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.”


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Economic slowdown throughout euro zone a worry for ECB: Liikanen






BERLIN (Reuters) – Economic growth is slowing to a worrying degree across the euro zone and not only in the periphery, European Central Bank Governing Council member Erkki Liikanen said in an interview to be published on Sunday in Germany’s Welt am Sonntag newspaper.


“There are a number of indications that the economy is getting weaker and not only in the indebted southern European countries, but across the euro zone,” Liikanen was quoted as saying in an excerpt released on Saturday.






“Economic developments are causing us concern,” he said, adding that no-one is immune to the effects of the debt crisis. “Not even the German economy.”


Liikanen did not say what action should be taken to deal with the slowdown, and a Reuters poll this week found economists are evenly split on what else – if anything – the ECB will do.


Thirty-nine economists said the ECB would hold its main refinancing rate at its current record low of 0.75 percent through the first quarter of next year, while 38 believed it would cut the rate to 0.5 percent.


The ECB on December 6 predicted the euro zone economy would shrink again in 2013. Its projections for economic performance ranged from a 0.9 percent drop to a meager 0.3 percent rise next year, suggesting contraction is far more likely than not.


It had previously penciled in a range of -0.4 percent to +1.4 percent for the euro area economy.


On Dec 7. the central banks of Germany and Austria forecast barely any economic growth in 2013, with the Bundesbank flagging risks of a recession in the euro zone’s biggest economy as the debt crisis hits the bloc’s core.


(Reporting By Erik Kirschbaum; Editing by Hugh Lawson)


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Nigeria governor, 5 others die in helicopter crash






LAGOS, Nigeria (AP) — A navy helicopter crashed Saturday in the country’s oil-rich southern delta, killing a state governor and five other people, in the latest air disaster to hit Africa’s most populous nation, officials said.


Nigeria‘s ruling party said in a statement that the governor of the central Nigerian state of Kaduna, Patrick Yakowa, died in the helicopter crash in Bayelsa state in the Niger Delta. The People’s Democratic Party’s statement described Yakowa’s death as a “colossal loss.”






The statement said the former national security adviser, General Andrew Azazi, also died in the crash. Azazi was fired in June amid growing sectarian violence in Nigeria, but maintained close ties with the government.


Yushau Shuaib, a spokesman for Nigeria’s National Emergency Management Agency, said four other bodies had been found, but he could not immediately give their identities.


The crash occurred at about 3:30 p.m. after the navy helicopter took off from the village of Okoroba in Bayelsa state where officials had gathered to attend the burial of the father of a presidential aide, said Commodore Kabir Aliyu. He said that the helicopter was headed for Nigeria’s oil capital of Port Harcourt when it crashed in the Nembe area of Bayelsa state.


Aviation disasters remain common in Nigeria, despite efforts in recent years to improve air safety.


In October, a plane made a crash landing in central Nigeria. A state governor and five others sustained injuries but survived.


In June, a Dana Air MD-83 passenger plane crashed into a neighborhood in the commercial capital of Lagos, killing 153 people onboard and at least 10 people on the ground. It was Nigeria’s worst air crash in nearly two decades.


In March, a police helicopter carrying a high-ranking police official crashed in the central Nigerian city of Jos, killing four people.


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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


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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.


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Best Buy extends deadline for founder bid






(Reuters) – Best Buy Co Inc agreed to extend the deadline to February 28 for founder Richard Schulze to make a bid for the company, continuing the uncertainty for shareholders over whether he can put a bid together.


Best Buy shares fell 14.2 percent to $ 12.12 on the New York Stock Exchange.






The company said on Friday the extension would allow Schulze to include the consumer electronics retailer’s full-year results as part of his due diligence review.


The new deadline will also give him more time to line up partners and financing for a bid. A source told Reuters on Thursday that Schulze didn’t have financing lined up in time for a December bid.


Schulze, who founded Best Buy in 1966, has said he would fund any deal through a combination of private equity and debt financing, as well as the reinvestment of some of his own equity in the company.


“Obviously with the extension, there is still some hesitation on the part of his private equity suitors about how much financing they would want to put up for this deal,” Morningstar analyst R J Hottovy said.


Under the extension, Schulze will be able to submit an offer any time during February, and the company will have 30 days to review and make a decision on the bid.


In August, Schulze made an informal proposal to acquire Best Buy for $ 24 to $ 26 per share, or a total of $ 8.16 billion to $ 8.84 billion. Including debt, it would be as much as $ 10.9 billion.


But Best Buy’s performance has continued to lag and its stock has slid since. Last month, the company reported a decline in same-store sales for the ninth time in the last 10 quarters.


Best Buy’s fortunes have faltered as consumers increasingly use its big box stores as showrooms for products they end up buying online at Amazon.com Inc and other websites.


To add to its troubles, the company forced out Schulze’s protégé, Brian Dunn, as chief executive earlier this year amid allegations he was having an inappropriate relationship with a female employee.


That scandal led to the ouster of Schulze from the board, and Best Buy hired turnaround expert Hubert Joly as CEO to come up with its own restructuring plan.


Schulze remains Best Buy’s largest shareholder with about one-fifth of the company’s outstanding shares.


If he can come in with a bid at about $ 16 or $ 17 a share when the market thinks the stock is only worth $ 12, it is in the interests of shareholders to extend the deadline, Hottovy said.


Others agreed.


“That’s really the best hope for investors, that Schulze takes it out because there’s been no other good news for the company,” said Rakesh Agrawal, principal analyst at San Francisco-based consulting firm reDesign Mobile.


Agrawal, who also advises hedge funds and money managers on the technology sector, said at this point the stock was trading entirely on whether a deal can get done or not.


A Best Buy spokesman said the extension will not affect the company’s day-to-day operations, especially during the all-important holiday season.


“We are determined to have a strong holiday season,” both in stores and online, spokesman Matt Furman said, adding that the company was moving “full speed ahead” with its turnaround plan.


(Writing by Brad Dorfman; Additional reporting by Olivia Oran in New York, and Siddharth Cavale in Bangalore; Editing by Jeffrey Benkoe)


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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.


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Verizon Offering $5 Shared 4G Plan for Samsung Galaxy Camera






Imagine the powerful Samsung Galaxy S III smartphone, except that it can’t make phone calls and its backplate has been replaced by a digital camera — handgrip, zoom lens, and all. That’s basically the Samsung Galaxy Camera in a nutshell, and whether it’s a small, awkwardly-shaped Android tablet or a digital camera that you can play Modern Combat 3 on depends on how you look at it.


When the Galaxy Camera launched last month, it was only available in white, and cost $ 499 on AT&T’s network with a month-to-month data plan. But on Dec. 13, it launches on Verizon’s network, in both white and black. The Verizon Galaxy Camera costs $ 50 more up front, but in return it has 4G LTE instead of HSPA+, and Verizon is offering a “promotional price” for the monthly charge: Only $ 5 to add it to a Share Everything plan, instead of the usual $ 10 tablet rate.






A 4G digital camera


While it’s capable of functioning as an Android tablet (or game machine), the biggest reason for the Samsung Galaxy Camera’s 4G wireless Internet is so it can automatically upload photos it takes. Apps such as Dropbox, Photobucket, and Ubuntu One offer a limited amount of online storage space for free, where the Galaxy Camera can save photos without anyone needing to tell it to. Those photos can then be accessed at home, or on a tablet or laptop.


Most smartphones are able to do this already, but few (with the possible exception of the Windows Phone powered Nokia Lumia 920) are able to take photos as high-quality as the Galaxy Camera’s.


Not as good of a deal as it sounds


Dropbox is offering two years’ worth of 50 GB of free online storage space for photos and videos, to anyone who buys a Samsung Galaxy Camera from AT&T or Verizon. (The regular free plan is only 2 GB.)


The problem is, you may need that much space. The photos taken by the Galaxy Camera’s 16 megapixel sensor take up a lot more space, at maximum resolution, than ordinary smartphone snapshots do. Those camera uploads can eat through a shared data plan, and with Verizon charging a $ 15 per GB overage fee (plus the $ 50 extra up-front on top of what AT&T charges) it may make up for the cheaper monthly cost.


On top of that, the Galaxy Camera’s photos are basically on par with a $ 199 digital camera’s — you pay a large premium to combine that kind of point-and-shoot with the hardware equivalent of a high-end smartphone.


It does run Android, though, right?


The Galaxy Camera uses Samsung‘s custom software for its camera app, and lacks a normal phone dialer app. Beyond that, though, it runs the same Android operating system found on smartphones, and can run all the same games and apps.


Some apps don’t work the same on the Galaxy Camera as they do on a smartphone, however. Apps which only run in portrait mode, for instance, require you to hold the camera sideways to use them (especially unpleasant when they’re camera apps). And while it can make voice and even video calls over Skype, it lacks a rear-facing camera or the kind of speaker you hold up close to your ear. So you may end up making speakerphone calls and filming the palm of your hand.


Jared Spurbeck is an open-source software enthusiast, who uses an Android phone and an Ubuntu laptop PC. He has been writing about technology and electronics since 2008.
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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.


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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)


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