Expensive new drugs for hepatitis C may work better than older treatments, but their high cost undermines their value, a panel of experts said Monday during a daylong forum in San Francisco Monday.
"The price makes it very hard for the health care system," said Steve Pearson, who oversaw the meeting Monday for the California Technology Assessment Forum, a group affiliated with health insurers that holds public meetings to weigh evidence on new treatments.
The 15-member panel, which included representatives of hospitals, insurers and patient advocates, didn't recommend how use of the drugs should be prioritized. Solvadi, which hit the market late last year, is made by Gilead Sciences and costs $1,000 a pill. Slightly less expensive is Olysio, made by Johnson & Johnson. A course of treatment with the drugs can cost $66,000 to $84,000, or more.
The panelists and experts who testified nearly all agreed that because of the cost and for medical reasons, not every patient with hepatitis C needs to be immediately treated with the new drugs. It is estimated there are at least 3 million Americans with the viral infection.
"I can't imagine how that would be feasible without bankrupting our system," said Rena K. Fox, a professor of medicine at the University of California, San Francisco. "What I really wish for is that we could push back on the price, rather than make patients wait. But since we don't have the ability to change the price, we have to decide which patients are the most urgent."
The drugmakers defend the prices, citing research costs and evidence that shows the pills cure many patients.
Waiting might be a better answer for some patients — particularly those with little or no liver damage — because other treatments are expected to hit the market within a year, outside experts and some panel members said. Patients with more advanced liver damage from the virus would be treated first.
Healthier people had also waited to use the older drugs, hoping for something to come along that would have fewer side effects.
Hepatitis C is a chronic liver infection that can take years or decades to progress. Over time, it can lead to cancer, cirrhosis or the need for a liver transplant.
At least 70 percent of those infected have no symptoms. The virus is spread mainly by intravenous drug use, but many people were unknowingly infected by poorly sterilized medical equipment and blood transfusions before widespread screening of the blood supply began in 1992. Some may also have been infected through tattoos and piercings with contaminated needles.
Patients may not want to wait, said Ryan Clary, executive director of the National Viral Hepatitis Roundtable, a consumer group partially funded by the drug industry. Television advertisements sponsored by Gilead are encouraging people to be screened for hepatitis and to talk with their doctors about new treatment options. The Centers for Disease Control and Prevention recommends that all baby boomers be tested for hepatitis C.
"If I was hepatitis C-positive and someone said there's this great treatment, but can you hold off because you're healthy and it might bankrupt the system ... patients don't think like that," said Clary, who spoke at the forum.
Private insurers, as well as those serving Medicaid patients, are wrestling with how to cover the new drugs. Many say they will require prior approval and may be limited to the sickest patients. Some Medicaid insurers have asked states for additional help in paying for the drugs.
A draft report prepared in advance of the San Francisco forum estimates that if every patient in California with advanced liver damage were treated, the cost would be $6.3 billion.
The panel's recommendations — including votes on questions about the effectiveness of the new treatments compared with older regimens — will be released within a month.
Arizona Gov. Janet Brewer, whose tenure has been marked by controversial decisions on immigration policy and a contentious relationship with the White House, says she will not seek another term in office.
As The Arizona Republic explains, to run for a second full term, Brewer would have had to mount a legal challenge to the state's term limits. Brewer if you remember, completed the final year of Janet Napolitano's term. Napolitano left office to become President Obama's Homeland Security Secretary.
Brewer won reelection in 2010. The Republic adds:
"Brewer made the announcement on her home turf, at Park Meadows Elementary School in Glendale, at an event attended by students and current and former Brewer staffers. A banner hanging behind the podium read 'Champion of the Arizona Comeback.'
"'I'm saddened to be leaving this post next year but I'm proud of the remarkable progress we've made for the state,' Brewer said, adding that being governor has been her 'proudest role.'
"'I will continue to champion and cheer Arizona from the sidelines,' she said."
Nationally Brewer will be remembered for championing a law that asked police to check the immigration status of those stopped for another violation. The Obama administration argued that the law usurped the responsibilities of the federal government.
Brewer took the fight all the way to the Supreme Court, which in 2012 sided with Obama administration when it struck down a key part of the law.
That decision was preceded by a tense confrontation with President Obama on the tarmac of the Phoenix-Mesa Gateway Airport.
Brewer said Obama confronted her over how she described a 2010 meeting in her book, Scorpions for Breakfast. She wrote that during that meeting Obama lectured her on immigration.
When they met on the tarmac in 2012, there were fireworks that culminated with an AP photograph of Brewer pointing at Obama in an animated manner.
If philosophy's main goal is to figure out what makes life worth living, it is also, by extension, a preparation for dying. Plato knew this and took it to heart. And now we can listen to him again, and learn something useful. The man who gave us philosophy as we know it is back, walking among us, going to TV talk shows, visiting Google's headquarters in Mountain View, having his brain examined by a na´ve reductionist neuroscientist, engaging with our current struggles.
For this we must thank Rebecca Newberger Goldstein's inventiveness and intellectual courage. Her book, Plato at the Googleplex: Why Philosophy Won't Go Away has just been published to rave reviews by people such as philosopher Colin McGinn. Ms. Goldstein's goal is clear: to show to the "philosophy-jeerers" — those who claim philosophy has no value whatsoever — how absurdly wrong (and mostly ignorant) they are. In a time when philosophical discourse has been abused by an excess of misplaced scientism, from claims related to the origin of the Universe (we can explain it!) to the meaning of mind and the nature of consciousness (we can explain it!), such an approach is most welcome and much needed.
To the seafaring Greeks, one of the greatest fears was to perish, without a trace, under the sea. Life must matter; you must make sure it does. This is what Goldstein aptly calls the "Ethos of the Extraordinary," the need to carve your permanence in this life so that it survives after your death. Blending Plato and Dylan Thomas, the message would go like this: rage, rage against the ordinariness of sameness. "It is, in the end, the only kind of immortality for which we may hope," Goldstein writes.
Plato clearly succeeded. His philosophical legacy, celebrated by many, torn to pieces by others, enigmatic, inspiring, is very much part of our concerns, even if we often are not aware of its pervasiveness. We can all benefit from using reason as tool to carve meaning out of existence, as a guide to live a life well-lived, to examine the nature of reality and truth, to make our lives matter. It is no coincidence that in his dialogue Apology, dedicated to Socrates' trial, Plato has his mentor declare that an unexamined life is not worth living.
Goldstein is the first to admit that there is an elitist trend in Plato's ideas, typical of an aristocrat who didn't have to work for a living. However, his teachings carry their meaning to modern times, where they need to be understood within their original context and not ours. That so much of Plato can be easily transported to TV talk shows and Mountain View, serves to show how prescient and timeless he was.
Philosophy has changed much since Plato, as it should. After all, its purview is precisely to examine and reexamine itself as a precondition to growth. No advance would be possible without this openness to criticism. (Incidentally, and not surprisingly, this is also how science functions. Plasticity is an essential property of any evolving knowledge system.) Goldstein's brilliantly constructed narrative, combining Plato's original texts with current-day events, shows how timely the central questions of philosophy remain, as the answers multiply.
Answers are never final or, if they seem to be, they shouldn't be interpreted as such. Yet, while in science it is easy to identify progress, in philosophy the task is harder. As Goldstein reflects upon Plato's legacy, she offers a portrait of the shifting nature of our philosophical inquiries and our search for meaning:
Philosophical progress is invisible because it is incorporated into our points of view. What was tortuously secured by complex argument becomes widely shared by intuition, so obvious that we forget its provenance. We don't see it, because we see with it.
Philosophy provides the goggles with which we make sense of reality.
Think a machine that can turn water into wine is too good to be true? Well, it turns out, it is.
About two weeks ago, two wine industry gurus started marketing a home appliance they called "The Miracle Machine." The machine, the spiel went, would use concentrates, flavor packets and "an array of electrical sensors, transducers, heaters and pumps" to make wine quickly and easily in your home.
That was enough to get 7,000 people to sign up for information about The Miracle Machine's Kickstarter campaign. And plenty of news organizations, including ABC News and TIME, published stories about the miraculous contraption, priced at $499.
We here at The Salt are always interested in the science behind new food developments and, after consulting an oenologist, we were skeptical of how this "miracle" could be pulled off. Even if The Miracle Machine did work, just how good could its product taste? We took our doubts to a wine expert, Dr. Andrew Waterhouse, a professor of oenology at the University of California, Davis, who agreed that the whole thing sounded pretty suspect.
So we pushed and prodded and, guess what? We can now report the whole thing was a sham. Turns out, the Miracle Machine was a marketing ploy cooked up (or perhaps "fermented" would be a better word?) by MSL Group, a public relations company, to promote their pro bono client of the year, a water charity called Wine to Water.
"It was insane to see how big it got and how fast it got there," said Philip James, one of the two wine industry figureheads behind the hoax.
James, founder of wine companies Lot18 and Snooth, teamed up with Kevin Boyer, who founded Napa Valley winery Boyanci. The two are chairman and president, respectively, of Customvine, a winemaking and marketing company. Customvine has been a supporter of Wine to Water for a while. Last year, James rode his motorcycle 17,000 miles to raise money for the charity.
"If by lending our reputations, we could bring a broader reach [to Wine to Water] and save one life, we'd do it 10 times over again," Boyer tells The Salt.
Wine to Water claims to have provided 250,000 people in 17 countries with clean water since 2004. However, because its revenues amount to less than $1 million, it doesn't warrant an official review or rating from watchdog sites like Charity Navigator.
Sandra Miniutti, vice president of Charity Navigator, tells us that these are some ways an individual can check out the credibility of a smaller charity:
- Examine their financial accountability and transparency. Look for an organization's 990 tax form, which they're required to file, for information about financial performance and how much of the budget is spent on programs versus overhead. Miniutti says that on average, an acceptable breakdown is 75 percent programmatic spending, 25 percent overhead. (Here's the 990 form for Water to Wine, if you want to check it out yourself.)
- Make sure the charity has at least five independent voting members on its board of directors. This information is also available in the 990 form. "You want to make sure there's independent oversight, not just a CEO reporting to a brother, sister and pal," she says.
- Make sure the charity has information readily available on its website about programs and results.
- If it's a local charity, pay them a visit. You can also give them a call on the phone to get a handle on whether they're measuring and reporting results.
So the moral of this story? Always ask questions, folks. (You know, like doubting Thomas.)
President Obama's planned move to expand the pool of the nation's employees covered by overtime pay laws was hailed Wednesday by Democrats as key to their mid-term election strategy.
And it was just as predictably criticized by conservatives as an overreach by a president who recently characterized income inequality as the "defining challenge of our time."
The president plans to exercise his executive authority on Thursday, leapfrogging Congress to direct the Labor Department to come up with guidelines that would set a new, higher income threshold at which employers are required to pay overtime.
Under current law, only workers earning $455 per week or less are eligible for overtime pay, though two states - California and New York - have independently raised their overtime minimums.
"Working and middle class people are not just feeling pressed, but really squeezed," says Mike Lux, a co-founder of Progressive Strategies. "In that environment, populism tends to rise."
"In terms of the fall campaign, we are building a whole message around helping middle class folks raise their wages, raise their incomes, and make their lives a little better," Lux says. "This executive order, as well as the president's executive order on minimum wages paid by federal contractors, makes a huge difference politically."
Marc Freedman, who heads the labor law policy shop for the U.S. Chamber of Commerce, predicted dire consequences blooming from the wage and overtime changes — and linked the problems to the president's health care legislation.
"Changing the rules for overtime eligibility will, just like increasing the minimum wage, make employees more expensive and will force employers to look for ways to cover these increased costs," he said in a statement.
"Similar to minimum wage, these changes in overtime rules will fall most harshly on small and medium-sized businesses already trying to figure out the impact of Obamacare on them," he said.
Obama in early February bypassed Congress and signed an executive order increasing to $10.10 per hour minimum wages government contractors are required to pay as of 2015.
He's also called for an increase in the national minimum wage from $7.25 to $10.10 over three years, and for indexing future increases to inflation. His executive moves are seen as part of his State of the Union promise of a "year of action" that would include vigorous use of his presidential authority.
"Wherever and whenever I can take steps without legislation to expand opportunity for more American families, that's what I'm going to do," he said in that January speech.
A White House official speaking on background Wednesday said that the president is making his move on overtime pay at a time when "one of the linchpins of the middle class, the overtime rules that establish the 40-hour work week, have been eroded."
The administration estimates that millions of salaried workers in lower-paying jobs, ranging from office assistants to fast food workers, can be expected to work up to 50 or 60 hours a week without seeing any overtime pay.
A $250 per week threshold for overtime pay eligibility was originally established in 1975 by the Labor Department, under the Fair Labor Standards Act, for "white collar" employees; it was increased by the Bush administration in 2004 to its current $455 level. The White House argues that, adjusted for inflation, that threshold for workers today, overwhelmingly not white collar workers, would be $553.
"This should be the central focus of the fall campaign for Democrats," Lux says, characterizing the president's action on income as appealing to swing voters and the party base.
"These issues play directly to the pocketbooks of white working class voters," he said, "and really helps us excite the base, turn out the base."
At the progressive National Partnership for Women and Families, president Debra Ness hailed Obama's move as a big step for "women and working families."
"Coercive overtime is a huge problem in this country," Ness said in a statement. "When this happens, workers, families, communities and, ultimately, our economy suffer."
A new Bloomberg National Poll suggests that while Americans have decidedly mixed feelings about the president, 69 percent of those polled last week support proposals that would raise the minimum wage.
But there's a caveat, says pollster Ann Selzer, who conducted the survey: the minimum wage is not a wedge issue for voters surveyed, at least "not at this point in the game."
"It's still a theoretical thing," says the Des Moines-based Selzer. "The middle class may start feeling that the Democrats are paying attention to them and doing something if it shows up in their pay check."
With national minimum wage changes requiring an act of Congress, the administration, as Selzer says, is looking for "arrows in the quiver to bolster the middle class."
The administration looks to be using the executive move on overtime as an arrow designed to potentially create a pay check effect that will actually move voters when they head to the polls in November.