Headlines: October 21, 2010
by Meg Larkin
First, in health reform news, some insurers are changing the way they pay for cancer treatments. According to the New York Times, “UnitedHealthcare plans to announce on Wednesday a one-year project with five oncology practices, offering doctors an additional fee. The new fee is meant to encourage doctors to follow standard treatments rather than opting too often for individualized and unproven courses of therapy, which can include the most expensive drug combinations.” The project aims to encourage doctors to choose lower cost treatments when they are appropriate and in the best interest of the patient. While some praise the program as a way to limit unnecessary and often painful care at the end of life, others worry that it is a step in the direction of denying patients care based on cost. At the same time, independent organizations are springing up to encourage doctors to follow existing treatment guidelines. The cost of cancer therapies often varies by thousands of dollars per treatment with no proven change in patient outcomes. However, in the public, and in the medical community there can be a perception that the newer and more expensive treatment may be more effective. Health policy experts caution that all possible cost containment programs inherently have problems, but that this should not be a reason to avoid working on the issue.
In other policy news, congressman Ed Markey has raised concerns about radiation treatment in thyroid cancer patients. Thyroid patients are often treated with radiation, and slowly emit radiation, often through urine or saliva, for a number of days after each treatment. Congressman Markey expressed concerns about these patients exposing other people to radiation risk in a recent letter to the Nuclear Regulatory Commission. Congressman Markey advocates for sequestration of patients treated with radiation in closed hospital wards for a number of days following administration of the therapy. While most hospitals have in place procedures to reduce the risk of inadvertent radiation exposure from thyroid cancer patients, an online survey conducted by a congressional subcommittee showed that many patients are allowed to leave the hospital without receiving proper instructions on isolation and the risks of exposing others to radiation.
In research news, a new federal study has found that women who take hormone replacement therapy are not only at a higher risk for breast cancer, they are also at a higher risk for dying of the disease. While it was already well known that women taking combined progestin-estrogen therapy to combat the symptoms of menopause were at higher risk for breast cancer, many researchers and physicians had thought that the death rate for the disease remained the same. The study, recently published the Journal of the American Medical Association, found that women taking the combined therapy, “were more likely to have tumors that appeared to be larger, were often hard to treat and were more likely to have spread to their lymph nodes. But most important, their risk of death appeared elevated.” While the study showed that the therapy doubled the relative risk of dying from breast cancer, the absolute risk of contracting cancer in the first place remains low. Therefore, patients and physicians should not be quick to discount hormone therapy entirely for women who could see a significant benefit from it.
Finally, in global health news, malaria is killing more people in India than previously estimated. A new study published in the Lancet and funded by the U.S. National Institutes of Health, the Canadian Institute of Health Research and the Li Ka Shing Knowledge Institute, has found that between 125,000 and 277,000 people in India die from malaria each year. Previous estimates had put the number around 15,000. The study found that most people dying from malaria lived in rural areas and did not receive medical treatment. Some officials have questioned the study’s methodology, which relied on reports by family and friends of the deceased as to the course of their illness. While malaria is treatable if it is caught early, in rural areas without access to medical care, it is a leading cause of death worldwide.
Meg Larkin is a third year law student at Boston University. Please feel free to email her with any questions, comments, suggestions or concerns.
