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Indian-made cigarettes under fire

Native American entrepreneurs, looking to take their tax-free cigarette trade to a new level, have discovered the benefits of no longer being just one link in the tobacco chain.

In a couple years, some of these Indian business interests have found the benefits of not just being the retailer, but also the maker, of cigarettes.

Leading the way is the Seneca brand, owned by Seneca businessman Arthur Montour Jr., and made on an Indian reservation in Ontario. There also is a network of Indian tribes throughout the nation to help distribute the tobacco everywhere from casinos to the Internet.

Health groups, however, are raising the cautionary flag. For starters, some of the cigarettes do not meet regulations for so-called fire safe cigarettes, which self-extinguish after a certain period of time to cut down on smoking-related fires. Also, Roswell Park Cancer Institute has found some higher-than-usual chemical elements in some of the cigarettes, raising questions about the already dangerous practice of smoking.

The booming sales have caught the eye of law enforcement agencies, some of which have moved in court to try to halt the trade. They claim the sales are illegal for a variety of reasons -- not the least of which is they are being sold tax-free.

Not surprisingly, so close to the beginning of the trade start point, Western New York smokers are especially attracted to these cheap smokes. The Seneca brand, for instance, two years ago attracted just 0.2 percent of adult smokers in the region. In 2008, according to Roswell Park, 10.3 percent said it was their usual smoke.

At issue for the state, besides what critics say are the health implications of more smokers being encouraged to keep smoking with the cheaper cigarettes, are the lost tax revenues. For Gov. David A. Paterson, the explosion of Indian-produced cigarettes represents yet another complication as he becomes the fourth governor to try to resolve the tax collection dispute.

-- Tom Precious

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The generic alternative

    A new report indicates the prescribing of generic drugs in upstate New York continues to increase because of greater acceptance and a rise in the number of popular brand-name medications  coming off patent.

   The percentage of prescriptions filled with a generic alternative across upstate rose last year from 63.9 percent to 68.4 percent and in Western New York from 68.4 percent to 72.7 percent, according to an updated analysis of prescription patterns released by Univera Healthcare and Excellus BlueCross BlueShield, its Rochester-based parent company.

   The health insurer estimated that the increased use of lower-cost generics resulted in a savings of $369 million in medication costs in 2008 alone.

    A generic drug is chemically identical to a brand name drug and can be produced once the patent protection expires for a brand name drug. Generics typically sell for significantly less than their brand-name counterparts.

   Greater use of generics is seen as one way to control soaring health care costs. But doubts still exist about whether some generic drugs are identically effective compared with their brand name counterparts.

   --- Henry L. Davis

Change is in the wind for nursing home industry

      The nursing home industry is one of the most regulated businesses in the nation. Their operation has become so regimented to control risks and costs that buildings look alike and virtually every decision is made for residents, from when to get up to what to eat.

   The regulations, although well-meaning, have combined with outdated payment system, to stifle innovation. There is little incentive to raise quality above minimum standards.

   Today, too many nursing homes offer a passionless, hospital-like service built for efficiency. It may have made sense decades ago, but now turns off people, struggles with high employee turnover and continues to experience quality problems.

   Against this backdrop, reformers in recent years have pushed for a radical rethinking of the long-term-care system known as "culture change."

   A smattering of nursing homes around the country, including Buffalo, have adopted a few aspects of the movement. Now, advocates in Western New York want to turn culture change into a regionwide initiative, making this community the first in the U.S. to attempt a transformation in elder care on a large scale.

-- Henry L. Davis

Teaching doctors to deliver bad news with care

   One of the hardest jobs in medicine doesn't require high-tech devices or sure hands. It's that painfully awkward moment when a doctor has to deliver bad news.

   Patients generally just want the facts cushioned by compassion and encouragement. Yet, as simple as that sounds, the right words often go unspoken.

  Of course, some doctors do communicate well with patients or work at the skill. But others don't, as reflected in the large number of studies about improving the doctor-patient relationship.

   Relaying bad news is difficult. Few people are comfortable talking about death and dying. And, empathy can take time that busy doctors often believe they don't have.

   Doctors also come with different skills and personalities. Some can communicate naturally while others are uncomfortable talking to their patients.

   Patients are different, as well. Some want their information direct. Others require a go-slow approach. Some will handle a diagnosis of cancer with poise. Others will wilt over a negative test result for a condition that isn't fatal.

   One expert put it this way: "It's a situation no one wants, yet there needs to be some interaction. Physicians are people. They are not all stamped out of the same mold. Patients are different and bring with them emotional, family, religious and cultural issues."

   -- Henry L. Davis

Obesity programs: do they work?

   The nation's childhood obesity rate has nearly doubled since 1980, and obese children and teenagers today are developing diseases formerly only seen in adults, such as type 2 diabetes.

   It's a growing epidemic in which American adults are getting fatter from unhealthy diets and lack of exercise, and their young ones are waddling in their footsteps.

   To reverse the trend, increasing attention here and across the U.S. is being paid to schools.

   Schools are where children spend a large part of their waking hours and consume a large portion of their daily calories.

  In the Buffalo-Niagara region, for instance, Independent Health recently announced a school-based obesity program. Later this month, Blue Cross and Blue Shield of Western New York is expected to introduce a school-based fitness program in collaboration with the Buffalo Bills. Those organizations join an existing program operated by Univera Healthcare.

   Still, it's not clear if such programs here and elsewhere across the U.S. work or are cost-effective. One of the problems with many of the programs is that there are few, if any, measurements to gauge success.

-- Henry L. Davis 

A prescription needed for fewer meds?

   A recent national study determined that for the first time, 51 percent of all insured American children and adults are taking one or more prescription drugs regularly for a chronic condition.

   The most widely used drugs are those that lower high blood pressure and cholesterol - problems often linked to heart disease, obesity, and diabetes.

   Medco Health Solutions, which manages prescription benefits for about one in five Americans, gathered the numbers last year. The company sampled 2.5 million customers, from newborns to the elderly and medication use was seen in:

• Almost two-thirds of women 20 and older.

•  One in four children and teenagers.

•  More than half of adult men.

• Three out of four people 65 and older.

   Do you think Americans are over-medicated?

   What steps have you taken to get off prescription medications?

   --- Deidre Williams

A stellar report card for area hospitals

   It may not be the final word yet, but at least the first word on the value of hospital care nationwide puts Buffalo on the map.

   A new study and index by a health care information firm ranks Buffalo Niagara No. 1 in the nation among large cities for the value of hospital care that is provided.

   That's after ranking eight Western New York hospitals as among the top 100 nationwide for hospital value.

   That doesn't mean the Buffalo-area hospitals offer the best possible care money can buy. But for the money you spend, it's the most bang for your buck of any large metropolitan area in the country, it contends.

   The study of more than 1,400 hospitals nationwide scored the institutions using publicly available data on medical quality, prices, the hospitals' costs, patient satisfaction and the hospitals' local reputations.

   All four Catholic Health System hospitals -- Sisters of Charity, Mercy Hospital of Buffalo, Kenmore Mercy Hospital and St. Joseph's Hospital -- made the top 100, as did Kaleida Health's Buffalo General Hospital, Erie County Medical Center, Niagara Falls Memorial Medical Center and Mount St. Mary's Hospital and Health Center in Lewiston.

   Not too shabby.

   -- Jonathan D. Epstein

Glut of medical ads crossing the line

   The advertising of prescription drugs and medical devices to consumers has grown  --  from $11.4 billion in 1996 to $29.9 billion in 2005. So, too, has controversy over the practice.

      Proponents of advertising to consumers say it encourages more informed decisions about health care and treatment options. But critics of this marketing contend it increases the demand for expensive brand-name medications, turns normal human experiences into medical conditions, skims over safety concerns while highlighting benefits, and interferes with the doctor-patient relationship.

      In the New England Journal of Medicine, an article by a Buffalo physician takes issue with a television ad for the Cypher heart stent by the Cordis Corp. He and others contend it crosses a line in direct-to-consumer advertising. The company defends the ad campaign as an effort to educate consumers and physicians about the newest research on the device and its use as a treatment option for coronary artery disease.

      The article comes at an important time. Congress and the Food and Drug Administration are conducting hearings about medical advertising to consumers. However, it is not clear what will happen. Some experts, even critics of current regulations, say there isn't enough information about the advertising in print, TV or online to make informed decisions about what policy changes to make.

     -- Henry L. Davis

Some shocking stats on teens and sex

   The first time I read about the study that says one-quarter of America's teenage girls has a sexually transmitted disease, I didn't believe it.

   It must be some fly-by-night non-scientific study that just surveyed girls going for birth control, I thought.

   But it was a study for the federal Centers For Disease Control, which says: "The authors analyzed data on 838 female adolescents (aged 14-19) who participated in the 2003-2004 National Health and Nutrition Examination Survey, a continuous annual study that examines a nationally representative sample of the U.S. household population to assess a broad range of health issues."

   So then we thought we'd ask local health care providers. Is this study for real, do you see the same things? And they said they weren't surprised. It's a wake-up call for many parents across the region.

   --Barbara O'Brien

Retired? Not for long

The dream of retiring with full health benefits is now just that - a dream.

As News reporter Deidre Williams reports in her Page 1 story today, more and more retirees are looking for parttime jobs to help pay the bills - particularly health insurance premiums.

Whether it's a parttime job at a fast-food restaurant, a supermarket, or a teaching position at a local university, retirees are spending as much time on the job as on the golf course.

  Also adding to the growing local labor pool are the baby boomers who are retiring in their 50s and early 60s, and who are faced with increasing health care costs, even before they're eligible for Social Security checks and Medicare benefits.

Is this the new retirement - going from a full-time job to a parttime job, just to pay for health care?

Locally, are there enough jobs available for all the retirees who need to work?

What can be done about the problem of soaring health care premiums for retirees?


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