Laws don’t curb pricey prostate cancer treatments

NEW YORK (Reuters Health) – Laws meant to prevent the overuse of expensive healthcare services don’t stop doctors from using pricey prostate cancer treatments, according to two new studies.

Researchers found doctors used robots and special radiation to treat prostate cancer regardless of whether their area had laws requiring government approval before money is spent on healthcare facilities and new equipment.

“Certificate of need laws were designed to align public need with use of different services,” said Dr. Bruce Jacobs, a lead author of one of the studies from the University of Michigan in Ann Arbor.

The U.S. government required states to implement the laws in the 1970s and early 1980s, but stopped a few decades ago. Still, some states continue to use the laws in an effort to control costs.

In each study, the researchers looked at treatments for prostate cancer, which is the most common cancer in American men.

The American Cancer Society estimates that one in every six men will be diagnosed with prostate cancer in their lifetime, but most will not die from it. Past research found that many men’s prostate cancer is slow-growing, and most are candidates for active surveillance or “watchful waiting.”

In Jacobs’s study, the researchers looked at whether states with strict laws – those that require approval for even low-cost equipment – used robotic surgery to remove fewer prostates than states with less strict or no laws.

Jacobs and his colleagues write in The Journal of Urology that the price of such robots, and the questions surrounding whether or not robotic surgery to remove a prostate is better than the old-fashioned way should make it an “ideal target” for review under the laws.

In September, for example, one of the studies that have questioned the usefulness of robotic surgery found that men who had robotic surgery ended up having fewer short-term complications, but questioned its long-term benefits and whether the hefty price tag of $ 1.5 million in startup costs is worth it. (see Reuters Health article of Sep. 12, 2012:)

But another recent study found robotic surgery led to fewer complications, fewer readmissions to the hospital, and fewer deaths due to surgery than traditional methods, according to Intuitive Surgical, the maker of the da Vinci Surgical System.

“That is significant for the patient and for reducing overall costs to the system,” wrote Angela Wonson, a spokesperson for Intuitive Surgical, in an email to Reuters Health.

Overall, in the new study, the use of robotic surgery to remove prostates in Medicare patients increased regardless of whether there were strict, less strict or no laws in place. Also, the chance a surgeon used robots had nothing to do with the laws.

RADIATION AND COSTS

A second study by another group of researchers looked at whether the laws limited the use of intensity modulated radiation therapy (IMRT) or slowed the growth of healthcare costs related to prostate cancer.

IMRT allows doctors to focus radiation beams onto the cancer without harming healthy tissue.

However, the researchers write that IMRT is costly and – to their knowledge – has not been compared to other prostate cancer treatments in a randomized controlled trial, which is considered the “gold standard” of medical research.

In a group of Medicare patients, Dr. Ganesh Palapattu, the chief of urologic oncology at the University of Michigan and the study’s senior researcher, found that areas with the laws actually saw greater growth in IMRT use.

Palapattu and his colleagues found that IMRT use increased from about 2 percent of all prostate cancer treatments in 2002 to almost half in 2009 in areas with the laws.

In areas without the laws, IMRT use increased from about 11 percent of all prostate cancer treatments to about 42 percent over the same time span.

The laws also didn’t seem to help control prostate cancer treatment costs when the researchers compared the price to treat one person with prostate cancer in states with laws, compared to states without laws.

Palapattu told Reuters Health that it may be time to reevaluate the regulations.

“If the goal is to limit the overutilization of more expensive therapies and to improve efficacy or health, then we have to reexamine how we’re doing this,” he said.

Jacobs told Reuters Health that there is more research to be done, because his group’s study did not look at how many applications for equipment may have been turned down by the states’ approval board.

“I think if we really want to get to the bottom of how effective these (laws) are, the next step is to really look closely at each state’s process of review,” he said.

Palapattu said he’d also like to see if the findings are the same for non-Medicare patients. But, for now, he said men with prostate cancer should talk to their doctors about which treatment is right for them.

“Newer isn’t always better, and it’s important to have a meaningful conversation with your physician on treatment options and which one might be best for you and why,” he said.

SOURCE: http://bit.ly/QzKXvE and http://bit.ly/R5AUhH The Journal of Urology, online November 19, 2012.

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Arsenal in £150m Emirates deal

23 November 2012 Last updated at 07:47 ET

Arsenal football club have signed a new £150m deal with Emirates airline, extending its shirt sponsorship to 2019.

The naming rights to the Emirates Stadium in north London were also extended to 2028 as part of the deal.

In total, the agreement brings in £30m a season for Arsenal in terms of shirt and stadium sponsorship.

The new contract is one of the biggest in football, eclipsing rivals such as Liverpool in terms of revenue earned.

“The original deal with Emirates was a key facilitator of our move from [previous stadium] Highbury and this next phase of our relationship will be just as critical to keep us at the top of the game in England and Europe,” said Arsenal chief executive Ivan Gazidis.

Emirates first signed its sponsorship agreement with Arsenal in 2004, providing the airline with naming rights to its then-brand new stadium until 2021 and a shirt sponsorship that began in the 2006 season.

With wages and costs of running a football club soaring, clubs are looking for more and more ways to earn money to compete on the European stage.

In 2011, Barcelona signed what was then the most lucrative shirt sponsorship deal in the game with Qatar Foundation – worth 30m euros (£24m) a year – but will see its kit feature Qatar Airways from next season. The deal was the first time the Barca kit had featured commercial sponsorship and has riled some fans.

Earlier this year, Manchester United signed a new deal to have US car brand Chevrolet on its shirts for seven years.

The deal, which begins in 2014, is reportedly worth at least £45m a season until 2021.

Liverpool signed an £80m, four-year shirt sponsorship deal with Standard Chartered in September 2009.

Last year, Manchester City signed a 10-year deal reportedly worth £400m with Etihad for the airline’s name to go on both the club’s shirt and the stadium.

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Former Ivory Coast leader’s wife wanted by ICC

THE HAGUE, Netherlands (AP) — The International Criminal Court unsealed an indictment Thursday against former Ivory Coast President Laurent Gbagbo‘s wife on charges including murder, rape and persecution. It was the first time in the court’s 10-year history it has charged a woman.

The world’s first permanent war crimes tribunal said the arrest warrant was issued on Feb. 29 for former first lady Simone Gbagbo for crimes against humanity.

Her husband, Laurent Gbagbo, is already in custody at the court’s detention unit in The Hague facing similar charges stemming from his fight to retain power after losing a 2010 presidential election. If his wife is extradited, they could face justice together in an unprecedented husband-wife trial.

But a senior member of Ivory Coast President Alassane Ouattara‘s government, who requested anonymity because he wasn’t authorized to speak to the media, said Ivory Coast has already informed the ICC that the nation will not let her go.

“We informed them of this a long time ago,” he said.

The court’s chief prosecutor, Fatou Bensouda, urged Ivory Coast to extradite Gbagbo.

“The type of crimes committed in the aftermath of the 2010 elections did not happen by chance — they were planned and coordinated at the highest political and military levels and all those bearing the greatest responsibility must be held to account,” Bensouda said in a statement.

She said prosecutors continue to investigate crimes committed by both sides in Ivory Coast’s bloody power struggle and expect to issue further arrest warrants in the future.

“The investigations are objective, impartial and independent, and are conducted in strict accordance with the law,” she said.

Ivory Coast officials are holding the 63 year old under house arrest in the northwest town of Odienne. Last week, Ivorian prosecutor Noel Dje Enrike Yahau said lawyers had questioned Simone Gbagbo there for two days and that the domestic charges against her remained the same: genocide, blood crimes and economic crimes.

Unsealing the ICC arrest warrant issued nearly nine months ago appears to be a tactic by the court to put pressure on Ouattara’s administration to hand over Ms. Gbagbo.

If authorities in Ivory Coast want to prosecute her, they have to convince judges at The Hague tribunal that their case involves the same crimes she is charged with at the ICC. It is a court of last resort, meaning it only takes cases from countries unwilling or unable to prosecute them.

The international court said in the warrant that there is evidence pro-Gbagbo forces deliberately attacked perceived supporters of Ouattara in the aftermath of the election.

Judges who reviewed evidence supporting the charges against Ms. Gbagbo said they found “there are reasonable grounds to believe that Ms. Gbagbo bears individual criminal responsibility for the crimes … as ‘an indirect co-perpetrator.’”

The warrant called Gbagbo an “alter ego for her husband” with the power to make state decisions. It said there is evidence to suggest she “instructed the pro-Gbagbo forces to commit crimes against individuals who posed a threat to her husband’s power.”

Her husband was the first former head of state to be taken into custody by the court when he was extradited to The Hague by the Ivory Coast government last year.

Prosecutors say about 3,000 people died in violence by both sides after Gbagbo refused to concede defeat following the election. Ouattara finally took power in April 2011 with the help of French and U.N. forces.

Ivory Coast is not a member state of the court, but has voluntarily accepted its jurisdiction.

It is very rare for a woman to be charged by an international war crimes court. In the past, the Yugoslav war crimes tribunal convicted former Bosnian Serb President Biljana Plavsic of persecution and sentenced her to 11 years imprisonment.

The announcement of the arrest warrant and Ivory Coast’s refusal to hand over Gbagbo appeared likely to raise tensions between supporters of her husband and those who back Ouattara.

Moussa Toure Zeguen, a leader of the Gbagbo allies in exile in Ghana, said by phone from Accra that the former president’s supporters had no faith in the Ivorian authorities to give Simone Gbagbo a fair trial.

“We don’t trust them. The only thing that Ouattara is doing is revenge,” Zeguen said. “He wants to try us without trying any of the fighters from his side who also committed crimes. It is not fair, and this cannot bring reconciliation.”

____

Associated Press writers Rukmini Callimachi in Dakar, Senegal, and Robbie Corey-Boulet in Abidjan, Ivory Coast, contributed to this report.

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Ex-’Price is Right’ model gets $8.5M in damages

LOS ANGELES (AP) — The producers of “The Price is Right” owe a former model on the show more than $ 7.7 million in punitive damages for discriminating against her after a pregnancy, a jury determined Wednesday.

The judgment came one day after the panel determined the game show’s producers discriminated against Brandi Cochran. They awarded her nearly $ 777,000 in actual damages.

Cochran, 41, said she was rejected when she tried to return to work in early 2010 after taking maternity leave. The jury agreed and determined that FremantleMedia North America and The Price is Right Productions owed her more than $ 8.5 million in all.

“I’m humbled. I’m shocked,” Cochran said after the jury announced its verdict. “I’m happy that justice was served today not only for women in the entertainment industry, but women in the workplace.”

FremantleMedia said it was standing by its previous statement, which said it expected to be “fully vindicated” after an appeal.

“We believe the verdict in this case was the result of a flawed process in which the court, among other things, refused to allow the jury to hear and consider that 40 percent of our models have been pregnant,” and further “important” evidence, FremantleMedia said.

In their defense, producers said they were satisfied with the five models working on the show at the time Cochran sought to return.

Several other former models have sued the series and its longtime host, Bob Barker, who retired in 2007.

Most of the cases involving “Barker’s Beauties” — the nickname given the gown-wearing women who presented prizes to contestants — ended with out-of-court settlements.

Comedian-actor Drew Carey followed Barker as the show’s host.

___

Anthony McCartney can be reached at http://twitter.com/mccartneyAP .

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Do drunks have to go to the ER?

NEW YORK (Reuters Health) – With the help of a checklist, ambulance workers may be able to safely reroute drunk patients to detoxification centers instead of emergency rooms, according to a new study.

Researchers in Colorado found no serious medical problems were reported after 138 people were sent to a detox center to sleep it off, instead of to an ER.

In 2004, according to the researchers, it’s estimated that 0.6 percent of all U.S. ER visits were made by people without any problems other than being drunk. Those visits ended up costing about $ 900 million.

“Part of the issue has been – as it is in many busy ER departments – there’s a lot of chronic alcoholics that are brought in by ambulance, police or just come in. Often they are brought in because they have not committed a crime or there is limited space in our detoxification center. So the majority were brought to the ER department,” said Dr. David Ross, the study’s lead author from Penrose-St. Francis Health Services in Colorado Springs.

Ross said the ambulance company where he serves as medical director created the checklist with the help of the local detox center, which provided limited medical care by a nurse, and the local hospitals to reduce the number of drunks without medical needs being sent to the local ERs.

They created a checklist with 29 yes-or-no questions, such as whether the patient is cooperating with the ambulance worker’s examination and if the patient is willing to go to the detox center.

The patient was sent to the ER if the ambulance worker checked “no” on any question.

The researchers then went back to look at the patients they transported between December 2003 and December 2005 to see whether or not any of them ended up having serious medical problems at the detox center.

During that two year period, the ambulance workers transported 718 drunks. The detox center received 138 and the local ERs got 580.

Overall, 11 of the patients who were taken to detox were turned away because there was no room, their blood alcohol level exceeded the limit, their family came to pick them up or they were combative.

Another four patients at the detox center were taken to the ER because of minor complications, including chest and knee pain. However, there were no serious complications reported.

“We really believe that we did not miss anybody with a serious illness and injury that didn’t go to the ER as they should have,” said Ross.

But the researchers write in the Annals of Emergency Medicine that their study did have some limitations.

Specifically, the researchers did not plan in advance to do a study when they were creating the checklist, which means their findings are limited to whatever information was collected at the detox center and ERs.

Also, the number of people who were sent to the detox center in their study is relatively small, so it’s hard to tell how many serious complications they’d see among a larger group of people.

“We tried to estimate how likely we would have been to encounter a serious event… We estimated at most we’d encounter three serious adverse events (in 748 patients),” Ross told Reuters Health.

SOURCE: http://bit.ly/QgPCT5 Annals of Emergency Medicine, online November 9, 2012.

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Serious About Free Markets? Prove It

On Friday the Republican Study Committee, a policy shop for congressional Republicans, published a memo on how to fix copyright law. By Saturday afternoon the group’s executive director had pulled the memo, which had evidently failed to approach the subject with “all facts and viewpoints in hand.” This is Washington’s way of saying that an interest group hit the roof, and indeed, Ars Technica reports that lobbyists from the “content industry”—Hollywood and recording companies—pressured the group to renounce the memo.

Copyright being in fact broken, you can still read copies of the memo online. It lays out what copyright reform advocates have been saying for years. Copyright protections now extend 70 years past the life of the author; for a corporation, 95 years after publication. This, along with punitive laws on copyright violation, hinders creativity and innovation. These facts aren’t new. What’s new is the tone. Derek Khanna, the memo’s author, writes like an unashamed free marketeer, and in doing so manages to latch on to a larger point: Laws that help businesses often harm markets. From the memo:

Today’s legal regime of copyright law is seen by many as a form of corporate welfare that hurts innovation and hurts the consumer. It is a system that picks winners and losers, and the losers are new industries that could generate new wealth and added value. We frankly may have no idea how it actually hurts innovation, because we don’t know what isn’t able to be produced as a result of our current system. (Emphasis in the original.)

Radical stuff. There’s no one in Washington to lobby for industries that don’t exist yet, and ever so briefly, Khanna and the Republican Study Committee stepped into that breach. Then they stepped back, to gather more facts and viewpoints. Here’s one: Pro-business and pro-market are not the same thing. The most pleasant place for a business is not elbows-out in the middle of a free market, but sitting alone, atop a fat monopoly. Ask your local cable provider. The larger a business gets, the more it has to protect from the companies and industries that might follow it with something better or cheaper. And the best way to protect what you have is to have it written into law.

Real markets, with real competition, are most helpful to newcomers. Small businesses and new industries create new value. Once created, they, too, move to Washington to protect it. Witness the growth of Google (GOOG) and Facebook’s (FB) lobbying operations in the Capitol. Khanna describes extended copyright protection as rent-seeking—in his words, “non-productive behavior that sucks economic productivity and potential from the overall economy.” What’s true of Hollywood and the recording industry could be said of any established industry.

Luigi Zingales, a professor at the University of Chicago Booth School of Business and a regular contributor to Bloomberg View, points out that larger companies can lobby for special exemptions in the tax code. This creates complexity in the tax code, which punishes smaller businesses that can’t pay for tax lawyers and don’t have anyone’s buttonhole on Capitol Hill. Zingales prefers simple regulations and simple taxes, which are harder for lobbyists to game and easier for democracies to understand. He sees this as a bipartisan problem. The left is inclined toward more regulation, and the right is pro-business, rather than pro-markets.

The direction Khanna was headed—a defense of open, competitive markets at the expense of existing businesses—is still wide open space, claimed by no party. This summer, conservatives such as Timothy Carney at the Examiner and Yuval Levin at National Review urged Mitt Romney to back markets, not businesses. But he chose not to, even though he, in his day, disrupted existing markets of his own. Some enterprising Republican can still do it. Derek Khanna in 2016! He’s young. Maybe VP.

Businessweek.com — Top News

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Ivory Coast: New prime minister named

ABIDJAN, Ivory Coast (AP) — President Alassane Ouattara has tapped Foreign Minister Daniel Kablan Duncan to serve as prime minister in a new government one week after the surprise dissolution of cabinet.

The appointment of Duncan, a member of the PDCI party of former President Henri Konan Bedie, was announced at a press conference Wednesday by Amadou Gon Coulibaly, general secretary of the presidency.

Ouattara dissolved the cabinet last week over a feud between his political party and the PDCI over proposed changes to the country’s marriage law.

The PDCI supported Ouattara in the November 2010 runoff election in exchange for the prime minister’s post, helping him defeat incumbent President Laurent Gbagbo. Gbagbo’s refusal to cede office led to five months of violence that claimed at least 3,000 lives before Ouattara’s forces won.

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6 actually useful smartphone apps to get you through Black Friday

Gracefully navigate the shopping madness by doing a little prep work on your iPhone or Android before you leave the house

Ah, the holidays! Big-box stores compete with online behemoths for customers, while customers compete with each other to get the best Black Friday savings. And, in a new digital twist, Black-Friday-focused apps are competing with one another for downloads. Developers are creating all sorts of helpful ways for customers to sniff out bargains, track spending, and manage their nephew’s wish list. Now that The Week has advised you on Black Friday “deals” to avoid, here’s a rundown of some of the more helpful apps out there: 

Black Friday by BradsDeals
The folks behind BradsDeals.com, a site known for tracking down coupons and discounts, put together this helpful Black Friday app that shows you all the leaked ads and discounted items from 100 major retailers like Sears, Kohls, and Macy’s. Who needs a newspaper? (iPhone-only)

Black Friday Deal Finder by Fat Wallet
Search for deals using variables like free shipping, doorbusters, online availability, rebates, and more. Useful for planning but also recommended for any quick-witted shopper who wants to do in-store product comparisons. (iPhone-only)

Black Friday app from DealNews
Both PC World and PC Magazine voted DealNews tops in its category thanks to its exhaustive, well-organized catalog. Like the other apps, this one lets you browse “leaked” and “confirmed” ads from major retailers so you can plot out your plan of attack beforehand. (iPhone, Android)

ShopSavvy Barcode Scanner
Use your phone’s camera to scan products for instant price comparisons — no need to painstakingly input your search queries while angry shoppers slam you with their carts. If there’s a better deal around you or online, this app will let you know. (iPhone, Android)

Wunderlist
Was it your nephew Charlie who wanted the new Call of Duty game? Or was that your boss’ son Jimmy? Instead of checking your list twice, try WunderList, a super-simple task management tool that syncs lists on your desktop, iPhone, and more. (iPhone, Android) 

Mint.com Personal Finance
The whirlwind holiday shopping season can make it difficult to keep your finances in check. One solution: Mint, a virtual-money manager that automatically keeps tabs on your bank and credit card accounts to help you master your budget with a friendly, easy-to-use interface. Best of all, it’s useful well after January rolls around; no wonder TIME Magazine named it one of the 50 best iPhone apps out there. (iPhone, Android)

SEE ALSO: Get rich quick: 6 people who accidentally found a fortune

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McCartney, Houston, Dylan lead Grammy Hall of Fame inductees

LOS ANGELES (Reuters) – Music by Paul McCartney, Bob Dylan, Elton John and late singers Whitney Houston and James Brown will be inducted into the 2013 Grammy Hall of Fame, The Recording Academy said on Wednesday.

Paul McCartney & Wings‘ 1973 album “Band on the Run,” long credited with reigniting McCartney’s career following the Beatles’ split in 1970, was one of the 27 new inductees into the Grammy Hall of Fame, on display at the Grammy Museum in downtown Los Angeles.

Houston‘s self-titled 1985 debut album was also named an inductee, following the singer’s sudden death aged 48 in February this year. Australian hard-rock band AC/DC’s top-selling 1980 “Back in Black” album was also named a new entry.

The Recording Academy, which also runs the Grammy awards, picks songs and albums from all genres that are at least 25 years old, with either “qualitative or historical significance” to be considered annually for the Grammy Hall of Fame by a committee.

“Memorable for being both culturally and historically significant, we are proud to add (the 2013 inductees) to our growing catalog of outstanding recordings that have become part of our musical, social and cultural history,” The Recording Academy President and CEO Neil Portnow said in a statement.

As well as albums, the Grammy Hall of Fame also includes songs of historic and cultural significance and the inductees for 2013 see a range of classic American songs.

Iconic Dylan song “The Times They Are A-Changing” from 1964, R&B singer Ray Charles’ 1961 tune “Hit the Road Jack,” Rat Pack star Frank Sinatra’s 1980 “Theme from ‘New York, New York’”, and ‘Godfather of soul’ James Brown‘s 1965 classic “I Got You (I Feel Good)” were all honored.

Other 2013 inductees include Elton John‘s 1970 self-titled second album and American debut, Billy Joel’s 1973 hit “The Piano Man” and Willie Mae “Big Mama” Thornton’s 1953 R&B classic “Hound Dog,” later covered by Elvis Presley.

(Reporting By Eric Kelsey; Editing by Piya Sinha-Roy and Andrew Hay)

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Longer waits for breast cancer patients on Medicare

NEW YORK (Reuters Health) – Women with a new diagnosis of breast cancer who are covered by Medicare are waiting longer and longer to get treatment, according to a new nationwide study.

Researchers found that between 1992 and 2005, the average waiting time between being diagnosed and having surgery rose from 21 days to 32 days. The delay was especially long for black and Hispanic women, and for those living in large cities.

Still, the study team noted, it’s unclear how big a difference the extra week or two would make in women’s long-term health.

“I don’t believe the delays we’re seeing here are problematic, (but) we’re clearly going to need to keep any eye on it because if those delays keep increasing, they may become problematic,” said the study’s lead author, Dr. Richard Bleicher.

Bleicher, from Fox Chase Cancer Center in Philadelphia, and his colleagues analyzed cancer registry data and Medicare claims for 72,586 older adults diagnosed with breast cancer between 1992 and 2005, 99 percent of whom were women.

Over that period, both the time between a patient’s first breast cancer-related visit and her first biopsy increased, as did the time between biopsies and surgery, according to findings published this week in the Journal of Clinical Oncology.

When the researchers accounted for patient characteristics such as tumor stage, as well as number and type of pre-surgery visits and screenings, the relative delay shrank from 11 days to five days.

Whether the extra waiting in more recent years is “clinically meaningful” remains to be seen, according to Bleicher‘s team.

Another report published in the same journal found that for women with advanced cancer, waiting 60 days or more for treatment was tied to a greater likelihood of dying in the five years after diagnosis.

Shorter delays, however, weren’t associated with worse outcomes.

Among 1,786 North Carolina women on Medicaid, the average time between diagnosis and treatment – usually surgery – was 22 days between 2000 and 2002, Dr. Electra Paskett from The Ohio State University in Columbus and her team found.

The length of that interval didn’t seem to affect a woman’s chance of surviving early-stage breast cancer. But for those with late-stage cancer, women who waited 60 days or more between diagnosis and treatment were 66 percent more likely to die of any cause over the next five years and 85 percent more likely to die of breast cancer, in particular.

In Paskett’s study, one in 10 women waited at least 60 days for treatment.

She pointed out that people on Medicaid, like those in her study, may have more problems getting timely treatment compared to people with private insurance.

“It could be that they had problems finding a doctor who would accept them, because they’re low income, or (there were) scheduling problems with the clinic,” Paskett told Reuters Health.

She recommended health systems look into having “patient navigators” to guide low-income people and others who may need help through the treatment process.

Bleicher said doctors and health systems can start using the new data to figure out how to consolidate the biopsies, second opinions and other visits that often happen between diagnosis and treatment.

But for now, he told Reuters Health that women with breast cancer shouldn’t panic if it takes them a few weeks to coordinate their surgery.

“Getting to the operating room for treatment is not something that’s an emergency, even though it feels like one,” Bleicher said.

Up to 60 days, Paskett said, should be “plenty of time to get second opinions, plenty of time to get consults and things like that.”

SOURCE: http://bit.ly/10tpzc9 and http://bit.ly/10tpIMu Journal of Clinical Oncology, online November 19, 2012.

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