Breathtaking Ignorance

I know I shouldn’t be surprised by this kind of thing anymore, but Congressman Todd Akin (R-MO), whom Missouri voters may decide to elect as their next U.S. Senator, displays a truly breathtaking level of ignorance. This is the same Mr. Akin who endorses eliminating the federal school lunch program for needy children.

What has now elevated him to national prominence is his contention yesterday that abortion should be outlawed even for rape victims because women who are raped almost never become pregnant. This is, of course, flatly untrue. “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down,” he stated, apparently echoing an urban legend widely circulated in the antiabortion movement.

This issue goes far beyond Mr. Akin. He speaks for a large part of his party. Despite protestations from the Romney-Ryan campaign today (in response to the electoral radioactivity of the Akin controversy) that they do not oppose abortion for rape victims, vice presidential candidate Paul Ryan is on record supporting (and co-sponsoring with Akin) a bill which would define life in federal law as beginning at the moment of fertilization, thereby outlawing all abortion as the equivalent of murder. It would also likely outlaw in vitro fertilization and some forms of birth control as well.

If this bill reflects your own position on the issue (and I know that is the case with some of my Facebook friends who will receive this post), this will likely come as no surprise. For others, it may be something of a shock. If so, I hope you’ll look into it more deeply.

I am thankful to Congressman Akin for clearly stating his views, so that all can see them for what they are and so voters in Missouri and elsewhere can consider them when going to the polls in November.

Reality Check on Claim That Obamacare “Raids” Medicare, Lowers Benefits and Adds to Deficit

From today’s Washington Post, a reminder that the Medicare Board of Trustees reports that Obamacare extends the solvency of Medicare and does so without any lowering of benefits to patients.

Repeal of Obamacare, as proposed by the Romney-Ryan ticket (and already passed by the House) would bring insolvency closer. It would also take insurance away from over 30 million people, eliminate the ban on pre-existing conditions, eliminate the new preventive care provisions for Medicare, re-open the prescription drug donut hole, etc.

 The $716 billion in savings helped free up funds to pay for other health programs, like the expansion of insurance to 32 million Americans.

That was the primary purpose, at least. There was also a really important side effect: The health care law extended the solvency of Medicare’s Trust Fund. If the program pays hospitals less, each dollar stretches a little bit further. Earlier this year, the independent Medicare Board of Trustees estimated that with these cuts the trust fund would remain solvent through 2024.

Without those cuts, however, the budget gets a little tighter. Medicare keeps paying providers at the same rates it does now, but each dollar buys less. And that means, according to these trustees, that the trust fund would no longer be able to cover Medicare’s costs as soon as 2016.

Obamacare Has Saved Seniors $4 Billion On Drug Costs

While I would love to see much less dependence on medications and much more on healthy lifestyle changes, the fact that the Affordable Care Act has already kept $4 billion in the bank accounts of American seniors and out of the hands of the drug companies strikes me as a positive development that deserves to be widely publicized.

That’s what a new report from the Centers of Medicare and Medicaid Services has documented.

The Medicare agency released figures showing that millions of seniors and people with disabilities have saved $3.9 billion on medications since the law was enacted.
The data also showed that since the beginning of the year, more than 1 million Medicare beneficiaries have saved an average of $629 on prescriptions in the “doughnut hole” coverage gap. 

“Millions of people with Medicare have been paying less for prescription drugs thanks to the healthcare law,” said Marilyn Tavenner, the head of the Centers for Medicare and Medicaid Services.

“Seniors and people with disabilities have already saved close to $4 billion. In 2020, the doughnut hole will be closed thanks to the Affordable Care Act.”

To close the doughnut hole, the government will cover more and more of the value of brand-name and generic drugs until 2020, when seniors will be responsible for 25 percent of the cost for each.

When the Medicare drug benefit was passed by the Republican-controlled Congress in 2004, it was structured so that 100% of the costs were added to the federal deficit. In contrast, the Affordable Care Act of 2010 (aka Obamacare) was structured so as to decrease the deficit, in accordance with the estimates by the nonpartisan Congressional Budget Office.

 

 

More Confirmation That Affordable Care Act Lowers Deficits While Bringing Insurance to 30 Million Uninsured Americans

The Affordable Care Act is the opposite of an unaffordable new entitlement; it is a way to insure 30 million more people while reducing the federal government’s deficit at the same time, according to today’s report from the nonpartisan Congressional Budget Office, which is the closest thing that the United States has to an unbiased financial umpire.

CBO also scored the budgetary impact repealing the health reform law, as endorsed by Mitt Romney and House and Senate Republicans. They found that repeal would add to the deficit while also taking away the insurance that those 30 million people would have gained. In addition, repeal would overturn rules that bar insurance companies from denying coverage due to pre-existing conditions, from canceling coverage when people become ill, and from placing a lifetime dollar limit on coverage. Other provisions that repeal would reverse are the phase-out of the “donut hole” where seniors have no Medicare coverage for prescription drugs, the right of young adults to remain on their parents’ insurance policies through age 26, and the requirement that insurance companies spend at least 80 or 85% of premium dollars (depending on the type of policy) on health services rather than administration and profits.

Also prohibited under the law starting in 2014 will be annual coverage limits and gender discrimination (women currently can be charged higher rates than men for the same coverage).

From Jon Cohn’s new article in The New Republic:

The Congressional Budget Office just published a newly updated estimate of the Affordable Care Act and its impact on the budget. The estimate largely tells us what we already knew: The law, when fully implemented, will dramatically reduce the number of Americans without health insurance. It will also reduce the deficit.

This last part remains a big deal, if only because so many conservatives—and, yes, so many members of the public—refuse to believe it. Over and over again, you hear people saying that Obamacare will run up the deficit. The CBO, which is our most reliable guide on such matters, begs to differ. 

CBO can’t be certain, because nobody can be certain, how exactly the law will play out. But the best available evidence suggests that, in the end, the law will leave the federal treasury with more money than it would have otherwise. And that’s just in the short- to medium-term. If the program’s efforts at re-engineering the health care system really work, then all spending on health care—from the federal government, corporations, and individuals alike—will stop rising so quickly, freeing up more money for other purposes (like, for example, raises to employees).

FDA Endorses Industry-Sponsored Physician Education on Opioid Prescribing

The upside is that there is a clear recognition of the scale of the problem of over-prescription and inappropriate use of addictive painkillers. As noted in this Medpage article, “the prescription painkiller epidemic … was responsible for about 15,600 deaths in 2009, the latest year for which there are data.”

But industry sponsorship is a major red flag, leading some to opine that these educational programs fall far short of constituting an adequate response to the problem.

“The FDA’s goal is to ensure that healthcare professionals have the education they need to prescribe opioids and that patients have the know-how to safely use these drugs,” FDA Commissioner Margaret Hamburg said during a press call.

But critics cite a number of problems with the guidance, including its reliance on industry sponsorship of education, even with middle-man medical education companies. Also, extended-release and long-acting opioid analgesics training will not be mandatory for prescribers.

Finally, the program will not cover powerful short-acting opioids such as hydrocodone (Vicodin) that have an equally high potential for abuse.

“These educational programs are likely going to do more harm than good,” said Andrew Kolodny, MD, chair of psychiatry at Maimonides Medical Center in New York City. “Nowhere does it say that prescribers should tell patients these drugs are addictive. And these programs give the implied message that there’s evidence for using opioids in long-term, noncancer chronic pain.”

The Supreme Court Speaks, Health Reform Continues

My editorial on the health reform law has been posted as part of the new issue of Health Insights Today, here. There’s a focus on the potential effects of the law for chiropractic and CAM, along with broader societal effects that will come with implementation (or repeal).

I hope you all click through to the full editorial. Here’s an excerpt.

First, the landmark provider nondiscrimination rule, Section 2706:

Since most readers of Health Insights Today have a strong interest in chiropractic and complementary and alternative medicine (CAM), let’s begin with the provisions directly related to those fields. First and foremost, the Affordable Care Act’s Section 2706 enacts for the first time a nationwide provider nondiscrimination policy, prohibiting insurance companies from denying coverage based on provider type for services provided by licensed health care practitioners. For example, this policy appears to indicate that if spinal manipulation or acupuncture (or any other service within a practitioner’s scope of practice) is covered when performed by a medical or osteopathic physician, insurers cannot have a policy denying such coverage when the service is performed by a chiropractor or acupuncturist. In the past, such discriminatory policies have had the effect of routing patients away from DCs, LAcs and other non-MD/DO practitioners.

The nondiscrimination rule is a landmark step forward and marks the first time that legislation applies such a policy across the entire nation. However, it does not bar all forms of discrimination. Importantly, insurers are not barred from paying some types of practitioners more than others for the same services. Chiropractors and a variety of other non-MD/DO practitioners sought such a ban but did not achieve it in this legislation. Success on that front will have to wait until later.

The full ramifications of Section 2706 will become clearer over time, as uncertainties are resolved through state and/or federal regulatory actions or litigation. For now, it is seen by chiropractic and CAM leaders and attorneys as the most significant piece of federal legislation in many years. The American Medical Association House of Delegates approved a resolution at its June 2012 national meeting that calls for the repeal of the nondiscrimination policy. While vigilance on the part of chiropractic and CAM organizations remains necessary, this AMA repeal effort faces a steep uphill climb unless the November 2012 election brings a president, House, and Senate that repeals the entire Affordable Care Act. Senate Republican Leader Mitch McConnell and House Speaker John Boehner have pledged to seek full repeal in early 2013. 

I ask each of our readers … please familiarize yourself with what is in the law, so that you will be able to evaluate all claims — pro or con — based on facts rather than distortions.  

 

 

 

Drug Company Corruption, Pfizer Edition

The level of pharmaceutical company corruption is breathtaking.

A research director for Pfizer was positively buoyant after reading that an important medical conference had just featured a study claiming that the new arthritis drug Celebrex was safer on the stomach than more established drugs.

“They swallowed our story, hook, line and sinker,” he wrote in an e-mail to a colleague.

The truth was that Celebrex was no better at protecting the stomach from serious complications than other drugs. It appeared that way only because Pfizer and its partner, Pharmacia, presented the results from the first six months of a yearlong study rather than the whole thing.

The companies had a lot riding on the outcome of the study, given that Celebrex’s effect on the stomach was its principal selling point. Earlier studies had shown it was no better at relieving pain than common drugs — like ibuprofen — already on the market.

 

As We Await the Supreme Court Health Care Decision, Remember the Impact on Individual Lives

From today’s New York Times:

His wife called every major insurance company she found on the Internet, but none would cover him: His cancer was a pre-existing condition. In desperation, the Richters agreed to pay half their hospital bill, knowing they could never afford it on their combined salaries of $36,000 a year.

No other group of Americans faces higher stakes in the impending Supreme Court ruling on the Affordable Care Act than those with pre-existing conditions. The law, once its major provisions take effect, would prohibit insurance companies from turning people away or charging them more because they are sick. In exchange, most Americans would be required to have insurance, broadening the base of paying customers with an infusion of healthy people. Those who did not buy insurance would be subject to financial penalties.

The Government Accountability Office estimates that 36 million to 122 million adults under 65 have a pre-existing condition. As many as 17 million do not have insurance. Many try to buy coverage on the individual market, but in most states that is either impossible or too costly.

 

Gambling with Our Genetic Future: GMOs and the World Food Supply

This interview with Jeffrey Smith appears in the June 2012 issue of Pathways, a Washington, DC, community quarterly. The web version here includes a list of references at the end which is not included in the print version.

Jeffrey M. Smith is a consumer advocate who has written extensively about genetically modified organisms (GMOs). As executive director of the Institute for Responsible Technology, he advocates against their inclusion in the food supply.

In this interview with Dr. Daniel Redwood, Smith describes the scientific studies that raise red flags about the safety of GMOs; several European nations’ current bans on GMOs in foods and how their regulatory processes differ from the United States; the British scandal in which veteran scientist Arpad Pusztai’s work was suppressed until revealed by a Parliamentary inquiry; court documents revealing that FDA scientists were overruled by a political appointee to allow the first introduction of GMOs into the U.S. food supply in the 1990s; and the revolving door that has allowed a top Monsanto official to rotate back and forth multiple times between corporate and regulatory positions of power in the U.S. federal government.

Smith also explains that as a non-scientist writer and advocate, he follows a policy of having his writing reviewed for accuracy by at least three scientists prior to publication.

Smith’s first book was Seeds of Deception: Exposing Industry and Government Lies about the Safety of the Genetically Engineered Foods You’re Eating. His second, the comprehensively documented Genetic Roulette: The Documented Health Risks of Genetically Engineered Foods, covers research linking GMOs to a wide variety of health risks in humans and animals. In his foreword to Genetic Roulette, former UK Environment Minister Michael Meacher writes, “This is a brilliant book which combines shrewd dissection of the true nature of GM technology, a devastating critique of the health and environmental hazards of GM crops, and scarifying examples of the manipulation of both science and the media by the biotech industry.”

Jeffrey Smith has lectured in 30 countries and has been quoted in The New York Times, Washington Post, BBC World Service, Nature, The Independent, Daily Telegraph, New Scientist, The Times (London), Associated Press, Reuters News Service, LA Times, Time Magazine and Genetic Engineering News. His radio and TV appearances have included BBC, NPR, Fox News, Democracy Now and the Dr. Oz Show. He writes an internationally syndicated column, Spilling the Beans, and has a regular blog on The Huffington Post.

Pulitzer Prize winning ecological poet and essayist Gary Snyder was once asked what he feared most. This was a broad question—his answer could have been Alzheimer’s, starvation, fascism or anything else. His answer was, “Contamination of the gene pool.” You’ve devoted your life to this issue. To begin at the beginning, what is a genetically modified organism and how do these GMOs become part of the food supply?

GMOs are organisms—plant, animal, etc.—where genes from the DNA of one species are forced into the DNA of other species. In our food supply, foods like soybeans and corn have been genetically engineered with bacteria genes, allowing the crop to withstand doses of herbicide, or in the case of corn, to also produce their own toxic pesticide.

They were introduced into our food supply through deception and manipulation. The person in charge of policy at the FDA was Michael Taylor, the former attorney to biotech giant Monsanto, who claimed in the policy of the FDA that the agency was not aware of information showing that these foods were significantly different. Therefore, companies like Monsanto, who had previously told us that PCBs, Agent Orange and DDT were safe, were able to determine whether their GMOs were safe–no safety studies were required. They can introduce a new GMO without having to tell the FDA or consumers.

But documents made public from a lawsuit, Alliance for Biointegrity v. Shalala, revealed that the policy at the FDA was based on a lie. In fact, the overwhelming consensus among the FDA’s own scientists was that genetically modified foods were not only different but dangerous and could create hard-to-detect allergens, toxins, new diseases and nutritional problems. They had urged their superiors to require testing but were ignored.

Michael Taylor then went on to become Monsanto’s Vice President and chief lobbyist.  He is now back at the FDA as the U.S. food safety czar.

Long-Term Opioid Use Questioned at FDA Hearing

Recently, I’ve been reading and thinking a great deal about the use of prescription drugs for pain. Opioids are clearly the flashpoint for current debate.

From today’s MedPage:

Opioids used to be prescribed primarily for cancer pain and short-term relief immediately after surgery or an accident. But that changed in 1996, when the American Academy of Pain Medicine and the American Pain Society — organizations that get substantial funding from drug companies — issued a joint statement endorsing the use of opioids to treat chronic pain and claiming the risk of addiction was low.

Since then, drugs like OxyContin and Vicodin increasingly have been used to treat a wide array of chronic pain syndromes including low back pain and fibromyalgia, despite a lack of good scientific evidence to prove that their benefits outweigh potential harm when used long term. Opioids are also increasingly being prescribed to the elderly, often for chronic pain.

The Obama administration has called the current prescription drug abuse epidemic a “public health crisis” worse than the crack and heroin epidemics of past decades. In 2007, there were 28,000 deaths from prescription drug overdoses — five times the number in 1990. Those deaths were driven largely by the abuse of prescription painkillers. Painkiller abuse now matches abuse of illegal drugs.

“[Opioids’] increasing use has resulted in a clearly unacceptable increase in addiction, overdose, and death,” Douglas Throckmorton, MD, deputy director for regulatory programs at FDA’s Center for Drug Evaluation and Research, said at the meeting.

But the meeting didn’t focus on safety concerns with opioids; rather, it focused on efficacy and effectiveness, and attendees discussed the existing evidence to support giving pain patients opioids long term.