Health Care Spending Nears $2 Trillion

In a report released in January, the journal Health Affairs says spending by Americans for prescription drugs continued to increase in the year 2005, but at a slower rate than in  recent years. The decline in growth of prescription drugs was due in part, the journal notes, to changes in therapy regimes and increased use of generic drugs. But even with that improvement, total spending for health care in the United States continued to grow in 2005, reaching almost $2 trillion, or $6,697 per person. About one-fifth of that spending was for physician and clinical services, with hospital care continuing to account for the largest share of overall spending. Health Affairs is published by Project HOPE; information is available at www.healthaffairs.org.

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A Review of School-Based Interventions to Reduce Bullying

A systematic review of more than 2,000 articles on bullying yielded only 26 studies that had been "rigorously evaluated," according to the authors of an article in the January 2007 issue of Archives of Pediatrics and Adolescent Medicine. The types of the 26 evaluated interventions could be characterized as curriculum (10 studies), multidisciplinary or "whole school" (10 studies), social skills groups (4 studies), mentoring (1 study) and social worker support (1 study). The article concludes that many school-based interventions directly reduce bullying, with better results from interventions that involve multiple disciplines; curricular change was found the least effective. Most reductions in bullying were relatively small and tended to concentrate on helping children who were victimized, rather than those who engaged in bullying. The article defines bullying as a form of aggression in which one or more children repeatedly and intentionally intimidate, harass, or physically harm a victim and notes that bullying is increasingly a matter of public concern and research. The journal Archives of Pediatrics and Adolescent Medicine can be contacted at http://archpedi.ama-assn.org.

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Arkansas May End BMI Screening

The lower House of the Arkansas state legislature voted January 29 to repeal a state-mandated measurement by schools of students’ body mass index (BMI) and reporting of the results to parents. The bill will not be final until approved by the state senate and signed by the governor. The sponsor of the house bill said parents who received notice that their children were overweight complained that the children were “stigmatized” at school, though individual results were supposed to be kept private; and he said BMI testing and reporting cost school districts in Arkansas “at least $175,000 annually.” The house vote came after a study released by the University of Arkansas for Medical Sciences showed 68 percent of parents were comfortable about receiving reports on their children’s body mass index and 64 percent were confident that the reports are confidential. Eighty-five percent of the students surveyed also reported being comfortable with BMI measurement and reporting. The Arkansas legislature adopted the nation’s first school BMI testing and reporting program in 2003 as part of a statewide initiative to curb obesity in children.

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January News Alerts

The following information appeared during the month of January 2007 in the News Alerts section of the website of the Center for Health and Health Care in Schools, at http://www.healthinschools.org.

January 8, 2007
Pharmacists Cite Patient ‘Non-Adherence’ to Prescriptions

Three-fourths of American admit they don’t take prescription medications as they were directed to by their health care professionals, according to a survey released last month by two national associations of pharmacists. The survey found various kinds of non-adherent behavior, including forgetting to take a prescribed medication, not filling a prescription, taking less than the recommended dosage, stopping taking the medicine before the supply ran out, and substituting an over-the-counter product for the prescribed medication. Failure to take medicines can have serious consequences, the pharmacists pointed out, particularly in the case of chronic illnesses. And in money terms, it’s estimated that non-adherence alone costs something like $100 billion every year in additional hospital and physician visits, laboratory tests, and even death. "By spending a little bit more up-front in terms of drug therapy and adherence programs, there will be increased savings by decreased hospitalizations and emergency room visits." Information about the survey report, "Take As Directed: A Prescription Not Followed," is available at  http://www.ncpanet.org.

January 9, 2007
Court Rules in Favor of State in Case Involving EPSDT

The United States Court of Appeals for the Tenth Circuit ruled against the Oklahoma Chapter of the American Academy of Pediatrics (OKAAP) and 13 Medicaid-eligible children January 3, in a case that questioned whether the children are receiving health care services required by Medicaid, including Early and Periodic Screening, Diagnosis and Treatment (EPSDT). In their lawsuit, the OKAAP and a community organization had joined the parents in alleging that the Oklahoma Health Care Authority fails to provide Medicaid services, including EPSDT, "with reasonable promptness" and fails to set reimbursement rates for providers sufficient to assure Medicaid recipients of equal access to quality health care. A lower court had ruled that Oklahoma should conduct a study to determine an appropriate schedule of fees for services under Medicaid, to assure "reasonably prompt access to health care for the minor children," and should immediately adopt and implement new periodicity schedules for EPSDT. In reversing that decision, the appeals court said federal law does not oblige states to deliver any medical services and only requires them to pay promptly for the services that are provided. The appeals court then sent the case back to the lower district court with instructions to find in favor of the state. The ruling is online at   http://www.kscourts.org/CA10.

January 23, 2007
FDA Proposes ‘Gluten-Free’ Food Labels

In a detailed announcement today, the federal Food and Drug Administration is asking for comment on a proposal to authorize "gluten-free" labels on foods that do not contain  wheat, rye, and barley, or ingredients processed from those grains. The FDA said its objective in establishing standards for the "gluten-free" label is to insure that individuals with celiac disease are not misled by foods claiming to be gluten-free when they are not.
Celiac disease is a chronic inflammatory disorder of the small intestine in genetically  susceptible individuals; it is triggered by ingesting certain proteins, commonly referred to as "gluten," that occur naturally in some cereal grains. It’s currently estimated that about 1 percent of the U.S. population, including children, may have either active or silent celiac disease. There is no cure, but individuals with the condition are advised to strictly avoid any consumption of gluten in their diets. For an exhaustive discussion of the meaning of the term "gluten" and the symptoms and effects of celiac disease, see the proposed FDA rules in the Federal Register for January 23, 2007. The Federal Register can be accessed online at http://frwebgate3.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=R5rWB4/0/2/0&WAISaction=retrieve.

January 24, 2007
Report Says Many Children Fare Poorly in Largest U.S. Cities

An analysis of the living conditions of children in the 100 largest U.S. metropolitan areas by the Harvard School of Public Health shows "a consistently bleak picture for black and Hispanic children, compared to white and Asian children." The report includes information on health factors such as disability rates, health insurance, births to teenager mothers, births to unmarried mothers, prenatal care, smoking during pregnancy, preterm births, and low birthweights. Harvard professor Acevedo-Garcia, a lead author of the study, said, "The analysis revealed that not only do black and Hispanic children literally live in different metropolitan neighborhoods than d other children, but that black and Hispanic children face life experiences fraught with dangers to their well-being." Factors that need to be addressed in order to improve the children’s lives include, first, alleviating child poverty (U.S. has the second-highest child poverty rate among developed countries), followed by reducing neighborhood and school segregation, Acevedo-Garcia said. The report, which is available online at http://diversitydata.sph.harvard.edu, is designed to enable readers to create profiles of specific urban areas.

January 29, 2007
FDA Calls New Generation Birth Control Pills 'Effective'

New types of birth control pills now reaching the market are as effective as older pills in preventing pregnancy, the federal Food and Drug Administration (FDA) said January 23. The FDA was responding to what it called inaccurate newspaper stories indicating that the newest hormonal contraceptives are significantly less effective than those approved decades ago. "In fact," the FDA said, "the newer generation products are highly effective in preventing pregnancy." The newspaper reports surfaced after the FDA convened a meeting of its Reproductive Health Drugs Advisory Committee to discuss  contraceptives. The meeting was intended, the FDA said, to determine how to design clinical trials so they will "reflect the diversity of users of hormonal contraceptives, expectations for efficacy and safety, and user acceptability of the newer products, including cycle control."

January 31, 2007
FDA Pledges Post-market Surveillance of New Drugs

The federal Food and Drug Administration (FDA) announced yesterday that in addition to evaluating and approving new drugs, it will now be watching for adverse reactions after those drugs go into widespread use. Responding to a 2006 report by the Institute of Medicine that pointed out problems with the system FDA has used until now, which relied primarily on doctors and clinics to report if a new drug was having undesirable or dangerous effects on patients, the FDA said it will employ "safety science" to take a more active role in surveillance. The agency said it is creating several new advisory groups and reorganizing its communications system to enable it to track drugs in the marketplace and disseminate information when adverse effects are found.  One of the new developments of interest to health care providers and patients, the FDA said, will be a website on which reports of adverse effects will be posted. Copies of the report, "The Future of Drug Safety—Promoting and Protecting the Health of the Public," are available on the FDA web page at http://www.FDA.gov.