Physicians News Briefs February 3, 2009

A new computerized survivorship program from Penn’s OncoLink, a cancer information Web site, just got a big boost from the Armstrong Foundation. The program, which analyzes the ongoing medical risks and needs of patients, will receive $2.3 million from the foundation over four years. Andy Miller, vice president of programs and policy for LAF, said OncoLink was ahead of the curve in developing survivorship-care plans that people can use easily. “What we’ve heard from survivors, this is what they need,” he said. “This is what the Institute of Medicine is calling for.”The Institute of Medicine published an influential report on survivorship called “Lost in Transition” in 2005, and organizations like the Lance Armstrong Foundation (LAF) are pushing better survivor care. Cancer centers are setting up survivor clinics that focus on helping patients watch for new cancers and manage treatment-related symptoms. They’re studying the physical and emotional needs of survivors and trying to improve coordination of care by cancer specialists and primary-care doctors, who may not always connect a new complaint with cancer treatment years before. LAF is partnering with Penn to market the computerized care plan, now called OncoLife. (Philadelphia Inquirer,February 3, 2009.)

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Seniors participating in the Part D Medicare Advantage prescription program cut back on their medications by 14 percent once they hit the “doughnut hole” coverage gap, raising questions about possible risks to their health. A new study from the University of Pittsburgh Graduate School of Public Health suggests that a better approach might be adding coverage for generic medication — for about one-fourth the cost of a brand name drug — during the coverage gap. Then, to offset the added expense for the program, a beneficiary’s contribution in the first phase would be slightly increased.Typically, those reaching the doughnut hole coverage gap were seniors with chronic conditions such as diabetes or hypertension who filled an average of five prescriptions per month. Once they hit the doughnut hole, though, their medication use dropped 14 percent, dropping on average nearly one of the five prescriptions. Because those with generic drug coverage did not see such a drop, “one can assume not only that the lack of coverage in the doughnut hole had adverse health consequences but also that it could have increased costs for hospital and physician services,” the authors concluded. (Pittsburgh Post-Gazette, February 3, 2009)

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Insulin appears to shield the brain from toxic proteins associated with Alzheimer’s disease, U.S. researchers said on Monday, supporting a theory that Alzheimer’s may be a third form of diabetes. And they said GlaxoSmithKline’s (GSK.L) diabetes drug Avandia, or rosiglitazone, which increases sensitivity to insulin, appeared to enhance this protective effect.“Our results demonstrate that bolstering insulin signaling can protect neurons from harm,” William Klein of Northwestern University, whose study appears in the Proceedings of the National Academy of Sciences, said in a statement. Klein said the findings support a new idea that Alzheimer’s is a type of diabetes of the brain. (Reuters, February 3, 2009)

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American College of Physicians believes that it is imperative that Congress fund immediate and sustained increases in payments for primary care to make it competitive with other career choices and to help struggling primary care practices keep their doors open. Doing nothing-or providing payment adjustments that are so small that they will have little or no impact on reversing the shortage of primary care physicians -must not be viewed as an acceptable outcome.Although Congress could fund primary care through budget neutral adjustments in the Medicare physician fee schedules, this option has several distinct disadvantages-including the likelihood that it will face strong opposition from other stakeholders that will undermine the political support needed to improve payments for primary care. Specifically, ACP recommends that Congress and the Obama administration consider the following options, in combination, to fund payment increases for primary care: (ACPonline.org, February 3, 2009)

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