Health Headlines - January 15

Glitches Interrupt Medicare Prescriptions

Tens of thousands of elderly poor people may have had trouble getting their medicine during the first two weeks of the government's prescription drug benefit, and about 20 states have been forced to step in to help them, the top Medicare official acknowledges.

The problems will be fixed, pledged Mark McClellan, administrator for the Centers for Medicare and Medicaid Services, in an interview with The Associated Press.

In some cases, people are not showing up in databases as being enrolled in a plan. When they do show up, many people are being told they need to pay hundreds of dollars before they can get their medicine. Instead, they should owe only nominal amounts.

"I'm working with the states, with the plans, with all of our partners to make sure people get the prescriptions they need," McClellan said Friday.

Under the program, about 42 million disabled and older people are eligible to enroll in private plans that will subsidize their prescription drug costs. Millions of prescriptions have been filled without trouble, McClellan said, but there is growing concern that some of the poorest beneficiaries cannot get their medicine.

Some advocacy groups say they believe McClellan underestimated the problems.

"We could see the problems coming. We expressed concern, and it was just pooh-poohed. Now, our worst fears have been realized," said Jeanne Finberg, a lawyer with the National Senior Citizens Law Center, which is based in Oakland, Calif.

The problems go beyond technical difficulties, such as when computer databases fail to note that a beneficiary is enrolled in a plan. In some cases, private plans are just not following guidelines established for their participation.

The plans are not issuing emergency supplies as required and they have set up prohibited restrictions on the types of medicine that beneficiaries can get during the first weeks of the program, according to the American Psychiatric Association.

"Relapse, re-hospitalization and disruption of essential treatment are some of the consequences of the bureaucratic nightmare," said the association's president, Steven S. Sharfstein. "I commend those states and other jurisdictions that have taken steps to assure that patients receive their medications in a timely manner."

McClellan said he has directed plans providing drug coverage to make it easier for pharmacists to resolve questions about a beneficiary.

"I've been in touch with the health plans today and they are setting up expedited processes for pharmacists to contact a plan without waiting in a long queue. The plans are setting up those systems right now," he said.

McClellan said plans were required to provide a 30-day supply of drugs, even if their plan does not cover a particular drug. In cases when a drug is not on the list, plans require pharmacists to get pre-authorization before dispensing the drug. Many plans are waiving the pre-authorization requirements, he said.

The agency also updated information on Friday so pharmacists can more quickly reach plans, McClellan said.

McClellan also said he contacted several governors and the staff of the National Governor's Association this past week on how best to help beneficiaries. Some lawmakers have demanded that the federal government reimburse states for those efforts, but McClellan said the insurers and other businesses offering coverage would do that.

"The plans are getting paid additional amounts to provide the extra coverage for the dual eligible beneficiaries. It's a matter of reconciliation," he said. "If the state works with us ... we can send that information onto the plan so the plan reimburses the state for the difference."

Democratic lawmakers wrote Health and Human Services Secretary Mike Leavitt on Friday with dozens of questions about the new program.

"We want to know why so many of our constituents have fallen through the cracks during implementation of the Medicare prescription drug benefit, and we urge you to take immediate action to correct the problems," the lawmakers said.

A spokeswoman for Senate Majority Leader Bill Frist, R-Tenn., sounded a more optimistic note.

"We are pleased with the successes of the program and are working with (the Health and Human Services Department) to resolve the problems, which will naturally occur when implementing a program of this magnitude," spokeswoman Amy Call. "But at the end of the day seniors will have better access to prescription drugs."

McClellan said Medicare also has caseworkers on hand for beneficiaries or pharmacists who are having trouble navigating the new benefit. They can call 1-800-Medicare for help, he said.

Flu Virus Resistant to 2 Drugs, CDC Says

The government, for the first time, is urging doctors not to prescribe two antiviral drugs commonly used to fight influenza after discovering that the predominant strain of the virus has built up high levels of resistance to them at alarming speed.

A whopping 91 percent of virus samples tested by the Centers for Disease Control and Prevention this flu season proved resistant to rimantadine and amantadine, a huge increase since last year, when only 11 percent were.

The discovery adds to worries about how to fight bird flu should it start spreading among people. Health officials had hoped to conserve use of two newer antiviral drugs, Tamiflu and Relenza, because they show activity against bird flu, unlike the older drugs.

Now, because of the resistance issue, the newer drugs are being recommended for ordinary flu, increasing the chances that resistance will develop more rapidly to them, too, as they become more commonly used.

The newer drugs work against Type A and B influenza strains; the older ones work only against Type A, but cost less and are available in generic form.

CDC officials took the unusual step of calling a Saturday news conference to announce that the predominant strain this season -— the type A H3N2 influenza strain -— was resistant to the older drugs.

"Clinicians should not use rimantadine and amantadine ... because the drugs will not be effective," said CDC director Dr. Julie Gerberding.

She said the lab tests, which CDC scientists had been analyzing since Friday, surprised health officials and the health agency rushed to get the word out.

"I don't think we were expecting it to be so dramatic so quickly this year," Gerberding said. "We just didn't feel it was responsible to wait three more days during a holiday weekend to let clinicians know."

The CDC tested 120 influenza A virus samples from the H3N2 strain and found that 109 were resistant to the two drugs. Two years ago, less than 2 percent of the samples were resistant. Last year, 11 percent were.

Gerberding said the agency didn't know how the resistance occurred, saying it may have been the result of a mutation in the virus or overuse of the drugs abroad, such as in countries that permit the drugs to be purchased without a prescription.

One flu expert, Dr. William Schaffner of Vanderbilt University, said the development was "disconcerting" as flu now has joined the ranks of other diseases, such as tuberculosis and HIV, that recently have acquired the ability to resist front-line medications.

But Schaffner said doctors have other options to fight influenza.

The CDC said that all H3 and H1 influenza viruses the agency has tested so far are susceptible to the newer antivirals: Tamiflu, also known as oseltamivir, and Relenza, also called zanamivir. Doctors also recommend an annual flu shot to help prevent getting influenza in the first place.

"Tamiflu is now readily available everywhere -— in most places, it is the primary antiviral being used" against flu, Schaffner said. "But we're always a bit frustrated when one of the therapeutic agents is foreclosed. It makes every infectious disease doctor worry a little bit."

That's especially worry with fears that bird flu could become turn into a human epidemic. The bird flu spreading through Asia infects people relatively rarely, but officials worry that it might morph into a form that spreads more easily, triggering a worldwide super-flu outbreak.

The CDC said it planned to alert doctors throughout the country via its emergency Health Alert Network and through a special edition of its weekly journal, the Morbidity and Mortality Weekly Report.

Each year, the flu kills about 36,000 people, and some 200,000 are hospitalized because of it in the United States, the CDC said. As of Dec. 31, the latest CDC data available, flu activity was only considered widespread in seven U.S. states, mainly in the Southwest and West: Texas, New Mexico, Arizona, Colorado, Utah, Nevada and California.

Flavored Cigarettes: The Next Battleground

The names sound like they belong on yogurt, chewing gum or candy bars.

But Twista Lime, Warm Winter Toffee and Midnight Berry are new flavors of cigarettes. And critics say they are actually thinly veiled efforts by the U.S. tobacco industry to entice children take up smoking.

Tobacco makers strongly refute that, but the critics have their doubts and advise parents to contact their legislators to urge a ban on the smokes.

It's necessary, experts add, to help convince kids not to take up the habit. That's critical, according to the American Lung Association, because tobacco use primarily begins in early adolescence -- one-third of all smokers had their first cigarette by the age of 14.

Flavored cigarettes date back to about 1999. But the last few years have seen a "big push" in their marketing, said Paul Billings, vice president of national policy and advocacy for the American Lung Association.

Several states have introduced legislation to ban the flavored smokes, said Billings, including Connecticut, Illinois, Massachusetts, Minnesota, New Jersey, New York, North Carolina, Texas and West Virginia.

"We strongly support this legislation," he added.

The timing of the new flavored products is hardly coincidental, a group of Harvard researchers contended in a report in the November/December 2005 issue of the journal Health Affairs.

"The proliferation of new flavored brands comes at a time when advertising and marketing restrictions have made it more difficult to target young smokers," said the researchers, led by Carrie Carpenter, a Harvard School of Public Health research analyst.

She was referring to the terms of the 1998 Master Settlement Agreement between the state attorneys general and major U.S. tobacco manufacturers. The tobacco makers agreed to change the way their products are marketed and pay the states an estimated $206 billion. The companies also agreed to finance a $1.5 billion anti-smoking campaign, open documents previously kept secret, and disband trade groups the attorneys general said conspired to conceal damaging research from the public.

Carpenter's team pored over internal tobacco industry documents as well as U.S. patents, both awarded and pending applications.

"Now we have evidence from the documents that this concept of flavored cigarettes has been associated with new and younger smokers," Carpenter said, referring to what she described as a 1988 R.J. Reynolds Tobacco report, identifying young adult smokers as the company's "most critical strategic need." Because aftertaste was mentioned by young smokers as a concern, one of the methods to counteract the problem is the "pellet technology" used in some flavored products. The pellet is inserted in the filter area to provide for controlled release of the filter, she said.

"There could be health risks associated with the pellet," said Carpenter.

But a spokesman for the R.J. Reynolds Tobacco Company said the target for the new product is not minors.

"Our one and only audience, regardless of brand or style, is legal-age adults who have made the decision to smoke," Fred McConnell, manager of communications for R.J. Reynolds, said.

"We don't want children to smoke," he added, "not only because it is illegal to sell to minors in every state, but also because children lack the maturity of judgment to assess the inherent health risks of smoking."

Billings suggests parents warn their underage children about the health risks of smoking, and lobby their lawmakers to outlaw the flavored smokes.

Doctor made up cancer study: hospital

A Norwegian cancer expert made up fictitious patients for an article about treatment of oral cancer published in a leading medical journal, the hospital said on Sunday.

"The material was fabricated," said Trine Lind, spokeswoman of the Norwegian Radium Hospital where Jon Sudbo has worked as a doctor and a researcher. "We are shocked. This is the worst thing that could happen in a research institution like ours."

Sudbo, 44, invented patients and case histories for a study of oral cancer that was published in the British medical journal the Lancet in October 2005, she said.

The Norwegian daily Dagbladet said that 250 of his sample of 908 people in the study all shared the same birthday.

Lind said Sudbo, who has not commented publicly on the hospital's charges and could not be contacted on Sunday, had admitted falsifying the data for the article.

The hospital has set up a commission to investigate why Sudbo falsified data and how his material passed a review by other experts.

The panel would also examine previous articles by Sudbo, including two in the New England Journal of Medicine.

The Radium Hospital had halted Sudbo's research at the department of Medical Oncology and Radiotherapy and was discussing whether he could continue treating patients.

The report in the Lancet was entitled "non-steroidal anti-inflammatory drugs and the risk of oral cancer."

It concluded that long-term use of the drugs could help reduce chances of oral cancer, including in smokers, but could also bring higher risks of death from heart disease.

Give Shoveling Injuries the Heave-Ho

That fresh snowfall may look beautiful, but shoveling it from driveways can be dangerous and even deadly, experts warn.

The Westchester Medical Center in Valhalla, N.Y., offers the following advice on how to shovel safely:

Warm up. Before you shovel, warm up your muscles by doing light exercises for a few minutes.
Push, don't lift. Pushing snow to the side is less injury-inducing than lifting it. If you have to lift it, do it properly: Squat with your legs apart, knees bent and back straight. Lift with you legs, without bending at the waist. Scoop small amounts of snow onto the shovel and walk to where you want to dump the snow.
Avoid twisting. Don't throw snow over your shoulder or to the side. This requires a twisting motion that puts stress on your back.
Pick the right shovel. Use a shovel that matches your height and strength. Don't use a shovel that's too heavy or long. Space your hands on the shovel handle to increase your leverage.
Stay sure-footed.Wear boots with slip-resistant soles to prevent falls while shoveling.

"Snow shoveling is considered by many an aerobic activity, similar to lifting weights. Take frequent breaks, drink plenty of fluids and don't try to do too much at one time. If you experience chest pain, shortness of breath or other signs of possible heart attack, stop immediately and call for help," Dr. David Asprinio, chief of orthopedics at Westchester, said in a prepared statement.

Wise Words on Wound Care

Slicing onions, falling down, even paper cuts: Wounds happen. And when cuts or other wounds occur, simple steps can help speed the body's natural healing process.

Experts writing in the Mayo Clinic Women's HealthSource offer up the following wound-care tips:

Cover, press, clean. Cover the wound with a sterile dressing and apply pressure to the wound to halt the bleeding. Use tap/bottled water or sterile saline to wash the wound. Seek medical help if you think you need stitches, you can't clean the wound, or if the injury was caused by an animal or human bite. You should also seek medical attention if it has been 10 years or longer since your last tetanus shot.
Medicate. Apply a topical antibiotic ointment to the wound. Cover the wound with a heavy lubricant such as Vaseline or Aquaphor to create a barrier to keep the wound moist. Don't use betadine, alcohol or hydrogen peroxide because they all interfere with healing.
Keep area moist. Experts have turned their back on older advice to keep wounds dry and exposed to the open air. Instead, they now recommend that individuals cover the wound with a sterile dressing to create a warm, moist environment, which is the best condition for wound healing. This kind of environment decreases pain, infection and the likelihood of re-injury.
Be well-dressed.The best kind of dressing is one that keeps the wound moist and the surrounding tissue dry. Use a nonstick dressing and gently change it every day or two. Try to keep the wet scab intact. Wounds should normally stay covered for about five days or until the surface layers have healed. Don't use plain gauze to cover the wound. It can stick to the scab and cause re-injury when it's removed.
Don't scratch. Scratching the healing wound can re-open it. Remember, itching is a normal (if frustrating) part of the healing process.
Eat right, don't smoke. Healthy lifestyles promote wound healing.
Watch it. If the wound shows signs of infection (redness, increased pain or swelling, yellow or green discharge), seek medical attention.

Food Fact:
Cheese it?

High-fat foods can have a place in low-fat cooking -- if you know how to pick your spots. For a true cheese flavor in gratins and pasta dishes, use small amounts of aged cheese, such as extra-sharp cheddar or Reggiano Parmesan. A tablespoon of grated Parmesan cheese has only 22 calories and 1.5 grams of fat. The result is far more satisfying than using a larger amount of a bland, low-fat cheese.

Fitness Tip of the day:
The 100-yard sale.

The gym isn't the only place to burn calories; you can find lots of ways to get in shape at the mall, if you know where to look. Start by parking an extra 100 yards away and walking to the mall entrance. Take a few laps around the shopping center when you go window shopping. Bring some friends; you'll have so much fun, you may not even realize how much of a workout you're all getting.

FAQ of the day:
What can I do to raise my HDL (good) cholesterol?

Your HDL level is largely inherited, but you can push it as high as possible with regular exercise and moderate alcohol consumption. Alcohol's effect on HDL levels explains why many health studies have reported that moderate drinkers live longer and have significantly less heart disease than non-drinkers. Of course, the protective effects are lost with heavy drinking, which worsens blood fats and damages the liver and other organs. A third way to maximize HDL is to make sure most of the fat in your diet is monounsaturated. A diet high in polyunsaturated fats or carbohydrates tends to lower HDLs.