There’s another bariatric procedure, gastric bypass surgery, which typically involves creating a small stomach pouch and a passage so food bypasses the rest of the stomach and parts of the small intestine. The authors argued in their paper that gastric banding is more appropriate for young patients because it is safer than gastric bypass as well as being “adjustable and reversible.”

Paul O’Brien, the lead author, said in an interview that “the band is safe, whereas the bypass is not yet safe enough.” For teenagers, the option to remove the band later in life is important, partly because new treatment options may emerge, according to O’Brien. “The band I can back away from, the bypass I can’t back away from,” he said.

But that argument is likely to spark some debate, reflecting the back-and-forth that’s already common among surgeons over which procedure is best for adults. Another prominent researcher, Thomas Inge of Cincinnati Children’s Hospital, who is leading a major NIH-funded study of bariatric surgery in young people, said “the jury is out for the teens on which is going to be more effective.” He said bypass operations are “generally more effective for weight loss,” and that the safety question is “subject to interpretation.”

Inge and others note that in the past, the Australian group that led the new study has seen better results from banding than are typical in the U.S., partly because of the fractured U.S. health system and payment policies that can limit follow-up care.

Image: iStockphoto

But the most bubbly statement we spotted came from the American Beverage Association — a trade group that’s been trying to quell ideas of putting a tax on sugary drinks.

The association today pledged to put calorie counts for its members’ products on the front of containers, soda fountains and vending machines they control. “The more easy-to-use information we give consumers, the better they’ll be able to choose the refreshing beverage that best meets their tastes and needs,” it said.

Coca-Cola (which, like archrival Pepsi, is a member of the American Beverage Association) said last year that it would start putting calorie counts on the front of its packages.

Here’s the WSJ story on the First Lady’s program.

And here, complete with the requisite acoustic-guitar backing track, is a YouTube video the White House put out today:

Photo via Business Wire

Probably not — it would increase the cost for everyone paying premiums, without doing much to help the sick. But where do you draw the line?

Real-world drugs are both cheaper and more helpful than our hypothetical example. Still, many new cancer drugs costs tens of thousands of dollars per patient and sometimes extend lives by only a few weeks or months on average.

This knotty issue came up again today in the U.K. The National Institute for Health and Clinical Excellence recommended against using Novartis’s Tasigna or Bristol-Myers Squibb’s Sprycel for patients who have chronic myeloid leukemia and are resistant to Novartis’s Gleevec.

The drugs cost somewhere around $50,000 per patient per year, and the evidence of their effectiveness is “very poor,” NICE said. Here’s a brief statement from the outfit; here’s a long, technical analysis that includes input from the companies.

“It would be heartening to hear that the pharmaceutical company manufacturers are prepared to share some of the very high cost of the drugs” the group’s public health director said in the statement.

Some drug makers have cut deals in the U.K. in the past few years. See, for example, what Roche did for its drug Tarceva, and how Pfizer gave away its Sutent.

More On Cancer Treatment: In the U.S., the insurer UnitedHealth is sending doctors reports assessing their treatment of cancer patients. Read more in today’s WSJ.

Image: iStockphoto

“You cannot abandon!” a former AMA official wrote to Beck, explaining that a doctor needs to give a patient a chance to find another doctor before discontinuing treatment.

In general, docs can fire patients who consistently miss appointments or refuse to pay their bills. Chronically abusing the doctor or disrupting the practice or seeking drugs for recreational use are also grounds for dismissal.

But this sort of thing can be messy and complex in real life. So we want to hear from our doctor readers.

Health Blog Question of the Day: When do you fire a patient? And how do you tell the patient that he’s no longer welcome at your practice?

Image: iStockphoto

Now, AstraZeneca’s statin Crestor has crossed a new threshold: It’s the cholesterol drug for people who don’t have high cholesterol.

The FDA just expanded the drug’s approval to include reducing the risk of heart attack and stroke in people who meet all of the following criteria:

• Older than 50 for men, older than 60 for women
• Elevated high-sensitivity C-reactive protein level (we’ll explain this one in a minute)
• At least one additional cardiovascular risk factor (such as high blood pressure, smoking, or a family history early heart disease)

The approval is based on a big study called Jupiter, which found that the drug reduced the risk of serious heart problems in patients with normal cholesterol but high levels of something called C-reactive protein.

CRP is a marker of inflammation. As we’ve noted before, it hasn’t joined measures such as blood pressure and cholesterol as a reliable measure of cardiovascular risk.

So whether Crestor’s new indication leads to broader use of the drug will depend in part on how often doctors measure their patients’ CRP levels, and how often they act on what they find.

Photo by CarbonNYC via Flickr

The study, published in the American Journal of Managed Care, compared geographic patterns of Medicare spending, using the Dartmouth Atlas data, with spending by big employers that cover their workers. The upshot was that the two didn’t correlate.

The reason didn’t seem to be that insurers (in this case, acting on behalf of big employers) are better than Medicare at saying no to paying for unneeded care since utilization pattenrs were somewhat parallel. Instead, the researchers suggest that when a small market has just one or a few big hospital systems, employers spend more than they do in large cities where there’s more competition, an issue that doesn’t generally affect government health payers like Medicare.

“We found that for commercial insurers, the higher-spending markets were those that were the least competitive on the provider side,” said Michael Chernew, the lead author and a professor at Harvard Medical School. The finding, he argues, signals that as policymakers push for integrated systems bringing together all kinds of health care under one umbrella, they should keep antitrust concerns in mind.

This idea matches up with a couple of recent reports from state officials, as noted here and here. But it seems to cut against some previous research arguing that when a market has a lot of hospitals, an “arms race” mentality can drive up costs as they vie to buy the best new technology.

The new study’s suggestion comes with a bucket of caveats. For one thing, there are other reasons why private insurers’ payments wouldn’t match up with Medicare’s. Most obviously, the under-65 population has different medical needs than older folks.

Some hospital executives have long argued that they are forced to rely on payments from private insurers to make up for the money they lose on government-covered patients, another reason why the two types of payment wouldn’t correlate. The database used in the study also had fewer than 60 large companies, a limited sample that could create distortions.

Photo: iStockphoto

First up for the Health Blog this year is Eli Lilly, which just filed its preliminary proxy.

John Lechleiter, the company’s CEO, had a package totaling $16.4 million, according to an analysis by Dow Jones Newswires. That includes $1.48 million in salary, $3.55 million in non-equity incentive plan compensation, $11.25 million in certain equity awards and $90,091 from a savings-plan match and tax reimbursements.

Lechleiter has requested that he not receive an increase in salary or bonus for 2010, “in light of the business challenges the company faces.”

The proxy’s summary compensation table, which uses a different methodology than Dow Jones, puts Lechleiter’s total compensation at $20.9 million. The table lists several other execs with multi-million-dollar compensation packages, including the CFO, the general counsel, the president of the company’s established markets unit and the doc who heads Lilly’s research labs.

Photo: Bloomberg News

One of the chief studies of the drug was supposed to involve 320 patients but only 140 were enrolled. Cell Therapeutics told the FDA it had trouble finding participants for the study because doctors preferred to use multiple chemotherapy drugs or supportive care, Reuters said, citing the FDA staff summary. Here’s the full FDA briefing document.

The study period was also cut short. The FDA said “a higher level of evidence is usually required in trials which discontinue prior to final analysis,” Dow Jones Newswires said.

Following the FDA staff comments, shares of Cell Therapeutics were trading down more than 25% around midday.

Cell Therapeutics hopes to sell the drug, pixantrone, under the brand name Pixuvri to treat non-Hodgkin’s lymphoma that has stopped responding to other treatments. The oncology advisory panel is to meet Wednesday. The FDA doesn’t have to follow the advice of its advisory panels, but it usually does.

People paying out of pocket tend account for bigger chunk of the patient population in many emerging markets, so offering discounts may be particularly compelling. At the same time, the FT notes, the cards may raise concerns in some quarters by giving a drug company information about the habits of individual patients.

Pfizer’s had an “eCard” program in the Philippines for several years, where more than two million patients are now in the system, and the company is looking to launch in key emerging markets such as Russia, Mexico and Brazil.

The company typically uses the program for drugs that patients take for chronic conditions such as high blood pressure and high cholesterol. The adherence rate for one blood pressure medicine more than doubled when patients used the card, the FT says.

Pfizer Bonus: Like many drug makers, Pfizer’s making a big push to grow in emerging markets. Here’s a WSJ story on the company’s strategy in Venezuela, and here’s a recent post on Pfizer’s approach to China.

Photo: Associated Press

But the state’s hospitals may ask to pay more taxes in order to stave off cuts to the program, the Tennessean reports.

Because Medicaid is jointly funded by states and the federal government, cuts at the state level can trigger cuts in federal matching funds. In the case of Tennessee, proposed cuts would save the state $380 million but could cost the state two to three times that much in federal aid, according to the article.

What’s more, if the cuts to the program drive up the number of people in Tennessee without insurance, hospitals could be on the hook for more unpaid bills. So the state’s hospitals may decide that it’s actually in their financial self interest to pay higher taxes to block some TennCare cuts, because a big chunk of federal Medicaid funds will through to hospitals.

The Tennessee Hospital Association’s board of directors will meet today to discuss the subject, the article says. The tax would be levied on hospital revenues; it’s unclear what the rate would be.

Photo: iStockphoto