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What's coming up in the world of new therapies

This year, we can look forward to a host of better drugs and heart and cancer treatments. But we're likely to pay more too.

January 06, 2003|Jane E. Allen and Linda Marsa | Times Staff Writers

Even the most astute prognosticator probably would not have predicted that 2002 would bring a cruise-ship crisis spawned by a virus called Norwalk, a smallpox vaccination for the president and controversy over a religious sect's claim to have produced the first human clone. Perhaps 2003 will bring even bigger surprises.

There are, however, a few sure bets for the year ahead: the biggest crop of new drugs in years, a revolutionary new treatment for coronary artery disease and spiraling medical costs that will pinch consumers' pocketbooks. Plus there's the prospect -- many say, a very good likelihood -- that Congress may finally do something about expanding prescription drug benefits for U.S. seniors.

"There will continue to be a strong and ongoing concern about health-care costs everywhere and by everybody," said Drew Altman, president of the Henry J. Kaiser Family Foundation, a Menlo Park, Calif.-based philanthropic and health policy organization. "Every employer and every state and county government will do something to address rising heath-care costs."

Rising costs will probably bring about a number of changes. Double-digit medical inflation will mean higher insurance premiums and out-of-pocket expenses for consumers, whether they get health coverage through their employers or purchase it themselves. There will be increased pressure on doctors, hospitals and other medical organizations to justify their fees, experts said, and perhaps a legislative push to regulate fees charged by private health plans. And the combination of higher medical costs and a still-struggling economy is likely to swell the ranks of the state's uninsured, as smaller businesses drop coverage for their workers and government health programs, such as Medi-Cal, face budget cutbacks.

In 2003, other key developments will involve new technologies and medications for illnesses such as heart disease, depression, impotence and influenza. Here are a few of them:

Heart disease

A new medical device -- a tiny drug-coated stent about the size of the spring in a ballpoint pen -- is about to revolutionize the treatment of coronary artery disease.

By delivering medication directly into the arteries, this new stent promises to make angioplasty a more effective and longer-lasting treatment for people with severe chest pain or heart attacks.

Although angioplasties have spared millions of patients the risks and pain of open-heart surgery, the procedures often fail. Up to 40% of the arteries cleared by angioplasty and propped open with standard metal mesh stents became re-clogged with scar tissue, forcing patients to undergo repeat angioplasties -- or, in some cases, the bypass surgery they hoped to avoid.

Hoping to overcome this problem, researchers developed a coated stent that drastically reduces the rate of re-clogging, called restenosis, after angioplasty. These stents are coated with medications that help to prevent the buildup of scar tissue that may eventually impede blood flow.

The Food and Drug Administration is expected to approve Johnson & Johnson's Cypher stent before April. The Cypher is coated with the antibiotic rapamycin (Sirolimus), which has been used previously to prevent rejection in kidney transplants. In a couple of European studies, none of the cardiac patients given Sirolimus-coated stents developed restenosis. In a U.S. study of more than 1,100 patients, the coated stents reduced re-clogging inside the stent by 91%. The researchers also reported a 67% reduction in cardiac-related deaths, heart attacks or subsequent artery- clearing procedures nine months after the stents were put in place. The numbers were so good that federal health officials agreed Medicare will pay for the coated stents.

However, with Johnson & Johnson expected to charge about $3,200 for the Cypher, at least $2,000 more than traditional stents, there are growing concerns that the coated device could drive up health-care costs, even while saving money in the long run.

Patient safety

As many as 20% of Americans have experienced some kind of medical error, according to a 2002 report from the Commonwealth Fund, a nonprofit health-care philanthropy. Several other reports have shed light on the thousands of preventable errors in medicine and surgery that occur every year, such as doctors amputating the wrong foot or patients dying after being given the wrong medication.

As of Wednesday, an influential hospital accrediting group required health-care facilities to take steps to reduce such mistakes. The Joint Commission on Accreditation of Healthcare Organizations is requiring the nation's more than 17,000 hospitals and health-care clinics to improve in six major areas: identifying patients, communication among caregivers, wrong-site surgery, medication mix-ups, problems with equipment alarms and the unsafe use of pumps that deliver medications into the bloodstream.

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