Policy & Practice


U.S. Infant Mortality Fails to Improve

The infant mortality rate in the United States did not improve between 2000 and 2005, according to a report from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention. The U.S. infant mortality rate was 6.86 per 1,000 live births in 2005, not statistically different from the rate of 6.89 in 2000. This 5-year period represents the first sustained time period without a drop in infant mortality since the 1950s. The lack of improvement is due in large part to an increase in the percentage of both very preterm and late preterm births and a lack of improvement in the infant mortality rate for very preterm infants, according to the CDC. However, preliminary data indicate there may have been a small decrease in infant mortality between 2005 and 2006, when the infant mortality rate dropped to 6.71. The United States also continues to rank near the bottom of industrialized countries in terms of infant mortality. The United States ranked 29th in the world on infant mortality based on 2004 data, down from a worldwide ranking of 12th in 1960 and 23rd in 1990.

FDA Issues Warning on Yaz Ads

The Food and Drug Administration has warned Bayer HealthCare Pharmaceuticals Inc. to tone down its advertising for Yaz (drospirenone and ethinyl estradiol tablets). Two television ads for the oral contraceptive overstate the drug's benefits and minimize its risks, according to an FDA letter to the company. “These violations are concerning from a public health perspective because they encourage use of Yaz in circumstances other than those in which the drug has been approved,” the FDA wrote in a letter. For example, the ads suggest that Yaz can treat the symptoms of premenstrual syndrome, but the drug is approved only for the treatment of premenstrual dysphoric disorder. The agency also complained that the ads did not effectively communicate the drug's risks because of distracting visuals and music.

Maternal Health Resolution Passes

The United States must do more to reduce maternal mortality in this country and abroad, according to a resolution passed unanimously by the Senate last month. S. Res. 616 also recognized that access to quality and affordable health care is critical to making improvements in maternal health. The resolution, which was introduced by Sen. Blanche Lincoln (D-Ark.) and Sen. Olympia Snowe (R-Maine), noted that globally, 536,000 women die during pregnancy and childbirth each year. “While the majority of deaths occur in developing countries, the United States has one of the highest maternal mortality rates among industrialized nations,” Sen. Lincoln said in a statement. “This is not a problem we can or should ignore. A mother's health affects the health of her child, her family's well-being, and the productivity of a community.” The House approved a companion resolution (H. Res. 1022) earlier this year.

GAO: FDA Needed Broader Pool

Food and Drug Administration officials might have avoided some conflicts of interest on the FDA's scientific advisory committees by expanding recruitment efforts beyond word-of-mouth nominations, according to a recent report from the Government Accountability Office. The report analyzed the recruitment and screening of FDA advisory committee members before the agency changed those processes in 2007. The FDA could have reached out beyond its usual source of experts to retired professionals, university professors, and experts in epidemiology and statistics, the GAO concluded. The evaluation was requested by members of the Senate.

Flat Rx Pricing Satisfies Consumers

Pharmacy customers who take advantage of flat-rate generic prescription drug prices have higher levels of satisfaction than those who don't, according to the second annual J.D. Power and Associates National Pharmacy Study. Nearly one-fourth of pharmacy customers participate in a $4 generic or similar flat-rate pricing program, with the greatest participation rate among customers aged 44 years and older, the study said. Satisfaction among customers who participate in flat-rate programs averages 826 on a 1,000-point scale, compared with 817 among those customers who don't participate in the programs.

Medicare Imaging Costs Fall 13%

Medicare Part B payments for physician-performed imaging services dropped almost 13% between 2006 and 2007 mainly because of caps on physician payments called for under the Deficit Reduction Act (DRA) of 2005, according to an analysis from the Government Accountability Office. Under the DRA, Medicare fees for certain imaging services provided in the physician's office may not exceed what Medicare pays under the hospital outpatient prospective payment system. The imaging payment cap went into effect Jan. 1, 2007, and Medicare Part B per-beneficiary expenditures for imaging services fell from $419 in 2006 to $375 in 2007. Expenditures for advanced imaging services such as computed tomography and MRI fell even more. Although per-beneficiary expenditures dropped, utilization of services continued to rise, according to the GAO, which concluded that beneficiary access at the national level was not affected by the payment cuts. However, the medical technology trade organization AdvaMed said the report indicated payment cuts were deeper than expected and are not in the interest of patients. Requiring accreditation of personnel in physician offices and developing appropriateness criteria would be better ways to curb high imaging expenses, suggested AdvaMed.

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