The Health Shopper

A New York Times editorial notes that two recent studies have found that older anti-psychotic drugs-used to treat schizophrenia and other mental health concerns-are just as effective as newer and far more expensive drugs in children ages 8 to 19.  The studies, which looked at Zyprexa, Risperdal and an older generic drug, "found no clear difference… in relieving the symptoms of schizophrenia." There was one major difference, however: Side effects. On average, children taking Zyprexa and Risperdal gained anywhere from eight to 13 pounds along with "changes in cholesterol and insulin levels that can increase the risk of diabetes."

So, to recap: The newer drugs are far more expensive, no more helpful, and more likely to cause detrimental side effects.

Los Angeles Times consumer affairs reporter David Lazarus has written an informative primer on some of the key differences between drugs and dietary supplements such as vitamins. The key difference: Unlike pharmaceutical drugs, which must go through rigorous testing to prove their safety and effectiveness, supplements don't undergo any scrutiny unless complaints about their safety start to pile up. 

And pile up they have, at least in a couple cases. In the past month, the CEO of Enzyte-which offered "natural enhancement for men"-was sentenced to 25 years in prison "for bilking customers out of $100 million." The manufacturer of Airborne-a common herbal supplement that individuals take to ward off colds-has paid $30 million in fines for making unsubstantiated claims.  And a recent study in the Journal of the American Medical Association found that supplements with the chemical Ayurvedic can lead to dangerously high levels of metals in the bloodstream.

A good suggestion from the New York Times: Call your doctor's office for your test results. The Times cites a study published in the journal Quality and Safety in Health Care that finds that errors occurs in about one in four lab tests, and in 7 percent of tests, or about one out of 14 cases, doctors and labs fail to notify patients of their test results. Although many patients assume that no news is good news, that isn't necessarily the case. Many of the patients who didn't get their test results-approximately 75 percent of them-had to pay more, suffered from poorer health, or were otherwise adversely affected by not receiving their test results.  So call your doctor.

A new clinical trial has found that Vytorin, a cholesterol drug with $5 billion in annual revenue taken by 3 million Americans, doesn't lower heart disease risk but may increase cancer risk. The limited good news from the trial is that, according to Business Week, is that the increase in cancer risk has not been proven conclusively, and since there is no clear cause for an increase in cancer risk and other trials have not shown similar results, it is possible that the results were ultimately a fluke.

Still, not good news.  A few months ago, the leading professional group for cardiologists recommended against prescribing Vytorin, though some patients are still on the drug.  Definitive proof about the drug's effectiveness is expected in 2012.

Medtral, a New Zealand based hospital, is one of the latest entrants into the growing medical tourism market, where officials hope that U.S. consumers will be attracted to low prices despite the country's higher standard of living. According to the Washington Post, patients at the privately owned hospital receive greater privacy and improved care coordination from nurses, along with follow-up care that is often superior to American follow-up care. Although prices are higher than in common medical tourism destinations such as India, hospital officials say that prices are still below costs in Europe and the United States and that they hope patients will be attracted to the higher standard of living and opportunities to see the country.

The Los Angeles Times has devoted its weekly health section to giving patients advice to find better health care. The Times notes that, even with common but serious treatments-such as heart bypass surgery-patients tend to better by seeing doctors and hospitals who have more experience with the condition. For patients who suffer from less common ailments, it's even more important to look for doctors who have experience with the rare disorder. The Times also suggests:

• Asking doctors for referrals to physicians with more experience in the condition
• Doing research through the government's database of medical trials at www.pubmed.gov
• Looking for clinical trials for the condition at www.clinicaltrials.gov
• Finding support groups-they can give emotional support and valuable advice about treatments
• Remaining realistic. There won't always be a cure and if there is, it may be expensive.

A study by Katzenbach Partners finds that customer service in the health care industry lags behind service in most other industries. According to the study, 26 percent of respondents had switched or thought about changing doctors due to an unpleasant experience, and nearly as many have used or thought about using retail clinics to avoid doctors and hospitals. Two in five said that banks provide better service than health providers, while one in five said that airlines provide better service.

According to Katzenbach's researchers, poor customer service impacts care quality and cost by causing consumers to shop around for doctors unnecessarily-leading to different doctors to duplicate tests. Consumers who do not trust doctors may be less likely to seek out treatment when necessary or understand and comply with follow up care instructions.

Two studies released at the American College of Cardiology suggest that older generics are at least as effective as newer drugs for most patients-and a lot cheaper. One study, of patients who took Vytorin, found that while the two drugs in combination helped reduce cholesterol and other risk factors for heart disease, the combination did not actually do any better than older generics at preventing heart disease. Writing in the New England Journal of Medicine, said that the drugs-which have generated $5 billion in sales in the past few years-should be used as a treatment of last resort.

A second study found that ACE Inhibitors, an older class of drugs used to treat high blood pressure, was as effective as newer ARB drugs at preventing heart attacks and other complications due to high blood pressure. The study, which tracked 17,000 patients over 56 months, found that patients taking the ACE inhibitors did just as well as patients taking ARBs in terms of medical outcomes-at a cost savings of about 20 percent per pill.

The Society for Clinical Oncology is developing guidelines to help oncologists discuss the financial costs of chemotherapy drugs with their patients. The specialty group is creating the guidelines in response to the rise in the number of cancer medications that can cost tens, if not hundreds of thousands of dollars, and to an average 15 percent annual increase in cancer treatment costs. Under the proposal, doctors would "treat cost essentially as another side effect to weigh in choosing a therapy" in order to help patients decide if the extra costs make sense medically and financially, particularly for terminal patients who may be balancing quality of life considerations with the potential for drugs to help prolong their lives.

Several insurance companies are placing restrictions on CT scans for policyholders and in many instances are requiring plan members to receive pre-authorizations before undergoing the scans. Insurers are following the lead of Medicare, which announced and then retracted restrictions on CT scans, due to limited clinical evidence supporting their use. At the time of Medicare's reversal, the New York Times noted that "The proposal to curtail payments met with fierce resistance from doctors who perform these scans and companies that make the equipment" who "strongly defended the scans." Medicare alone spent as much as $50 million on the scans in 2006, and in the past six years, their use has been increasing 13 percent annually.

Evidence in favor of their widespread use remains weak, however. A few months ago, Consumer Reports listed CT Scans as one of the ten most overused medical treatments in the United States. A month later, a group of researchers writing in the New England Journal of Medicine found that approximately one third of CT scans were unnecessary, exposing "perhaps 20 million adults and, crucially, more than 1 million children per year in the United States" to a radiation dose roughly equal to 85 to 200 chest x-rays.

The good news is that requiring pre-authorizations seems to work. According to a study by the Robert Wood Johnson Foundation's Center for Health System Change, a health plan that required pre-authorization of the scans successfully reduced the growth rate on scans while denying only 1.5 percent of scan requests. As one insurer said, "We're not saying ‘No' that much, but because people have to now justify what difference the test is going to make, they aren't requesting it as much."