registered or reported, says Kay
Dickersin, the director of the Center for Clinical Trials at the Johns Hopkins
Bloomberg School of Public Health. "We need something more
meaningful," she said. "The average person has no idea that www.clinicaltrials.gov
is not comprehensive."
The New England Journal study also
points to the need for the FDA to disclose more information about the studies
it receives, says Robert Hedaya, a professor of clinical psychiatry at
Georgetown University Hospital. He said it was "disturbing" that the
information on the negative studies wasn't made widely available by the FDA.
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The FDA does post information,
including unpublished studies, for some drugs on its Web site, says Dr. Turner.
But information that hasn't yet made it online is hard to come by. Dr. Turner
said he made public records requests for information not on the Web site more
than a year ago, but the requests have gone largely unfulfilled. He said he was
able to get some of the FDA's information on unpublished studies from other
researchers who acquired it from the agency through their own record requests.
The 'Effect Size'
In this week's study, the researchers
found that failing to publish negative findings inflated the reported
effectiveness of all 12 of the antidepressants studied, which were approved
between 1987 and 2004. The researchers used a measurement called effect size.
The larger the effect size, the greater the impact of a treatment.
The average effect size of the
antidepressant Zoloft rose 64% by the failure to publish negative or
questionable data on the drug, the researchers found.
Parents' Pessimism
Affects Children's Investing
Parental attitudes can
significantly influence children's decisions to invest. The key is the extent
to which parents trust society, according to "Social Capital as Good
Culture," a new National Bureau of Economic Research working paper by
Luigi Guiso of the European University Institute; Paola Sapienza of the Kellogg
School of Management and Luigi Zingales of the University of Chicago.
The economists find
that pessimism among parents is passed on to their children as a form of social
capital, which is defined as the set of beliefs and values that inspire
cooperation in members of a community. Passing on pessimism leads children to
avoid investment and prevents them from gaining their own knowledge of society,
according to the paper. Allowing pessimistic values to flow from generation to
generation until society is stuck at a point the paper deems a "no-trust
no-trade equilibrium."
They tested their
model using two different samples: the World Value, a survey to determine the
correlation between young people's rate of learning and average level of trust
in their parents, and the German Socio Economic Panel to link parents' and
children's beliefs.
While it doesn't
specify how to alter a low trust state, it shows that even a temporary shock to
society can alter the perceptions passed from one generation to the next. In a
shock that lasts three generations, for example, 19% of families eventually
stop investing. If the shock lasts five generations, it drops to 8%.
"This 'temporary'
shock is sufficient to induce almost all family lines to have an optimistic
prior and always invest. Most interesting, this effect persists forever even
after the shock disappears," the researchers conclude.
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The economists sought
to prove that lasting effect by demonstrating that the difference in social
capital in Northern and Southern Italy today resulted from a period of
independence in cities in Northern Italy more than 500 years ago. Italian
literature from the 19th century showed that Northern literature was punctuated
by intense optimism and faith in others, while Southern literature displayed a
sense of mistrust toward the community. Data from the 1990s shows the
sentiments persisted long after the "shock." Though 42% of
Northerners trusted others, only 25% of Southerners felt the same.
The cycle can change
within individuals as well, though. The paper found that as a person ages,
trust tends to increase as his life experiences meld with his parents' views.
This was based on the finding that parents generally pass conservative versions
of their beliefs on to children. It also found that mothers have a stronger
influence in passing on personal values and beliefs.
Shifting levels of
trust are applicable to second generation Americans also, who often correlate
their trust in American society with the level they held in their native
countries. This can continue for generations.
"Our model
implies also that when transmitting priors, parents should do so in a
conservative way, so that the prior they transmit is on average lower than the
one they hold," the researchers conclude. "Furthermore, parents that
have stronger beliefs about the trustworthiness of others should transmit less
conservative priors." -Sara Murray
Telescopes have captured astonishing
images of far-away galaxies and other cosmic mysteries. Now, a new book called
Touch the Invisible Sky is helping everyone appreciate those pictures, even
people who can't see.
This isn't the first book written by
Noreen Grice, an astronomer who works at the Museum of Science in Boston. Back
in 1984, Grice was a 21-year-old studying astronomy at Boston University. She
had a job at the planetarium, and one Saturday, a group of blind people came to
the show.
"I didn't know what to do because
I didn't know anyone who was blind," says Grice. Her manager told her to
just help the people to their seats.
After the show was over, Grice went up
to the group.
"I said, 'So how did you like the
show?' And there was an uncomfortable pause," she recalls. "And then
they said, 'This stunk' and walked away. And that left me speechless because I
thought the planetarium was, like, the best place in the world."
The next day, Grice took a bus to a
nearby school for the blind. She found its library and looked for astronomy
books. They were thick books, printed in Braille.
"But something was missing. I
said, 'Where are the pictures? Are there any pictures these books?'"
The librarian explained that it's
expensive to translate an image into raised lines and textures that a person
can feel with their fingers. So textured images are uncommon in books for the
blind. Grice hated the idea that blind people weren't getting the same kind of
cool astronomy books she loved as a kid.
"I had grown up in the housing
projects outside Boston," says Grice. "People would say, 'you're a
project kid, you're not welcome here.' I understood what it meant to be
labeled. And I didn't really know how to make astronomy accessible. But I
thought, 'I'll try.'"
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Her first book, Touch the Stars, came
out in 1990. She used a Braille printer to trace out the constellations. Her
next book, Touch the Universe, traced out photos taken by the Hubble Space
Telescope. Grice created that one using thin plastic sheets.
"Basically, I was etching them by
hand, in my kitchen," she says. "Some were like, really difficult.
When you have diffuse gas, that you can hardly see, it is very difficult to
apply a texture to it."
Touch the Invisible Sky, her latest
book, was written with two co-authors. It's beautiful, designed to be read by
both blind people and sighted people.
The book has images taken by
telescopes that detect things like radio waves, x-rays and gamma rays — the
wavelengths of light that no one can see with the naked eye.
"I think we all have the same
thing in common with this book," says Grice. "No human can see these
other wavelengths so we're all approaching it together."
There's a real need for more books
like this one, says Marc Maurer, president of the National Federation of the
Blind.
"Most people think that astronomy
is the study of light, and they think therefore that blind people can't do it
and would not be interested," he says. "Blind people can do it, and
we find it fascinating."
Maurer loved the science textbooks his
mom read to him when he was going to school. But a popular science book he
could read by himself — there was nothing like that.
"There still are not enough
books," he says, explaining that exciting science books with pictures and
graphics are a rarity for blind people.
That's one reason why Chelsea Cook, a
high school student in Newport News, Virginia, got her family to drive four
hours to Baltimore for the new book's unveiling. She says Noreen Grice's
astronomy books are "really interesting, you know, the visuals are easy to
read, and they're just cool to look at."
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Cook says she has enough vision to see
a full moon, but not stars. Still, she wants to study astrochemistry and
astrophysics. And she's fascinated by the idea of space exploration.
Her ultimate career goal? To become
the first "blind astronaut." It will be "a lot to work
towards," she says, "but I think it's possible."
The United States Constitution never
uses the word "God" or makes mention of any religion, drawing its
sole authority from "We the People." However, Republican presidential
candidate Mike Huckabee thinks it's time to put an end to that.
"I have opponents in this race
who do not want to change the Constitution," Huckabee told a Michigan
audience on Monday. "But I believe it's a lot easier to change the
Constitution than it would be to change the word of the living god. And that's
what we need to do -- to amend the Constitution so it's in God's standards
rather than try to change God's standards so it lines up with some contemporary
view."
When Willie Geist reported Huckabee's
opinion on MSNBC's Morning Joe, co-host Mika Brzezinski was almost speechless,
and even Joe Scarborough couldn't immediately find much to say beyond calling
it "interesting,"
Scarborough finally suggested that while
he believes "evangelicals should be able to talk politics ... some might
find that statement very troubling, that we're going to change the Constitution
to be in line with the Bible. And that's all I'm going to say."
Geist further noted of Huckabee that
if "someone without his charm," said that, "he'd be dismissed as
a crackpot, but he's Mike Huckabee and he's bascially the front-runner."
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If you had to choose between two sets
of speaker cables, one costing a few dollars and sounding fine, the other a few
thousand dollars but perhaps sounding slightly better, and you chose the second
pair, then you would have had a great time last week in Las Vegas.
The city's many goings-on included The
Home Entertainment Show, an audiophile trade show held in two small motels off
the Strip. Audiophiles, as you probably know, are the hi-fi zealots who think
nothing of spending $50,000 on a turntable. I've learned over the years that
audiophiles actually come in two varieties: the totally insane and the merely
crazy.
The latter have a sense of humor and
shrug that theirs is just one of many hobbies -- like wine -- for people with
money, expansive vocabularies and the ability to discern differences lost on
the rest of us.
By contrast, my interests involve the
extent to which beliefs influence perceptions. Scientists have discovered that
brain scans of wine drinkers show they physically enjoy a wine more if they
think it is expensive. Can audiophiles really hear all the differences they say
they can, without being influenced by the brand or price of their equipment?
To find out, Portals became an
official exhibitor at T.H.E. Show last week. I set up a room with two sound
systems, identical except for one component. Everything except the speakers was
hidden behind screens. (A shout-out to Totem Acoustics for the Forest speakers
loan and to Magnum Dynalab for the MD-308 amps. They all sounded sensational.)
With the same music playing on both,
participants used a remote control to switch between the two, and then tell me
which sounded better.
One of the tests compared a
high-quality MP3 file from an iPod with a CD on a $3,000 player. Three-quarters
of the 24 people taking this test preferred the CD.
That was no surprise. However, when I
played .wav files on the iPod -- these are digital but uncompressed files; I
was connecting the headphone jack to the amplifier -- 52% of the 21 who took
this test preferred the iPod.
That made me smile, not because snooty
audiophiles got the "wrong" answer, but because it suggests great
sound can come from popular, cheap gear.
I also tested speaker cables, which
are controversial even among audiophiles. Some spend tens of thousands of
dollars on cabling, while others consider it an absurd waste of money.
Using two identical CD players, I
tested a $2,000, eight-foot pair of Sigma Retro Gold cables from Monster Cable,
which are as thick as your thumb, against 14-gauge, hardware-store speaker
cable. Many audiophiles say they are equally good. I couldn't hear a difference
and was a wee bit suspicious that anyone else could. But of the 39 people who
took this test, 61% said they preferred the expensive cable.
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That may not be much of a margin for
two products with such drastically different prices, but I was struck by how the
best-informed people at the show -- like John Atkinson and Michael Fremer of
Stereophile Magazine -- easily picked the expensive cable.
Its sound was described as
"richer," "crisper" and "more coherent." Like
some wines, come to think of it.
In absolute terms, though, the
differences weren't great. Mr. Atkinson guesstimated the expensive cables
sounded roughly 5% better. Remember, by definition, an audiophile is one who
will bear any burden, pay any price, to get even a tiny improvement in sound.
Attendance at the show was
disappointing, so I didn't get the numbers of participants I wanted. Even if I
had, I'm not sure I would have settled anything. These "A-B" tests
have limits, including the fact that differences you might not pick up right
away can become more apparent with extended listening.
Skeptics out there might think I've
gone all mushy and credulous on them.
Not so.
Consider the thriving audiophile
product category of power-line conditioners, said to remove noise and
distortions caused by your electrical supply, a problem you may not realize you
have. A rep from Audience LLC accepted my invitation for an A-B test of the
company's $2,800 AdeptResponse aR6 conditioner.
He picked the system using his
conditioner -- the other was plugged into the wall -- two out of three times.
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Note that the aforementioned
"merely crazy" audiophiles say that while they might have home setups
costing six figures, the rest of us can get splendid sound for under $1,000 by
shopping at specialty audio shops, the sort that sell unfamiliar brands.
I can't help you with brands, but my
tests suggest you might want to do your ripping as .wav files. While they take
up a lot more room than MP3s, falling disk prices make this feasible even for
big collections.
As for cables, good ones can cost well
under $2,000. I'd still be happy at the hardware store, but you may be the
golden-ear sort who can hear a difference. As in "Dirty Harry,"
you've got to ask yourself, "Do I feel lucky?"
Well, do you?
A cocaine boom in Europe and the
continent's strong currency have combined to fuel a thriving industry: euro
laundering.
With the euro approaching $1.50 and
soaring demand for cocaine in countries like Spain and Italy, Europe has become
a far more lucrative place to do business for Latin American drug cartels than
in previous years.
To obscure the origins of the funds,
and escape government scrutiny in the process, the cartels use a complex system
to launder their proceeds -- much of which is landing on U.S. shores.
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In late March, U.S. authorities
arrested a man carrying a leather duffel bag who had just landed at Los Angeles
International Airport on a flight from Santiago, Chile. Inside the bag was more
than $1.9 million in cash, mostly in bundles of €500 and €200 notes.
Authorities are struggling to make a
dent in the booming drug trade in Europe. WSJ's Mark Schoofs tags along with
Spanish police as they search for clues to the source of cocaine that keeps
pouring into the country.
U.S. and Chilean law enforcement
officials believe the man was at the end of a money-laundering trail that
begins in Europe. Over a period of four and a half years, he and his associates
flew to the U.S. from Latin America some 280 times, openly toting more than
$244 million worth of euros into the country, according to documents in a case
brought by federal authorities in U.S. District Court in New York.
The big bills have become so symbolic
of the lush life that they have recently crept into pop culture: The rapper
Jay-Z's video for Blue Magic -- the debut single from his new album
"American Gangster" -- features a suitcase full of €500 notes and
someone thumbing through a stack of them as Jay-Z raps the words, "the
kilo business." Hype Williams, director of the music video, said that he
and Jay-Z chose euros because they are "more valuable" and because
they wanted to "one-up" their hip-hop competitors by showing
"the things people are into now."
The wads of euros carried by people
like the man arrested at LAX are often the spoils of Europe-bound cocaine
shipments -- many of which transit through Africa, law-enforcement officials
say.
Consumption of the drug has soared in
much of Western Europe, according to a report released last year by the U.N.
Office on Drugs and Crime. In Italy, use of the drug rose to 2.1% of the
general population in 2005 from 1.1% just four years earlier. In France, it
tripled from 2000 to 2005, from 0.2% to 0.6% of the adult population. Cocaine
use in England doubled from 1998 to 2006, according to Britain's National
Health Service, to 2.4% among adults.
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Some narco-euros are laundered
directly in Europe. But officials say the lion's share is routed back to South
America as cash and eventually ends up in the U.S.
"This is still a cash
business," says Donald Semesky, the Drug Enforcement Administration's head
of financial-crimes investigations.
The first step is to convert small bills
accumulated from thousands of street sales into €500 notes, which are easy to
transport. Obtaining large quantities of these conspicuous notes, though, isn't
easy. So drug traffickers turn to specialized criminal rings -- whose members
are often involved in banking and real estate -- to gain access to them, says
José Manuel Álvarez Luna, chief of the money-laundering section of the Spanish
police.
Spain is the center for such
aggregation, according to authorities. A high-level Spanish banking official
says a disproportionate share of the euro zone's €500 notes, known as Bin
Ladens for their scarcity, circulate in Spain.
The purpose of money-laundering is to
disguise the criminal origins of ill-gotten gains so the funds appear
legitimate. In most cases, laundering also helps criminals escape the notice of
tax collectors and law-enforcement officials, boosting the value of their
illegal proceeds.
Particularly since 9/11, tightened
antilaundering regulations, known by banks as "know your customer"
rules, have forced drug cartels to use more circuitous routes to circulate
their funds around the globe.
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For starters, the drug cartels do not
themselves bring their narco-euros to the U.S. Instead, they usually sell their
euros to South American black-market currency brokers or to foreign-exchange
houses, known in Spanish as casas de cambio. The casas' business as currency-exchange
houses gives them a natural cover for moving large amounts of cash.
But in South America, there are few if
any legitimate buyers for the huge sums of euros that the casas obtain --
directly or indirectly -- from the traffickers. So the casas funnel most of the
narco-euros, sometimes via middlemen, through a chain of exchange houses in
countries like Colombia, Peru, Brazil and Chile, says the DEA's Mr. Semesky.
Often, the drug traffickers will sell
their euros for Colombian pesos, and then the euros entering the U.S. no longer
belong to the drug cartels but to the casa de cambio. In other cases, says Mr.
Semesky, traffickers pay the casas to move funds into one of their U.S. bank
accounts. These funds aren't usually intended for withdrawal, but rather to pay
various debts. This is achieved by wiring funds to the account of whomever the
trafficker wishes to pay.
On a recent night at a bar on Madrid's
bustling Gran Vía, a shirtless, tattooed waiter served tables and a buxom drag
queen in a nurse's uniform worked the crowd. In the trendy venue was a man in
his 30s who talked by cellphone with his dealers. A few minutes later, he
stepped outside, leaned into the window of a small car and handed over €60, or
about $90. For that sum, he received one gram of cocaine.
Such street sales have surged. Spain
now has a larger percentage of its population (3%) using cocaine than the U.S.
(2.3%), the previous top per-capita consumer, according to United Nations
figures. In the first half of 2007, a kilo of cocaine sold for €33,000, or
about $43,900, in Madrid, more than triple the $12,500-$14,600 it fetched in
Los Angeles and far more than the $13,000-$26,000 it sold for in New York,
according to the Spanish police and the DEA.
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Last year, seven European countries
banded together to form the Maritime Analysis and Operations Center-Narcotics,
or MAOC-N, an international agency dedicated to stopping drug traffic over the
Atlantic. Already, the center is helping to make major busts.
In October, on the high seas off West
Africa, Spanish authorities -- acting on a tip from MAOC-N -- seized an aging,
cockroach-infested trawler. Called the Opnor, it allegedly had more than three
metric tons of cocaine hidden below the floor of its cargo hold. Apparently
registered in Panama, the vessel was captained by a grizzled Dutch man in his
late 60s and is believed to have been heading toward Senegal.
The boat was following a typical
pattern, authorities say. They surmise that, if it hadn't been seized, its
cocaine would have been warehoused in West Africa, where crushing poverty, weak
law enforcement and, often, rampant corruption make for an ideal way station.
The traffickers would have then sent the drugs to Europe by boat, either
directly or via North Africa. Increasingly, say Spanish and American
authorities, cocaine is also being flown from North Africa in small planes
landing in Spain and Portugal on clandestine airstrips.
The traffickers were forced to take
those routes because Spanish, Portuguese and British authorities were
intercepting boats coming to Europe directly from South America.
Spain is a favorite entry point
because of its proximity to Africa, its long coastline and its language, which
it shares with Colombia and most other South American countries. Spanish
officials say they seized almost 100 metric tons of cocaine in 2005 and 2006.
According to United Nations statistics, Spain seized more cocaine than any
European nation between 1999 and 2005.
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Authorities suspect that Europe's
thriving cocaine business likely provided the euros in the duffel bag of
Mauricio Mazza-Alaluf, the man arrested at LAX in March. Along with a cousin,
Luis Mazza-Olmos, he ran an exchange house in downtown Santiago, Chile,
according to U.S. and Chilean law-enforcement officials.
The probe into the Mazzas began in
August 2004, says Christian Caamaño, an investigator for the Investigative
Police of Chile. The tip-off was a Peruvian passenger on a flight from Colombia
who arrived at the Santiago airport carrying a backpack stuffed with €600,000,
according to Mr. Caamaño. Alarmed, Chilean authorities began monitoring such
couriers and noticed that they dropped off their bags full of euros at the
Mazzas' exchange house.
Later, the Mazzas' routine evolved: A
courier from Colombia, allegedly carrying European proceeds, would deliver cash
at the Santiago airport to an armored-car service. Personnel would count the
money in a parked truck and turn it over to the Mazzas or one of their
associates, says Hernán Peñafiel, the lead prosecutor in a parallel case
brought in Chile against the Mazzas. One of the Mazzas or their associates
would then board a U.S.-bound flight with the money, Mr. Peñafiel says.
Once on U.S. soil, according to
authorities, the Mazzas allegedly moved their euros with breathtaking openness.
Their main tactic was to dutifully fill out paperwork at customs points and
financial institutions, using real family and business names, according to law
enforcement officials and court documents from the U.S. case.
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After the Mazzas or their associates
cleared customs at Los Angeles International Airport, they would transfer their
cash to Associated Foreign Exchange Banknotes Inc., a currency-exchange firm
headquartered in Encino, Calif. AFEX Banknotes then converted the euros into
dollars and wired the dollars to U.S. bank accounts the Mazzas had opened,
according to law-enforcement officials and two AFEX Banknotes employees.
The Mazzas had accounts with at least
three banks in the U.S., according to the court documents from the New York
case: Israel Discount Bank of New York; Harris Bank in Chicago; and J.P. Morgan
Chase in Dearborn, Mich. In opening each account, the Mazzas gave their
company's real name and openly described it as a tourism and currency-exchange
agency.
The Mazzas proceeded to move huge sums
of money through these accounts, according to the court documents, often after
receiving faxed instructions, intercepted by Chilean authorities, from people
or entities with suspected ties to Colombian traffickers.
In a single year, according to court
documents, the Mazzas wired $133 million into the Harris Bank account and $117
million out. At their J.P. Morgan Chase account, they wired $35.5 million in
and $34 million out in less than three months, and their IDB checking account
recorded more than 2,500 transactions totaling more than $29 million during
2003 and 2005, according to the court documents.
Asked to comment, Harris Bank said in
a written statement that it "identified suspicious activity" after
conducting its own investigation and "closed the account in accordance
with banking regulations." IDB said in a statement that the events outlined
in the New York case "occurred under former management" and it no
longer maintains accounts for unlicensed money transmitters, including the
Mazzas' casa de cambio. Chase declined to comment.
AFEX Banknotes compliance officer
Andrew Scherer says his company is "mortified" that it may have
helped facilitate illegal activity, but added that it has strong
anti-money-laundering policies and has taken "substantive measures"
to improve its anti-money-laundering policies in the wake of the Mazza case. He
declined to be more specific, citing security concerns.
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When Mr. Mazza-Alaluf landed at LAX on
March 31, he didn't attempt to conceal his money. Like he and his associates
had done hundreds of times before, he filled out the standard declaration
forms, a requirement for passengers entering the U.S. carrying more than
$10,000 worth of currency. But this time, he was immediately arrested. The
55-year-old Chilean maintained his innocence.
Mr. Mazza-Alaluf has pleaded not
guilty to federal felony charges of conspiracy and operating an unlicensed
money-transmitting business. His attorney, Bernard Alan Seidler, calls the
charges "a classic case of the government overreaching."
Chilean authorities nabbed members of
the Mazza clan and their associates in a coordinated operation. They are now in
jail in Santiago, facing money-laundering charges. Their lawyer, Yieninson
Yapur, says they are all innocent. In an email sent via Mr. Yapur, Mr.
Mazza-Olmos said he is a legitimate businessman and has done nothing illegal.
The U.S. investigation of the Mazza
case was conducted by a multi-agency task force based in New York and led by
the DEA and the Internal Revenue Service. Officials tout it as an important
success. But it's unlikely to significantly restrict the flow of narco-euros
gushing out of Europe.
On a recent afternoon, far from the
glitz of the night life on Gran Vía, a homeless addict walked around in a
northern Madrid shantytown with a syringe hanging out of his forearm.
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Even as police tore down the
surrounding shacks to make way for a new development, residents hammered away,
rebuilding their wood and cardboard houses. "The demand for cocaine is
huge, so knocking these shacks down does nothing," says Gema Bautista, a
social worker with Fundación Atenea Grupo GID, which runs a mobile clinic and
needle-exchange program. "The shacks just pop up again."
Health insurers are taking a new tack
in a bid to improve patient safety and reduce health-care costs: refusing to
pay -- or let their patients be billed -- for hospital errors.
Aetna Inc., WellPoint Inc. and other
big insurers are moving to ban payments for care resulting from serious errors,
including operating on the wrong limb or giving a patient incompatible blood.
The companies are following the lead
of the federal Medicare program, which announced last summer that starting this
October, it will no longer pay the extra cost of treating bed sores, falls and
six other preventable injuries and infections that occur while a patient is in
a hospital. The following year, it will add to the list hospital-acquired blood
infections, blood clots in legs and lungs, and pneumonia contracted from a
ventilator.
Private insurers are looking first at
banning reimbursements for only the gravest mistakes. But health-insurance
executives say it is only a matter of time before the industry also stops
paying for some of the more common and less clear-cut problems that Medicare is
tackling, such as hospital-acquired catheter infections or blood poisoning.
"I'd rather have the cudgel in place first than push the list too
far," says Aetna President Mark Bertolini.
Some hospitals and others are
concerned that the new strategy could drive up medical costs in other ways as
hospitals absorb or pass on the expense of introducing the safety and screening
procedures needed to help avoid mistakes.
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Ultimately, insurers say, the efforts
will trigger safety improvements and savings for patients.
Aetna, the country's third-largest
insurer by number of members, is beginning to stipulate in hospital contracts
up for renewal that it will no longer pay nor let patients be billed for 28
different "never events." Compiled by the National Quality Forum, a
coalition of physicians, employers and policy makers, these mistakes include
leaving an instrument in a patient after surgery, the death of a mother in a
low-risk pregnancy, allowing a patient to develop bedsores or using
contaminated devices. Such errors are so egregious "there can't be any
argument that they should ever happen," says Troy Brennan, Aetna's chief
medical officer.
WellPoint, the largest insurer, is
testing the same approach in Virginia with four errors from the forum's
never-events list, including leaving a sponge or other object in a patient
after a procedure and performing the wrong procedure. It plans to extend the
policy soon to its plans in New England, New York and Georgia. UnitedHealth
Group Inc. and Cigna Corp. say they're exploring policies similar to
Medicare's. The Blue Cross Blue Shield Association says that its 39 member
health plans are looking at approaches similar to Aetna's or working with
hospitals on reducing errors.
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The National Quality Forum's so-called
never events are rare enough that private insurers say they don't expect to see
a big financial savings at first. In Minnesota, where hospitals are required by
law to report such errors, 154 never events were reported last year out of nine
million hospital admissions. Rather, the idea is to spur more attention to
safety and public reporting of mistakes.
"It's not a matter of not paying
for them. It's about getting them not to happen in the first place," says
Thomas Granatir, director of policy and research at Humana Inc., which is
working on a policy similar to Medicare's.
The more common errors offer the
biggest potential for savings -- in both lives and money. The Centers for
Disease Control and Prevention estimates that patients develop 1.7 million
infections in hospitals a year, causing or contributing to as many as 99,000
deaths a year. On average, urinary-tract infections and hospital-acquired
pneumonia -- which are on the Medicare list but not on the never-events list --
can add more than $10,000 to a patient's hospital bill. A more serious
antibiotic-resistant bloodstream infection can result in more than $100,000 in
extra costs. Such common errors total more than $4.5 billion in additional
health spending a year, according to the CDC.
Despite growing evidence that
hospitals can take steps to reduce infections drastically, until recently,
infections typically have been considered an inevitable part of care and billed
accordingly. "It's something that no one ever questions when you see it on
the bill. But now that Medicare will, maybe that's going to change," says
Nora Johnson, director of compliance and education at Medical Billing Advocates
of America, a nationwide patient-advocacy network that deciphers hospital and
insurance bills for consumers and advocates on behalf of uninsured patients.
As insurers roll out the policy across
the country, they say they are structuring their contracts with hospitals so
that the hospitals also won't be able to charge patients for care made
necessary by medical errors. Given the high rate of medical billing errors,
however, consumer advocates advise patients to examine their bills carefully,
especially if they are aware of errors or problems that occurred during their
stay. People with health insurance should check their bills against the
explanation of benefits they receive from the health plan, or press their
insurers to make sure they haven't been overcharged.
When it comes to medical errors, some
hospitals say they forgive bills or adjust charges on a case-by-case basis. But
the complex billing and payment arrangements between hospitals and insurers can
make it hard to avoid paying for errors and for patients to know whether
they're being charged.
Last January, when Arlene Whitfield, a
Los Angeles elementary-school teacher, underwent a hip replacement at Centinela
Hospital in Inglewood, Calif., she accidentally received B-positive blood,
instead A-positive.
The mistake lengthened her recovery
time by two days and she ended up staying in the hospital for a week, for which
Centinela billed accordingly. That is because Medicare's hospital billing
guidelines require hospitals to document and itemize all the care they provide
to a patient, says Von Crockett, the hospital's president and chief executive. "That's
different than what we expect to collect and get paid for it," he says.
"It's a documentation of what happened to the patient." He says Ms.
Whitfield's portion of the bill was forgiven.
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