First Responders Face Haunting Memories






Police and paramedics who descended on the scene of the massacre at a Connecticut grade school face haunting memories and nightmares in the days and weeks to come, particularly if they have children of their own, experts say.


Twenty children and seven adults were killed Friday after a gunman opened fire at Sandy Hook Elementary School in Newtown, Conn. The shooter, identified as 20-year-old Adam Lanza, then killed himself.






“How the first responders react depends on how closely they identify with the victims,” said Dr. Charles Marmar, chair of psychiatry at NYU Langone Medical Center in New York City. “Let’s say somebody has a son or a daughter the same age as the victims — we know that makes a big difference.”


CLICK HERE for full coverage of the tragedy at the elementary school.


After the initial shock of such a violent attack fades, first responders sometimes struggle with flashbacks and sleep disturbances that can take a personal and professional toll.


Neal Schwieterman, a first responder at the 1999 Columbine massacre, still struggles with memories of what he saw there.


“Part of me is still missing from that day,” said Schwieterman, who was a sheriff’s deputy in his last week with the Jefferson County Police Department at the time. “I will never be the same.”





Alex von Kleydorff/AP Photo







Newtown Teacher Kept 1st Graders Calm During Massacre Watch Video





Newtown School Shooting: What to Tell Your Kids Watch Video



Schwieterman rushed to the scene where he evacuated eight carloads of wounded students.


“It’s a grieving process for everyone after this kind of thing, including first responders,” said Schwieterman, who sought counseling to cope with the harrowing day. “It took a complete toll on me, and rightfully so.”


Schwieterman was not a father at the time, but now has a 10-year-old daughter.


“I just can’t imagine,” he said of the Newtown shooting. “It rips your heart out.”


CLICK HERE for live updates on the Connecticut school shooting.


Experts say first responders are surprisingly resilient, with the vast majority recovering from the stress of a horrific scene within days or weeks.


“But some will continue to have symptoms, and those people will probably benefit from some form of counseling,” said Dr. Spencer Eth, a professor of clinical psychiatry at the University of Miami. “Unfortunately, when it comes to police, they sometimes try to act tough even when they’re feeling badly, and that’s an obstacle to getting the help they need to recover.”


The fact that most of the victims in Newtown were children, Eth said, could mean more first responders will need counseling.


“The shock and horror of seeing children killed is more personally distressing than almost any other situation they have to deal with,” he said, adding that first responders in many cases are also responsible for notifying families of the deceased. “Having to notify parents of their child’s death is among the most difficult things they have to do in their professional lives.”


With help, first responders can learn to cope. But they can never forget. Schwieterman, who is now the mayor of Paonia, Colo., still speaks of Columbine with a shaky voice, pausing often to gather himself. And when he heard about the Newtown shooting, he knew his phone would be ringing.


“I’ve had several family members call and ask if I’m doing OK,” he said. “That kind of support helps you through these things.”


Health News Headlines – Yahoo! News


Read More..

20 children, 6 adults killed at Conn. school shooting



Twenty children died today when a heavily armed man invaded a Newtown,
Conn., elementary school and sprayed staff and students with bullets.



The gunman, identified as Adam Lanza, 20, was found dead in the school.



Lt. Paul Vance said 18 children died in the school and two more died
later in a hospital. Six adults were also slain, bringing the total to
26.



In addition to the casualties at the school, Lanza's mother Nancy Lanza
was killed in her home, federal and state sources told ABC News.



According to sources, Lanza shot his mother in the face, then left his
house armed with at least two semi automatic handguns, a Glock and a Sig
Sauer, and a semi automatic rifle. He was also wearing a bullet proof
vest.



Lanza drove to Sandy Hook Elementary School and continued his rampage,
killing 26 people, authorities said. He was found dead at the school. It
appears that he died from what is believed to be a self inflicted
gunshot wound. The rifle was found in his car.



In the early confusion surrounding the investigation, federal sources
initially identified the suspect as Adam's older brother Ryan Lanza, 24.
He is being questioned by police.



LIVE UPDATES: Newtown, Conn., School Shooting



"Evil visited this community today," Gov. Dan Malloy said at a news conference this evening.



First grade teacher Kaitlin Roig, 29, locked her 14 students in a class bathroom and listened to "tons of shooting" until police came to help.



"It was horrific," Roig said. "I thought we were going to die."



She said that the terrified kids were saying, "I just want Christmas…I don't want to die. I just want to have Christmas."



A tearful President Obama said there's "not a parent in America who doesn't feel the overwhelming grief that I do."



The president had to pause to compose himself after saying these were
"beautiful little kids between the ages of 5 and 10." As he continued
with his statement, Obama wiped away tears from each eye.



He has ordered flags flown as half staff.



CLICK HERE for more photos from the scene.



The alert at the school ended when Vance announced, "The shooter is deceased inside the building. The public is not in danger."



The massacre prompted the town of Newtown to lock down all its schools
and draw SWAT teams to the school, authorities said today. Authorities
initially believed that there were two gunmen and were searching cars
around the school, but authorities do not appear to be looking for
another gunman.



It is the second worst mass shooting in U.S. history, exceeded only by
the Virginia Tech shooting in 2007 when 32 were killed before the
shooter turned the gun on himself. Today's carnage exceeds the 1999
Columbine High School shooting in which 13 died and 24 were injured.



The Newtown shooting comes three days after masked gunman Jacob Roberts
opened fire in a busy Oregon mall, killing two before turning the gun
on himself.



Today's shooting occurred at the Sandy Hook Elementary School, which
includes 450 students in grades K-4. The town is located about 12 miles
east of Danbury.



State Police received the first 911 call at 9:41 a.m. and immediately
began sending emergency units from the western part of the state.
Initial 911 calls stated that multiple students were trapped in a
classroom, possibly with a gunman, according to a Connecticut State
Police source.



Lt. Paul Vance said that on-duty and off-duty officers swarmed to the
school and quickly checked "every door, every crack, every crevice" in
the building looking for the gunman and evacuating children.



A photo from the scene shows a line of distressed children being led out of the school.



Three patients have been taken to Danbury Hospital, which is also on lockdown, according to the hospital's Facebook page.



"Out of abundance of caution and not because of any direct threat
Danbury Hospital is under lockdown," the statement said. "This allows us
simply to focus on the important work at hand."



Newtown Public School District secretary of superintendent Kathy June
said in a statement that the district's schools were locked down because
of the report of a shooting. "The district is taking preventive
measures by putting all schools in lockdown until we ensure the safety
of all students and staff," she said.



State police sent SWAT team units to Newtown.



All public and private schools in the town were on lockdown.



"We have increased our police presence at all Danbury Public Schools due
to the events in Newtown. Pray for the victims," Newtown Mayor Boughton
tweeted.



State emergency management officials said ambulances and other units were also en route and staging near the school.



A message on the school district website says that all afternoon
kindergarten is cancelled today and there will be no midday bus runs.




Also Read

Read More..

NKorea rocket launch shows young leader as gambler






PYONGYANG, North Korea (AP) — A triumphant North Korea staged a mass rally of soldiers and civilians Friday to glorify the country’s young ruler, who took a big gamble this week in sending a satellite into orbit in defiance of international warnings.


Wednesday’s rocket launch came just eight months after a similar attempt ended in an embarrassing public failure, and just under a year after Kim Jong Un inherited power following his father’s death.






The surprising success of the launch may have earned Kim global condemnation, but at home the gamble paid off, at least in the short term. To his people, it made the 20-something Kim appear powerful, capable and determined in the face of foreign adversaries.


Tens of thousands of North Koreans, packed into snowy Kim Il Sung Square, clenched their fists in a unified show of resolve as a military band tooted horns and pounded on drums.


Huge red banners positioned in the square called on North Koreans to defend Kim Jong Un with their lives. They also paid homage to Kim Jong Un’s father, Kim Jong Il, and his grandfather, North Korean founder Kim Il Sung.


Pyongyang says the rocket put a crop and weather monitoring satellite into orbit. Much of the rest of the world sees it as a thinly disguised test of banned long-range missile technology. It could bring a fresh round of U.N. sanctions that would increase his country’s international isolation. At the same time, the success of the launch could strengthen North Korea’s military, the only entity that poses a potential threat to Kim’s rule.


The launch’s success, 14 years after North Korea’s first attempt, shows more than a little of the gambling spirit in the third Kim to rule North Korea since it became a country in 1948.


“North Korean officials will long be touting Kim Jong Un as a gutsy leader” who commanded the rocket launch despite being new to the job and young, said Kim Byung-ro, a North Korea specialist at Seoul National University in South Korea.


The propaganda machinery churned into action early Friday, with state media detailing how Kim Jong Un issued the order to fire off the rocket just days after scientists fretted over technical issues, ignoring the chorus of warnings from Washington to Moscow against a move likely to invite more sanctions.


Top officials followed Kim in shrugging off international condemnation.


Workers’ Party Secretary Kim Ki Nam told the crowd, bundled up against a winter chill in the heart of the capital, that “hostile forces” had dubbed the launch a missile test. He rejected the claim and called on North Koreans to stand their ground against the “cunning” critics.


North Korea called the satellite a gift to Kim Jong Il, who is said to have set the lofty goal of getting a satellite into space and then tapped his son to see it into fruition. The satellite, which North Korean scientists say is designed to send back data about crops and weather, was named Kwangmyongsong, or “Lode Star” — the nickname legendarily given to the elder Kim at birth.


Kim Jong Il died on Dec. 17, 2011, so to North Koreans, the successful launch is a tribute. State TV have been replaying video of the launch to “Song of Gen. Kim Jong Il.”


But it is the son who will bask in the glory, and face the international censure that may follow.


Even while he was being groomed to succeed his father, Kim Jong Un had been portrayed as championing science and technology as a way to lift North Korea out of decades of economic hardship.


“It makes me happy that our satellite is flying in space,” Pyongyang citizen Jong Sun Hui said as Friday’s ceremony came to a close and tens of thousands rushed into the streets, many linking arms as they went.


“The satellite launch demonstrated our strong power and the might of our science and technology once again,” she told The Associated Press. “And it also clearly testifies that a thriving nation is in our near future.”


Aside from winning him support from the people, the success of the launch helps his image as he works to consolidate power over a government crammed with elderly, old-school lieutenants of his father and grandfather, foreign analysts said.


Experts say that what is unclear, however, is whether Kim will continue to smoothly solidify power, steering clear of friction with the powerful military while dealing with the strong possibility of more crushing sanctions. The United Nations says North Korea already has a serious hunger problem.


“Certainly in the short run, this is an enormous boost to his prestige,” according to Marcus Noland, a North Korea analyst at the Peterson Institute for International Economics in Washington.


Noland, however, also mentioned the “Machiavellian argument” that this could cause future problems for Kim by significantly boosting the power of the military — “the only real threat to his rule.”


Successfully firing a rocket was so politically crucial for Kim at the onset of his rule that he allowed an April launch to go through even though it resulted in the collapse of a nascent food-aid-for-nuclear-freeze deal with the United States, said North Korea analyst Kim Yeon-su of Korea National Defense University in Seoul.


The launch success consolidates his image as heir to his father’s legacy. But it could end up deepening North Korea’s political and economic isolation, he said.


On Friday, the section at the rally reserved for foreign diplomats was noticeably sparse. U.N. officials and some European envoys stayed away from the celebration, as they did in April after the last launch.


Despite the success, experts say North Korea is years from even having a shot at developing reliable missiles that could bombard the American mainland and other distant targets.


North Korea will need larger and more dependable missiles, and more advanced nuclear weapons, to threaten U.S. shores, though it already poses a shorter-range missile threat to its neighbors.


The next big question is how the outside world will punish Pyongyang — and try to steer North Korea from what could come next: a nuclear test. In 2009, the North conducted an atomic explosion just weeks after a rocket launch.


Scott Snyder, a Korea specialist for the Council on Foreign Relations, wrote recently that North Korea‘s nuclear ambitions should inspire the U.S., China, South Korea and Japan to put aside their issues and focus on dealing with Pyongyang.


If there is a common threat that should galvanize regional cooperation, “it most certainly should be the prospect of a 30-year-old leader of a terrorized population with his finger on a nuclear trigger,” Snyder said.


____


Jon Chol Jin in Pyongyang, and Foster Klug and Sam Kim in Seoul, South Korea, contributed to this report. Follow Jean H. Lee on Twitter: (at)newsjean.


Asia News Headlines – Yahoo! News


Read More..

Sony’s PlayStation 4 could lose to the next Xbox before it’s even released






I love all game consoles equally. My Xbox 360 is used equally as much as my PlayStation 3. The Wii — oh, I’ll just leave it at that. The current generation of consoles is all but over — 10-year life cycle be damned — and new consoles are rumored to be coming next fall. If not next fall, then in 2014. Whatever is the case, Sony (SNE) can’t afford to lag in third place again. Sure, the Xbox 360 and PS3 are neck-in-neck in global lifetime sales, and the Xbox 360 did have a one year head start, but coming off the disappointing PS Vita, “confidence is less high” that Sony will deliver a console next year in time to compete with Microsoft (MSFT), according to Kotaku.


[More from BGR: Has the iPhone peaked? Apple’s iPhone 4S seen outselling iPhone 5]






I want a new console just as much as any other gamer. There’s a reason people are still pouncing on those Wii U consoles and flipping them on eBay. Six years is unusually long for a console to still be kicking around.


[More from BGR: Apple execs said to be ‘seething’ over Google Maps praise]


According to the well-informed Stephen Totilo, Editor-in-Chief of Kotaku, the game blog that first broke news on the next-gen Xbox, Microsoft’s “Durango” is ”on the mark” and “Sony appears to inspire less confidence…due to the on-and-off troubles of the PlayStation 3 and the struggles of the Vita vs. how much lost confidence is due to any problems looming for PS4.“


Totilo says “confidence is high that the next Xbox will be out in time for next Christmas” and confidence is low that the PS4 will be right there on store shelves next to it.


The “on-and-off troubles of the PlayStation 3″ Totilo is referring to is the anchor that’s weighed the console down since launch: tougher development due to the Cell processor and less available RAM – 256MB vs. 512MB in the Xbox 360.


In the months before the PS3′s launch in 2006, Sony said the console would be the most powerful console ever created, and here we are six years later and multi-platform games on the console consistently end up being buggier and uglier than on the Xbox 360 in many cases. Cases in point: Skyrim, Mass Effect 3 and Call of Duty: Black Ops II.


Sony’s in a rut right now. It has the chops to build beautiful and powerful hardware that’s a developer’s dream (ex: PS Vita), but at the same time, it’s always launching after the competition nowadays.


If Sony’s learned any lessons in the last half a decade, it better apply them to the PS4. The console needs to offer next-level processing and graphics. It needs to be backward-compatible with PS3 games and play Blu-ray discs. It should be small and quiet. It should have a strong online platform, support a greater array of apps and most importantly be easy for developers to program for.


Game exclusives will always be important, but now that games are million-dollar productions, multi-platform will be where developers hope to reap back their costs.


With Microsoft said to be preparing an “Xbox 720″ and an “Xbox Lite,” Sony can’t make the mistake of launching late or pricing the console too high. A launch in spring of 2014 would mean Sony will miss Black Friday and Cyber Monday, the two biggest shopping days of the year that bring in massive sales.  Ceding sales and market share to Microsoft and Nintendo by launching late would be disastrous.


The PS3 screwed up too many times. At this point, the PS4 needs to be perfect out of the door.


This article was originally published by BGR


Get more from BGR.com: Follow us on Twitter, Facebook


Gaming News Headlines – Yahoo! News


Read More..

Matt Damon fracking film in Berlin festival lineup






BERLIN (Reuters) – The Berlin film festival on Thursday announced the first movies of its 2013 lineup, and among the main competition entries will be U.S. director Gus Van Sant‘s drama starring Matt Damon and centering around the controversial shale gas industry.


“Promised Land” will have its international premiere at the annual cinema showcase, although it is scheduled to be launched first in the United States.






According to online reports, “The Bourne Identity” star Damon was originally down to direct the movie tackling the practice of hydraulic fracturing, or “fracking” for shale gas, which has raised concerns over its environmental impact.


The film reunites the actor and film maker after Van Sant directed Damon in the acclaimed 1997 drama “Good Will Hunting”.


Damon was nominated for a best actor Academy Award for his performance and won a screenplay Oscar along with co-writer Ben Affleck for a movie that helped launch their Hollywood careers.


Also in the main competition in Berlin is “Gloria”, directed by Chilean film maker Sebastian Lelio, Korean entry “Nobody’s Daughter Haewon” directed by Hong Sangsoo and Romanian picture “Child’s Pose” by Calin Peter Netzer.


There will be a world premiere for “Paradise: Hope”, the final installment of Austrian director Ulrich Seidl’s Paradise trilogy, while out of competition in Berlin is 3D animation film “The Croods”, featuring the voice of Nicolas Cage.


And under the Berlinale Special heading comes documentary “Redemption Impossible”.


The 63rd Berlin film festival runs from February 7-17.


(Reporting by Mike Collett-White, editing by Paul Casciato)


Movies News Headlines – Yahoo! News


Read More..

Confused by medication guides? You’re not alone






NEW YORK (Reuters Health) – The information sheets that come stapled to certain prescriptions picked up at the pharmacy are too complex and difficult for people to understand, according to a new study.


“Anyone who’s seen these are not going to be surprised by the fact that they’re difficult to read,” said Michael Wolf, the study’s lead author and an associate professor at Northwestern University’s Feinberg School of Medicine in Chicago.






The U.S. Food and Drug Administration-approved medication guides are attached to drugs that the agency considers to have “serious and significant public health concerns,” according to the report.


Patients are supposed to read the guides before taking the drugs to learn about risks, side effects, potential interactions with other drugs and why the medication should be taken as prescribed.


“You want to make sure that message is effective. Otherwise it can do major harm,” Wolf told Reuters Health.


In previous studies, Wolf and his colleagues found several problems with the guides, including patients not understanding their content and – in many cases – not even receiving them along with their medication.


The number of drugs required to be accompanied by a so-called med guide increased from 40 in 2006 to 305 last year. That led the researchers to look into whether the guides had gotten easier to understand.


For the new study, the researchers first analyzed 185 medication guides in April 2010, which represented the majority of those available on the FDA’s website at the time.


On average, the guides were about 2,000 words long, none of the guides had a review section or brief summary and only one met “suitability” guidelines frequently used as the standard for medical education materials.


Then, Wolf and his colleagues asked 449 adults at two Chicago clinics to read three medication guides then answer a series of questions about the drugs, including how they should be stored and their possible side effects. The participants were allowed to refer back to the guides during the test and were not rushed to answer the questions.


On average, the participants were only able to correctly answer half of the questions.


People with the lowest literacy level did the worst, answering only about a quarter of all the questions correctly. That compared to people with the highest level of literacy, who answered about 65 percent of the questions correctly.


The researchers add, however, that the results are limited, because they only tested three medication guides and people may not pay as close attention to the material if they’re not actually taking the drugs.


But, Wolf said, in general people failed the test.


“It was highly educated and lowly educated people. It didn’t make a difference. Everyone struggled,” said Wolf.


In their analysis, Wolf and his colleagues found the guides were typically written for someone at an 11th or 10th grade reading level.


They write in the Journal of General Internal Medicine that the Plain Writing Act of 2010 requires federal agencies to make information available to the public in a clear and understandable way. The Act, however, does not provide a way to measure what is understandable.


Some researchers have suggested that materials be written for people with a 4th to 8th grade reading level.


“If you’ve ever tried to create things at a 4th grade reading level, it’s incredibly difficult. And I don’t know if the evidence is clear as to what grade level is the target,” said Wolf.


There are a few possible solutions to the problem, including creating a uniform guide, which the researchers say is something the pharmaceutical industry and a private institution are working together to develop.


Wolf told Reuters Health that his team is also working with the U.S. Agency for Healthcare Research and Quality to create a how-to guide for medical organizations to make educational materials easy to understand.


He added that they’re also testing a new medication guide prototype in a clinical trial.


Until better guides become available, Wolf said patients should not be afraid to ask their doctors and pharmacists questions.


“Have that conversation when they’re getting it prescribed to them, but understand the pharmacist is available,” he said.


The FDA did not respond to a request for comment.


SOURCE: http://bit.ly/Y19pZ0 Journal of General Internal Medicine, online December 2012.


Medications/Drugs News Headlines – Yahoo! News


Read More..

Rice drops out of race for top State post


Susan Rice (Stephen Lam/Reuters)Susan Rice, the embattled U.S. ambassador to the U.N., withdrew her name on Thursday from consideration to be secretary of state in the face of angry Republican opposition.


"If nominated, I am now convinced that the confirmation process would be lengthy, disruptive and costly—to you and to our most pressing national and international priorities," Rice wrote in a letter to President Barack Obama. (NBC News first reported the news.)


Obama had not formally nominated her, but Rice was the favorite for the post and spent time on Capitol Hill trying—vainly—to placate her Republican critics. The move leaves Democratic Sen. John Kerry, who chairs the Senate Foreign Relations Committee, as the likely front-runner.


In a statement, Kerry praised Rice as "an extraordinarily capable and dedicated public servant" and underlined that "today's announcement doesn't change any of that."


"As someone who has weathered my share of political attacks and understands on a personal level just how difficult politics can be, I've felt for her throughout these last difficult weeks, but I also know that she will continue to serve with great passion and distinction," Kerry said.


Obama confirmed her withdrawal in a statement on Thursday afternoon, saying: "While I deeply regret the unfair and misleading attacks on Susan Rice in recent weeks, her decision demonstrates the strength of her character, and an admirable commitment to rise above the politics of the moment to put our national interests first."


Talk of Rice being nominated to succeed Secretary of State Hillary Clinton stirred significant controversy due to Rice's role in the handling of the Sept. 11, 2012, attack on the U.S. Consulate in Benghazi, Libya. The assault claimed the lives of Ambassador Chris Stevens and three other Americans.


Republicans accused Rice of misleading the public about intelligence that indicated the attack was premeditated. (The Obama administration has also been accused of ignoring requests for increased security at the American compound.) The White House steadfastly denied deliberately misleading the public.


Rice's withdrawal amounted to a painful postelection defeat for Obama, who had staunchly defended Rice and even vowed to nominate her over Republican objections if he concluded that she was the best person for the job. It will be viewed as a win for Arizona Republican Sen. John McCain and other Republican senators who had vowed to block Rice's confirmation.


McCain spokesman Brian Rogers emailed Yahoo News to express that the senator "thanks Ambassador Rice for her service to the country and wishes her well. ... He will continue to seek all the facts about what happened before, during and after the attack on our consulate in Benghazi that killed four brave Americans."


Republican Sen. Lindsey Graham of South Carolina, another leading Rice detractor, declared in a statement on Thursday, "I respect Ambassador Rice's decision." Graham said Obama "has many talented people to choose from" to succeed Clinton.


Graham has accused the administration of stonewalling efforts to look into the Benghazi attack and vowed to keep "working diligently to get to the bottom of what happened."


If Obama picks Kerry, that could touch off a political war in Massachusetts for his Senate seat. Republican Sen. Scott Brown, defeated on Nov. 6 by Democrat Elizabeth Warren, could make a play for that spot.


Obama is expected to overhaul much of his foreign policy and national security teams for the coming term. Defense Secretary Leon Panetta is departing, the position of director of the CIA is open after the David Petraeus scandal and Homeland Security Secretary Janet Napolitano is rumored to be looking to replace Attorney General Eric Holder.



Read More..

Cuban lawmakers meet to consider economy, budget






HAVANA (AP) — Cuban lawmakers are holding the second of their twice-annual sessions with a year-end report expected on the state of the country’s economy.


Legislators are also to approve next year’s budget.






Cuban leaders have sometimes used the parliamentary gatherings to make important announcements or policy statements.


Observers will be watching for word on the progress of President Raul Castro‘s economic reform plan and efforts to promote younger leaders.


The unicameral parliament will reconvene in February with a new membership following elections. It is then expected to name Castro to another five-year term.


State-run media said Castro presided over Thursday’s session.


It was not open to international journalists.


Latin America News Headlines – Yahoo! News


Read More..

Documents: Prisoner plotted to kill Justin Bieber






LAS CRUCES, N.M. (AP) — An imprisoned man whose infatuation with Justin Bieber included a tattoo of the pop star on his leg has told investigators in New Mexico he hatched a plot to kill him.


Court documents in a New Mexico district court say Dana Martin told investigators he persuaded a man he met in prison and the man’s nephew to kill Bieber, Bieber’s bodyguard and two others not connected to the pop star.






He told investigators that Mark Staake and Tanner Ruane headed east, planning to be near a Bieber concert scheduled in New York City. They missed a turn and crossed into Canada from Vermont. Staake was arrested on an outstanding warrant. Ruane was arrested later.


The two men face multiple charges stemming for the alleged plot.


Entertainment News Headlines – Yahoo! News


Read More..

More pressure to justify cost of cancer drugs versus benefits






(Reuters) – Medical providers have begun to think more about cost, as well as safety and effectiveness, when they decide on cancer treatments.


In the past, pharmaceutical companies could launch a high-priced drug with little push back. But now, there is more pressure from insurers as well as doctors to justify using drugs that provide only incremental benefits. Products that offer clear-cut advances in treatment, however, still command premium prices.






The pressure on costs is likely to accelerate. The U.S. Affordable Care Act includes several provisions aimed at improving the value of healthcare, including paying hospitals for the quality of care rather than the quantity.


“It’s a sign of the times,” said Mark Mynhier, partner, healthcare industries advisory at PricewaterhouseCoopers PwC. “We are in fact in a significantly financially challenging environment.”


Four-fifths of U.S. health insurers recently polled by PwC now require evidence of cost savings or a clear clinical benefit to include new products on their lists of covered drugs.


Doctors at New York’s Memorial Sloan-Kettering Cancer Center decided in November not to use Zaltrap, a new $ 11,000 a month colon cancer drug, because it has a “modest” impact on survival, works no better than Avastin, a similar but cheaper competitor, and has worse side effects.


Sanofi SA, according to the hospital, responded by offering the drug to all health providers at a 50 percent discount to its wholesale price.


The Manhattan cancer center still does not include Zaltrap on its list of available drugs. Sanofi and Regeneron, which helped develop and also sells the drug, both declined to comment.


“In order to warrant the price, you are going to have to have better overall survival,” said Rhonda Greenapple, chief executive at Reimbursement Intelligence, a consulting firm specializing in medical reimbursement.


Linking value to patient outcomes – mainly a drug’s impact on survival – is particularly important in oncology, where treatment costs can total tens of thousands of dollars a year.


“In cases where there are co-pays, they really do effect the consumer,” Mynhier said. “Patients are saying ‘I can’t afford to pay 10 or 20 percent of a $ 100,000 therapy.’”


WellPoint Inc, the second-largest U.S. health insurer by market value, said it is increasing the amount it pays for less expensive generic cancer drugs as an incentive for doctors to use them.


PROFIT OPPORTUNITY FOR DOCTORS


Infused cancer medications are first purchased by doctors, who then bill insurers for reimbursement. That is different from pills and other oral drugs for which doctors typically write a prescription filled at a pharmacy.


The offer of a 50-percent discount to Zaltrap’s list price is a potential windfall for doctors. Patients, health insurers, the government or anyone else who pays healthcare bills would not see a benefit.


“At the very least it is an incentive for doctors to use the drug,” said Dr Leonard Saltz, chief of Memorial Sloan-Kettering’s gastrointestinal oncology service. “And I find that concerning.”


He noted that rebates and discounts for cancer drugs are not uncommon, but said this is the first time he is aware of a verbal across-the-board offer for a half-price discount.


The average U.S. oncologist, according to the Journal of Oncology Practice, generated revenue of nearly $ 5 million last year, of which drug costs accounted for nearly $ 3 million.


To combat the temptation of wider profit margins, health plans in recent years began reimbursing doctors for cancer drugs based on average sales prices, rather than wholesale prices. But for a new drug such as Zaltrap, reimbursement is based on the full list price until a sales track record is established.


WellPoint said it is raising reimbursements to independent oncologist on a range of generic chemotherapy drugs by as much as 140 percent.


“These drugs are the backbone of many therapies recommended by the National Comprehensive Cancer Network (NCCN) … and typically much less expensive than their brand counterparts,” said Jennifer Malin, WellPoint’s medical director oncology.


She said the goal is to shift the system away from what has been a largely drug-revenue based practice model, to one where oncologists are paid for providing good patient-centered care.


“The payers are looking at the quality data and demanding incremental value over existing products,” said Dan Mendelson, chief executive officer of consulting firm Avalere Health.


“COKE DIDN’T WORK, SO LET’S TRY PEPSI”


Zaltrap was approved in August by the Food and Drug Administration after a study found it improved survival, in combination with chemotherapy, by 1.4 months in colon cancer patients who had stopped responding to chemo.


That is the same benefit seen with Avastin, sold by Roche Holding AG for around $ 5,000 a month, or about half the price of Zaltrap.


NCCN guidelines say either one or the other drug should be used, not both, but Dr Saltz said most Zaltrap use is likely in patients who were already treated with Avastin – a practice that insurers will eventually stop.


“It’s like saying Coke didn’t work so let’s try Pepsi,” he said.


As scientists unravel the biological underpinnings of cancer cells, new targeted therapies are being developed, but the process is expensive.


Dr. Saltz said the solution might just be to walk away from drugs with small, incremental benefits.


“We simply can’t afford to pay these very, very large amounts for drugs that offer most people very small benefit,” Dr Saltz said. “We haven’t figured out how to rein it in.”


(Reporting By Deena Beasley in Los Angeles. Editing by Andre Grenon)


Medications/Drugs News Headlines – Yahoo! News


Read More..