Seth Meyers remarks at the 2011 White House Correspondents' Dinner

 

The brain’s hypothalamus plays a key role in obesity and one of its major complications – type 2 diabetes. Nerve cells in the hypothalamus detect nutrients and hormones circulating in the blood and then coordinate a complex series of behavioral and physiological responses to maintain a balance between calories eaten and calories burned. Obesity and diabetes can result when this regulatory mechanism goes awry.

Now, research by postdoctoral fellow Clémence Blouet, Ph.D., and Gary Schwartz, Ph.D., professor of medicine and in the Dominick P. Purpura Department of Neuroscience at Albert Einstein College of Medicine of Yeshiva University, has revealed a molecule in the brain that may contribute to those health problems, both of which are reaching epidemic proportions. A 2008 study in the journal Obesity predicted that 86 percent of U.S. adults will be overweight or obese by 2030 if current trends continue. And last October the U.S. Centers for Disease Control and Prevention estimated that the prevalence of diabetes among American adults could rise from the current 1 in 10 to as many as 1 in 3 by 2050. 

 In work involving mouse models of obesity and diabetes, Drs. Blouet and Schwartz have shown that excess nutrient availability leads to an overabundance of a protein found in nutrient-sensing nerve cells of the hypothalamus. They concluded that increased levels of this protein, known as thioredoxin-interacting protein, or TXNIP, contribute to the onset of obesity and the impaired control of blood sugar levels that characterizes type 2 diabetes. Their findings were published in the April 20 online edition of the Journal of Neuroscience.

“Our study indicates that TXNIP in hypothalamic nerve cells provides a crucial link between brain nutrient sensing and the increases in body weight and fat mass that lead to obesity and diabetes,” said Dr. Schwartz. “Hyperglycemia—pathologically elevated glucose levels—causes an excess of TXNIP in hypothalamic neurons, which in turn may contribute in several ways to a breakdown in energy homeostasis—the balance between calories taken in and calories burned. For example, we’ve found that elevated TXNIP in nerve cells contributes to obesity by decreasing energy expenditure, as evidenced by decreased physical activity, and by reducing the rate at which fat is burned to produce energy. In addition to increasing fat mass, hypothalamic TXNIP overabundance also impairs glucose tolerance and insulin sensitivity—two of the hallmarks of diabetes.”

Dr. Schwartz notes that these findings regarding TXNIP could eventually lead to therapies. “Interventions that can suppress TXNIP production or selectively inactivate this protein might help in preventing weight gain and the obesity and diabetes that result from it,” he said.

The title of the paper is “Nutrient-sensing hypothalamic TXNIP links nutrient excess to energy imbalance in mice.” The research was funded by the Skirball Institute for Nutrient Sensing and the National Institutes of Health through the Albert Einstein Diabetes Research and Training Center and the New York Obesity Research Center. Albert Einstein College of Medicine is actively seeking licensing partners interested in pursuing clinical application of this patent-pending technology.

The Lab Interoperability Cooperative is recruiting hospitals to participate in a program that will electronically connect hospital laboratories with public health agencies. Establishing this connection will enable hundreds of hospitals to engage in electronic reporting that helps public health officials act more rapidly and efficiently to control disease. Application is open to all U.S. hospitals, including critical access hospitals located in rural parts of the United States. Hospitals interested in participating in this project may register by visiting www.labinteroperabilitycoop.org and clicking on and completing the "Phase I Checklist" by April 29, 2011.

Funded by a grant from the Centers for Disease Control and Prevention, the LIC includes participation from the American Hospital Association, the College of American Pathologists and Surescripts. It is intended to help hospital labs meet criteria established by the Office of the National Coordinator for Health Information Technology for meaningful use of electronic health records. This criteria includes submission of electronic data on reportable laboratory results to public health agencies. During the two-year grant period, the LIC will recruit, educate and connect to the appropriate public health agencies a minimum of 500 hospital labs -- at least 100 will be critical access or rural hospitals.

By engaging hospital labs, which handle the majority of lab tests in the United States, the LIC represents a unique opportunity to advance lab interoperability with public health agencies and the nation's health care system overall. The LIC will provide the necessary educational and technical assistance to enable those hospital labs selected to participate in the program to begin electronically transmitting lab results.

Electronic laboratory reporting has many benefits, including improved timeliness of reporting, reduction of manual data entry errors and reports that are more complete. Electronic laboratory reporting has been promoted as a public health priority for the past several years, and its inclusion as a meaningful use objective for public health serves as a catalyst to accelerate its adoption. While technical standards exist to enable the electronic exchange of lab results, commercial labs, hospitals and providers have implemented and make use of these standards on a limited basis.

Based on the Surescripts Network for Clinical Interoperability, the LIC will support all federal and state policies and standards for health information exchange, including privacy and security standards (such as HIPAA and state law), technology interoperability standards (such as Direct), and message types such as HL7.

For more information on the LIC, visit www.labinteroperabilitycoop.org.

 

Gil Kerlikowske, White House Director of National Drug Control Policy; Assistant Secretary for Health and Human Services, Howard Koh, M.D.; Food and Drug Administration Commissioner, Margaret A. Hamburg, M.D.; and DEA Administrator, Michele M. Leonhart released the Obama Administration's comprehensive action plan to address the national prescription drug abuse epidemic and announced new Federal requirements aimed at educating the medical community about proper prescribing practices.

The Administration's Epidemic: Responding to America's Prescription Drug Abuse Crisis provides a national framework for reducing prescription drug diversion and abuse by supporting the expansion of state-based prescription drug monitoring programs, recommending more convenient and environmentally responsible disposal methods to remove unused medications from the home, supporting education for patients and healthcare providers, and reducing the prevalence of pill mills and doctor shopping through enforcement efforts. The plan is the culmination of six months of collaboration across the Federal government, with agencies including the Departments of Justice, Health and Human Services, Veterans Affairs, the Department of Defense, and others.

In support of the action plan, the Food and Drug Administration (FDA) today announced that it is requiring an Opioids Risk Evaluation and Mitigation Strategy (REMS). The new program will require manufacturers of long-acting and extended-release opioids to provide educational programs to prescribers of these medications, as well as materials prescribers can use when counseling patients about the risks and benefits of opioid use. The Food and Drug Administration Amendments Act of 2007 gave FDA the authority to require manufacturers to develop and implement a REMS to ensure the benefits of a drug or biological product outweigh its risks.

"Today we are making an unprecedented commitment to combat the growing problem of prescription drug abuse," said Vice President Biden. "The Government, as well as parents, patients, health care providers, and manufacturers all play a role in preventing abuse. This plan will save lives, and it will substantially lessen the burden this epidemic takes on our families, communities, and workforce."

"The toll our Nation's prescription drug abuse epidemic has taken in communities nationwide is devastating ," said Director Kerlikowske. "We share a responsibility to protect our communities from the damage done by prescription drug abuse. This plan will build upon our already unprecedented efforts to coordinate a national response to this public health crisis by addressing the threat at the Federal, state, and local level."

"Abuse of prescription drugs, especially opioids, represents an alarming public health crisis." said Howard K. Koh, M.D., M.P.H. Assistant Secretary for Health. "This Plan, which coordinates a public health approach with a public safety approach, offers hope and health to our Nation."

"Unintentional drug overdose is a growing epidemic in the US and is now the leading cause of injury death in 17 states," CDC Director Dr. Thomas Frieden said. "There are effective and emerging strategies out there to address this problem. Support for this action plan will help us implement those strategies which will go a long way to save lives and reduce the tremendous burden this problem has on our healthcare system and our society."

"Long-acting and extended-release opioid drugs have benefit when used properly and are a necessary component of pain management for certain patients, but we know that they pose serious risks when used improperly, with serious negative consequences for individuals, families, and communities," said FDA Commissioner Margaret A. Hamburg, M.D. "The prescriber education component of this Opioid REMS balances the need for continued access to these medications with stronger measures to reduce their risks."  

"DEA is committed to implementing this important and much needed action plan to reduce the demand for prescription drugs, enforce our nation's drug laws, and take back unneeded prescription drugs," said DEA Administrator Michele M. Leonhart. "When abused, prescription drugs are just as dangerous and just as addictive as drugs like methamphetamine or heroin. The more we can do to stop the abuse of prescription drugs, the more effective we will be in reducing the death, destruction and despair that accompanies all drug abuse."

Prescription drug abuse is our Nation's fastest-growing drug problem. The number of people who have unintentionally overdosed on prescription drugs now exceeds the number who overdosed during the crack cocaine epidemic of the 1980's and the black tar heroin epidemic of the 1970's combined. In 2007, approximately 27,000 people died from unintentional drug overdoses, driven mostly by prescription drugs. Additionally, a ccording to the Substance Abuse and Mental Health Services Administration, the number of Americans in 2009 aged 12 and older currently abusing pain relievers has increased by 20 percent since 2002. Further, visits by individuals to hospital emergency rooms involving the misuse or abuse of pharmaceutical drugs have doubled over the past five years.

ONDCP is coordinating an unprecedented government-wide public health approach to reduce drug use and its consequences in the United States . This effort includes requesting an increase in funding for drug prevention by $123 million and treatment programs by $99 million dollars for Fiscal Year 2012, to train and engage primary health care to intervene in emerging cases of drug abuse, expand and improve specialty care for addiction—including care for families and veterans, and to better manage drug-related offenders in community corrections.

To read the full Action Plan, click here.

To read the FDA's Opioids Risk Evaluation and Mitigation Strategies (REMS), click here.

To get involved in DEA's National Prescription Drug Take-Back Initiative, click here.

For more information on National efforts to reduce drug use and its consequences visit: www.WhiteHouseDrugPolicy.gov

The IMS Institute for Healthcare Informatics reported a 2.3 percent increase in spending on prescription medicines in the U.S. last year, markedly lower than the 5.1 percent growth rate in 2009. In a new study, The Use of Medicines in the United States: Review of 2010, the IMS Institute finds that total dollars spent on medications in the U.S. reached $307.4 billion last year – or real per capita spending of $898, up $6 from 2009. The volume of prescription medicines consumed overall rose at historically low levels in 2010.

“Last year, we saw the convergence of key dynamics leading to diminished growth in drug spending, which included the greater use of generics, loss of patent protection for major branded products, slower demand and less spending on new therapies,” said Michael Kleinrock, director, Research Development, IMS Institute for Healthcare Informatics. “Moreover, fewer patients visited physician offices and initiated new chronic therapy treatments last year, likely the result of the slower economy.”

In its latest analysis, the IMS Institute identifies the following key market dynamics:

• Volume of medicines consumed: The total volume of medicines consumed in oral or nasal form increased 0.5 percent in 2010, representing a decline of 0.3 percent on a per capita basis due to lower or declining demand in nearly every major therapy area. Medicines administered by injection or infusion increased 0.2 percent last year, or a per capita decline of 0.6 percent, primarily the result of reduced utilization in hospital settings.
• Patient doctor visits and new therapy starts: The number of visits to doctor offices was down 4.2 percent in 2010, extending a declining trend that began in mid-2009. Also, the number of patients starting new treatments for chronic conditions declined by 3.4 million last year. Contributing factors may include the enduring effect of high unemployment levels and rising healthcare costs, more careful healthcare spending by some, and the impact of additional patients losing their healthcare coverage
• Patient payment for medicines: The average patient copayment was $10.73 in 2010, down 20 cents from 2009, mainly due to the increased use of generics. Commercial third-party insurance was used by patients to pay for 63 percent of dispensed prescriptions, down from 66 percent five years ago. Prescriptions filled under a Medicare Part D plan or through Medicaid coverage represented 30 percent of all prescriptions in 2010, compared with 22 percent in 2006, the first year of the Medicare Part D program.
• Pricing of medicines: The average cost of oral or inhaled medicines, which made up 60 percent of overall spending last year, declined 0.1 percent in 2010 due to changes in price as well as in the mix of generics and branded products. Costs of medicines administered by injection or infusion, representing 28 percent of spending, rose 5.7 percent last year. Spending on protected brands increased by $16.6 billion in 2010 due to invoice price changes, compared with $15.8 billion the prior year. Increasing levels of off-invoice discounts and rebates negotiated by payers and intermediaries accompanied these increases, resulting in net growth from pricing of $12.1 billion, or 4.2 percent of total spending.
• Retail channels used by patients: Of the 3.99 billion prescriptions filled through retail channels, chain drugstores increasingly were chosen by patients – reflecting both the convenience of these pharmacies and the availability of discounted generics. In addition, chain drugstores continued to acquire independent stores, and overall increased their market share by 0.5 percent last year.
• New products: Forty-four new branded products became available to patients in 2010. Ten of those products featured innovative mechanisms of action, including a new oral therapy for multiple sclerosis, a monoclonal antibody for osteoporosis and bone metastases, and a therapeutic vaccine for prostate cancer. Additionally, five orphan drugs and six new chemical entities using existing mechanisms were launched, bringing new options to patients with rheumatoid arthritis, prostate cancer and meningitis. Average spending per new branded product – those available 24 months or less – was $62 million last year, down from $114 million in 2006. This reflects a shift in the mix of new products toward orphan drugs and medicines with the same mechanism of action as existing treatments.
• Brands and generics: Spending on brands declined 0.7 percent in 2010, while spending on branded and unbranded generics rose 4.5 percent and 21.7 percent, respectively. Generics now account for 78 percent of all retail prescriptions dispensed – a result of the greater availability of molecules in generic form as patents expire, along with patients choosing lower-cost options. On average, more than 80 percent of a brand’s prescription volume is replaced by generics within six months of patent loss.

The IMS Institute study also finds that in the leading therapy areas, 2010 spending growth largely was driven by product life cycle dynamics, rather than price or volume. The top five therapy classes were: oncologics, with $22.3 billion in 2010 spending; respiratory agents, at $19.3 billion; lipid regulators, at $18.7 billion; antidiabetes drugs, at $16.9 billion; and antipsychotics, at $16.1 billion. Growth in spending among these classes ranged from 0.9 percent for lipid regulators to 12.5 percent for antidiabetes medications. Notably, total spending on oncologics grew only 3.5 percent, the lowest increase ever recorded in that therapy class.

Said Kleinrock, “It became apparent in 2010 that the healthcare landscape is shifting in significant ways. Physicians and patients have more therapy options than ever, and yet spending on medicines is rising at historic lows with the impact of patent expiries and reduced patient activity. The long-term effect on patient health of fewer doctor office visits and new therapy starts is unclear and requires closer attention.”

To access the IMS Institute report, The Use of Medicines in the United States: Review of 2010, click here. The study also features additional details on the U.S. pharmaceutical market, including top therapeutic classes, products and dispensing locations.

Analyses conducted for The Use of Medicines in the United States: Review of 2010 report are based on prescription-bound products, including Insulins that are available without a prescription. OTC products are excluded from the report. Spending figures are derived from IMS National Sales Perspectives™ and reported at wholesaler invoice prices that do not reflect off-invoice discounts and rebates. Prescription data are derived from IMS National Prescription Audit™, which tracks national prescription trends and activity for all pharmaceutical products. Other IMS information resources used in this report include NPA Market Dynamics™, IMS Formulary Focus™, Plantrak CoPay™, IMS National Disease and Therapeutic Index™, and IMS MIDAS™. More detail on information sources is included in the report.

About the IMS Institute for Healthcare Informatics
The IMS Institute for Healthcare Informatics, supported by IMS Health, provides key policy setters and decision makers in the global health sector with unique and transformational insights into healthcare dynamics derived from granular analysis of information. It is a research-driven entity with a worldwide reach that collaborates with external healthcare experts from across academia and the public and private sectors to objectively apply IMS’s proprietary global information and analytical assets. More information about the IMS Institute can be found at: http://www.theimsinstitute.org.

 

New partnership between Administration, the private sector, hospitals and doctors to
make care safer, potentially save up to $50 billion

Health and Human Services Secretary Kathleen Sebelius, joined by leaders of major hospitals, employers, health plans, physicians, nurses, and patient advocates, today announced the Partnership for Patients, a new national partnership that will help save 60,000 lives by stopping millions of preventable injuries and complications in patient care over the next three years.  The Partnership for Patients also has the potential to save up to $35 billion in health care costs, including up to $10 billion for Medicare.  Over the next ten years, the Partnership for Patients could reduce costs to Medicare by about $50 billion and result in billions more in Medicaid savings.  Already, more than 500 hospitals, as well as physicians and nurses groups, consumer groups, and employers have pledged their commitment to the new initiative.

“Americans go the hospital to get well, but millions of patients are injured because of preventable complications and accidents,” said Secretary Sebelius.  “Working closely with hospitals, doctors, nurses, patients, families and employers, we will support efforts to help keep patients safe, improve care, and reduce costs. Working together, we can help eliminate preventable harm to patients.”

Today, leaders from across the nation pledged their commitment to this new initiative.  To launch this initiative, HHS announced it would invest up to $1 billion in federal funding, made available under the Affordable Care Act.  Today, $500 million of that funding was made available through the Community-based Care Transitions Program.  Up to $500 million more will be dedicated from the Centers for Medicare & Medicaid Services (CMS) Innovation Center to support new demonstrations related to reducing hospital-acquired conditions.  The funding will be invested in reforms that help achieve two shared goals:

• Keep hospital patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40-percent compared to 2010.  Achieving this goal would mean approximately 1.8 million fewer injuries to patients, with more than 60,000 lives saved over the next three years. 
• Help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20-percent compared to 2010.  Achieving this goal would mean more than 1.6 million patients will recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.

The Partnership will target all forms of harm to patients but will start by asking hospitals to focus on nine types of medical errors and complications where the potential for dramatic reductions in harm rates has been demonstrated by pioneering hospitals and systems across the country.  Examples include preventing adverse drug reactions, pressure ulcers, childbirth complications and surgical site infections. The CMS Innovation Center will help hospitals adapt effective, evidence-based care improvements to target preventable patient injuries on a local level, developing innovative approaches to spreading and sharing strategies among public and private partners in all states.  Members of the partnership will identify specific steps they will take to reduce preventable injuries and complications in patient care. 

“With new tools provided by the Affordable Care Act, we can aggressively implement programs that will help hospitals reduce preventable errors,” said CMS Administrator Donald Berwick, M.D.  “We will provide hospitals with incentives to improve the quality of health care, and provide real assistance to medical professionals and hospitals to support their efforts to reduce harm.” 

HHS has committed $500 million to community-based organizations partnering with eligible hospitals to help patients safely transition between settings of care.  Today, community-based organizations and acute care hospitals that partner with community-based organizations can begin submitting applications for this funding.  Applications are being accepted on a rolling basis.  Awards will be made on an ongoing basis as funding permits.

In coordination with stakeholders from across the health care system, the CMS Innovation Center is planning to use up to $500 million in additional funding to test different models of improving patient care and patient engagement and collaboration in order to reduce hospital-acquired conditions and improve care transitions nationwide.   These collaborative models will help hospitals adopt effective interventions for improving patient safety in their facilities. 

The programs announced today are just two of the many ways the Affordable Care Act is helping improve the health care system.  Last month, HHS announced the first-ever National Quality Strategy, which will serve as a tool to help coordinate quality initiatives between public and private partners as well as to leverage and coordinate existing efforts by federal agencies and departments to improve patient care.  HHS also announced new rules to help doctors, hospitals, and other providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs).  By 2015, a portion of Medicare payments to the majority of hospitals will be linked to whether hospitals are delivering safer care, using information technology effectively and meeting patient needs.  Payment incentives and supports to improve quality and lower costs will also be available to state Medicaid programs.

“No single entity can improve care for millions of hospital patients alone,” said Berwick.  “Through strong partnerships at national, regional, state and local levels – including the public sector and some of the nation’s largest companies – we are supporting the hospital community to significantly reduce harm to patients.”

For more information about the Partnership for Patients, visit www.HealthCare.gov/center/programs/partnership.  For a fact sheet on today’s announcement, visit www.HealthCare.gov/news/factsheets/partnership04122011a.html.  For more information about the Community-based Care Transitions Program funding opportunity, visit www.cms.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1239313.

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Note: All HHS press releases, fact sheets and other press materials are available at http://www.hhs.gov/news.

Last revised: April 12, 2011

Five innovative and leading health systems, each of whom are pioneers in the use of electronic medical records for their patients, joined together today to announce a new initiative to securely exchange electronic health data, with the first data exchange planned in the next year.

Electronic medical information is one of the most important care support tools available in world health care today. That tool works much better when the caregivers for a single patient can connect electronically. These leading care systems have created the Care Connectivity Consortium to pioneer the effective connectivity of electronic patient information in an approach that protects patient confidentiality.

Collectively bringing together both the latest technology and a shared mission to deliver patient-centered high-value health care to the citizens of this nation, Geisinger Health System (PA), Kaiser Permanente (CA), Mayo Clinic (MN), Intermountain Healthcare (UT), and Group Health Cooperative (WA) today announced the creation of an interoperability consortium. The consortium will utilize standards-based health information technology to share data about patients electronically.

"Five of the nation's premier health care providers have decided to form this consortium to help lead the health care discussion in this country with this unprecedented health IT collaboration created to deliver high-quality, patient-centered care," said Glenn Steele, Jr., MD, PhD, president and chief executive officer, Geisinger Health System.

The goal of the consortium is to demonstrate better and safer care with better data availability. Patients will benefit. If a patient from one system gets sick far from home and must receive health care in another system — or if any system sends patients to another — doctors and nurses at each of the consortium systems will be able to easily and quickly access invaluable information about the patient's medications, allergies, and health conditions, allowing them to provide the right kind of treatment at the right time and avoid unintended consequences like adverse medication interactions.

"This collaborative effort exists because we all have reached the same important conclusion about linking and sharing patient-specific data," said George Halvorson, chairman and chief executive officer of Kaiser Permanente. "Our five organizations share the common mission of improving health care in the United States and our belief is that when doctors have real-time data about patients, care is better and more effective."

The five health systems believe that achieving electronic health information interoperability and connectivity will be a critical next step in the United States becoming a 21st century, information-enabled health care system. With patient privacy and security as overarching priorities, the Care Connectivity Consortium's goal is to demonstrate that effective and timely health information exchange using the latest national IT standards is possible in a secure environment and among geographically disparate health care providers.

Individually, each of the five member organizations have been health care electronic information pioneers — each site already proving the value of health IT for their own patients. Electronic medical records specific to each care setting are improving the quality of care for patients with chronic conditions such as heart disease, diabetes, and asthma today, as well as providing the best care in emergency situations. Collectively, the goal of the consortium will be to take the practical steps needed to actually link needed data between the separate care systems and medical records.

"Each of our organizations can point to concrete examples in which information technology allowed us to develop new knowledge, facilitate decisions, improve safety, efficiency and coordination of care, and offer the best treatment for the patient," said John Noseworthy, MD, president and chief executive officer, Mayo Clinic. "This collaboration will demonstrate what is possible when a unique union of forces is brought to bear on this multi-faceted challenge: realizing the promise of health information technology for patients across the nation."

Members of the Care Connectivity Consortium have a clear vision that the same benefits of the full medical information that exists in each of our systems should be extended to all patients by connecting all communities and the nation in order to improve health care for all Americans. The collective goal is to implement first generation CCC interoperability tools over the next year, in a manner consistent with national health IT standards. The consortium partners are already clear leaders in health IT implementation — all are committed to sharing experiences with the health care community to improve care delivery and outcomes for all patients in America.

"As part of our continuing efforts to improve the coordination of patient care, whether for our patients or those who choose to see other providers, Group Health is pleased to partner with these exceptional care systems to provide the ability to share clinical information," said Scott Armstrong, chief executive officer, Group Health Cooperative. "Our hope is that this partnership will grow and help accelerate the implementation of a national health information exchange, leading to better care for everyone."

"With more than 40 years of extensive experience in health IT, Intermountain Healthcare has been able to use clinical systems to promote evidence-based best practices that improve patient outcomes. Our consortium partners join with us in having a clear vision for developing IT solutions and standards," said Charles W. Sorenson, MD, president and chief executive officer, Intermountain Healthcare. "Together, we are advancing how health IT can be used to improve care while lowering overall health care costs to the communities we serve."

To access the press briefing online, visit http://www.visualwebcaster.com/CareConnectivityConsortium.