By Ted Burnham, NPR News
This story comes from KHN partner ‘s Shots blog.

Drug errors inside hospitals remain a big problem.

By one estimate, 1 in 7 hospitalized patients suffers some form of error in care. Nearly a third of those mistakes are related to drugs. And those mix-ups can lead to longer hospital stays, unnecessary suffering, permanent damage or death.

One way to reduce mistakes is to have doctors enter the prescriptions on a computer instead of with pen and paper. After the switch, hospitals can see error rates drop by a whopping 60 percent.

That’s the result of a study,published today in PLoS Medicine, that tracked medication errors in two Australian hospitals before and after installing electronic prescription systems.

For starters, the old saw about doctors having illegible chicken scratches is for real.

“People can actually read the prescribing orders now,” Johanna Westbrook, director of the Centre for Health Systems and Safety Research at the University of New South Wales and lead author on the study, tells Shots. “You’re not relying on trying to interpret handwriting.”

Incomplete and unclear prescriptions, which numbered in the hundreds during the months before the systems were installed, dropped to single digits at both hospitals.

But the computerized systems do more than eliminate poor penmanship. Even the most legible prescriptions can include miscalculations and oversights. A doctor might get the dose wrong, or choose a drug that interacts harmfully with another medication.

On the other hand, Westbrook says, the design of the software can introduce errors “that would never occur on paper,” like picking the wrong option from a drop-down menu.

In Westbrook’s analysis, software design accounted for 35 percent of the remaining errors after the systems were installed. Most mistakes were minor, and many could be prevented by improving the program — say, by putting the most-used options at the top of each menu.

That means the potential of electronic prescriptions is even greater than the 60 percent error reduction seen in the study. For comparison, Westbrook points to a standardized paper medication chart introduced in Australia in 2006, which she says reduced errors by a paltry 4 percent.

With numbers like these, you’d think hospitals would be rushing to move to digital prescriptions. But an annual survey by the Leapfrog Group, a nonprofit that has established quality and safety standards for health systems, finds only 17 percent of responding hospitals in the U.S. use computerized ordering systems now.

“I think it’s surprising to most people that the vast amount of hospitals are still using pen and paper for prescribing,” says Leapfrog CEO Leah Binder.

Hospitals are reluctant to install the systems, Binder says, because they’re seen as expensive and painful to implement. And hospitals that do make the investment can’t assume they’ll be perfect right out of the box, she says.

Leapfrog requires that hospitals test their systems to see if the pre-programmed rules actually catch harmful mistakes. They feed in fake patients and fake prescription orders — some of which contain fatal errors. Across the board, about one-third of them slip through.

In practice, most of those mistakes would be caught by a doctor, pharmacist or nurse before any harm was done. Binder says the failures in the software underscore the need for continued testing and improvement.

But, she says, there are clear advantages for hospitals that have made the switch. Take Boston’s Brigham & Women’s, which was an early adopter back in 2004. “That’s a safer hospital,” Binder says. “Period.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

By Merrill Goozner, The Fiscal Times
This story comes from our partner 

Julie Grabow, an oncologist at the Fred Hutchinson Cancer Center in Seattle, recently prescribed an exciting new therapy for a 60-year-old woman with metastatic breast cancer.

Three-and-a-half years into her battle against the disease, the patient had already exhausted three different anti-estrogen therapies, each of which only put a temporary check on the spreading tumors.

The newly prescribed drug, Novartis’ Afinitor, is one of the recently approved targeted therapies that have generated a lot of excitement among cancer patients and oncologists in recent years.

Drugs that target just the cancer cells promise the same or better results as toxic chemotherapy, but with far fewer side effects.

There was a catch, though. Like many of the latest cancer drugs, Novartis is charging exorbitant amounts for the treatment – in this case, $10,000 per month.

That quickly put an end to that possibility for Grabow’s patient. Her monthly co-payment, even after her insurance company agreed to pay its share of the off-label use the drug (the Food and Drug Administration has only approved Afinitor for kidney and pancreatic cancer, not breast cancer), was $2,900.

“She can’t afford this, even though it’s potentially a less toxic and potentially equally effective regimen,” Grabow said. “Chemo will help her, and it’s a reasonable choice. But that choice is 100 percent driven by economics.”

Over the past year, official Washington and candidates on the campaign trail have locked horns over the best way to curb rising health insurance costs. The public has been bombarded with dueling slogans – Republicans vowing to fight the “death panels” and “rationing” of Obamacare while Democrats promise “guaranteed access” and “affordability” with the Affordable Care Act.

But an economic drama that neither side wants to confront is playing itself out in cancer wards and oncologists’ offices across the country.

Unaffordable new drugs, even when they’re covered by insurance, are being rationed by price as patients, doctors and hospital officials struggle with what is likely to be the most pressing problem for the nation’s health care system over the next decade: how to pay for the spectacular rise in the cost of cancer care, especially drugs and diagnostic tests.

“In the real world of private practice where most care is delivered, it would be a mistake to say rising costs haven’t affected care,” said Eric Nadler, a head, neck and lung cancer specialist at Baylor University Medical Center.

The growing cost of cancer care will impose its greatest burden on the nation’s Medicare system, since 55 percent of all cancers are diagnosed in individuals 65 or older.

A recent study by the National Cancer Institute projected the cost of treating the 29 most common cancers in men and women will rise 27 percent by 2020, even though incidence of the disease is going down due to successful public health campaigns like the war on smoking.

The study pointed out that its projections were based on 2006 Medicare claims data, which predated the development of most of the latest targeted therapies.

There’s no doubt that there will be many new therapies for cancer coming to market in the years ahead. The nation’s $150 billion public investment in understanding the biology of cancer – the science side of the War on Cancer launched by President Richard Nixon in 1971 – is beginning to bear fruit.

The pharmaceutical industry, which draws on that publicly funded science to develop drug candidates, now has 887 new cancer drugs in development, over 30 percent of its total portfolio of new drug candidates, according to the Pharmaceutical Research and Manufacturers of America, the industry trade group. That’s up from 646 or 26 percent of the total devoted to cancer in 2006.

The industry is pouring increased research and development resources in cancer therapeutics in hopes that it will replace the revenue being lost from the expiration of patents on blockbusters like Lipitor.

However, since there are fewer cancer patients than there are people with chronic conditions like elevated cholesterol, and many don’t live very long, the prices needed to support the industry’s current size and structure, and profits must be substantially higher.

“They’re trying to maximize profits given their incentives,” said Peter Neumann, director of the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center, which receives funding from the drug industry.

Possible solutions, he said, include letting Medicare set prices based on the medical value of adding extra months to life. That’s a variation on Great Britain’s cost-effectiveness model, which has been roundly condemned by most U.S. politicians and the press.

The other path is to turn to a bundled payment for every for every episode of cancer care and let the health care delivery organizations and private insurers sort it out. (Bundled payments account for all medical services associated with a given episode of care—doctors, nurses, technicians, etc.) That approach, in essence, would force the marketplace to execute the rationing.

“Bundled payment isn’t a panacea, but it does create incentives,” Neumann said. Some private insurers are experimenting with bundled payments for cancer care.

A quick review of the new cancer drugs approved by the Food and Drug Administration last year reveals how fast drug prices are rising.

Most of the older chemotherapy regimens for cancer, some of which have been around since the 1950s, are generic and relatively inexpensive.

But among the six new drugs approved in 2011, the cheapest – Johnson & Johnson’s Zytiga for advanced prostate cancer – cost $44,000 a year. The drug extended life by an average of less than 5 months to 16 months, according to a company spokesperson.

At the high end of the spectrum was Adcetris, a biotech product from Seattle Genetics that treats recurrences of Hodgkin’s lymphoma. A highly curable disease when initially treated in the 8,830 mostly middle-aged patients who get the disease every year, it is usually fatal if a drug-resistant strain emerges later in life.

Adcetris, the first new treatment to come along since 1977, kept the cancer in check for nearly 7 months in the single small trial that led to its quick FDA approval. It’s price tag: $216,000 for a full course of treatment.

Skin cancer specialists had a lot to cheer about in 2011 with two new therapies coming on the market for metastatic melanoma, which is fatal within one year for about 75 percent of the 10,000 people stricken each year.

But Roche/Genentech’s Zelboraf cost $61,400 a year and Bristol-Myers Squibb’s Yervoy, which nearly doubled the one-year survival rate from 25 percent to 46 percent, cost $120,000 for a four-month course of treatment.

“We price our medicines based on a number of factors including the value they deliver to patients and the scientific innovation they represent,” said Sarah Koenig, a spokeswoman for Bristol-Myers. “We have one of the most robust patient assistance programs for cancer patients in the industry.”

Most drug companies have patient assistance programs for poor or struggling patients, but many only come into play if patients are poor or families have exhausted their savings.

And since many of the latest therapies, like the older chemotherapies they are replacing or supplementing, extend life for brief periods of time, patients wind up weighing whether they want to deplete their children’s inheritances for a couple extra months of being very, very sick.

A study released at last June’s annual conference of the American Society of Clinical Oncology, which represents the nation’s 25,000 oncologists, revealed that patients with co-payments over $500 a month were four times more likely to refuse treatment than those whose co-payments were under $100 a month.

“The price of drugs can’t be set so outrageously high,” study author Lee Schwartzberg told Reuters. Schwartzberg is the chief medical officer at Acorn Research, which conducted the study.

“All stake holders have to get together and compromise to translate this great science into great patient care without breaking the bank.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

The first of two articles on the epidemic by InvestigateWest’s Carole Smith appears today on the news and opinion websitce CrossCut.com.

Smith writes:

An InvestigateWest analysis of U.S. Drug Enforcement Administration data shows Washington ranked fourth highest nationally in per-capita prescribing of methadone in 2006 (the most recent year for which reliable data is available) and 11th for oxycodone — the two biggest killers.

Even more disturbing, more than half of all prescription drug-related deaths in the state occur in the state’s poorest and most vulnerable population — people on Medicaid, a population that is itself exploding in our recent economy. A 2009 federal study showed the age-adjusted risk of death from prescription opiates in Washington was nearly six times higher for Medicaid enrollees than those not on the program.

An accompanying documentary will air on KCTS at 9 p.m. Jan. 30. The documentary will be followed by a half-hour in-studio discussion.

The Seattle Times also tackled this issue in its December series: The Politics of Pain.

To learn more:

• Read Smith’s CrossCut article: Prescription for Abuse: Washington tries to get serious.

• Read The Seattle Times series The Politics of Pain.

• Read other LocalHealthGuide coverage of the topic of prescription drug abuse.

• The National Institutes Health has published a brochure to help you select drug treatment programs.

Local Resources:

• Alcohol Anonymous (AA)/Seattle: www.seattleaa.org

• MetroKC Alcohol and Other Drug Prevention program: www.metrokc.gov/health/atodp

• MetroKC Mental Health & Substance Abuse Links: www.metrokc.gov/dchs/mhd/mhlinks.htm

• Northeast Seattle Coalition to Prevent Underage Drinking: www.preventionworksinseattle.org

• Substance Abuse Treatment Facility Locator: http://FindTreatment.samhsa.gov

The booklet, Seeking Drug Abuse Treatment: Know What to Ask, says there are five key questions you should ask about a program:

Five Key Questions:

• Does the program use treatments backed by scientific evidence?

• Does the program tailor treatment to the needs of each patient?

• Does the program adapt treatment as the patient’s needs change

• Is the duration of treatment sufficient?

• How do 12-step or similar recovery programs fit into drug addiction treatment?

To learn more:

• Read the whole booklet Seeking Drug Abuse Treatment: Know What to Ask.

Additional Resources:

• American Academy of Addiction Psychiatry
• American Academy of Child & Adolescent Psychiatry
• Mental Health America
• National Alliance on Mental Illness
• NIDA’s DrugPubs Research Dissemination Center
• NIDA’s Clinical Trials Network
• NIH’s ClinicalTrials.gov
• NIDA’s Principles of Drug Addiction Treatment: A Research Based Guide
• Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Locator: 1-800-662-HELP
• National Suicide Prevention Lifeline: 1-800-273-TALK

Each year, about 70,000 young people in the U.S. aged 15 to 39 years are diagnosed with cancer.

In the series, a group of teens and young adults from Children’s Adolescent Young Adult Oncology Program talk about their experiences with the disease – from treatments and hair loss, to dealing with school, friends and family.

Producers of the series hope that seeing other teens and young adults with cancer talk about their experiences will help other young patients struggling with the diagnosis of cancer cope.

“It is so important for these teens and young adults with cancer to know that there is a peer out there that understands what they are going through and that support is available,”  Dr. Rebecca Johnson, medical director of the Adolescent and Young Adult Oncology Program at Seattle Children’s Hospital.

The discussion group was facilitated by Teen Talking Circles, a nonprofit organization that offers teens “a safe place to tell their truth,” and trains adults to start Teen Talking Circles in their communities.

• To view the complete series go to:  ”Good Times and Bald Times” or click on individual episodes listed below.

• To learn more visit the website of the Children’s Adolescent Young Adult Oncology Program.

To learn more about the challenges facing teens and young adults with cancer read our series from the NCI Cancer Bulletin.

Series Episodes:

• Good Times and Bald Times – Meet the Circle
• Good Times and Bald Times – Family, Friends & Cancer
• Good Times and Bald Times – How Did it Feel?
• Good Times and Bald Times – Treatment and Medication
• Good Times and Bald Times – Eggs
• Good Times and Bald Times – Fertility Preservation
• Good Times and Bald Times – Food, Appetite & Cancer
• Good Times and Bald Times – Feeding Tubes
• Good Times and Bald Times – Losing Your Hair
• Good Times and Bald Times – PICC Lines, Hickman Lines & Ports, Oh My!
• Good Times and Bald Times – Dealing with School
• Good Times and Bald Times – What If