Plavix advertising indirectly cost taxpayers an extra $207 million over five years*

Advertising brand-name prescription medications directly to patients is a uniquely American custom, and a controversial one at that. A study published today in the Archives of Internal Medicine may stir new debate over the practice. In the case of one blockbuster drug, the study found, a major advertising campaign did little to expand the medication's use but brought price hikes that cost taxpayers hundreds of millions over a seven-year period.

Both critics and defenders of direct-to-consumer drug advertising agree on one thing: that the advertising of prescription medications will run up the bill that taxpayers foot to provide healthcare insurance to the elderly, disabled and poor through Medicare and Medicaid. When patients see commercials for a branded drug, they will ask for these medications in greater numbers, and they will get them, the reasoning goes.

But whether that higher price tag buys better healthcare is the point of dispute. Critics charge that advertising allows drug companies to pump up their sales to Medicare and Medicaid patients who might otherwise be treated with safer, cheaper medications. Defenders of the practice argue that drug ads spur more patients to seek treatment for conditions (such as high blood pressure or depression) that are widely under-diagnosed: Sure, it'll cost the taxpayer more, they say, but that's because more Medicare and Medicaid patients will get the treatment they need because they saw an ad.

But what if neither side is right? What if advertising a drug did not spur a rise in a drug's use, just in its price?

That, effectively, is what a pair of Canadians who teamed up with researchers from Harvard University and Kaiser Permanente found when they looked at the cost and use of the drug Plavix,* used to prevent blood clots, from 1999 to 2005. Plavix was on the market for two years, and its use was growing steadily when Bristol-Myers Squibb launched a major advertising campaign for the drug in 2001. Over the next five years, the drug company spent $350 million to promote Plavix in advertisements aimed at consumers.

But according to Michael Law of the University of British Columbia, the advertising campaign did not accelerate the growth in sales of Plavix, which reached $5.9 billion in 2005. While they continued to grow, Plavix sales grew no faster after advertising began than they had before the ads hit the airwaves.

But the cost of the drug certainly accelerated, Law found. Looking at Medicaid expenses in 27 states, Law and his co-authors found that the cost of Plavix shot up from $3.40 per prescription just before advertising began. "Immediately after [advertising] initiation, we found a large, sudden, and statistically significant increase" of 12% in the cost of a Plavix prescription. By the end of 2005, the cost to taxpayers a Plavix prescription filled by a Medicaid patient rose 25% beyond the more modest rate of inflation that would have been expected before advertising began.

Translation: In the Medicaid program alone, just 27 states spent a collective $207 million more on Plavix prescriptions after the big advertising campaign began than would have been expected. If one were to figure in the added cost to Medicare programs and the Medicaid programs of the remaining 23 states, the added cost would look like real money indeed.

Lawmakers in recent years have wrangled over whether and how to rein in drug advertising directed at patients rather than physicians, with no changes made to date. The authors say it's not time to put the debate aside. "Payers and policymakers should appropriately still be concerned about [direct-to-consumer advertising] increasing total drug costs for publicly funded reimbursement programs such as Medicare and Medicaid," they wrote.

--Melissa Healy

* An earlier version of this post incorrectly said that Plavis is a cholesterol drug.

Those medical bills won't just go away; now's the time to get a handle on them

Medical debt doesn't take care of itself. As with a serious illness, ignoring the symptoms will simply ensure more problems down the road.

So today, Families USA offers up tips on what to do about it. The advice from the organization, whose ultimate mission is affordable healthcare for all Americans, is practical and straightforward. It begins with, "Make sure the charges are correct," and ends with links to organizations that can provide additional services.

Here's the complete guide: Your Medical Bills: A Consumer’s Guide to Coping With Medical Debt.

For a general look at medical debt, from the Washington Post and Kaiser Health News, there's this: Americans ensnared by medical debt.

And here's a recent look specifically at California. This report, from the UCLA Center for Health Policy Research, finds that almost 1 in 7 nonelderly Californians has medical debt of one kind or another. It includes breakdowns by region and county.

And here's some more advice, from an article that first appeared in the L.A. Times' Health section: Negotiating Your Medical Bills.

It begins: "Unless you've been rushed to the hospital in an emergency, the time to start thinking about paying the bill for hospital care comes as soon as your doctor says you need to have a test, procedure or surgery."

-- Tami Dennis

Photo: When it comes to costs, and debt, those medical tests can add up.

Credit: John Moore / Getty Images

Health crimes and punishments: Employers -- and employees -- can decide

Turns out, those employer wellness programs are not the benignly helpful initiatives that some Americans might have perceived them to be. Sure, they encourage workers to act in their own best health interests, but they're now also having an impact on those who don't. Ultimately, they could ... well, who knows.

And that's the point of today's Los Angeles Times story on healthcare overhaul. It begins:

"Who could object to rewarding people who quit smoking, lose weight or start to exercise? The American Cancer Society and the American Heart Assn., for starters.

"Some companies are charging lower insurance premiums to workers who meet benchmarks for healthy living. The Senate's healthcare overhaul legislation would expand the trend.

"But instead of cheering the proposal, some patient advocacy and health groups are worried that it could mean higher rates for less-fit Americans, possibly pricing them out of their employers' insurance plans."

That story: Insurance discounts for healthy habits spur debate in Washington

But it's open enrollment time, and the debate is more than theoretical. It's personal and now faced by millions of Americans of varying states of health. Another recent L.A. Times story notes that some companies won't let workers sign up for health insurance until they sign up for risk assessments that were once optional. It says:

"If the assessment discovers manageable problems, you may be encouraged to join a fitness or smoking cessation program. Do that and you're likely to get bigger financial incentives -- somewhere in the neighborhood of $100 to $500 annually.

"But if you don't, your employer might restrict your health insurance choices to plans that demand higher deductibles and offer fewer services and benefits, which could cost you hundreds of dollars."

That story: This open enrollment period, expect rewards and penalties

Don't like the approach? You could take a stand. And pay for it, of course.

Not wild about helping to pay, in a roundabout way, for your smoking colleague's medical costs? Here's your chance to get just a little bit even and benefit from your own, perhaps wiser, choices.

Either way, the trend's increasing prominence suggests each of us should ask what such "incentives" might ultimately entail -- for good or ill.

Here's a recent Washington Post look at the issue. And an NPR story on Safeway's incentive programs.

-- Tami Dennis

Photo: Stop smoking -- or you might face limited healthcare choices.

Credit: John MacDougall / AFP / Getty Images

Lack of health insurance played a role in thousands of child deaths, researchers say

An analysis of 23 million hospital records from 37 states shows that a lack of health insurance likely played a role in the deaths of nearly 17,000 U.S. children over a 17-year period.

Researchers at Johns Hopkins Children's Center examined records from 1988 to 2005. They compared the risk of death in hospitalized children who were covered by health insurance with those who did not, and found that uninsured kids were 60% more likely to die, regardless of their medical condition. This does not mean that the children received less aggressive care at the hospital but that they were probably in poorer health before the arrived, researchers said. Insurance status did not affect how long a child spent in the hospital, according to the study.

The study did not count children who died outside the hospital or after leaving the hospital, which means that deaths among uninsured children are probably even higher. The report will be published Friday in the Journal of Public Health.

"Can we say with absolute certainty that 17,000 children would have been saved if they had health insurance? Of course not," a co-author of the study report, David Chang, said in a news release. "The point here is that a substantial number of children may be saved by health coverage. From a scientific perspective, we are confident in our findings that thousands of children likely did die because they lacked insurance or because of factors directly related to lack of insurance."

As the healthcare reform debate reaches a critical stage in Washington, the study is a reminder of the human cost of healthcare inequality. About 7 million American children are uninsured.

"In a country as wealthy as ours, the need to provide health insurance to the millions of children who lack it is a moral, not an economic issue," Dr. Peter Pronovost, a co-author of the study, said in a news release.

-- Shari Roan

Photo: Healthcare reform advocates protest outside the offices of Cigna Insurance in Los Angeles. Credit: Mark Ralston / AFP/Getty Images

Zombies are evolving; these have an agenda

For creatures on the prowl for brains, a growing number of zombies seem especially thoughtful. Or at least less single-minded than usual.

Last weekend, they turned up in Santa Rosa to tout the need for healthcare reform. Here's the Press Democrat story and the YouTube video.

And this Saturday -- yes, yes, Halloween -- they'll be lurching around Silver Lake Reservoir to raise money for brain cancer research. Proceeds from that event, Zombiethon: A Run for Brains, will benefit City of Hope.

Whether you consider the zombie and brain-cancer connection witty or grotesque (here, we didn't agree), find out more at http://www.silverlakezombiethon.blogspot.com/. (There's a costume contest too.)

The zombies-with-a-cause appear to be a slightly more evolved offshoot of the pop-culture-fad-of-the-moment-zombies.

But presumably even the less health-conscious versions -- if they make a habit of the white-face-and-bloody-mouth look -- would want to know about the potential problems with the trappings of their pastime.

Here's a U.S. News & World Report story on the topic of face paint. One day of use is unlikely to do harm, says one expert quoted. But those who make themselves up routinely may have makeup side effects, amid other problems.

-- Tami Dennis

But surely people providing healthcare have health insurance

As the nation's leaders discuss who should get health insurance and in what fashion and how much it should cost, many people who provide healthcare are watching from the sidelines.

First, the Kaiser Family Foundation offered up an analysis this week of the nation's much-discussed 46 million uninsured people.

That report notes: "More than eight in ten of the uninsured are in working families -- about two thirds are from families with one or more full-time workers and 14% are from families with part-time workers. Only 19% of the uninsured are from families that have no connection to the workforce. Even at lower
income levels, the majority of the uninsured are in working families. Among the uninsured with
incomes below the poverty level ($22,025 for a family of four in 2008), 55% have at least one worker in
the family.

Then came a closer look at healthcare workers specifically, many of whom would fall into this category. (And by healthcare workers, think beyond doctors and nurses to include the people doing the most basic tasks.)

Using National Health Interview Survey data, researchers at the University of Minnesota found that 11% of healthcare workers are uninsured. Residential care workers are especially likely to lack coverage. 

Here's the abstract of that study, published online Thursday in the American Journal of Public Health.

-- Tami Dennis

And now a word from a connoiseur of world healthcare systems...

T.R. Reid's a busy guy. First the journalist and author schleps from one country to another in his quest to assess the world's healthcare systems -- and their treatment options for his aching shoulder. Then he schleps from one interview and appearance to the next in his quest to discuss his findings -- and the book that resulted.

That book, "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," explains in highly readable fashion how other countries manage to offer healthcare to their citizens -- and what those citizens can expect.

Reid wrote last month in a Newsweek article that synopsized his book quite efficiently:

"The design of any country's health-care system involves political, medical, and economic decisions. But the primary issue for any health-care system is, as President Obama made clear last week, a moral question: should a rich society provide health care to everyone who needs it? If a nation answers yes to that moral question, it will build a health-care system like the ones in Britain, Germany, Canada, France, and Japan, where everybody is covered. If a nation doesn't decide to provide universal coverage, then you're likely to end up with a system where some people get the finest medical care on earth in the finest hospitals, and tens of thousands of others are left to die for lack of care. Without the moral commitment, in other words, you end up with a system like America's."

The book lays out the precise differences among other nations' systems, not just the ones mentioned above. (His recount of the Ayurvedic approach in India is especially riveting.) And those differences are considerable even among countries that try very hard to get it right, with "universal healthcare" being markedly different than a universal approach. 

Whether you're primed to agree with Reid's bleak assessment of the U.S. healthcare system or not, his perspective -- both global and intimate -- makes for worthwhile reading as the nation tries to come to terms with its current and future approach to healthcare.

(Today's news story: Healthcare triumph gives way to heightened battle)

If you're looking for Reid giving a quick primer on the topic, here he is recently on NPR's "Fresh Air", in a question-and-answer article on Oprah.com, and in a podcast from Stanford School of Medicine. As noted, he's been busy.

Then there's the "Frontline" documentary that spawned it all: "Sick Around the World." And of course, the book itself.

-- Tami Dennis  

Photo: T.R. Reid.Credit: "Frontline" / PBS

How does your state's healthcare rank?

The cost of healthcare, quality of healthcare, access to healthcare and overall outcomes related to healthcare ... they vary from state to state. Surprised? No. Interested in the details? The Commonwealth Fund is here for you.

Its second state scorecard ranks all the states on a variety of health-related measures and estimates the lives and money that could be saved with improvement.

Vermont, Hawaii, Iowa, Minnesota, Maine and New Hampshire are singled out as doing a pretty darned good job overall. California, on the other hand, ranks 31st overall -- moving up from 40th in 2007. The state didn't fare well in the prevention and treatment category, but in factors summed up under "healthy lives," it ranked fifth.

The summary stresses, on the downside, the state of insurance coverage for adults and rising healthcare costs and, on the upside, improvements in children's coverage.

-- Tami Dennis

Poll reflects the shifting tides of American support for health reform

Amid the mercurial American public, support for healthcare reform may have slid over the summer (blame it on the doldrums perhaps, if not individual performances), but now it's fall -- and the support seems to be ticking back up. 

In August, 53% of Americans said they wanted healthcare change; in September, 57% were behind it. In August, 42% thought the nation couldn't afford to tackle the issue at the moment; in September, that number had ebbed to 39%.

These numbers are found in a new poll from the Kaiser Family Foundation.

The percentage of Americans who think their family would be better off with reform moved upward as well, from 36% in August to 42%. Those who think they and their loved ones would fare more poorly declined, from 31% in August to 23%.

For a closer look at American public opinion, including support for various proposals (individual mandates, employer mandates, state program expansions and the like), go here.

(The site also offers an easy way to compare major healthcare reform efforts, for those truly riveted by the debate.)

Of course, more than a fourth of the nation still thinks health reform wouldn't affect them much one way or the other.

-- Tami Dennis

Photo credit: Gary Friedman / Los Angeles Times

Young adults and healthcare. Who cares?

Young adults are the least likely among all age groups to get outpatient medical care even though there is plenty of evidence that seeing a doctor once a year or so would benefit people ages 20 to 29 just as much as older or younger folks.

A study published in the September issue of the Annals of Internal Medicine used national survey data from 1996 to 2006 to show that annual visits for healthcare drops sharply between peaks of heavy usage in childhood and middle age. Young men, especially, are unlikely to get regular healthcare, as are people without insurance. About one-third of young adults are uninsured, according to the researchers from the University of Rochester School of Medicine and Dentistry. Young adults are also less likely to have a primary care doctor.

People in their 20s often appear to be in good health, which may lead many to conclude that they don't need healthcare. But numerous studies show that many health problems peak in early adulthood, including homicide, accidents, sexually transmitted diseases and substance abuse disorders. Rates of suicide, smoking, HIV infection and psychiatric disorders are also higher in this age group than in several other age groups. A large portion of young adults are overweight or obese or sedentary.

"In contrast to adolescents, young adults garner relatively little attention from researchers, advocacy groups, or policymakers," the authors wrote. "Our findings emphasize the need for a national agenda to improve access to care and preventive services for all young adults."

-- Shari Roan

Photo credit: Mark Boster  /  Los Angeles Times