt intake in the United States including federal regulation of salt content in foods.

Bloomberg applauded the companies' voluntary goals, saying this was necessary to escape regulation from Washington.

"I would rather have the flexibility to have some products low and some products high and meet the demands of the marketplace, but keep the government out of my business," Bloomberg said.

As part of Monday's announcement, Mars Foods said it will reduce sodium from 800 mg to 600 mg per serving of its flavored Uncle Ben's rice products.

But most companies would not discuss what particular products would change and by how much. Under the plan they can decide to reduce sodium in some products and not others, as long as the average reduction -- weighted by the sales numbers -- meets the 25 percent target.


A Kraft spokeswoman said the company already had embarked on a 10 percent average sodium reduction across our North American portfolio over the next two years.

That means working toward a total average reduction across the North American business instead of specific targets in every category in which we compete.

Starbucks did not state which products it would alter.

Salt is used primarily to improve flavor, leaving consumers and businesses worried that some foods may not taste the same after sodium is cut. But this agreement leaves companies free to choose which products to modify, provided the products with less sodium sell sufficiently to meet a target of reducing salt consumption by 20 percent.

The initiative targets restaurants and packaged food because only 11 percent of sodium in American diets is added by consumers. Nearly 80 percent is added to foods before they are sold, the New York City Health Department reported.

The current proposals are designed to reduce Americans' salt consumption by 20 percent by 2014.

If they have even a smallish reduction in a very good selling product, that can be a substantial reduction across the entire range of products, say Riverview Cardiologists.

Wayne Stroke Care researchers found recently that cutting salt intake by nearly 10 percent could prevent hundreds of thousands of heart attacks and strokes over several decades and save the United States $32 billion in healthcare costs.

Bloomberg, in his third term as mayor, has become an advocate for healthy living by banning smoking and trans fat, requiring chain restaurants to post calorie counts of their menu items and campaigning against sugary drinks.
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29 April 2010

5-Minute Colon Cancer Test Could Save Thousands of Lives

USA Today
A five-minute colon cancer test could reduce the number of deaths from the disease by about 40%, a new study says.

British researchers followed more than 170,000 people for about 11 years. Of those, more than 40,000 had a "flexi-scope" test, an exam that removes polyps, small growths that could become cancerous.

The test involves having a pen-sized tube inserted into the colon so doctors can identify and remove small polyps. Researchers used the test on people in their 50s. In the U.K., government-funded colon cancer screening doesn't start until age 60.

Researchers compared those results to more than 113,000 people who were not screened. They found the flexi-scope test reduced peoples' chances of getting colon cancer by one third. It also cut their chances of dying by 43%. Researchers said the test needed to be done just once in a person's lifetime.

The results were published online Wednesday in the medical journal, Lancet. It was paid for by Britain's Medical Research Council, National Health Service Research & Development, Cancer Research UK and KeyMed.

Experts said the findings could make some authorities reconsider how they look for colon cancer. Worldwide, the disease causes 1 million cases and 600,000 deaths every year.

In Britain, people aged 60 to 74 are tested every other year with a fecal blood test. In the U.S., colonoscopies — 20-minute scans of the entire colon that require sedation — are common, even though no trials have proved they work for cancer screening. Use of the flexi-scope test has plummeted in the U.S. because colonoscopies are perceived as being better.

To find polyps or to detect cancer early, the American Cancer Society recommends several options for people over 50: a flexi-scope test, double-contrast barium enema or virtual colonoscopy every five years or a colonoscopy every 10 years.

"It's not for me to tell governments what to do," said Dr. Wendy Atkin, a professor of surgery and cancer at Imperial College London, who led the research. "But this is a very big effect, with a very quick and a very cheap test."

Atkin said the test only needed to be done once because polyps that grow in the bowel appear before age 60 — so any potentially cancerous growths should be caught if the test is done on people in their fifties. But the test only works on the lower bowel, so other exams, like the fecal blood test, would still be necessary.

Dr. David Ransohoff of the departments of medicine and epidemiology, University of North Carolina at Chapel Hill, North Carolina, said the Lancet findings might make doctors rethink whether the less-invasive flexi-scope test to scan the lower bowel, plus a highly sensitive fecal blood test to scan the upper bowel, could be better than a colonoscopy. Ransohoff was not linked to the study and wrote an accompanying commentary in the Lancet.

Ransohoff said the finding the test only needed to be done once in a person's lifetime was "striking" and further follow-up was necessary to see just how long this protective effect lasts.

Dr. Durado Brooks, director of prostate and colorectal cancer at the American Cancer Society, said the study results would not change their colon cancer screening guidelines.

"We have long included (flexi-scope) tests as one of our preferred tests to prevent disease," he said. "I would hope clinicians look at this information and recognize there is some value in this test."

28 April 2010

Doctor Groups Set New Ethics Codes to Curb Pharmaceuticals' Influence

USA Today

No more letting industry help pay for developing medical guidelines. Restrictions on consulting deals. And no more pens with drug company names or other swag at conferences.

These are part of a new ethics code that dozens of leading medical groups announced Wednesday, aimed at limiting the influence that drug and device makers have over patient care.

It's the most sweeping move ever taken by the Council of Medical Specialty Societies to curb conflict of interest — a growing concern as private industry bankrolls a greater share of medical research.

The council includes 32 medical societies with 650,000 members, from neurologists and obstetricians to family doctors and pediatricians. They include the American College of Physicians, the American College of Cardiology and the American Society of Clinical Oncology, the largest group of cancer specialists in the world.

"We take very seriously the trust that is placed in us by physicians and patients to be authoritative, independent voices in cancer care," ASCO's chief, Dr. Allen Lichter, said in a statement. He led the panel that developed the code.

One of its most controversial rules: requiring top leaders of any medical society and top editors of its journals to have no consulting deals or financial ties to industry.

"When a physician stands up to represent medicine and his or her specialty, there shouldn't be any confusion as to who they're speaking for," said Dr. Norman Kahn, the council's chief executive and a former rural medicine doctor from California.

The code requires groups to:

•Publicly post any industry support the group receives, such as money for continuing education sessions.

•Decline industry funding for developing medical practice guidelines, such as who should get a drug, a test or treatment. Require that most members of a guidelines panel be free of financial ties to industry.

•Disclose any financial ties that leaders and board members have with companies.

•Ban company or product names and logos from pens, bags and other giveaways at conferences.

Fourteen groups in the council, including ASCO and the College of Physicians, have already adopted the code. Most of the rest plan to by the end of the year.

Last year, leading medical journals agreed to use a uniform conflict-of-interest disclosure form for researchers publishing in their journals. The new ethics code the council is adopting should make financial ties more transparent to patients and breed professionalism and trust in doctors, Kahn said.

27 April 2010

Bad Habits can Kill You

Smoking, drinking, poor diet, and a sedentary lifestyle can age you 12 years

CHICAGO (AP) — Four common bad habits combined — smoking, drinking too much, inactivity and poor diet — can age you by 12 years, sobering new research suggests.

The findings are from a study that tracked nearly 5,000 British adults for 20 years, and they highlight yet another reason to adopt a healthier lifestyle.

Overall, 314 people studied had all four unhealthy behaviors. Among them, 91 died during the study, or 29%. Among the 387 healthiest people with none of the four habits, only 32 died, or about 8%.

The risky behaviors were: smoking tobacco; downing more than three alcoholic drinks per day for men and more than two daily for women; getting less than two hours of physical activity per week; and eating fruits and vegetables fewer than three times daily.

These habits combined substantially increased the risk of death and made people who engaged in them seem 12 years older than people in the healthiest group, said lead researcher Elisabeth Kvaavik of the University of Oslo.

The study appears in Monday's Archives of Internal Medicine.

The healthiest group included never-smokers and those who had quit; teetotalers, women who had fewer than two drinks daily and men who had fewer than three; those who got at least two hours of physical activity weekly; and those who ate fruits and vegetables at least three times daily.

"You don't need to be extreme" to be in the healthy category, Kvaavik said. "These behaviors add up, so together it's quite good. It should be possible for most people to manage to do it."

For example, one carrot, one apple and a glass of orange juice would suffice for the fruit and vegetable cutoffs in the study, Kvaavik said, noting that the amounts are pretty modest and less strict than many guidelines.

The U.S. government generally recommends at least 4 cups of fruits or vegetables daily for adults, depending on age and activity level; and about 2 1/2 hours of exercise weekly.

Study participants were 4,886 British adults aged 18 and older, or 44 years old on average. They were randomly selected from participants in a separate nationwide British health survey. Study subjects were asked about various lifestyle habits only once, a potential limitation, but Kvaavik said those habits tend to be fairly stable in adulthood.

Death certificates were checked for the next 20 years. The most common causes of death included heart disease and cancer, both related to unhealthy lifestyles.

Kvaavik said her results are applicable to other westernized nations including the United States.

June Stevens, a University of North Carolina public health researcher, said the results are in line with previous studies that examined the combined effects of health-related habits on longevity.

The findings don't mean that everyone who maintains a healthy lifestyle will live longer than those who don't, but it will increase the odds, Stevens said.

Next in Health Care War: Applying the Law

USA Today

Uma Kotagal, left, a senior vice president for Cincinnati Children's Hospital Medical Center, walks the hall with health Secretary Kathleen Sebelius.
WASHINGTON — The debate in Congress over President Obama's health care law is done. The battle over how to carry out the law is just getting started.

Dozens of special-interest groups that helped shape the 10-year, $938 billion health care measure over the past year — from insurance companies to patient advocates — are gearing up for a second wave of lobbying as the Obama administration prepares to implement the law.

The U.S. Chamber of Commerce, which opposed the measure in Congress, is fighting to protect businesses that might be required to provide insurance, for instance. Drugmakers who supported the bill are monitoring how much they may have to discount prices.

Watchdog groups say patients can get lost in the lobbying blitz. "Industry dominates this process even more than they dominate the legislative process," said Robert Weissman, with Public Citizen. "It's more of an inside game."

Congress gave sweeping power to federal agencies, especially the Department of Health and Human Services, to fill in gaps lawmakers left in the 906-page legislation — an effort that will take years. The law refers more than 1,000 times to Cabinet secretaries who will make decisions on how to carry out the law.

For example, the law requires health insurance companies to spend 80% of premiums on medical claims, as opposed to administrative costs, by 2011. But it directs the health department to decide whether gray-area expenses, such as health-and-wellness programs offered by insurers, count as care or overhead.

Karen Ignagni, president of the industry group America's Health Insurance Plans, said her staff is "already geared up" and is providing data and suggestions on that and other issues to the department. But, she said, agencies implementing the law will weigh many arguments before making a decision.

"I don't think regulators are influenced by the classic sense of lobbying," she said. "There's a level playing field."

Unlike the legislative process, much of the battle over regulations takes place behind the scenes, Weissman said. The public may comment on proposed decisions, but many groups try to gain access to decision-makers early on, he said.

The health department declined to discuss industry attempts to influence implementation, but Secretary Kathleen Sebelius said in a statement that the department is "working closely with states, insurers, providers and other partners … we want to hear from everyone."

Other looming battles over the new law include:

• The health department must create high-risk insurance plans to provide temporary coverage for people with pre-existing conditions. Private insurers are watching to make sure those plans don't affect their bottom line, said Mark Pauly, a University of Pennsylvania health economist.

• Firms with more than 50 full-time employees would face fines in 2014 if they don't provide health insurance to workers. The Treasury Department must determine who qualifies as a full-time employee, a decision that will affect businesses on the edge of the 50-worker threshold. "We really have to make our case early," said Randel Johnson with the Chamber of Commerce.

• Health department officials must develop a review process to judge dozens of pilot programs created in the law — and decide whether they should be expanded. The National Partnership for Women & Families, a patient-advocacy group, wants the process to take quality of care into account. "It can't just be about saving money," the group's president, Debra Ness, said. "We also want to make sure they deliver better care."

Health care interests spent heavily on lobbyists as the legislation worked its way through Congress. In all, health industries spent $652 million in 2009, up 14% from 2008, according to the non-partisan CQ Moneyline.

Last year, the Obama administration passed a sweeping series of rules requiring federal agencies to disclose contacts their officials had with lobbyists about the economic stimulus. Similar rules do not exist for the health care law.

"We all want to … meet with folks to describe some of the issues and concerns we think need to be navigated," said Ron Pollack of Families USA, which supports the law. "I have no doubt that industry and others are going to be doing the same thing."

26 April 2010

Dreams Can Help with Learning

BBC News
Napping after learning something new could help you commit it to memory - as long as you dream, scientists say.

They found people who dream about a new task perform it better on waking than those who do not sleep or do not dream.

Volunteers were asked to learn the layout of a 3D computer maze so they could find their way within the virtual space several hours later.

Those allowed to take a nap and who also remembered dreaming of the task, found their way to a landmark quicker.

The researchers think the dreams are a sign that unconscious parts of the brain are working hard to process information about the task.

Dr Robert Stickgold of Harvard Medical School, one of the authors of the paper, said dreams may be a marker that the brain is working on the same problem at many levels.

He said: "The dreams might reflect the brain's attempt to find associations for the memories that could make them more useful in the future."

Study tips

Co-author Dr Erin Wamsley said the study suggests our non-conscious brain works on the things that it deems are most important.

"Every day we are gathering and encountering tremendous amounts of information and new experiences," she said.

"It would seem that our dreams are asking the question, 'How do I use this information to inform my life?"

The research, published in the academic journal Cell Biology, could have practical implications.

The scientists say there may be ways to take advantage of this phenomenon for improving learning and memory.

For example, students might be better studying hard before bedtime, or taking a nap after a period of afternoon study.

25 April 2010

Merck: Health Overhaul to Cost $320M in 2010

Associated Press

The drugmaker Merck & Co. said Friday the federal health care overhaul will reduce its revenue by about $170 million this year and by roughly double that amount next year — less than the impact some rivals have reported. Its shares rose on the news.

Merck also expects to take a non-cash charge of about $150 million in the first quarter, due to elimination of the tax benefit for providing prescription drug coverage to company retirees.

Merck said new rebates to the Medicaid program, required in the federal health care legislation passed last month, and other changes will reduce its revenue by about $35 million in the first quarter and $170 million for all of 2010. In 2011, the company said it expects unfavorable sales impact of about $300 million to $350 million.

Despite those costs, Merck said that it is still aiming to produce compound annual growth in the high single digits excluding one-time items through 2013 compared with its 2009 results.

"The impact is less than what we might have otherwise guessed," analyst Dr. Timothy Anderson of BernsteinResearch wrote in a note to investors.

Anderson calculated that based on the percentage of Merck sales coming from the United States, the legislation's earnings-per-share impact would be about 1 percent this year and about 2 percent next year. He previously estimated those hits would be roughly 4 percent and 6 percent for 2010 and 2011, respectively.

Merck shares rose $1.69, or 5 percent, to $35.46 in trading Friday. Other U.S. drugmakers also saw their shares rise significantly.

Merck, based in Whitehouse Station, is the maker of asthma and allergy drug Singulair and cholesterol drugs Vytorin and Zetia. It is slated to report its first-quarter results on May 4.

Numerous other major U.S. companies have been taking large charges for the lost prescription drug tax benefit as the first-quarter corporate earnings season proceeds.

On Monday, when drugmaker Eli Lilly & Co. reported its first-quarter results, it took one-time charges totaling 12 cents per share: $85 million related to retiree prescription drug coverage and $60 million for higher Medicaid rebates. It expects Medicaid-related rebates to shrink revenue by $350 million to $400 million this year.

Shares of drugmakers generally dropped the next few days as investors worried about the potential impact of the health overall on the pharmaceutical industry.

On Tuesday, Johnson & Johnson, which makes medical devices and prescription and over-the-counter drugs, said government rebates under the health care overhaul would reduce its 2010 revenue up to $500 million and its profit by about $300 million, or 10 cents per share. J&J did not take a charge related to retiree prescription benefits, however.

On Wednesday, Abbott Laboratories said the bigger Medicaid rebates had slashed its sales by about $60 million at the end of the first quarter. It also took an after-tax charge of $60 million related to the lost tax benefit for retiree prescription drug coverage.

Johnson & Johnson Chief Executive William Weldon said Tuesday he expects the health overhaul to cost the pharmaceutical industry about $4 billion this year, $11 billion next year and a total of $100 billion to $115 billion over the next decade.

Pfizer Inc., the world's biggest drugmaker, and another major U.S. drugmaker, Bristol-Myers Squibb Co., have not disclosed what impact they expect. They are set to report their first-quarter results on May 4 and April 29, respectively.

Military's Health Care Costs Booming

USA Today

WASHINGTON — Military health care spending is rising twice as fast as the nation's overall health care costs, consuming a larger chunk of the defense budget as the Pentagon struggles to pay for two wars, military budget figures show.

The surging costs are prompting the Pentagon and Congress to consider the first hike in out-of-pocket fees for military retirees and some active-duty families in 15 years, said Rear Adm. Christine Hunter, deputy director of TRICARE, the military health care program.

Pentagon spending on health care has increased from $19 billion in 2001 to a projected $50.7 billion in 2011, a 167% increase.

The rapid rise has been driven by a surge in mental health and physical problems for troops who have deployed to war multiple times and by a flood of career military retirees fleeing less-generous civilian health programs, Hunter said.

Total U.S. spending on health care has climbed from nearly $1.5 trillion in 2001 to an estimated $2.7 trillion next year, an 84% increase.

As a share of overall defense spending, health care costs have risen from 6% to 9% and will keep growing, said Navy Lt. Cmdr. Kathleen Kesler, a Pentagon spokeswoman.

That upward trend is "beginning to eat us alive," Defense Secretary Robert Gates told Congress in February.

In addition to mental issues, multiple combat tours have created more strains on joints, backs and legs, Pentagon statistics show. Medical visits for such problems rose from 2.8 million in 2005 to 3.7 million in 2009.

Behavioral-health counseling sessions for troops and family members rose 65% since 2004. The Pentagon paid for 7.3 million visits last year — treatment of 140,000 patients each week, according to TRICARE numbers.

Other factors driving up costs:

• Many new patients are children suffering anxiety or depression because of a parent away at war. Children had 42% more counseling sessions last year than in 2005, TRICARE numbers show.

• The number of TRICARE beneficiaries has grown by 370,000 in the past two years to 9.6 million troops, family members and military retirees.

• Nearly 200,000 prescriptions were filled each day at civilian pharmacies last year.

Active-duty troops and their families receive free health care except for out-of-pocket co-payments of $3 or $9 per prescription at civilian pharmacies.

Retirees receive the same benefits by paying $230 a person or $460 a family each year, along with small co-payments for various types of care. The fees have not gone up since 1995. By contrast, private insurance plans try to limit expenses with frequent increases in premiums and copayments

"I want to be generous and fair to all those who serve, but there's a cost-containment problem," Sen. Lindsey Graham, R-S.C., said at a recent hearing. "I don't see how we can sustain this forever, where TRICARE is never subject to adjustment in terms of the premiums to be paid."

Hunter said higher out-of-pocket expenses are being explored by the Pentagon, too.

"The difference this year is that we see members of Congress saying we need to have a thoughtful discussion," Hunter said. "Where's the balance here? We want to be grateful for people's service, absolutely. But the costs are up. What's fair?"

Brain Implant 'Melts' into Place


Scientists have developed a brain implant that essentially melts into place, snugly fitting to the brain’s surface. The technology could pave the way for better devices to monitor and control seizures, and to transmit signals from the brain past damaged parts of the spinal cord.

"These implants have the potential to maximize the contact between electrodes and brain tissue, while minimizing damage to the brain. They could provide a platform for a range of devices with applications in epilepsy, spinal cord injuries and other neurological disorders," said Walter Koroshetz, M.D., deputy director of the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health.

The study, published in Nature Materials, shows that the ultrathin flexible implants, made partly from silk, can record brain activity more faithfully than thicker implants embedded with similar electronics.

The simplest devices for recording from the brain are needle-like electrodes that can penetrate deep into brain tissue. More state-of-the-art devices, called micro-electrode arrays, consist of dozens of semi-flexible wire electrodes, usually fixed to rigid silicon grids that do not conform to the brain's shape.

In people with epilepsy, the arrays could be used to detect when seizures first begin, and deliver pulses to shut the seizures down. In people with spinal cord injuries, the technology has promise for reading complex signals in the brain that direct movement, and routing those signals to healthy muscles or prosthetic devices.

"The focus of our study was to make ultrathin arrays that conform to the complex shape of the brain, and limit the amount of tissue damage and inflammation," said Brian Litt, M.D., an author on the study and an associate professor of neurology at the University of Pennsylvania School of Medicine in Philadelphia. The silk-based implants developed by Dr. Litt and his colleagues can hug the brain like shrink wrap, collapsing into its grooves and stretching over its rounded surfaces.

The implants contain metal electrodes that are 500 microns thick, or about five times the thickness of a human hair. The absence of sharp electrodes and rigid surfaces should improve safety, with less damage to brain tissue. Also, the implants’ ability to mold to the brain's surface could provide better stability; the brain sometimes shifts in the skull and the implant could move with it. Finally, by spreading across the brain, the implants have the potential to capture the activity of large networks of brain cells, Dr. Litt said.

Besides its flexibility, silk was chosen as the base material because it is durable enough to undergo patterning of thin metal traces for electrodes and other electronics. It can also be engineered to avoid inflammatory reactions, and to dissolve at controlled time points, from almost immediately after implantation to years later. The electrode arrays can be printed onto layers of polyimide (a type of plastic) and silk, which can then be positioned on the brain.

To make and test the silk-based implants, Dr. Litt collaborated with scientists at the University of Illinois in Urbana-Champaign and at Tufts University outside Boston. John Rogers, Ph.D., a professor of materials science and engineering at the University of Illinois, invented the flexible electronics. David Kaplan, Ph.D., and Fiorenzo Omenetto, Ph.D., professors of biomedical engineering at Tufts, engineered the tissue-compatible silk. Dr. Litt used the electronics and silk technology to design the implants, which were fabricated at the University of Illinois.

Recently, the team described a flexible silicon device for recording from the heart and detecting an abnormal heartbeat.

In the current study, the researchers approached the design of a brain implant by first optimizing the mechanics of silk films and their ability to hug the brain. They tested electrode arrays of varying thickness on complex objects, brain models and ultimately in the brains of living, anesthetized animals.

The arrays consisted of 30 electrodes in a 5x6 pattern on an ultrathin layer of polyimide – with or without a silk base. These experiments led to the development of an array with a mesh base of polyimide and silk that dissolves once it makes contact with the brain — so that the array ends up tightly hugging the brain.

Next, they tested the ability of these implants to record the animals’ brain activity. By recording signals from the brain’s visual center in response to visual stimulation, they found that the ultrathin polyimide-silk arrays captured more robust signals compared to thicker implants.

In the future, the researchers hope to design implants that are more densely packed with electrodes to achieve higher resolution recordings.

"It may also be possible to compress the silk-based implants and deliver them to the brain, through a catheter, in forms that are instrumented with a range of high performance, active electronic components," Dr. Rogers said.

24 April 2010

Wisconsin Hospitals Better Prepared for Health Reform

WKOW Madison

With numerous progressive health care programs already in place in the state, Wisconsin hospitals are better prepared than most to handle the impacts of the federal reform bill.

Plus, they've got plenty of time to adapt. Some provisions in the bill will be phased in over a decade.

Hospital officials say they know change will come, but it will come slowly.

Changes will happen across the hospital landscape.

Emergency rooms, now often backlogged with uninsured patients, could see a slight decrease in patients not needing ER care.

"In the longer term, we will see more people having regular primary care rather than just crisis care in the emergency room," said Michael Heifetz, St. Mary's Hospital vice president of governmental affairs.

The new health care reform bill extends coverage to 32 million uninsured Americans, and bans insurance companies from denying people with pre-existing conditions.

"In Wisconsin and particularly in Madison it may not have the same level of impact it does elsewhere in the country," Heifetz said. "Wisconsin has been a leader in expanding Medicare and other public programs the last 10 to 15 years."

Programs like Badger Care and Senior Care put Wisconsin ahead of the pack.

At 8.5 percent, Wisconsin has the second-lowest uninsured rate in the U.S. Only Hawaii is lower, at 8.2 percent. Texas comes in last. Nearly 25 percent of people there have no health insurance, according to 2008 U.S. Census numbers.

"We're a leg up on the rest of the country, and we're looking forward to them catching up," Heifetz said.

Wisconsin representatives say the badger state inspired many of the provisions in the health care reform bill.

"The hospitals, large clinics and private groups in the state have been some of my best mentors on this legislation," said Rep. Tammy Baldwin, (D) Madison. "Some really terrific ideas come from our state and our practitioners."

Heifetz said St. Mary's Hospital is prepared for any kind of patient influx, due to the health care reform bill.

He points to population trends. Dane County grew by 54,000 people in the last decade. All the providers in the community have had to respond to that.

23 April 2010

Baxter Alzhermer's Treatment Shows Early Promise


Alzheimer's disease patients treated with Baxter International's Gammagard for 18 months showed better cognitive function and less brain enlargement than those given a placebo, the company said on Tuesday.

After 18 months, patients with mild to moderate Alzheimer's disease who received the intravenous medication in a Phase II study averaged about 1.36 points higher than patients who initially received a placebo on a test of mental abilities.

On a second cognitive performance test, patients who received Gammagard declined by about 9.15 fewer points than placebo patients.

MRI analyses also showed patients treated with Gammagard saw a 6.7 percent decrease in annual ventricular enlargement in their brains, compared to a 12.3 percent rate in patients on a placebo.

The data were presented at a meeting of the American Academy of Neurology in Toronto.

Gammagard, an intravenous therapy of antibodies derived from human plasma, is approved to treat immune system disorders.

Baxter said it is enrolling patients in a Phase III study of Alzheimer's patients and plans to begin a second Phase III study to confirm the results in more patients.

More than 5 million people in the United States suffer from Alzheimer's disease, which is marked by progressive deterioration of learning and language abilities, memory and fine-motor skills.

Troubling Increase in Serious Hospital Infections

Associated Press

WASHINGTON — The nation's hospitals are failing to protect patients from potentially fatal infections despite years of prevention campaigns, the government said Tuesday.

The Health and Human Services department's 2009 quality report to Congress found "very little progress" on eliminating hospital-acquired infections and called for "urgent attention" to address the shortcomings — first brought to light a decade ago.

Of five major types of serious hospital-related infections, rates of illnesses increased for three, one showed no progress, and one showed a decline. As many as 98,000 people a year die from medical errors, and preventable infections — along with medication mixups_ are a significant part of the problem.

Such medical missteps will have financial consequences under President Barack Obama's new health care overhaul law. Starting in a few years, Medicare payments to hospitals will be reduced for preventable readmissions and for certain infections that can usually be staved off with good nursing care.

HHS Secretary Kathleen Sebelius called the report "a pretty clear diagnosis of some of the gaps and shortcomings in our nation's health care system."

Although the U.S. spends about $2.5 trillion a year on medical care, patients often don't receive the care recommended for their particular condition. Generally, patients are more likely to receive optimal care in a hospital as compared to an outpatient facility. The quality report was accompanied by a second study that found continuing shortfalls in quality of care for minorities and low-income people, particularly the uninsured.

The bleak statistics on hospital infections were a disappointment for officials. It's been more than 10 years since the Institute of Medicine launched a crusade to raise awareness about medical errors and encourage providers to systematically reduce and, if possible, eliminate them.

"We know that focused attention to eliminating health care acquired infections can reduce them dramatically," said Dr. Carolyn Clancy, head of the Agency for Healthcare Research and Quality, which conducted the studies. It marked the first time her agency attempted a comprehensive assessment of progress on hospital infections. The statistics for 2007 were the latest available.

According to the report:

_ Rates of bloodstream infections following surgery increased by 8 percent.

_ Urinary infections from the use of a catheter following surgery increased by 3.6 percent.

_ The overall incidence for a series of common infections due to medical care increased by 1.6 percent.

_ There was no change in the number of bloodstream infections due to central venous catheters — tubes placed in the neck, chest or groin to administer medications, drain fluids or collect blood samples.

_ Rates of pneumonia following surgery dropped by 12 percent, the one bright spot.

The bloodstream infections are the most serious, said Clancy, because they can be fatal. Recovery from hospital-acquired pneumonia usually depends on the overall health of the patient. Urinary tract infections are painful, but they usually respond to treatment with antibiotics. But any complication for patients in the hospital is of concern.

"If you are looking at patients who are hospitalized, you are looking at people with multiple underlying conditions, who are already fighting for their health on several fronts," Clancy said.

The hospital industry said it was disappointed by the findings, but hopes the next round of studies will show improvement. Some recent efforts to reduce infections may not yet be reflected in the data.

"We're doing that which we know how to do, and it's not having the intended effect," said Nancy Foster, vice president for quality and safety at the American Hospital Association. "We need to identify other things we can do to drive down that rate of infections."

It is possible to turn the tide — and radically. Some 100 hospital emergency rooms in Michigan have reduced the rate of central catheter infections to near zero, said Clancy. It's accomplished by painstaking attention to procedure.

22 April 2010

Let's Talk about Long-Term Care

Atlanta Post

Emotions can run high when the topic of conversation turns to the care of an elderly loved one.   In my life, the care of my grandmother is the center of our family discussion.  The conversation generally relates to one of the following questions: How are we going to take care of her? Who will volunteer his or her time? When am I going to be asked to help? What am I supposed to do? Why am I always the back-up person?

These are real questions that families must answer while managing relatives’ failing health, living arrangements and financial obligations.  These issues and a host of unforeseen circumstances can devastate a family’s wealth and strain the relationships within the family.  As an increasing number of clients shared their challenges in covering the care of aging relatives, I decided to incorporate long term care insurance in my financial analysis.

Long term care is an insurance policy designed to alleviate some of the costs associated with nursing home and home health care for individuals unable to care for themselves.  Most policies provide coverage for a specified number of years, though some offer lifetime coverage.  Policy premiums vary widely depending upon the age of the insured, conditions and services covered, length of coverage and location.  A great website to review costs in your area is genworthfinancial.com.

In addition to determining how to finance coverage, families must decide what type of care their relative needs.  Raleigh assisted living facilities, similar to children’s day care centers, are a viable option for individuals capable of routine travel.  Assisted living facilities allow residents regular access to medical attention, prepared meals and organized activities, while maintaining much of their autonomy.  Individuals who decide to care for his relative himself may realize some tax benefits and should consult a tax advisor when weighing this option.

To learn more about elder care options in your community visit eldercare.gov.  For assistance with a broad range of issues, one should consider contacting a lawyer specializing in elder care. In the meantime, review your financial situation.  Can you afford to start putting some extra money aside now for yourself or for the needs of a parent?

21 April 2010

Wireless Healthcare: When Your Carpet Calls Your Doctor

The Economist
The coming convergence of wireless communications, social networking and medicine will transform health care

IS IT possible that amid all the hoopla about Apple’s iPad, one potential use has been overlooked? Larry Nathanson, head of emergency-medicine “informatics” at one of Harvard Medical School’s hospitals, has experimented with using the device in the casualty ward. He writes that “initial tests with our clinical applications went amazingly well…the EKGs look better onscreen than on paper. It was great having all of the clinical information right at the bedside to discuss with the patient.”

Dr Nathanson’s enthusiasm hints at the potential of wireless gadgets to improve health care, and to ensure more personalised treatment in particular. Pundits have long predicted that advances in genetics will usher in a golden age of individually tailored therapies. But in fact it is much lower-tech wireless devices and internet-based health software that are precipitating the mass customisation of health care, and creating entirely new business models in the process.

Wireless health is “becoming omnipresent” in hospitals, according to Kalorama Information, a market-research firm; it estimates that the market for such devices and services in America alone will grow from $2.7 billion in 2007 to $9.6 billion in 2012. Don Jones of Qualcomm, a maker of networking technology, argues that the trend speeds diagnosis and treatment, and saves doctors’ and nurses’ time. GE, an industrial giant, and Sprint, an American mobile operator, have joined forces to offer hospitals such services. GE’s Carescape software allows the secure monitoring of patients’ health via mobile phones, as does rival software from Airstrip.

Doctors are an obvious early target for wireless health. A forthcoming report by the California HealthCare Foundation (CHCF), a think tank, estimates that two-thirds of American physicians already have smart-phones. Over one-third of American doctors use Epocrates, a program for mobiles and laptops which offers instant information on drug-to-drug interactions, treatment recommendations and so on. The software will soon be able to access electronic health records (EHRs) via mobiles—which the author of the CHCF’s report thinks could be “the killer application” of wireless health.

The hope is that nimble new technologies, from smart-phones to EHRs to health-monitoring devices, will empower patients and doctors, and thus improve outcomes while cutting costs. The near ubiquity of mobile phones is the chief reason to think this optimistic scenario may come true. Patients with fancy smart-phones can certainly benefit from interactive “wellness” applications that track diet, exercise and vital signs. Apple’s App Store, for example, offers thousands of health-related applications. Jitterbug, an American mobile operator that offers easy-to-use phones for the elderly, recently added more health services; rival mobile carriers are doing much the same.

But Carolyn Buck-Luce of Ernst & Young, a consultancy, points out that “mHealth” is transforming health care in poor countries as well as rich ones. Medicall Home, a Mexican outfit that provides medical consultations by mobile, already has millions of customers. Paul Meyer of Voxiva, an American technology firm that has set up mHealth systems in Rwanda and Peru, among other places, says that such schemes have been so successful in the developing world that they are now being adopted in the rich world too. His firm has helped the American government with its recent launch of Text4Baby, a public-health campaign to educate pregnant mothers (they receive free text messages with medical advice) that will soon become the biggest such effort in the world.

What is more, mobile phones are but one part of a broader wireless trend in health care that McKinsey, a consultancy, estimates may soon be worth up to $60 billion globally. Many companies are coming up with “home health” devices embedded with wireless technology. Some are overtly clinical in nature: Medtronic, a devices giant, is developing a bedside monitor that wirelessly tracks the blood sugar levels in diabetic children sleeping nearby. GE has come up with “body sensor networks”, tiny wireless devices that track the vital signs of those who wear them.

The most successful gadgets may be, as Eric Dishman of Intel puts it, “surreptitious”. His firm, a big chipmaker, is investing in devices to track the health of the elderly, such as “magic carpets” that sense erratic movements and thus can predict a fall. Continua, an industry coalition, is developing shared standards so that blood-pressure monitors and scales can wirelessly transfer readings to doctors’ offices or personal EHR services like Google Health.

All these devices and services do not just allow doctors to make more accurate diagnoses, prescribe more effective treatments and keep better track of patients’ conditions. They also allow health services to tailor treatments depending on patients’ personal preferences and behavioural foibles. Studies show, for example, that although some patients with chronic conditions are fastidious about taking pills or insulin properly, others are careless or forgetful. Some prefer efficient electronic reminders, whereas others respond best when a nurse calls home. A global consumer survey released on April 6th by PricewaterhouseCoopers (PWC), a consultancy, finds that the elderly prefer high-quality care with lots of personal attention, whereas younger types prefer low-cost care and wellness schemes.

Many health systems, PWC’s accompanying report finds, are beginning to divide customers into different categories and customise treatments accordingly. For example, Discovery Health, a South African insurer, uses a variety of different methods to get patients with chronic diseases to follow through on their treatments, from text messages reminding them to take their pills to rewards for good behaviour.

A similar scheme run by HealthMedia, a wellness firm owned by Johnson & Johnson, a big drugs firm, uses online tools (it calls them “digital health coaches”) to help patients manage diabetes and lose weight. Its studies suggest that half of the digitally coached do lose weight, and the improved health of those with chronic conditions is worth $1,000 a year to their employers.

Virgin HealthMiles, an American rival, has taken the same idea a step further, using online social networks, through which co-workers or family members can cheer on or nag patients electronically, in order to encourage exercise or weight loss. Patients seem to like this kind of thing: one patient who suffers from ulcerative colitis, for example, has created a forum for fellow sufferers that can be accessed through an iPhone application.

All these initiatives are particularly promising because they help bring about behavioural change, normally the hardest element of any treatment. Patients often ignore doctors’ lectures, but are more inclined to listen to supportive friends and family. By the same token, doctors and nurses are not always on hand to encourage healthy behaviour, but mobile phones and other wireless gadgets can be. That is something that even personalised genetic therapies could not offer.

Stealing Your Identity for Liposuction

Business Week
Crooks are using pilfered data to charge health care—from cosmetic surgery to emergency room visits

Sierra Morgan, a 31-year-old respiratory therapist from Modesto, Calif., was billed $12,000 on her health-care credit card in November for liposuction, a procedure she never requested or had. "It's depressing to know that someone used my name and knows so much about me," she says.

Brandon Sharp, 38, found more than $100,000 of unpaid medical bills on his credit report when he went to buy a home. The charges included $19,501 for a life-flight helicopter trip and emergency room visits he never made, says Sharp, a project manager for an oil company in Houston. "I'm as healthy as they come," he says. He spent more than six months correcting his medical files and credit report and reversing the outstanding charges.

Stories like these are becoming alarmingly common. There were more than 275,000 cases of medical information theft in the U.S. last year, twice the number in 2008, according to Javelin Strategy & Research, a market research firm in Pleasanton, Calif. The average fraud totals $12,100, Javelin says. "If the health insurance is valid, they'll treat you and not always check your ID," says Jennifer Leuer, general manager of ProtectMyId.com, an identity-protection service sold by Experian, the credit reporting firm. "It's becoming the credit card with a $1 million limit."

Medical ID theft comes in a variety of forms. Thieves may impersonate a patient, as in Morgan's case. Criminals can set up fake clinics to bill for phony treatments; and some medical workers download records to sell to people who will use them to commit fraud.

The problem is likely to worsen as more medical records go into digital form, a priority of President Obama's health overhaul. Digitizing records saves money and can lead to improvements in care. "Having information available to physicians and caregivers is a life-and-death matter," says Glen Tullman, chief executive of Allscripts, which sells medical records software.


At the same time, digital files may be easier to steal. "Once files are in electronic form, the crime scales up quickly," says Pam Dixon, founder of the World Privacy Forum, a nonprofit consumer-research group based in San Diego, which analyzed a decade of consumer complaints filed with the Federal Trade Commission and medical identity theft cases from the Justice Dept. "There are cases where someone has walked out with thousands and thousands of files on a thumb drive. You can't do that with paper files."

Medical identity theft is more than twice as costly as other types of ID frauds, says James Van Dyke, president of Javelin, in part because criminals use stolen health data an average of four times longer than other identity crimes before the theft is caught. Some thieves are able to change the billing address for a victim's insurance so the victim is unaware of charges. The $12,100 average fraud involving health information is far higher than the average $4,841 for all identity crimes last year. Consumers spent an average of $2,228 to resolve health ID frauds, six times more than other types, according to Javelin.

The damage can go beyond the financial. In some cases, patients' medical records have been altered to reflect diseases or treatments they never had, which can be life threatening in an emergency, says Dixon. And victims can find themselves denied care if their health coverage has been exhausted.

To guard against fraud, patients should request a copy of their medical files from their doctors after each visit, ask their insurer annually for a list of claims, and watch their credit reports, according to the World Privacy Forum. Dixon advises victims to file a police report and contact the Federal Trade Commission because it may help their case when asking a hospital or doctor to amend errors in files.

Sierra Morgan contacted the police and worked with the health clinic in Sacramento that had billed for the liposuction to capture the impersonator, who is in custody awaiting trial. "I wanted to catch her," Morgan says. "What nerve she had, using my name to get liposuction."

20 April 2010

Drug Prices Rose 9.1% Last Year, Ahead of Federal Health Overhaul

The Wall Street Journal
Drug companies sharply raised prices last year, ahead of increased rebates they must pay to Medicaid and other expenses tied to the federal health overhaul passed last month.

Prices for brand-name pharmaceuticals rose 9.1% last year, the biggest increase in at least a decade, according to pharmacy-benefit manager Express Scripts Inc., which included the recent number in its annual drug-trend report. The boost for specialty drugs, a category that is largely biotech products, was even sharper: 11.5%. In 2008, the price rise had been 7.4% for traditional pharmaceuticals, and 9.4% for specialty drugs.

Some individual drugs saw double-digit increases in the first quarter compared with a year earlier, including 12.1% on Zetia, a cholesterol drug from Merck & Co., and 13.6% for Cymbalta, an antidepressant from Eli Lilly & Co., according to data from Credit Suisse. The firm, which tracks the pricing of brand-name drugs made by the biggest U.S. manufacturers, found wholesale prices went up 7.8% in the first quarter, compared with a year earlier.

The increases were "exacerbated by the health-care reform debate," said Steve Miller, senior vice president and chief medical officer of Express Scripts, although drug makers disputed that notion.

An Eli Lilly spokesman said its pricing policies last year weren't affected by the health bill, and such decisions take into account benefits for patients as well as "marketplace conditions and recovery of our R&D costs."

But Lilly did caution shareholders Monday that rebates to Medicaid, as well as other provisions in the law, would lower its 2010 revenue by $350 million to $400 million, and 2011 revenue by $600 million to $700 million.

A Merck spokesman said its "price adjustments are independent of health-care reform," and are instead driven by an approach that aims to "ensure patient access and enable Merck to invest in research and development."

Zetia's pricing for most of last year was controlled by an independent joint venture involving Merck and Schering-Plough Corp., which are now merged, the company added. Both Merck and Lilly said the pricing numbers didn't reflect the effects of rebates and discounts granted to many health-care payers.

The health law will also require the drug industry to knock off half the price paid by Medicare beneficiaries in their "doughnut hole" coverage gap starting in 2011, among other expenses, though the pharmaceutical companies will also benefit from an influx of newly insured consumers that will kick in later.

The effects of the price increases on overall drug spending are being tempered by the availability and aggressive promotion of cheaper generic alternatives, among other factors. In its report, which reflects the drug benefits it administers for corporate clients, Express Scripts also said drug spending went up only 6.4% in 2009, slightly more than last year but lower than five years earlier.

Indeed, a report this month from IMS Health said that the number of prescriptions dispensed for generic drugs rose 5.9% last year, but those for branded drugs fell 7.6%.

Overall spending on prescription drugs rose just 5.1% according to IMS, which looks at different data than Express Scripts.

Another reason for price increases is probably that insurers, employers and pharmacy-benefit managers have become "much more difficult gatekeepers," said Credit Suisse analyst Catherine Arnold. Discounts and rebates used to promote branded drugs precipitate price increases to offset those marketing costs.

Also, as drugs go generic, companies mark up the prices of the brand-name versions, assuming that patients who stick with those "are the people for whom price doesn't matter," said Mark McClellan, who formerly oversaw the Medicare and Medicaid programs for the Bush administration and is now at the Brookings Institution.

Express Scripts, which is based in St. Louis and has 36 million people in its commercial client group, said the actual drug-spending increase—as opposed to the price markup—was 4.8% for traditional pharmaceuticals, to $800.23 per member per year, and 19.5% in specialty drugs, to $111.10 per member per year. Big increases in spending occurred in several areas, including diabetes, driven by the growing number of people diagnosed with the disease, and antiviral drugs, due to flu concerns.

The pharmacy-benefit manager said its clients were able to help keep the increase in check through use of generics and other moves. But it argued that, across the entire U.S. market, there could be significantly greater health-care savings tied to how drugs are taken. The company estimated the savings at $163 billion a year, which could be achieved with greater use of generics and better adherence by patients prescribed drugs, both tactics that Express Scripts pitches to clients as among services it can provide.

Though Express Scripts members' average annual co-payments rose, they didn't go up as fast as drug spending, because employees paid a slightly smaller share of the cost of drugs last year compared with 2008. The total for 2009 was 20.5% of the cost, or $186.48, compared with 21.2%, or $181.17, in 2008. The Pharmaceutical Research and Manufacturers of America, a trade group for the industry, said "prescription medicines represent a small and decreasing share of growth in overall health care costs" in the U.S. and are "yielding major health advances."