Fw: Cancer drug shortages

This is one of the problems that drives health care costs up. Are there government regulations that are causing these shortages? Is government impedeing competition? Who can help us answer these questions? We must find free market answers to drive down the cost of health care! J.Paul   U.S. cancer drugs shortage has doctors scrambling Health » By Debra Sherman and Julie Steenhuysen CHICAGO | Tue Jun 7, 2011 1:41pm EDT CHICAGO (Reuters) - Cancer medicines desperately needed by sick children and adults are in short supply, undermining the ability of U.S. doctors to administer treatments, top oncologists warned this week. Many drugs are scarce because there is no incentive for drugmakers to manufacture low-cost generics, which have slim profit margins for pharmaceutical companies. Doctors do not expect that equation to change any time soon, making them scramble to find acceptable alternatives, or to ration or delay treatment when they cannot. Generic chemotherapy drugs are in particularly tight supply at the nation's hospitals, including mainstay cancer treatments such as cisplatin, doxorubicin, cytarabine and leucovorin. "These are chestnuts. These are not old-fashioned drugs. They remain incredibly important drugs which serve as the backbone for treating many of the most common and treatable cancers," said Dr. Robert Mayer of the Dana-Farber Cancer Institute in Boston and a past president of American Society of Clinical Oncology (ASCO) which held its annual meeting in Chicago this week. Cisplatin is used to treat testicular, bladder and ovarian cancers that have spread. The drug, also used to treat lung cancers, is sold under multiple brand names, originally by Bristol-Myers Squibb. A generic form is sold by Teva Pharmaceutical Industries Ltd, among others. Doxorubicin, also available under multiple brands and as a generic from Teva and others, is used to treat non-Hodgkin's lymphoma, multiple myeloma, acute leukemias and other cancers. Cytarabine, produced by Hospira Inc and others, is used to treat certain types of leukemia. Leucovorin, also sold by Teva, is used along with certain chemotherapy drugs to treat colorectal, head and neck and other cancers. Dr. Michael Link, a pediatric oncologist at the Mayo Clinic and current ASCO president, called it a disheartening crisis. "Here we have highly effective drugs, they've been shown they work and to think we don't have them available is almost unconscionable," Link said. "We don't see an end in sight." In some cases, doctors can substitute another drug for one that is in short supply. "It's still uncomfortable to say that this is ideally what we'd like to do, but unfortunately we don't have it," Link said. "You can imagine the conversation and I'm sure they're going on all over -- doctors have to tell their patients or their patients' parents that we can't give them the proven drug because we don't have it." NO SUBSTITUTE For some of these medicines in short supply, there may not be acceptable alternatives. "One could say that substituting Pepsi for Coca-Cola doesn't make a difference. Maybe it does and maybe it doesn't," Mayer said. "But more often it might be substituting 7-UP for Coca-Cola, and that might make a difference." Leucovorin, a form of folic acid that is used to enhance the effectiveness of other chemotherapy drugs, is one example. "This is the one that I hear the most about from my colleagues. If you don't have it, you just have to omit it. It certainly isn't in the best interest of patients. It is a very inexpensive drug," Mayer said. Sophia Parhas, a pharmacy manager at Children's Memorial Hospital in Chicago, said if there is a shortage of the generic, the hospital will often buy the branded product. "We make some substitutions ... so doctors will go back and forth between daunorubicin and doxorubicin, depending upon which one is short," she said. Another option is for doctors to flip the order that drugs are given depending on the supply situation. Allen Vaida, executive vice president of the Institute for Safe Medical Practices, which has been tracking the shortage, said doctors have also been forced to delay or ration treatments. "Patients are started on a therapy and they may go through four or five or six cycles. When a drug becomes short, your cycle may be coming up a month later than planned," he said. "Oncologists, especially in major cancer centers, are in a quandary. 'Do I start my patient on therapy? Do I save what I have for patients who started two cycles ago?'" Dr. Richard Schilsky, cancer specialist at the University of Chicago and a past ASCO president, said the shortages have been going on for about nine months with no sign of abating. "When you talk to the drug companies, they say there are manufacturing problems or they are taking plants offline and then it takes a while to get them back up," he said. "They point the finger at the FDA (Food and Drug Administration), saying the FDA is under-resourced and they can't get plants inspected to allow resumption of drug production. The drug suppliers are in the middle of this as well," he said. But underlying all of this, he said, is a dearth of financial incentive to make the lower-cost cancer drugs, especially when new cancer drugs command huge premium prices. "The return on investment of manufacturing generic drugs is pretty low. If something goes wrong, it may be that some manufacturers decide to pull out rather than fix the problem." Hospira spokesman Dan Rosenberg said shortages arise for many reasons -- capacity constraints, commodity shortfalls, or when a competitor withdraws its product for some reason or when competitors have shortfalls. It is not always possible for Hospira to ramp up production that quickly, Rosenberg said. "We are doing everything we can to ensure access to these products for clinicians and patients," he said. "Often, we continue manufacturing products at a loss because we realize there is a critical medical need and we are the only company that provides the medication." A Teva spokesman said its California plant that makes injectable drugs, which was closed last year due to quality issues, is now back up. But the plant will not reach full capacity until the end of this year. To address the shortages, U.S. senators Amy Klobuchar, a Democrat from Minnesota, and Robert Casey, a Democrat from Pennsylvania, introduced a bill in February that would make drug companies inform the FDA about supply problems or plans to stop making a drug. The FDA would then have time to work with other suppliers to make the drugs or arrange for imports. "That is a canary in the coal mine," Schilsky said. "It doesn't really resolve the fundamental problem." (Reporting by Debra Sherman and Julie Steenhuysen; Editing by Michele Gershberg and Matthew Lewis) J. Paul Brown Colorado State Representative House District 59 State Capitol 200 E. Colfax, Room 271 Denver, Colorado 80203 303-866-2914

Fw: Brown's Bill to Modernize the Alternative Fuel Tax Credit Signed into Law

J. Paul Brown Colorado State Representative House District 59 State Capitol 200 E. Colfax, Room 271 Denver, Colorado 80203 303-866-2914   --- On Fri, 6/3/11, Owen Loftus <Owen.Loftus@state.co.us> wrote: From: Owen Loftus <Owen.Loftus@state.co.us> Subject: Brown?s Bill to Modernize the Alternative Fuel Tax Credit Signed into Law To: Date: Friday, June 3, 2011, 9:21 AM Colorado House of Representatives State Capitol Denver, Colo. 80203 FOR IMMEDIATE RELEASE June 3, 2011 Contact: Owen Loftus, 303-866-5679         Contact: Michelle Yi, 303-866-2988 Brown's Bill to Modernize the Alternative Fuel Tax Credit Signed into Law Measure Allows Vehicles that Run on Liquefied Petroleum Gas to Qualify for Alternative Fuel Tax Credit DENVER—A measure that will help rural communities and the environment was signed into law on Thursday evening.   House Bill 1081, sponsored by State Rep. J. Paul Brown, brings the state's alternative fuel tax credit in line with the federal definition of alternative fuels by including in the credit vehicles converted to run on a propane and butane mixture known as liquefied petroleum gas.   Vehicles that currently qualify for the alternative fuel tax credit are hybrid gas and electric vehicles, as well as vehicles that run on compressed natural gas, propane, ethanol or electricity.   "The measure is important to the state, especially rural parts like Southwestern Colorado.  Families and small businesses need all the help they can get with gas prices on the rise," said Brown, R-Ignacio.  "By extending the alternative fuel tax credit to vehicles that use liquefied petroleum gas, more families and small businesses can use energy efficient vehicles that are more affordable."   The tax credit is only available in the year the vehicle was bought or converted.   The law goes into effect on Jan. 1, 2014.                     ### Owen K. Loftus Majority Press Secretary Colorado House of Representatives 303-866-5679 (o) 719-406-6564 (c) owen.loftus@state.co.us

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For some reason long term health care facilities (nursing homes) have not had the authority under state law to employ a physician. This only makes sense to me. Many times nurses need a Doctors help and advice in caring for folks in these homes. SB 11-084 is a remedy for this. The bill passed through the house and is headed for the Governor for signature. This seemed to me to be a common sense bill that should have been law many years ago.
 

J. Paul Brown

Colorado State Representative

House District 59

State Capitol

200 E. Colfax, Room 271

Denver, Colorado 80203

303-866-2914

 

We deal with a lot of different issues. Recently we passed SB 11-081 which extended the period for which state income tax return forms shall include a line allowing taxpayers to make a voluntary contribution to the 9Health Fair fund. There are 15 places on the Colorado income tax forms for different contributions to benefit the specific benefits. Each beneficiary must collect at least  $75000 per year or it is eliminated and another benefit takes it's place. There is usually a sunset clause which requires the legislature to recertify the line. That is what SB 11-081 did. As long as contributions to the 9Health Fair Fund are at least the minimum amount you will see it on your income tax form until January 1, 2016. The bill is headed to the Governor for signature.
 

J. Paul Brown

Colorado State Representative

House District 59

State Capitol

200 E. Colfax, Room 271

Denver, Colorado 80203

303-866-2914

 

2/14/11 Legislature, Ag committee

HB11-1107 concerning enforcement of illegal immigration violations was Postponed Indefinitely by the sponsor, Rep. Baumgardner. It may come back at a later date. HB11-1068 which would have allowed leasing agricultural water for up to 80 years by the authority of the state water engineer and not through the water courts was postponed indefinitely by the bill sponsor Rep. Fisher. I strongly opposed the bill because it bypassed current water law and would take water out of ag production without evaluating the effect on water rights. J. Paul Brown Colorado State Representative House District 59 State Capitol 200 E. Colfax, Room 271 Denver, Colorado 80203 303-866-2914

Thought for the Day

"We must not let our rulers load us with perpetual debt."  --Thomas Jefferson J. Paul Brown Colorado State Representative House District 59 State Capitol 200 E. Colfax, Room 271 Denver, Colorado 80203 303-866-2914