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Study Reveals "Unacceptable Delays" In Stroke Prevention Surgery
Only one in five UK patients have surgery to reduce their risk of stroke within the two week target time set by the National Institute for Health and Clinical Excellence (NICE), finds a study published on bmj.com today.

Study Finds Association Between Sudden Death And Stimulant Medications Among Children And Adolescents
Researchers found support for an association between the use of stimulants and sudden unexplained death among children and adolescents, according to a study released today by The American Journal of Psychiatry.
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White House Budget Chief Says Issue Of Abortion Coverage In Health Reform Still Under Debate
In an appearance on "Fox News Sunday," White House Office of Management and Budget Director Peter Orszag said that he is "not prepared to say explicitly" whether health care reform legislation would prohibit the use of federal tax revenue to fund abortion coverage, the New York Times reports. Orszag"s statement came in reply to a question asking whether he was prepared to say that "no taxpayer money will go to pay for abortions." Orszag said, "It"s obviously a controversial issue, and it"s one of the questions that is playing out in the debate" (Pear/Liptak, New York Times, 7/20).Sen. Judd Gregg (R-N.H.), who also appeared on "Fox News Sunday," said, "No matter what your views are on abortion, you shouldn"t ask people to use their tax dollars if they think that abortion is taking a life." Gregg added, "I would hate to see the health care debate go down over that issue. We do really need health care reform, and it has to be substantive. ... So hopefully we won"t get ourselves wrapped around the wheel of abortion in this debate" (FoxNews.com, 7/19). According to the Times, there is an ongoing behind-the-scenes debate over handling abortion coverage in health overhaul legislation. The debate affects both the public insurance plan the legislation would create and private insurers, who would receive tens of billions of dollars in federal subsidies to expand coverage for low- and moderate-income U.S. residents. A provision in the House health reform bill (HR 3200) calls for a federal advisory committee to advise the HHS secretary on an "essential benefits package" that most insurers would be required to provide. Abortion-rights opponents want abortion coverage excluded from the package, while abortion-rights advocates say the decision should be left to medical professionals. House committees working on health reform legislation have rejected Republican amendments that would have restricted abortion coverage. The Hyde Amendment, first enacted in 1976, prohibits the use of federal Medicaid money for abortion services. However, abortion-rights opponents argue that federally subsidized coverage of the uninsured would not be subject to the existing restrictions. The National Right to Life Committee issued an analysis of the House bill, stating, "There is no doubt that coverage of abortion will be mandated, unless Congress explicitly excludes abortion from the scope of federal authority to define "essential benefits."" According to the group, even if the HHS secretary did not require abortion coverage, "federal courts would interpret the broadly worded mandatory categories of coverage to include abortion" (New York Times, 7/20).
Public Health

One In Ten Advanced Colon Cancer Patients Worry About Prescription Drug Costs

The vast majority of advanced colon cancer patients in a clinical trial were not concerned about the cost of prescription drugs for managing chemotherapy side effects, such as infection, pain and nausea and few adopted strategies to reduce drug cost burdens after joining the clinical trial, according to a study led by researchers at Dana-Farber Cancer Institute in Boston. Although few patients reported substantial worry about drug costs, still fewer reported discussing drug cost issues with their physicians, suggesting there are opportunities for improving how physicians integrate discussions about drug costs into clinical practice. The study"s findings (abstract 9503) were presented at the American Society of Clinical Oncology"s annual meeting in Orlando, Fla. "We were reassured to learn that few patients enrolled in the clinical trial engaged in coping strategies to minimize the impact of prescription drug costs, but we also recognize that these findings may not generalize to patients treated outside the clinical trial context," said the study"s lead author, Deborah Schrag, MD, MPH, of Dana-Farber. Schrag added that given the current state of the economy, with a growing number of people losing their jobs and possibly some or all of their insurance coverage, "we could witness growing anxiety among cancer patients about their ability to pay for medications that may help them adhere to their therapy." The researchers surveyed 409 patients with metastatic colorectal cancer who were enrolled in a Cancer Leukemia Group B (CALGB) Phase III clinical trial that compared outcomes of patients who received combination chemotherapy in conjunction with bevacizumab and cetuximab together or with cetuximab alone. The participants also received prescriptions for "supportive" drugs, such as anti-nausea medications, antibiotics and painkillers. They explored whether financial concerns prompted the patients to take money-saving steps that could negatively impact their care. They found that 10 percent of the patients were very worried about paying for their supportive medications, less than 15 percent adopted a money-saving strategy -- such as not filling a prescription, taking less than the recommended dose -- and 12 percent of the patients reported speaking with their physicians about drug costs. "The cost of cancer care today does force patients to make some hard financial decisions," said Schrag. "As oncologists, we need to be mindful that this issue may be a concern for some patients and that communication about this topic both may help alleviate anxiety and identify strategies to minimize the cost burden." The study was funded in part by CALGB. Anne Doerr Dana-Farber Cancer Institute


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