1. Art and Diseño

TUESDAY, FEBRUARY 3, 2015
H E A LT H & S C I E N C E
Insurers using drug costs to discriminate patients
FORT LAUDERDALE: Insurance companies, perhaps more than previously thought, may be charging the sickest patients extra for drugs under the
federal health law, in an effort to discourage them
from choosing certain plans, according to a study
released Wednesday.
One of the cornerstones of President Obama’s
signature health law forbids insurance companies
from turning away people with pre-existing conditions such as diabetes or cancer. Yet hundreds of
patient advocacy groups say insurance companies
have found a way to discriminate against these
people, who are more expensive to cover because
they require life-long treatments.
The companies do this by putting all of their
medications in a special category where the patient
is required to pay a percentage of the cost of the
drug, rather than a flat co-pay. Some are as high as
50 percent, leaving people on the hook for thousands of dollars. That compares to the average $10
to $40 per-medication co-pay that most pay.
A study published in the New England Journal
of Medicine only examined HIV drugs, but noted
the problem applies to mental illness, cancer,
rheumatoid arthritis, diabetes and other chronic
conditions. Patient advocates have complained that
prescriptions for these patients were virtually unaffordable in some plans offered on healthcare.gov.
The AIDS Institute even filed a formal complaint
with Health and Human Services officials last summer about four plans in Florida. Georgia plans to
file a similar complaint, but the scope of the problem has been difficult to gauge as many of the
complaints have been anecdotal.
The researchers studied 48 plans in 12 states
using the federal marketplace: Delaware, Florida,
Louisiana, Michigan, South Carolina, Utah, Illinois,
New Jersey, Ohio, Pennsylvania, Texas, and Virginia.
They found that one-quarter of the plans placed
all of the HIV drugs into the highest-cost category
and required consumers to pay at least 30 percent
of the drug costs instead of a flat co-pay. Annual
drug costs in these plans were more than triple
compared with other plans ($4,892 to $1,615),
according to the analysis. And 50 percent had to
pay a separate deductible for drugs, compared to
only 19 percent of consumers in other plans.
Insurers have historically placed drugs in categories with higher co-pays to encourage consumers to select generic or preferred brand-name
drugs. The problem is exacerbated as more plans
place all drugs, including generics, in the more
expensive category.
“Our findings suggest that many insurers may
be using benefit design to dissuade sicker people
from choosing their plans,” the study noted.
Over time, researchers predicted sicker people
will enroll in plans that don’t charge such high
prices. That means certain plans could have a higher number of sicker, more expensive consumers
than their competitors. The federal law has financial
protections for those plans but some will be
phased out in 2016.
The law does ban insurers from charging an individual more than $6,350 in out-of pocket costs a
year and no more than $12,700 for a family policy.
Insurance companies say the main issue is increasing drug costs and they’re shouldering the bulk of
it. But they acknowledge the increased prices are
also passed onto consumers.
For example, Atripla, the most popular HIV AIDS
treatment and one of the highest-selling drugs in
the U.S., costs insurers $27,026 a year. Patients only
pay a portion of that, said Clare Krusing, a spokeswoman for the trade association America’s Health
Insurance Plans.
But insurers noted consumers have the flexibility
to choose from plans at all levels with different
cost-sharing requirements and that the health law
has a component that rewards plans for value and
efficiency “not on their ability to attract healthier
enrollees,” Krusing said.
Advocates have asked federal health officials to
intervene and nearly 300 patient groups sent a letter last month urging Health and Human Services
Secretary Sylvia Burwell to beef up enforcement.
The federal government has warned against such
discrimination.
“We analyze plan information submitted by
insurance companies to uncover discriminatory
benefit designs, and work with outlier plans to
update formularies so they do not discourage
enrollment of consumers with specific medical conditions,” agency spokesman Aaron Albright said in
an email.
It’s unclear what the penalties are for insurance
companies who discriminate. Meanwhile, insurance
officials in some states are stepping in. Three out of
four insurance companies restructured their plans
in Florida late last year. — AP
‘Still Alice’
highlights
hidden toll of
Alzheimer’s
WASHINGTON: Her performance as a vibrant woman fading into the darkness of Alzheimer’s is doing more than
earning awards for actress Julianne Moore. The movie “Still
Alice” is raising awareness of a disease too often suffered in
isolation, even if the Hollywood face is younger than the
typical real-life patient.
Some things to know about Alzheimer’s:
ALZHEIMER’S IS INCREASING BUT
THE EARLY-ONSET FORM ISN’T COMMON
The movie is about a linguistics professor stricken at the
unusually young age of 50 with a form of Alzheimer’s that
runs in her family. That type of Alzheimer’s accounts for a
small fraction of the brain-destroying disease.
About 35 million people worldwide, and 5.2 million in
the US, have Alzheimer’s or similar dementias. The vast
majority are 65 or older. Barring medical breakthroughs,
US cases are expected to more than double by 2050,
because of the aging population.
As many as 4 percent of cases worldwide are thought to
be the early-onset form that strikes people before age 65,
usually in their 40s or 50s, said the Alzheimer’s
Association’s chief science officer, Maria Carrillo, who
served as a scientific adviser for the movie. In the US, the
association estimates that’s 200,000 people.
GENE TESTING ISN’T
RECOMMENDED FOR MOST PEOPLE
Alice’s type is even more rare; she tells her three adult
children in the movie: “It’s familial. It’s passed on genetically.”
With this autosomal dominant form of young
Alzheimer’s, inheriting one of three genes with particular
mutations leads to the disease. Children of an affected parent have a 50 percent chance of having inherited the family’s culprit mutation. As in other families, Alice’s children
have to grapple with whether they want to be tested to
find out.
But the vast majority of Alzheimer’s isn’t linked to a particular bad gene. There are various genes that can increase
the risk, but people who never develop dementia symptoms can carry them, too. That’s why medical guidelines
don’t recommend genetic testing for the average person.
MANY SYMPTOMS ARE UNIVERSAL
REGARDLESS OF AGE OF ONSET
“I can see the words hanging in front of me and I can’t
reach them, and I don’t know who I am or what I’m going
to lose next,” Alice says.
To help with the movie’s first-person perspective,
Carrillo’s group put actress Moore in touch with someone
in the earlier stages of Alzheimer’s who could describe
how disorienting symptoms felt - that frustrating inability
to retrieve a word or the fear that comes with suddenly not
recognizing a familiar place.
Forgetting a word now and then happens to lots of
people. The Alzheimer’s Association lists warning signs
that may distinguish between normal forgetfulness and
something you should discuss with a doctor. On the worry
list: memory loss that disrupts daily life, difficulty completing familiar tasks, withdrawing from social activities and
personality changes.
PEOPLE MAY COMPENSATE FOR A WHILE
If it seemed like the movie’s Alice suddenly declined
fast, consider a concept that neuroscientists call “cognitive
reserve.” People who have had more years of education are
thought to have some protection because the extra learning increased connections between their brain’s neurons.
When Alzheimer’s begins blocking those connections, the
brain at first can choose an alternate route to retrieve a
memory.
“Your brain’s kept buffered up,” explained Carrillo. But
eventually, the brain reaches a tipping point and can’t
compensate any longer, so “the change seems more dramatic.”
WHAT’S IN THE PIPELINE
There is no cure for Alzheimer’s, and today’s treatments
only temporarily ease some symptoms. Scientists aren’t
even sure what causes the disease, although a sticky brain
protein called amyloid is one suspect.
Nor is diagnosis simple. There is no one Alzheimer’s test,
but a battery of evaluations. Sometimes, doctors use PET
scans to measure amyloid buildup, but only in carefully
selected cases because plenty of people without
Alzheimer’s harbor the gunk, too.
The Obama administration has declared a goal of finding effective Alzheimer’s treatments by 2025. Research
suggests Alzheimer’s begins silently ravaging the brain up
to 20 years before symptoms begin. One approach under
study now is testing to see whether curbing sticky amyloid
during that window period might at least postpone symptoms a few more years, if not prevent them. — AP
CALIFORNIA: Pediatrician Charles Goodman vaccinates 1 year- old Cameron Fierro
with the measles-mumps-rubella vaccine, or MMR vaccine.
CALIFORNIA: Boxes of single-doses vials of the measles-mumps-rubella virus vaccine live, or MMR vaccine and ProQuad vaccine are kept frozen inside a freezer at the
practice of Dr Charles Goodman.— AP photos
Doctors won’t see patients
with anti-vaccine views
Approach raises questions about doctors’ ethical responsibilities
LOS ANGELES: With California gripped by a measles
outbreak, Dr Charles Goodman posted a clear notice in
his waiting room and on Facebook: His practice will no
longer see children whose parents won’t get them vaccinated. It’s a sentiment echoed by a small number of
doctors who in recent years have “fired” patients who
continue to believe debunked research linking vaccines
to autism. They hope the strategy will lead parents to
change their minds; if that fails, they hope it will at least
reduce the risk to other children in the office.
“Parents who choose not to give measles shots,
they’re not just putting their kids at risk, but they’re also
putting other kids at risk - especially kids in my waiting
room,” the Los Angeles pediatrician said. The tough-love
approach - which comes amid the nation’s secondbiggest measles outbreak in at least 15 years, with 95
cases or more since last month, most of them traced
directly or indirectly to Disneyland in Southern
California - raises questions about doctors’ ethical
responsibilities.
The American Academy of Pediatrics says doctors
should bring up the importance of vaccinations during
visits but should respect a parent’s wishes unless there’s
a significant risk to the child. “In general, pediatricians
should avoid discharging patients from their practices
solely because a parent refuses to immunize his or her
child,” according to guidelines issued by the group.
‘Betrayed and upset’
However, if the relationship between patient and
doctor becomes unworkable, the pediatrics academy
says, the doctor may want to encourage the vaccine
refuser to go to another physician. Some mothers who
have been dropped by their doctors feel “betrayed and
upset,” said Dotty Hagmier, founder of the support
group Moms in Charge. She said these parents made up
their minds about vaccines after “careful research and
diligence to understand the risks versus the benefits for
their own children’s circumstances.”
Dropping patients who refuse vaccines has become
a hot topic of discussion on SERMO, an online doctor
hangout. Some doctors are adamant about not accepting patients who don’t believe in vaccinations, with
some saying they don’t want to be responsible for
someone’s death from an illness that was preventable.
Philosophical reasons
Others warn that refusing treatment to such people
will just send them into the arms of quacks. The
measles-mumps-rubella vaccine, or MMR, is 97 percent
effective at preventing measles, according to the
Centers for Disease Control and Prevention. Measles
spreads easily through the air and in enclosed spaces.
Symptoms include fever, runny nose, cough and a rash
all over the body. In rare cases, particularly among
babies, measles can be deadly. Infection can also cause
pregnant women to miscarry or give birth prematurely.
All US states require children to get certain vaccinations
to enroll in school. California is among 20 states that let
parents opt out by obtaining personal belief waivers.
Some people worry that vaccines cause developmental problems, despite scientific evidence disproving
any link. Others object for religious or philosophical reasons. Nationally, childhood measles vaccination rates
have held steady for years at above 90 percent. But
there seem to be growing pockets of unvaccinated people in scattered communities, said Dr Gregory Wallace
of the CDC. — AP
CHICAGO: Kathy Burnett prepares a snack for her daughters Claudia, center, and Sabina right, after their
gymnastics class Jan 29, in Chicago. Burnett says she tries to feed her girls healthy, natural foods rather than
commercial packaged products. A study by the federal Centers for Disease Control and Prevention found
that many packaged foods and snacks marketed for toddlers contain too much salt and sugar and could
potentially contribute to childhood obesity and high blood pressure. — AP
Toddler food often has
too much salt, sugar
CHICAGO: Many packaged meals and snacks for toddlers contain worrisome amounts of salt and sugar, potentially creating
an early taste for foods that may contribute to obesity and other health risks, according to a new government study.
About seven in 10 toddler dinners studied contained too
much salt, and most cereal bars, breakfast pastries and snacks
for infants and toddlers contained extra sugars, according to
the study by researchers at the federal Centers for Disease
Control and Prevention. They advise parents to read food labels
carefully and select healthier choices.
The researchers analyzed package information and labels
for more than 1,000 foods marketed for infants and toddlers.
Results appeared in the journal Pediatrics yesterday.
The study notes that almost one in four US children ages 2
to 5 are overweight or obese - and that almost 80 percent of
kids ages 1 to 3 exceed the recommended maximum level of
daily salt, which is 1,500 milligrams. Excess sugar and salt can
contribute to obesity and elevated blood pressure even in
childhood, but also later on.
“We also know that about one in nine children have blood
pressure above the normal range for their age, and that sodium,
excess sodium, is related to increased blood pressure,” said the
CDC’s Mary Cogswell, the study’s lead author. “Blood pressure
tracks from when children are young up through adolescence
into when they’re adults. Eating foods which are high in sodium
can set a child up for high blood pressure and later on for cardiovascular disease.”
Healthy choices
The researchers collected data on foods available in 2012.
They didn’t list brand names, but foods studied included popular brands of baby food, toddler dinners including packaged
macaroni and cheese, mini hot dogs, rice cakes, crackers, dried
fruit snacks and yogurt treats.
The Grocery Manufacturers of America, a trade group whose
members include makers of foods for infants and toddlers,
issued a statement saying the study “does not accurately reflect
the wide range of healthy choices available in today’s marketplace ... because it is based on 2012 data that does not reflect
new products with reduced sodium levels.”
The study “could needlessly alarm and confuse busy parents
as they strive to develop suitable meal options that their children will enjoy,” the group said.
The researchers said theirs is the most recent, comprehensive data on commercial foods for young children. Cogswell
acknowledged there have been some improvements in the
marketplace and said the findings aren’t all negative.
“The good news is that the majority of infant foods were low
in sodium,” she said. It was surprising, she said, that “seven out of
10 toddler foods were high in the amount of sodium per serving and that a substantial proportion of toddler meals and the
majority of other toddler foods and infant’s and toddler’s snacks
contained an added sugar.”
Switched brands
Foods for toddlers should contain no more than about 210
milligrams of salt or sodium per serving, under Institute of
Medicine recommendations, but the average for toddler meals
studied was 361 milligrams - almost 1.5 times higher than that
limit. Sodium amounts per serving ranged from 100 milligrams
to more than 900 milligrams.
High sugar content was defined as more than 35 percent of
calories per portion coming from sugar, based on Institute of
Medicine guidelines for foods served in schools. Many foods in
the study exceeded that. On average, sugar contributed 47 percent of calories for infant mixed grains and fruit; 66 percent of
calories in dried fruit snacks, and more than 35 percent of calories in dairy-based desserts.—AP