Citizens' Issues
Transparency Program Obscures Pharma Payments to Nurses, Physician Assistants
New data on drug and device company payments to doctors largely excludes nurse practitioners and physician assistants, though they play an ever-larger role in health care. One advanced-practice nurse pleaded guilty last month to taking drug company kickbacks
 
This story was co-published with NPR's Shots blog.
 
A nurse practitioner in Connecticut pleaded guilty in June to taking $83,000 in kickbacks from a drug company in exchange for prescribing its high-priced drug to treat cancer pain. In some cases, she delivered promotional talks attended only by herself and a company sales representative.
 
But when the federal government released data Tuesday on payments by drug and device companies to doctors and teaching hospitals, the payments to nurse practitioner Heather Alfonso, 42, were nowhere to be found. 
 
That’s because the federal Physician Payment Sunshine Act doesn’t require companies to publicly report payments to nurse practitioners or physician assistants, even though they are allowed to write prescriptions in most states.
 
Nurse practitioners and physician assistants are playing an ever-larger role in the health care system. While registered and licensed practice nurses are not authorized to write prescriptions, those with additional training and advanced degrees often can. 
 
A ProPublica analysis of prescribing patterns in Medicare’s prescription drug program, known as Part D, shows that these two groups of providers wrote about 10 percent of the nearly 1.4 billion prescriptions in the program in 2013. They wrote 15 percent of all prescriptions nationwide (not only Medicare) in the first five months of the year, according to IMS Health, a health information company.
 
For some drugs, including narcotic controlled substances, nurse practitioners and physician assistants are among the top prescribers.
 
“Nurse practitioners see patients, order tests, recommend procedures and prescribe medications,” Dr. Walid Gellad, an associate professor of medicine at the University of Pittsburgh and co-director of its Center for Pharmaceutical Policy and Prescribing, wrote in an email. “It seems straightforward to think that their relationships with the pharmaceutical and device industries are of as much relevance as physicians, dentists, chiropractors, etc.”
 
He added, “If the purpose of the act is to shine a light on the relationship between industry and the health care sector, then you’ve left out an important component of that sector.”
 
When the Sunshine Act was drafted, those involved say, nurse practitioners weren’t part of the discussion. “Physician groups were among the stakeholders who were very engaged,” said Allan Coukell, senior director for health programs at the Pew Charitable Trusts. “Nursing groups weren’t part of the policy discussions and weren’t ultimately covered by the law.”
 
Still, Coukell said, “To the extent that a lot of prescribing now is done by health professionals who aren’t physicians, and a lot of marketing is directed at them, they ideally should also be part of the disclosure.”
 
Asked whether payments to these providers should be reported, a spokesman for the Centers for Medicare and Medicaid Services, which manages the disclosure system, said: “Nurse practitioners and physician assistants are currently not covered recipients under the statute for Open Payments.”
 
A representative of the Pharmaceutical Research and Manufacturers of America, the industry trade group, declined comment.
 
Although payments to nurse practitioners are not required to be reported under the law, a handful of companies did so anyway. Of the 606,000 providers who received payments in 2014, several hundred self-identified as nurse practitioners or physician assistants. The rest were doctors, dentists, optometrists, podiatrists and chiropractors. (Some of the self-identified nurse practitioners and physician assistants actually appear to be doctors, but have misclassified themselves.)
 
Alfonso was employed as an advanced-practice nurse at Comprehensive Pain and Headache Treatment Center in Derby, Connecticut. An investigation revealed that she was a heavy prescriber of Subsys, an expensive drug used to treat cancer pain, the U.S. Attorney’s Office for Connecticut said. Between January 2013 and March 2015, she wrote more than $1 million in Subsys prescriptions to Medicare patients alone, more than any other prescriber in Connecticut, prosecutors alleged.
 
“Interviews with several of Alfonso’s patients, who are Medicare Part D beneficiaries and who were prescribed the drug, revealed that most of them did not have cancer, but were taking the drug to treat their chronic pain,” the U.S. attorney’s
office said in a press release.
 
Prosecutors said Alfonso was paid as a promotional speaker by Subsys’ maker, Insys Therapeutics Inc., for more than 70 dinner programs at a rate of about $1,000 per event. “In many instances, the dinner programs were only attended by Alfonso and a sales representative for the drug manufacturer,” the U.S. attorney said in the release. “In other instances, the programs were attended by individuals, including office staff and friends, who did not have licenses to prescribe controlled substances. For the majority of these dinner programs, Alfonso did not give any kind of presentation about the drug at all.”
 
The charge against Alfonso carries a maximum sentence of five years in prison and a fine of up to $250,000. Sentencing is scheduled… Continue Reading…
 
Courtesy: ProPublica
 

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How rural India gained 86 mn illiterate people
About 86 million more rural Indians have been counted as illiterate than the 2011 census data found.
 
This is revealed by the Socio Economic and Caste Census (SECC), which counted 315.7 million Indians in rural areas as illiterate in 2011, the same year as the census and the highest number of illiterates of any country in the world.
 
Put another way, rural India has more illiterate people than the population of Indonesia – the world’s fourth-most populous country – and twice the population of Pakistan.
 
Released last week, the SECC, which focused on rural India, counted more people (literate and illiterate) than the census: 35.73 percent of Indians in rural areas as illiterate, as against 32.23 percent counted by census 2011.
 
The new data has also revealed the low levels of literacy in rural India.
 
Those who are literate can barely read or count
 
As many as 14 percent (123 million people)  of literate Indians in rural areas have not studied past class five, while 18 percent (157 million) have completed primary education, or class five.
 
Given that educational levels in India do not reflect real learning, 280 million literate Indians in rural areas are only nominally literate.
 
As IndiaSpend reported earlier, only a fourth of all children in class III can read a class II text fluently, a drop of more than 5 percent over four years. With math, a quarter of children in class III could not recognise numbers between 10 and 99, a drop of 13 percent over four years, according to the 2014 Annual Status Report on Education (ASER).
 
Only 3 percent (three million) of Indians in rural areas have completed graduation or a higher level of education.
 
Central India reported the highest illiteracy rate of 39.20 percent and east India 38.79 percent, followed by west India (35.15 percent), north India (32.87 percent), the northeast (30.2 percent) and south India (29.64 percent).
 
Union territories fared the best with less than 15 percent of the population illiterate.
 
Rajasthan reported the worst illiteracy rate: 47.58 percent or 25.88 million people, followed by Madhya Pradesh with 44.19 percent or 22.80 million illiterate people, Bihar with 43.85 percent or 42.89 million illiterate people and Telangana with 40.42 percent or 9.5 million illiterate people. 
 
The surprises are the presence of the southern states of Telangana and Andhra Pradesh in the top 10 state for illiteracy.
 
Kerala is another surprise in the SECC analysis. While state surveys and the census have repeatedly claimed a literacy rate of more than 90 percent,  the SECC report says 11.38 percent, or 3 million Keralites, are illiterate.
 
Among union territories, Dadra & Nagar Haveli reported the highest illiteracy rate of 36.29 percent.

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Comatose for nine years, 2006 train blasts victim dies
Nine years after being in coma, Parag Sawant, who was injured in the July 11, 2006 Mumbai suburban train serial blasts, died here early Tuesday, officials said.
 
Then aged 27, Sawant was travelling in a Churchgate-Virar train to his home when a bomb ripped apart a coach of the suburban local near Bhayander.
 
He suffered extensive head injuries and brain trauma and was rushed to the Bhaktivedanta Hospital in Mira Road before being shifted to P.D. Hinduja Hospital in south Mumbai.
 
"I am sad to hear the news. In fact last week, I was discussing with his family members my plans to visit Parag (Sawant) at the hospital on the ninth anniversary of the 7/11 blasts next Saturday. His family and Parag took the tragedy bravely," said Kirit Somaiya, Mumbai North-East BJP MP.
 
One of the last survivors of the terror attack, Sawant, 36, is survived by his wife Priti, rehabilitated with a job in Indian Railways, and minor daughter Praniti, eight years old whom he never saw as she was born after he lapsed into a vegetative state.
 
Sawant had become popular among the masses for his will to live, had regained consciousness briefly in 2008, and was visited by personalities like former deputy prime minister L.K. Advani and union Minister Sushma Swaraj.
 
The 7/11 Mumbai suburban trains serial blasts, carried out in a span of just 11 minutes, targeted the crowded suburban services during the evening peak hours as bombs kept in pressure cookers went off in north-bound locals on Western Railway.
 
A total of 209 commuters were killed and another 700-plus injured in the most deadly attack on Mumbai's lifeline at Bhayander, Borivali, Jogeshwari, Khar Road, Bandra, Mahim and Matunga Road, while one unexploded bomb was found by police and defused at Borivali.

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