(Circulation. 2000;101:e9050.)
© 2000 American Heart Association, Inc.
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Cardiovascular News
Medicare Prescription Drug Battle Heats Up
Citing the rising prices of drugs commonly prescribed for the elderly population, in late April the Clinton Administration began to heat up its campaign to persuade Congress to approve a comprehensive Medicare drug benefit. The plan, which is estimated by the Office of Management and Budget to cost $195 billion over 10 years, takes into account the increased costs of such drugs.
The patient advocacy group FamiliesUSA issued a report entitled "Still Rising: Drug Price Increases for Seniors, 1999–2000" in late April at a White House briefing. Ron Pollack, president of FamiliesUSA, noted that the prices for the 50 most-often-prescribed drugs for seniors rose faster than the inflation rate. The report evaluated the costs of drugs in the 1999 to 2000 period and in the 6 years from 1994 through 2000.
Pollack further noted that "this report underscores the importance of protecting seniors from the growing burden of prescription drug prices. Each year, it becomes increasingly difficult for millions of senior citizens to pay for the drugs they need. Their incomes remain fixed as they watch drug prices soar out of sight, taking the promise of effective treatment with them."
The report showed that prices for 33 of the drugs rose at least 1.5 times the rate of inflation and that prices for 25 of the drugs rose at least twice the inflation rate. In some instances, drug prices increased 3, 4, or more times the inflation rate.
For example, the report noted that the cost of the diuretic
furosemide rose by 50%, which is 
23 times the rate of inflation.
The price hikes over the 6-year period showed a similar trend. A total
of 39 of the 50 drugs were on the market for the entire 6-year period.
Of those, the prices of 37 rose faster than the rate of inflation, and
22 rose at least twice the rate of inflation.
FamiliesUSA researchers said they hoped the report’s findings would
have an impact on the debate over how to provide the prescription drug
benefit. The Clinton Administration is proposing a voluntary benefit
for all covered by Medicare. House Republican leaders have proposed
subsidizing the costs of prescription drugs only for those with incomes
150% of the federal poverty level, which is $12 525 each
year for a single person. "A widow living on $1000 a month and trying
to pay for housing, food, and utilities will find ... prescription
drugs unaffordable," said Pollack. He estimated that the drugs could
cost one-sixth or more of the income of a Medicare recipient at 150%
of poverty who had the most common chronic complaints.
According to President Clinton, "More than 3 in 5 American seniors today lack affordable and dependable prescription drug coverage. Today’s report shows that the burden on these seniors is getting worse. In my budget, I propose a comprehensive plan to provide a prescription drug benefit that is optional, affordable, and accessible for all. A plan based on price competition, not price controls; a plan that will boost seniors’ bargaining power to get the best prices possible; a plan that is part of an overall effort to strengthen and modernize Medicare so we will never have to ask our children to shoulder our burden when the baby boom generation retires."
Clinton said that although he was glad to see both parties sign on to the prescription drug benefit, he does not think that the plan proposed by House Republican representatives will meet the need.
In response to the FamiliesUSA report, Alan F. Holmer, president of the group Pharmaceutical Research and Manufacturers of America, said, "Government statistics contradict the political study by FamiliesUSA. According to official government data from the US Bureau of Labor Statistics, the Producer Price Index for all finished goods went up 3.3% in 1999, compared to an increase of only 1.3% for prescription drugs. FamiliesUSA ignores the fact that these 50 medicines, both brand-name and generic, help keep patients out of the hospital, off the surgery table, on the job, and in the home. We wish FamiliesUSA would put away its election year rhetoric and join us in working to expand access to prescription drugs for America’s seniors through a strengthened and improved Medicare program."
The study can be found on the FamiliesUSA web site at http://www.familiesusa.org
Emphasize the Systolic
The National High Blood Pressure Education Program (NHBPEP) and the National Heart, Lung, and Blood Institute (NHLBI) recommend that systolic blood pressure be emphasized in the diagnosis and treatment of hypertension in middle aged and older adults. This clinical advisory appears in the May issue of Hypertension, a journal of the American Heart Association (Hypertension. 2000;35:1021–1024).
"Systolic hypertension is a major health threat, especially for older Americans," said NHLBI director Claude Lenfant, MD. Although it cannot be cured, systolic hypertension can be treated and its complications can be prevented. Lenfant noted that May is National High Blood Pressure Education month and that his agency wants to highlight the fact that systolic blood pressure is a better indicator than diastolic blood pressure of the risk of heart disease for those in their middle and later years.
Daniel W. Jones, MD, American Heart Association representative to the NHBPEP Coordinating Committee and Director of the Division of Hypertension at the University of Mississippi Medical Center in Jackson, said, "Control of systolic blood pressure is important. This is a crucial message for healthcare providers, patients, and their families. For many years, the importance of lowering systolic blood pressure to <140 mm Hg has been overlooked and underemphasized. This new NHBPEP advisory points out the overwhelming evidence that lowering systolic blood pressure can save lives."
In the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (NIH Publications, 1997), experts recommended using both systolic and diastolic blood pressures for diagnosis and treatment at all ages. However, NHLBI officials said that the importance of systolic blood pressure in assessing the presence and severity of high blood pressure in middle-aged and older adults has become evident.
Other recommendations in the new advisory include the following.
- Blood pressure at all ages should be kept at <140/90
mm Hg.
- Treatment for hypertension must begin early to prevent organ damage—whatever the patient’s age.
- In hypertensives with diabetes, blood pressure should be kept at <130/85 mm Hg; in those with renal failure or heart failure, it should be kept at the lowest level tolerated.
- Blood pressure should be reduced carefully in elderly persons with longstanding severe systolic hypertension; for resistant patients, blood pressure goals may take longer to reach.
- Treatment for hypertension must begin early to prevent organ damage—whatever the patient’s age.
Cursive Classes for MDs
Physicians at Cedars-Sinai Medical Center in Los Angeles were offered a special handwriting class on May 9, 2000, as part of the hospital’s efforts to reduce the risk of medical errors. Physicians, who are often criticized for their illegible handwriting, signed up for the 3-hour special class after the hospital conducted a campaign that included the scrawl of one staff member on posters placed in strategic locations.
"Bad handwriting can lead to dramatic medication errors," said Paul B. Hackmeyer, MD, chief of the medical staff at Cedars-Sinai Medical Center. "Clear, easy-to-read handwriting can help protect patients from the consequences of taking the wrong medicine." Hackmeyer noted that although the hospital has high rates of customer satisfaction, "many of our physicians don’t write legibly and we wanted to take the initiative and address this concern." The Institute of Medicine’s study on medical errors was one of the rationales for the course, as was a much-publicized 1999 Texas case in which a jury awarded a woman $450 000 because her husband took the wrong medication and blamed a physician’s penmanship for the error.
In the Heart of a Dinosaur
A dinosaur’s fossilized heart suggests a circulatory system more advanced than those of reptiles, said researchers at North Carolina State University and the North Carolina Museum of Natural Sciences in the April 21 issue of the journal Science (2000;288:503–505). The dinosaur—the first such specimen found with a fossilized heart—is on display in the building.
The heart’s structure supports the notion that dinosaurs were warm-blooded, said Dale Russell, PhD, a paleontologist at North Carolina State. The computer-enhanced images of the dinosaur’s chest suggest that the creature had a four-chambered, double-pump heart with a single systemic aorta. That would make the organ more similar to that of a mammal or bird than that of a reptile.
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