Global HCV 150 Million: reused syringes, IDU, sexual transmission, HIV coinfection, China/India/Pakistan, Africa
China and India together have an estimated 123 million people chronically infected with HBV and 59 million people chronically infected with HCV, accounting for almost 50 percent of all HBV and HCV infections worldwide.....
India is one the fastest growing economies with approximately 25-30 percent of the population living below the poverty line. More than 30 million people in India are infected with HBV and 19 million are infected with HCV.....
Approximately 40 million people are infected with HCV in China, which led the Chinese government to declare it as an urgent public healthcare issue That culprit, identified in 1989, was hepatitis C virus (HCV). Some 130-200 million people are now estimated to be infected worldwide.
Rates of transmission in the United States, Europe and Japan have plummeted since the virus was identified, however, thanks to disposable medical instruments and a screened blood supply. But the virus continues to thrive in developing nations, which lack the resources to treat people who do not appear ill. Treatment is expensive, lengthy and causes numerous side effects - and, for all that, it works only about half the time. The upshot is that more than 350,000 people worldwide die from HCV-related liver disease every year...
Vertex Four-Drug Hepatitis C Combo Shows Promise
August 3, 2011
Half of the hepatitis C virus (HCV)-infected participants in a small midstage trial receiving a four-drug combination that included two Vertex Pharmaceuticals medications were able to discontinue treatment after 12 weeks, the company reported. According to Vertex, 400 milligrams of its experimental oral drug VX-222 (a polymerase inhibitor) was administered with its recently approved Incivek (a protease inhibitor) and the standard regimen of pegylated interferon and ribavirin. The trial, known as Zenith, also revealed that 12 weeks after the combo discontinuation, 93 percent of those patients retained undetectable HCV levels.Those patients not eligible to stop treatment at 12 weeks received another 12 weeks of standard therapy. All 13 who continued in the trial appeared cured at 24 weeks, Vertex said.
Although Sanford Bernstein analyst Geoffrey Porges considers the results of the study "more encouraging" than expected, he cautions that the trial had incomplete results, and that the drugs' "tolerability and safety will need to be established in much larger trials."Between 130 million and 170 million people worldwide are chronically infected with HCV, 350,000 of whom die annually, says the World Health Organization. Incivek and a similar Merck & Co. drug, Victrelis, hold out the promise of substantially higher cure rates while simultaneously halving the standing 48-week treatment regimens of older drugs alone.Trial participants had the most common and more difficult to treat genotype 1 form of the disease and were new to treatment. Side effects, which caused six patients to discontinue treatment, included fatigue, nausea, diarrhea, anemia, itchiness, and rash.JPMorgan analyst Geoff Meacham echoed Porges' assessment that the trial was "encouraging," noting no instances of severe diarrhea or kidney failure.
Special Issue of the Journal of Gastroenterology and Hepatology Foundation
Special Issue: Australian Gastroenterology Week 2011, 12-15 September 2011, Brisbane Convention & Exhibition Centre, Australia Volume 26, Issue Supplement s4, pages 44–55, September 2011
Check It Out Here;
http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2011.06823.x/abstract
Liver Health
Caffeine and alcohol consumption influences liver fibrosis
Aug 4
A study in the latest issue of Liver International investigates the effects of caffeine and alcohol consumption on liver fibrosis.
Role of caffeine consumption in chronic hepatitis B virus (HBV)-infected patients and the interaction with alcohol consumption is unclear.
Dr Arlinking Ong and colleagues from the Philippines investigated the relationship between caffeine and alcohol consumption and liver stiffness in chronic HBV-infected patients.
Chronic HBV-infected patients who underwent transient elastography examination in 2006–2008 were studied.
Advanced fibrosis was defined as liver stiffness more than 9 kPa for patients with normal alanine aminotransferase or more than 12 kPa for those with elevated ALT according to previous validation study.
Caffeine and alcohol consumption was recorded using a standardized questionnaire.
22% of patients reported alcohol consumption
Liver International
Excessive alcohol intake was defined as 30 g/day in men and 20 g/day in women.
The liver stiffness of 1045 patients who completed the questionnaire was 8 kPa.
The team found that 21% of patients had advanced fibrosis.
The research team identified that 19% of patients who drank 1 cup of coffee or more had advanced fibrosis, compared with 22% patients who drank less than 1 cup.
The amount of caffeine intake had positive correlation with the amount of alcohol intake.
The researchers observed that although 22% of patients reported alcohol consumption, only 1% had excessive alcohol intake.
The prevalence of advanced fibrosis among patients with mild to moderate alcohol intake was comparable to that among non-drinkers.
Dr Ong's team concluded, "Caffeine intake does not affect liver stiffness in chronic HBV-infected patients."
"Patients who drink coffee regularly tend to drink alcohol."
"Most chronic HBV-infected patients do not have excessive alcohol consumption."
"The prevalence of advanced fibrosis among mild to moderate alcohol drinkers was low in this population."
Liver Int 2011: 31(7): 1047–1053
04 August 2011
Abnormal Liver Tests Associated With Increased Death Rates In People Over 75
Aug 3
One in six people over 75 are likely to have at least one abnormal liver test and those that have two or more are twice as likely to die from cancer and 17 times more likely to die from liver disease, according to research in the August issue of Alimentary Pharmacology and Therapeutics.
UK researchers studied 13,276 patients who were registered with 53 family doctors and agreed to an in-depth health assessment. Patients were drawn at random from the general population and those who were terminally ill or living in nursing homes were excluded.
"The aim of our study was to see how prevalent abnormal liver tests were in a random sample of people aged 75 plus and examine the association between positive results and deaths from all causes and specific causes" says lead author Dr Kate Fleming from the University of Nottingham.
"Previous studies from The Netherlands, South Korea, the USA and Scotland produced conflicting results and none particularly focused on older people."
The study covered liver tests for abnormal levels of asparate transaminase (AST), alkaline phosphatase (ALP) and bilirubin, with patients being followed up for an average of just over seven years. The elderly patients with the abnormal liver tests were compared with patients with normal liver tests.
"A wide range of health problems can lead to elevated levels of enzymes in the liver, not just liver disease" explains Dr Fleming. "These can include heart disease, bone disorders, kidney disease and striated muscle disorders."
Key findings of the study included:
Abnormal liver tests are common in elderly people, but were only associated with a modest increase in deaths from all causes.
16.1% of the patients had at least one abnormal liver test, 1.5% had two abnormal tests and just 0.07% has three abnormal tests.
9.2% of the total sample had abnormal levels of ALP, 5.4% had abnormal bilirubin and 3.3% had abnormal AST.
Patients with elevated AST measurements tended to be younger and there was an association with alcohol consumption of more than seven units in the previous week. Patients with elevated ALP tended to be older and report lower alcohol consumption.
Diabetes and dementia were associated with increased AST and ALP and a history of heart attacks with raised ALP. Men were more likely to have increased bilirubin as were people who had never smoked.
Abnormal AST was associated with a sevenfold increased risk of death from liver disease and a 56% increase in cancer risk. However, only 1.8% of the subjects with an abnormal AST died from liver disease during the follow-up period.
Abnormal ALP was associated with nearly a six-fold increased risk of death from liver disease. It also raised the risk of death from a number of other illnesses: heart disease (34%), cancer (61%) and respiratory disease (58%). Only 1% of the patients with an abnormal ALP died from liver disease during the follow-up period.
Abnormal bilirubin was associated with a small 15% increase in death risk, following adjustment for factors such as age, gender, other health issues, smoking status, alcohol intake and waist-hip ratio.
Patients who had two or more elevated liver tests faced a 54% increased risk of all-cause mortality and the risk of dying from cancer doubled. They were 17 times more likely to die from liver disease than patients with no abnormal liver tests.
"Our study shows that abnormal liver tests are common in elderly people, but are only associated with a modest increase in deaths from all causes, with specific reference to liver disease, cancer, heart disease and respiratory disease" says Dr Fleming.
"There is currently no evidence that a single abnormal and isolated measurement of AST, ALP or bilirubin leads to an overwhelming increase in death rates. Given that, the current clinical practice of only referring and actively investigating patients with multiple or persistent abnormalities should be continued.
"Older people represent an increasingly large group of healthcare users in the UK and we hope that this research will provide useful information in an area that has previously suffered from lack of research."
Sources: Wiley-Blackwell, AlphaGalileo Foundation.
AIDS
HIV Rising Among Young Black MSM, Stable Overall
The rate of new HIV infections in the U.S. is roughly stable at about 50,000 a year, but there are alarming increases among some groups, the CDC reported.
Australian researches find a protein block to kill HIV, Ebola
A WORLD-FIRST medical breakthrough developed in Australia could pave the way to cures for deadly illnesses such as HIV and Ebola.
Researchers at the University of Newcastle and the Children's Medical Research Institute in Sydney have created a compound that blocks viruses from entering the body and spreading.Working in conjunction with colleagues in Germany, the researchers have successfully tested the compound's effectiveness against HIV and hepatitis C.
But Professor Adam McCluskey said 70 per cent of viruses used a protein called clathrin as a way of entering cells and infecting a body. By inhibiting clathrin's functions, those viruses had no way of taking hold, he said.
"A person diagnosed with an infectious illness could take a drug blocking clathrin and stop the illness from spreading," he said. "The infected cell would then die."Tests at a cellular level and on a species of fish known as a lamprey have proved successful.Professor McCluskey said the next step would be to refine the compound and test it on more complex animals before finally developing it for human use.
It's a process that can take up to 15 years, but Professor McCluskey said treatments for fatal illnesses were often fast-tracked because death was the only other option for patients.The team's research will be published today in Cell, one of the world's most prestigious science journals.
Diabetes
Reversal of misfortune; can diabetes be reversed?
Reversing diabetes is a top of mind subject for anyone who has ever suffered from the onset or daily threat of this disease. While the debate continues on about whether or not the disease can be reversed, here’s what I have found (resources listed within of this blog) through various resources including an interesting article written by CNN (http://www.cnn.com/2011/HEALTH/01/28/reverse.diabetes/index.html) reporting on a middle aged man who found a way to “stave-off” the onset of Type II diabetes.
UPDATE 3-Novo Nordisk modern insulins growth slowing
Thu Aug 4, 2011 8:11am EDT
(Adds CFO quotes, further details, updates share price)
* Q2 EBIT 5.27 bln crowns vs forecast 5.34 bln crowns
* Raises full-year 2011 outlook
* Raises outlook on back of Victoza, modern insulin sales
* Shares up 1.1 pct, outperforming wider market
By Mette Fraende and Shida Chayesteh
COPENHAGEN, Aug 4 (Reuters) - Danish drugmaker Novo Nordisk (NOVOb.CO) faces slowing growth and fierce competition in the crucial modern insulins market that leaves it vulnerable to any delay in bringing new products to market.
The world's biggest insulin producer raised full-year guidance following a rise in sales of modern insulins and diabetes treatment Victoza, but acknowledged that it faces a slowdown of modern insulin sales, which in the second quarter accounted for 43.6 percent of total group sales.
Novo Nordisk said it now expects full-year sales in local currencies to rise by 9 percent to 11 percent, up from an earlier forecast of 8-10 percent, and operating profits to rise 15-19 percent, up from an earlier forecast of around 15 percent.
Chief Financial Officer Jesper Brandgaard told Reuters he expected modern insulin sales growth to slow quarter by quarter from now and until a new product was launched.
"All else equal, when you launch a new product you will have a fall in growth rates quarter by quarter, and the only way we can get growth going again is by launching a new product," Brandgaard said. "We hope that degludec and degludec plus will come in and create new growth for our insulins in the United States," he said.
The company would "soon" file a registration application for degludec in the United States, he said. Once filed to the authorities, it could likely a year and 18 months for the drug to be launched.
"It is clear that degludec, if given a strong labelling...could become a big blockbuster," Brandgaard said.
A blockbuster is a drug with annual sales of more than $1 billion.
But Novo warned of intense generic competition in oral anti-diabetic products and challenges from healthcare reforms world-wide. Analysts said slower growth rates left the company vulnerable to delays in the launch of new drugs.
Swedbank analyst Johan Unnerus said: "We expect modern insulin growth to slow ahead of approvals for the next generation of insulin, which will probably be late next year with the approval of degludec." Degludec is an ultralong-acting insulin.
"It leaves Novo a bit more exposed to any negative news or delays of degludec approval as the company faces slower growth," Unnerus said. He said Sanofi-Aventis' competing drug Lantus had proven very successful......
Audio-Health Report
Chronic pruritis - an itching sensation
listen download (6.2MB)
Researchers at Emerton University in Atlanta, Georgia, have found that chronic pruritis can have a devastating effect on patients, causing health problems such as depression, anxiety and interruption of sleep. According to the research chronic pruritis can affect patients the same way as chronic pain. Read Transcript
Melanoma that has spread to the liver
listen download (3.8MB)
Cancer specialists in the US have tested a new procedure to treat melanoma that has spread to the liver. Read Transcript
Pharmaceutical
Ghostwriting, RICO And Fraud On The Court?
The contentious debate over ghostwriting shows no sign of abating. Even the definition of ghostwriting - the mysterious practice in which an article lands in a medical journal with the name of an author who, as it turns out, had little or nothing to do with the substance of the publication - prompts argument. Meanwhile, the issue has caused several scandals for several drugmakers and medical journals, causing embarrassment and turmoil.
Express Scripts Deal Hurts Everyone: Gay Explains
Last month, Express Scripts announced plans to buy Medco Health Solutions, a rival pharmacy benefit manager, for $29 billion. The deal quickly raised antitrust questions, given that the combined company will hold a dominant share of the PBM and specialty pharmacy markets. Among those complaining to the Federal Trade Commission are small specialty pharmacies that stock or compound medicines for hard-to-treat chronic diseases, such as rheumatoid arthritis, hepatitis C, hemophilia and multiple sclerosis, among other maladies. We spoke with Russell Gay, executive director of the Independent Specialty Pharmacy Coalition, a group of 20 such operations, about fears these smaller players will be muscled out of the market…
GI Bleeding
FOBT Not Fooled by Upper GI Bleeds
By Charles Bankhead, Staff Writer, MedPage TodayPublished: August 03, 2011 Reviewed by Robert Jasmer, MD;
Associate Clinical Professor of Medicine, University of California, San Francisco.
Bleeding in the upper gastrointestinal (GI) tract did not alter the accuracy of immunochemical fecal occult blood testing (FOBT) for lower-GI lesions, according to results of a large prospective cohort study.
FOBT had a sensitivity of 24.3% and specificity of 89% for lower-GI bleeding, and twice as many patients with endoscopy-confirmed lower-GI lesions had positive FOBT results compared with patients who had negative tests.
In contrast, a similar proportion of patients with positive and negative FOBT results had endoscopy-confirmed upper-GI lesions, as reported online in CMAJ.
"We found that the specificity of the immunochemical fecal occult blood test was almost 90% for predicting colorectal cancer, adenoma, or any important lesions in the lower gastrointestinal tract," Tsung-Hsien Chiang, MD, of National Taiwan University in Taipei, and co-authors wrote in their discussion.
"These findings support those of previous studies showing that the immunochemical fecal test is a specific diagnostic tool."
"In our study, the prevalence of lesions in the upper tract was consistently about 20%, whether among participants with a positive immunochemical fecal test result, a negative fecal test result, or a positive fecal test result and a negative finding on colonoscopy," they added.
"These findings indicate that the immunochemical fecal occult blood test cannot predict the presence of lesions in the upper gastrointestinal tract."
FOBT has a controversial history because of conflicting results from different studies. In part, the controversy has arisen from the heterogeneity of study populations and the inability of guaiac-based tests to distinguish between upper and lower GI bleeding, the authors noted in the background of their report.
Increasingly, immunochemical FOBT has replaced guaiac-based tests. Immunochemical tests react with human globin, which is digested by upper-GI enzymes, potentially reducing the conflict of a positive FOBT and negative colonoscopy, they continued.
To verify the greater specificity of immunochemical FOBT for lower-GI bleeding, investigators in Taiwan conducted a prospective cohort study involving adults recruited to undergo FOBT and bidirectional endoscopy (colonoscopy and esophagogastroduodenoscopy).
Study participants collected stool samples within two days of starting bowel preparation for screening endoscopy. Participants brought the samples with them the day of screening, and the specimens were tested within 24 hours. Investigators used a commercially available test with a positive cutoff of 50 ng/mL.
The study involved 2,796 participants, of whom 397 (14.2%) had positive FOBT results.
For detection of lower-GI lesions, the test had a positive predictive value of 41.3% and a negative predictive value of 78.7%, in addition to the sensitivity of 24.3% and specificity of 89.0%. The results translated into a positive likelihood ratio of 2.22, negative likelihood ratio of 0.85, and accuracy of 73.4%.
The authors found that 41.3% of participants with positive FOBT results had lower-GI lesions compared with 21.3% of those with negative results (P<0.001).
Bidirectional endoscopy revealed upper-GI lesions in 20.7% of patients with positive FOBT results versus 17.5% of those with negative results (P=0.12).
Colonoscopy revealed cancer in 28 patients, 27 (96.4%) of whom had positive FOBT results. In contrast, none of the three patients with endoscopy-detected esophageal or gastric cancer had a positive FOBT (P<0.001, lower- versus upper-GI).
Investigators identified two independent predictors of false-positive fecal test results (positive FOBT-negative colonoscopy): use of antiplatelet drugs (OR 2.46, 95% CI 1.21 to 4.98) and a low hemoglobin concentration (OR 2.65, 95% CI 1.62 to 4.33).
The study was supported by the Taipei Institute of Pathology.
The authors had no relevant disclosures.
Organ Donation
U.K.: Kidney Donor Payments 'Would Save Lives'
(BBC News, online, August 2, 2011)
"Sue Rabbitt Roff, a researcher at Dundee University, said it was time to 'explore' kidney donors being paid as an 'incentive'…The British Medical Association (BMA) said it would not support cash being paid for organs. It is currently illegal to pay for organs for transplantation under the Human Tissue Act. The act also makes it an offence to attempt to buy or sell organs for transplant…Three people a day die on the UK kidney transplant list -- but the number of donations is not keeping pace with the demand for the organs...And the need for kidneys is only likely to rise with the increase in conditions such as diabetes and high blood pressure, she said. But Dr Tony Calland, chairman of the BMA's medical ethics committee, rejected the call for donor payments…The Human Tissue Authority (HTA) said the organisation would 'continue to explore' the issues around living donation that had the potential to increase the number of organ transplants."
U.S.: Living Kidney Donors Push for Better Data on Risks
Deborah L. Shelton(Chicago Tribune, July 31, 2011)
"Unlike other surgical patients, living donors undergo a major operation solely to help someone else, facing risks without any possibility of medical benefit to themselves. Their unique situation creates a special vulnerability, and advocates say extra precautions should be taken to ensure their interests are protected…Unlike with kidney recipients, however, there is no national registry of living donors that would allow long-term tracking. And efforts to collect short-term data have yielded limited information, in large part because many transplant centers do not complete required follow-up forms or have lost contact with donors."Free registration required.
U.K.: Driving Licence Applicants Asked to Join Organ Donor Register
Peter Walker (The Guardian, London, online, July 31, 2011)
"Anyone applying for a driving licence…will [now] be obliged to answer a question about joining the organ donor register, the health department has announced, in an attempt to boost the numbers of potential donors. Those applying for a licence online will be obliged to tick one of three boxes about the register as a condition of completing the form. They can say they would like to sign up there and then, that they are already on the register or that they would like to think about it on another occasion. A similar question existed previously but it was optional and many applicants missed or ignored it. The change is the latest salvo in a long-running campaign by the Department of Health to increase the number of organ donors."Free registration required.
Recalled
36M lbs. of turkey recalled in salmonella outbreak
By MARY CLARE JALONICK Associated Press
WASHINGTON (AP) --
Meat giant Cargill is recalling 36 million pounds of turkey after a government hunt for the source of a salmonella outbreak that has killed one person in California and sickened dozens more.
The Agriculture Department and the Minnesota-based company announced Wednesday evening that Cargill is recalling fresh and frozen ground turkey products produced at the company's Springdale, Ark., plant from Feb. 20 through Aug. 2 due to possible contamination from the strain of salmonella linked to 76 illnesses and the one death.
Illnesses in the outbreak date back to March and have been reported in 26 states coast to coast. Both the Agriculture Department and the federal Centers for Disease
Control and Prevention are still working to identify the source. Meanwhile, the Agriculture Department has warned consumers to properly cook ground turkey.
Just before the recall announcement Wednesday, CDC epidemiologist Christopher Braden said he thought health authorities were closing in on the suspect. He said some leftover turkey in a package at a victim's house was confirmed to contain the strain of salmonella linked to the outbreak.
In announcing the recall, Cargill officials said all ground turkey production has been suspended at the Springdale plant until the company is able to determine the source of the contamination.
"Given our concern for what has happened, and our desire to do what is right for our consumers and customers, we are voluntarily removing our ground turkey products from the marketplace," said Steve Willardsen, president of Cargill's turkey processing business.
The Minnesota-based company said it was initiating the recall after its own internal investigation, an Agriculture Department investigation and the information about the illnesses released by the CDC this week.
All of the packages recalled include the code "Est. P-963," according to Cargill. The packages were labeled with many different brands, including Cargill's Honeysuckle White.
According to food safety attorney Bill Marler, who publishes a database of outbreak statistics, the ground turkey recall is one of the largest meat recalls ever.
A chart on the CDC's website shows cases have occurred every month since early March, with spikes in May and early June. The latest reported cases were in mid-July, although the CDC said some recent cases may not have been reported yet. The CDC said the strain is resistant to many commonly prescribed antibiotics, which can make treatment more difficult.
The states reporting the highest number sickened are Michigan and Ohio, with 10 each. Texas has reported nine illnesses; Illinois, seven; California, six; and Pennsylvania, five.
Twenty states have one to three reported illnesses linked to the outbreak, according to the CDC. They are Alabama, Arizona, Georgia, Iowa, Indiana, Kentucky, Louisiana, Massachusetts, Minnesota, Missouri, Mississippi, North Carolina, Nebraska, Nevada, New York, Oklahoma, Oregon, South Dakota, Tennessee and Wisconsin.
The CDC estimates that 50 million Americans each year get sick from food poisoning, including about 3,000 who die. Salmonella causes most of these cases, and federal health officials say they've made virtually no progress against it.
Government officials say that even contaminated ground turkey is safe to eat if it is cooked to 165 degrees. But it's also important that raw meat be handled properly before it is cooked and that people wash their hands with soap for at least 20 seconds before and after handling the meat. Turkey and other meats should also be properly refrigerated or frozen and leftovers heated.
The most common symptoms of salmonella are diarrhea, abdominal cramps and fever within eight to 72 hours of eating a contaminated product. It can be life-threatening to some with weakened immune systems.
Cargill executive Willardsen said, "Public health and the safety of consumers cannot be compromised."
"It is regrettable that people may have become ill from eating one of our ground turkey products," he said, "and, for anyone who did, we are truly sorry."
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Online:
USDA recall announcement: http://www.fsis.usda.gov/News-&-Events/Recall-060-2011-Release/index.asp
CDC info on salmonella in ground turkey: http://www.cdc.gov/salmonella/heidelberg/080111/index.html
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Find Mary Clare Jalonick on Twitter at http://twitter.com/MCJalonick
Salmonella Superbug on the Rise
Helen Briggs(BBC News, online, August 3, 2011)
"The outbreak emerged in Africa then spread to Europe, picking up antibiotic resistance along the way, says a team of international researchers. They are calling on health officials to step up monitoring to stop the 'superbug' spreading globally. Cases have grown from a handful in 2002 to 500 worldwide in 2008, they report…Most of the millions of Salmonella infections a year are not serious, causing only mild stomach upsets…The strain, known as S. Kentucky, has developed resistance to the antibiotic Ciprofloxacin, often used for treating severe Salmonella cases…Although the first infections outside Africa seem to be in international travellers, more recent cases seem to have been acquired in Europe, perhaps through contaminated food, say the researchers. Cases have been seen in England, Wales, Denmark and France."
Off The Cuff
Coping with long waits at the doctor’s office
I love my daughters’ pediatrician: She’s smart, knowledgeable, easy to talk with, and cautious without being alarmist. And thanks to her uber-efficient office staff, she has never kept us waiting – something that’s beyond important to this sometimes-stressed (and frequently rushed) mom. I recognize this isn’t the norm, though, and I read with interest a piece in tomorrow’s New York Times (but online now) on long waits at medical offices...
US physicians spend nearly 4 times more on health insurance costs than Canadian counterparts
ITHACA, N.Y. —
U.S. physicians spend nearly $61,000 more than their Canadian counterparts each year on administrative expenses related to health insurance, according to a new study by researchers at Cornell University and the University of Toronto.
The study, published in the August issue of the journal Health Affairs, found that per-physician costs in the U.S. averaged $82,975 annually, while Ontario-based physicians averaged $22,205 – primarily because Canada's single-payer health care system is simpler.
Canadian physicians follow a single set of rules, but U.S. doctors grapple with different sets of regulations, procedures and forms mandated by each health insurance plan or payer. The bureaucratic burden falls heavily on U.S. nurses and medical practice staff, who spend 20.6 hours per physician per week on administrative duties; their Canadian counterparts spend only 2.5 hours.
"The magnitude of that difference is what is interesting," said co-author Sean Nicholson, Cornell professor of policy analysis and management in the College of Human Ecology. "It's the nurse time and the clerical time, rather than physician time, that's different. That's driving the increased costs."
The authors offer ideas U.S. policymakers and health insurers could use to streamline inefficiencies and reduce administrative costs. Chief among them: standardize transactions and conduct them electronically. Physical mail, faxes and telephone calls can slow practices down, according to Nicholson. The result is an additional $27 billion spent every year in the U.S. when compared to the costs incurred by physicians in Canada.
"We're not saying that these extra $27 billion are wasted," Nicholson said. "Health insurance companies put some of these rules in place to keep health care costs down. The $27 billion of 'extra' cost to physicians have to be balanced against some of the benefits that come from following these rules."
Nicholson said the study should be used to examine which rules make cost-benefit sense, and which rules need reform. "That's what we hope will come out of this," he said, "that informed decisions can be made by private and public health care insurers about what really works and what is not worth the money."
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Funding for the study came from the Robert Wood Johnson Foundation.
Contact Syl Kacapyr for information about Cornell's TV and radio studios
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