January 2009 
In This Issue
Changes at the FDA
Saving Money -our own healthcare at risk
Millions weighing medical costs to find savings
LOS ANGELES TIMES January 2, 2009
Amber Eyerly, 32, says she's never been much good at saving money. But with only minimal raises, at best, expected for 2009 at the Los Angeles public relations firm where she works, Eyerly carefully studied her health insurance benefits package this year to see where she could trim costs.

She made one cut for 2009 by signing up for a medical flexible spending account, which takes money, pretax, from each paycheck to spend on health care costs and reduces her taxable income. And when she read that, unlike trips to a specialist, visits to her primary care doctor don't require her to first pay down a health insurance deductible, Eyerly arranged to have her dermatology records for a minor skin condition sent to her primary care physician, who now writes prescriptions for any dermatology medicines the young executive needs.

Eyerly's personal health cost review is being repeated across the country, as the economic downturn worsens and jobs - and the benefits that often come with them - get slashed. "Millions of consumers are weighing their medical costs and trying to see what expenses they can jettison to save some money," says Cathy Tripp, a senior consultant in the Minneapolis office of benefits consulting firm Watson Wyatt.

A Watson survey of 2,500 U.S. employees released this month found that 17 percent of those surveyed had avoided a recommended doctor's visit this year to save costs (the question was not asked in the firm's 2007 survey). And 17 percent did not fill a prescription or skipped doses of prescribed medicine, an increase from 13 percent in 2007.

But health care leaders worry that short-term savings could lead to serious illness, and even deaths. "We're seeing that consumers are willing to take risks by not doing what they perceive to be small things, such as putting off going to the doctor and deciding not to pay for medicines," says Dana Goldman, head of health economics at research firm Rand Corp. in Santa Monica. "That puts the individual at risk, but the potential harm doesn't stop with them," Goldman says. "It also becomes a problem for society if, for example, infections spread because some people don't fill a needed antibiotic prescription, or if an increase in hospitalizations for chronic illnesses places a deeper financial burden on a hospital or city."

Says J. James Rohack, president-elect of the American Medical Association: "Consumers need to take steps to stay healthy, such as getting exercise and losing weight, if necessary, and finding help through private and public channels to help pay for health care costs."
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Jean Rexford
Executive Director
P.O Box 231335
Hartford, CT 06123 
One prominent candidate to head the federal agency:Joshua Sharfstein, Baltimore's health commissioner.
A big dose of change prescribed for FDA
Obama seeks a new head for the beleaguered agency.
By Miriam Hill
Inquirer Staff Writer
President-elect Barack Obama is prowling for a new head for the U.S. Food and Drug Administration, which, in the eyes of some outraged Americans, is like hunting for someone to put tainted toothpaste back in its tube.
In the last several years, the agency has lurched from crisis to crisis. Whether the problem was poisonous pet food, sullied toothpaste and blood-thinner from China; food-borne salmonella; or dangerous drugs such as Vioxx, the FDA has appeared to be unprepared at best and compromised by industry at worst.
Critics of the agency, including some of its own scientists, have said it caters more to the pharmaceutical industry than to the public's safety needs. Some scientists wonder whether it's even possible to protect everyone in the modern economy, where drugs and food ingredients come from all over the world.
And another thing: The FDA has a budget of only $2 billion to oversee $1 trillion in drugs, medical devices and food. It's a pittance by Washington standards. The Centers for Disease Control and Prevention, by contrast, has $8.8 billion.
Who would want the job?
"There is so much wrong with the FDA that what is needed is a new approach. That includes more funding and more regulation and leadership that comes from outside, not inside," said Tom Kline, a Philadelphia plaintiff's lawyer who was involved in suing Merck & Co. Inc. over its Vioxx pain reliever.
Garret FitzGerald, who heads the pharmacology department at the University of Pennsylvania School of Medicine and was coauthor of a recent report on the agency, agreed.
"The first challenge is to restore the American public's confidence in the FDA, and also the world's, because they tend to rely on us," FitzGerald said.
The need for change could collide with the wishes of the pharmaceutical industry, which donates millions to politicians every year.
The current FDA commissioner, Andrew von Eschenbach, has told his staff that he plans to resign effective Jan. 20. Von Eschenbach, a Philadelphia native who graduated from St. Joseph's University, said he would work with Obama's transition team to ensure a smooth transfer of leadership.
Even the FDA has admitted that change is necessary.
The list of candidates has focused on:
Joshua Sharfstein, a member of Obama's transition team and Baltimore's health commissioner.
Steven Nissen, the head of the cardiology department at the Cleveland Clinic and a leading drug researcher who has called for an industry overhaul.
Also on the list, but generating less buzz, are:
Frank Sasinowski, a former FDA staffer who now is an industry lawyer.
Susan Wood, who left the FDA after a battle over whether politics influenced the agency's decision about the emergency contraceptive known as Plan B, or the "morning-after pill."
Cardiologist Robert Califf, who oversees clinical trials at Duke University.
Janet Woodcock, the current director of the FDA's Center for Drug Evaluation and Research.
Only Sasinowski agreed to an interview. He would not say whether he had been contacted about the job but said he wanted to restore the public's confidence in the FDA and to capitalize on its expertise as the country considers overhauling its health-care systemArticle Headline

MRSA fight extends into the community
By Anne Zieger Comment | Forward
MRSA continued to extend its terrifying grip both in and outside healthcare settings during 2008, including the emergence of new strains and more appearances outside of healthcare settings.This year, MRSA increasingly showed up in community settings like schools and sports teams, and a deadly strain also struck men in predominantly gay communities in San Francisco and Boston.

Experts say the spread of MRSA (and other antibiotic-resistant bugs) is inevitable, but aren't quite sure how to contain it. Several studies gave varying answers to the question of whether screening patients would reduce MRSA infection rates, though aggressive screening of health workers was highly recommended.
In the meantime, patient advocates have been fighting to find out what the infection rates were in their area hospitals, and states like Washington started tracking MRSA cases in response. However, California decided just to track community infections and took a drubbing for it. States are likely to remain cautious about such demands for some time to come, unfortunately. Until hospitals get comfortable baring their souls when it comes to infection rates, this is going to be a controversial issue.
Next year might see more progress on the control of MRSA, however. Several promising new ways to fight MRSA infections were discovered this year, including careful monitoring of the use of antibiotics and an experimental antibiotic called oritavancin.