Timothy F. Kirn

TORONTO — Prescription drug abuse is growing at a faster rate than is illegal substance abuse, particularly among adolescents, Joseph A. Califano Jr. said at the annual meeting of the American Psychiatric Association.

“We think the country has got to deal with this problem, because the reality is we are seeing a tremendous increase in prescription drug abuse, particularly in young people,” said Mr. Califano, chairman of the National Center on Addiction and Substance Abuse (CASA) at Columbia University, New York and a former Health and Human Services secretary under the Carter administration.

According to a large research project conducted by CASA that drew on several surveys and databases, the number of Americans abusing prescription drugs exceeds the numbers abusing illegal drugs, except marijuana, he said.

In 2003, 15 million Americans were abusing prescription drugs, compared with only 6 million using cocaine and 4 million using hallucinogens.

The number of Americans abusing drugs increased dramatically between 1991 and 2003, with the greatest rate increase coming among adolescents, for whom the absolute numbers rose from about 700,000 in 1992 to 2.3 million in 2003, an increase that surpasses 200%, Mr. Califano said.

That increase coincided with a huge increase in prescriptions for controlled substances, he noted. From 1992 to 2002, the population of the country grew 13%. The number of prescriptions written grew 57%. But the number of prescriptions for controlled substances rose 154%.

Physician and pharmacist surveys suggest that lax practice by members of both professions is partly to blame, or at least represents a missed opportunity to curb some prescription drug abuse, Mr. Califano said.

In a survey of 1,000 physicians and 1,000 pharmacists, a little more than half of each group said they blamed patients for most prescription drug abuse; altered prescriptions, doctor shopping, and outright lying were cited as ways people obtain controlled substances for abuse. However, 33% of the doctors said that before prescribing a controlled drug, they do not check and obtain patients' medical records to investigate patients' previous conduct and contact with physicians. Forty-three percent of doctors do not ask patients about their drug abuse history.

Sixty-one percent of the pharmacists said they never question patients about prescriptions for controlled drugs before they fill the prescriptions; one-third said they never review the patients' other previous or current prescriptions, and 28% said they do not regularly validate the Drug Enforcement Administration number on the prescription.

It is clear, too, that these prescription drugs are getting into the hands of teenagers and that teenagers who abuse prescription drugs will abuse other drugs, Mr. Califano said. Teenagers who abuse prescription drugs are twice as likely to abuse alcohol, five times more likely to use marijuana, and 15 times more likely to use ecstasy.

Focus groups suggest that adolescents do not view prescription drugs with the same reservations that they view illegal substances such as marijuana and cocaine.

“They don't look at them as illegal drugs,” Mr. Califano said. Part of that probably stems from the ubiquitous nature of prescription drugs. Teenagers see prescription drugs advertised, and they also see their friends—and even their parents—taking them. “For some kids, the medicine cabinet is a worse threat than the local dealer,” he added.

TORONTO — Prescription drug abuse is growing at a faster rate than is illegal substance abuse, particularly among adolescents, Joseph A. Califano Jr. said at the annual meeting of the American Psychiatric Association.

“We think the country has got to deal with this problem, because the reality is we are seeing a tremendous increase in prescription drug abuse, particularly in young people,” said Mr. Califano, chairman of the National Center on Addiction and Substance Abuse (CASA) at Columbia University, New York and a former Health and Human Services secretary under the Carter administration.

According to a large research project conducted by CASA that drew on several surveys and databases, the number of Americans abusing prescription drugs exceeds the numbers abusing illegal drugs, except marijuana, he said.

In 2003, 15 million Americans were abusing prescription drugs, compared with only 6 million using cocaine and 4 million using hallucinogens.

The number of Americans abusing drugs increased dramatically between 1991 and 2003, with the greatest rate increase coming among adolescents, for whom the absolute numbers rose from about 700,000 in 1992 to 2.3 million in 2003, an increase that surpasses 200%, Mr. Califano said.

That increase coincided with a huge increase in prescriptions for controlled substances, he noted. From 1992 to 2002, the population of the country grew 13%. The number of prescriptions written grew 57%. But the number of prescriptions for controlled substances rose 154%.

Physician and pharmacist surveys suggest that lax practice by members of both professions is partly to blame, or at least represents a missed opportunity to curb some prescription drug abuse, Mr. Califano said.

In a survey of 1,000 physicians and 1,000 pharmacists, a little more than half of each group said they blamed patients for most prescription drug abuse; altered prescriptions, doctor shopping, and outright lying were cited as ways people obtain controlled substances for abuse. However, 33% of the doctors said that before prescribing a controlled drug, they do not check and obtain patients' medical records to investigate patients' previous conduct and contact with physicians. Forty-three percent of doctors do not ask patients about their drug abuse history.

Sixty-one percent of the pharmacists said they never question patients about prescriptions for controlled drugs before they fill the prescriptions; one-third said they never review the patients' other previous or current prescriptions, and 28% said they do not regularly validate the Drug Enforcement Administration number on the prescription.

It is clear, too, that these prescription drugs are getting into the hands of teenagers and that teenagers who abuse prescription drugs will abuse other drugs, Mr. Califano said. Teenagers who abuse prescription drugs are twice as likely to abuse alcohol, five times more likely to use marijuana, and 15 times more likely to use ecstasy.

Focus groups suggest that adolescents do not view prescription drugs with the same reservations that they view illegal substances such as marijuana and cocaine.

“They don't look at them as illegal drugs,” Mr. Califano said. Part of that probably stems from the ubiquitous nature of prescription drugs. Teenagers see prescription drugs advertised, and they also see their friends—and even their parents—taking them. “For some kids, the medicine cabinet is a worse threat than the local dealer,” he added.

TORONTO — Prescription drug abuse is growing at a faster rate than is illegal substance abuse, particularly among adolescents, Joseph A. Califano Jr. said at the annual meeting of the American Psychiatric Association.

“We think the country has got to deal with this problem, because the reality is we are seeing a tremendous increase in prescription drug abuse, particularly in young people,” said Mr. Califano, chairman of the National Center on Addiction and Substance Abuse (CASA) at Columbia University, New York and a former Health and Human Services secretary under the Carter administration.

According to a large research project conducted by CASA that drew on several surveys and databases, the number of Americans abusing prescription drugs exceeds the numbers abusing illegal drugs, except marijuana, he said.

In 2003, 15 million Americans were abusing prescription drugs, compared with only 6 million using cocaine and 4 million using hallucinogens.

The number of Americans abusing drugs increased dramatically between 1991 and 2003, with the greatest rate increase coming among adolescents, for whom the absolute numbers rose from about 700,000 in 1992 to 2.3 million in 2003, an increase that surpasses 200%, Mr. Califano said.

That increase coincided with a huge increase in prescriptions for controlled substances, he noted. From 1992 to 2002, the population of the country grew 13%. The number of prescriptions written grew 57%. But the number of prescriptions for controlled substances rose 154%.

Physician and pharmacist surveys suggest that lax practice by members of both professions is partly to blame, or at least represents a missed opportunity to curb some prescription drug abuse, Mr. Califano said.

In a survey of 1,000 physicians and 1,000 pharmacists, a little more than half of each group said they blamed patients for most prescription drug abuse; altered prescriptions, doctor shopping, and outright lying were cited as ways people obtain controlled substances for abuse. However, 33% of the doctors said that before prescribing a controlled drug, they do not check and obtain patients' medical records to investigate patients' previous conduct and contact with physicians. Forty-three percent of doctors do not ask patients about their drug abuse history.

Sixty-one percent of the pharmacists said they never question patients about prescriptions for controlled drugs before they fill the prescriptions; one-third said they never review the patients' other previous or current prescriptions, and 28% said they do not regularly validate the Drug Enforcement Administration number on the prescription.

It is clear, too, that these prescription drugs are getting into the hands of teenagers and that teenagers who abuse prescription drugs will abuse other drugs, Mr. Califano said. Teenagers who abuse prescription drugs are twice as likely to abuse alcohol, five times more likely to use marijuana, and 15 times more likely to use ecstasy.

Focus groups suggest that adolescents do not view prescription drugs with the same reservations that they view illegal substances such as marijuana and cocaine.

“They don't look at them as illegal drugs,” Mr. Califano said. Part of that probably stems from the ubiquitous nature of prescription drugs. Teenagers see prescription drugs advertised, and they also see their friends—and even their parents—taking them. “For some kids, the medicine cabinet is a worse threat than the local dealer,” he added.

ASPEN, COLO. — When Colorado had two separate outbreaks of aseptic meningoencephalitis associated with enterovirus 71, the patients were more likely to have the virus detected in throat swabs than in the cerebrospinal fluid, Dr. Mark J. Abzug said at a conference on pediatric infectious disease sponsored by Children's Hospital, Denver.

That may mean this particular virus is easily transmissible via respiratory secretions, and that could explain the recent, prolonged outbreaks of this very serious disease that have been occurring in various locations, primarily in East Asian countries and most notably in Taiwan, said Dr. Abzug, a professor of pediatrics at the University of Colorado, Denver.

In the outbreaks, infection with this virus has been associated with brain stem encephalitis with an acute flaccid paralysis reminiscent of polio and, in the cases where it has proved fatal, pulmonary edema and cardiovascular collapse. In children less than 5 years of age, who make up the majority of patients with these infections, the disease has been fatal in 20% of cases.

Colorado has had 17 cases, with 8 in 2003 and 9 in 2005. The children ranged in age from 4 months to 9 years; most were under 5 years of age. One child died and one was left respirator-dependent. Three were left with some persistent paralysis.

Only 5 of these 17 patients had virus retrieved from the cerebrospinal fluid, with all of the testing being polymerase chain reaction (PCR) assay. These patients tended to be the younger ones; they generally were tapped early in the course of their illness, and none had pleocytosis. Most of these patients had less severe disease.

Those with pleocytosis tended to be the older patients, and they generally did not have virus retrieved from their cerebrospinal fluid.

On the other hand, all of the 12 patients who had throat swabs tested by PCR were positive for the virus. Some of these patients had stools that tested positive as well.

Many of these patients had mucocutaneous rash, and the progression in those who developed acute flaccid paralysis was rapid, Dr. Abzug said.

Imaging of patients has suggested that the virus causes lesions in the spinal anterior horn cells, much like polio virus does. The hypothesis is that the cardiopulmonary manifestations of severe cases come not from direct destruction of the heart and lungs by the virus, but rather from the brain stem lesions causing sympathetic system hyperactivity.

Care is largely supportive, Dr. Abzug added. In Taiwan, physicians have treated patients with intravenous immunoglobulin, but the experience has suggested that it does not help, and a small trial conducted in Australia of immunoglobulin also found it was of no benefit.

Others have tried interferon-α, corticosteroids, and pleconaril, none of which have shown any benefit.

Supportive care includes fluid restriction and vasodilators for those with cardiac and pulmonary involvement. Inotropes have been shown to be associated with a worse outcome, but milrinone, which is both an inotrope and a vasodilator, may be associated with some improvement in outcome.

Notable enterovirus 71-encephalitis outbreaks are becoming more common, but infection does not appear to be rare and it is not seen just in foreign locales, Dr. Abzug said. One serosurvey conducted in New York state found that 26% of adults had antibodies to the virus. Prior to the Colorado cases, there was a previous U.S. outbreak in 1994.

There have been three proposed explanations for the recent outbreaks. One is that the virus itself may be becoming more neurovirulent. Another is that it has become more readily transmissible via respiration. The last is that perhaps more people are becoming susceptible to serious sequelae. Prior to the Colorado evidence, findings from Taiwan have suggested that all three are probably factors, Dr. Abzug said.

ASPEN, COLO. — When Colorado had two separate outbreaks of aseptic meningoencephalitis associated with enterovirus 71, the patients were more likely to have the virus detected in throat swabs than in the cerebrospinal fluid, Dr. Mark J. Abzug said at a conference on pediatric infectious disease sponsored by Children's Hospital, Denver.

That may mean this particular virus is easily transmissible via respiratory secretions, and that could explain the recent, prolonged outbreaks of this very serious disease that have been occurring in various locations, primarily in East Asian countries and most notably in Taiwan, said Dr. Abzug, a professor of pediatrics at the University of Colorado, Denver.

In the outbreaks, infection with this virus has been associated with brain stem encephalitis with an acute flaccid paralysis reminiscent of polio and, in the cases where it has proved fatal, pulmonary edema and cardiovascular collapse. In children less than 5 years of age, who make up the majority of patients with these infections, the disease has been fatal in 20% of cases.

Colorado has had 17 cases, with 8 in 2003 and 9 in 2005. The children ranged in age from 4 months to 9 years; most were under 5 years of age. One child died and one was left respirator-dependent. Three were left with some persistent paralysis.

Only 5 of these 17 patients had virus retrieved from the cerebrospinal fluid, with all of the testing being polymerase chain reaction (PCR) assay. These patients tended to be the younger ones; they generally were tapped early in the course of their illness, and none had pleocytosis. Most of these patients had less severe disease.

Those with pleocytosis tended to be the older patients, and they generally did not have virus retrieved from their cerebrospinal fluid.

On the other hand, all of the 12 patients who had throat swabs tested by PCR were positive for the virus. Some of these patients had stools that tested positive as well.

Many of these patients had mucocutaneous rash, and the progression in those who developed acute flaccid paralysis was rapid, Dr. Abzug said.

Imaging of patients has suggested that the virus causes lesions in the spinal anterior horn cells, much like polio virus does. The hypothesis is that the cardiopulmonary manifestations of severe cases come not from direct destruction of the heart and lungs by the virus, but rather from the brain stem lesions causing sympathetic system hyperactivity.

Care is largely supportive, Dr. Abzug added. In Taiwan, physicians have treated patients with intravenous immunoglobulin, but the experience has suggested that it does not help, and a small trial conducted in Australia of immunoglobulin also found it was of no benefit.

Others have tried interferon-α, corticosteroids, and pleconaril, none of which have shown any benefit.

Supportive care includes fluid restriction and vasodilators for those with cardiac and pulmonary involvement. Inotropes have been shown to be associated with a worse outcome, but milrinone, which is both an inotrope and a vasodilator, may be associated with some improvement in outcome.

Notable enterovirus 71-encephalitis outbreaks are becoming more common, but infection does not appear to be rare and it is not seen just in foreign locales, Dr. Abzug said. One serosurvey conducted in New York state found that 26% of adults had antibodies to the virus. Prior to the Colorado cases, there was a previous U.S. outbreak in 1994.

There have been three proposed explanations for the recent outbreaks. One is that the virus itself may be becoming more neurovirulent. Another is that it has become more readily transmissible via respiration. The last is that perhaps more people are becoming susceptible to serious sequelae. Prior to the Colorado evidence, findings from Taiwan have suggested that all three are probably factors, Dr. Abzug said.

ASPEN, COLO. — When Colorado had two separate outbreaks of aseptic meningoencephalitis associated with enterovirus 71, the patients were more likely to have the virus detected in throat swabs than in the cerebrospinal fluid, Dr. Mark J. Abzug said at a conference on pediatric infectious disease sponsored by Children's Hospital, Denver.

That may mean this particular virus is easily transmissible via respiratory secretions, and that could explain the recent, prolonged outbreaks of this very serious disease that have been occurring in various locations, primarily in East Asian countries and most notably in Taiwan, said Dr. Abzug, a professor of pediatrics at the University of Colorado, Denver.

In the outbreaks, infection with this virus has been associated with brain stem encephalitis with an acute flaccid paralysis reminiscent of polio and, in the cases where it has proved fatal, pulmonary edema and cardiovascular collapse. In children less than 5 years of age, who make up the majority of patients with these infections, the disease has been fatal in 20% of cases.

Colorado has had 17 cases, with 8 in 2003 and 9 in 2005. The children ranged in age from 4 months to 9 years; most were under 5 years of age. One child died and one was left respirator-dependent. Three were left with some persistent paralysis.

Only 5 of these 17 patients had virus retrieved from the cerebrospinal fluid, with all of the testing being polymerase chain reaction (PCR) assay. These patients tended to be the younger ones; they generally were tapped early in the course of their illness, and none had pleocytosis. Most of these patients had less severe disease.

Those with pleocytosis tended to be the older patients, and they generally did not have virus retrieved from their cerebrospinal fluid.

On the other hand, all of the 12 patients who had throat swabs tested by PCR were positive for the virus. Some of these patients had stools that tested positive as well.

Many of these patients had mucocutaneous rash, and the progression in those who developed acute flaccid paralysis was rapid, Dr. Abzug said.

Imaging of patients has suggested that the virus causes lesions in the spinal anterior horn cells, much like polio virus does. The hypothesis is that the cardiopulmonary manifestations of severe cases come not from direct destruction of the heart and lungs by the virus, but rather from the brain stem lesions causing sympathetic system hyperactivity.

Care is largely supportive, Dr. Abzug added. In Taiwan, physicians have treated patients with intravenous immunoglobulin, but the experience has suggested that it does not help, and a small trial conducted in Australia of immunoglobulin also found it was of no benefit.

Others have tried interferon-α, corticosteroids, and pleconaril, none of which have shown any benefit.

Supportive care includes fluid restriction and vasodilators for those with cardiac and pulmonary involvement. Inotropes have been shown to be associated with a worse outcome, but milrinone, which is both an inotrope and a vasodilator, may be associated with some improvement in outcome.

Notable enterovirus 71-encephalitis outbreaks are becoming more common, but infection does not appear to be rare and it is not seen just in foreign locales, Dr. Abzug said. One serosurvey conducted in New York state found that 26% of adults had antibodies to the virus. Prior to the Colorado cases, there was a previous U.S. outbreak in 1994.

There have been three proposed explanations for the recent outbreaks. One is that the virus itself may be becoming more neurovirulent. Another is that it has become more readily transmissible via respiration. The last is that perhaps more people are becoming susceptible to serious sequelae. Prior to the Colorado evidence, findings from Taiwan have suggested that all three are probably factors, Dr. Abzug said.

SEATTLE — With generic prescribing, a little can go a long way. In fact, by using generics 10% of the time, the Medicare Part D program could reduce drug spending by as much as $2.3 billion, according to an analysis presented at the annual research meeting of Academy Health.

That could be important because the analysis also showed that about 22% of Medicare beneficiaries who used to receive a $600 subsidy for prescription drugs under the previous Medicare program will no longer qualify for a subsidy and 16%–23% will probably end up in what is called the “doughnut hole” of Medicare Part D, where they will have no drug coverage, said M. Christopher Roebuck, an economist with CareMark, Hunt Valley, Md., a leading pharmacy-benefits management company.

To conduct the analysis, Mr. Roebuck and colleagues used data from 37,425 individuals enrolled in Medicare drug discount card programs for at least 6 months, and who had filled at least one prescription. The researchers then assumed those same usage patterns, with some increase in usage when out-of-pocket costs go down, and applied a 3.5% annual rate for inflation.

“We think one of the strong points of our research is that it is based on actual claims data,” he said.

The enrollees filled a mean of 19 prescriptions per year, 10 of which were for generic medications and 9 for brand name. The mean total cost for their prescriptions was $849, of which they paid a mean $538 out of pocket.

Depending on the assumption used to estimate how the new coverage might increase use, the analysis suggests that out-of-pocket costs could increase for these beneficiaries by $38 to $187 annually.

Those beneficiaries who are low income and currently qualify for the $600 subsidy could face an increase in out-of-pocket costs in the range of $58 to $86 annually, provided they still qualified for the subsidy.

Those increased costs could mean that some would choose to forgo some prescriptions, decisions that could have health consequences.

On the other hand, if the generic prescription rate were increased by 10%, it would save the beneficiaries a mean amount in the range of $41–$55 in out-of-pocket costs and would decrease the amount spent by Medicare on each beneficiary by $62 to $71.

Extrapolating that to 33 million beneficiaries, Medicare could reduce its spending by $2 billion to $2.3 billion annually, Mr. Roebuck said.

The 10% increase in the use of generics would also reduce the number of these beneficiaries who would get into the doughnut hole by 1%–2%.

The so-called doughnut hole—where Medicare Part D stops coverage—kicks in when a patient has spent $2,250 on drugs and lasts until they have spent $5,100, at which point coverage begins again.

SEATTLE — With generic prescribing, a little can go a long way. In fact, by using generics 10% of the time, the Medicare Part D program could reduce drug spending by as much as $2.3 billion, according to an analysis presented at the annual research meeting of Academy Health.

That could be important because the analysis also showed that about 22% of Medicare beneficiaries who used to receive a $600 subsidy for prescription drugs under the previous Medicare program will no longer qualify for a subsidy and 16%–23% will probably end up in what is called the “doughnut hole” of Medicare Part D, where they will have no drug coverage, said M. Christopher Roebuck, an economist with CareMark, Hunt Valley, Md., a leading pharmacy-benefits management company.

To conduct the analysis, Mr. Roebuck and colleagues used data from 37,425 individuals enrolled in Medicare drug discount card programs for at least 6 months, and who had filled at least one prescription. The researchers then assumed those same usage patterns, with some increase in usage when out-of-pocket costs go down, and applied a 3.5% annual rate for inflation.

“We think one of the strong points of our research is that it is based on actual claims data,” he said.

The enrollees filled a mean of 19 prescriptions per year, 10 of which were for generic medications and 9 for brand name. The mean total cost for their prescriptions was $849, of which they paid a mean $538 out of pocket.

Depending on the assumption used to estimate how the new coverage might increase use, the analysis suggests that out-of-pocket costs could increase for these beneficiaries by $38 to $187 annually.

Those beneficiaries who are low income and currently qualify for the $600 subsidy could face an increase in out-of-pocket costs in the range of $58 to $86 annually, provided they still qualified for the subsidy.

Those increased costs could mean that some would choose to forgo some prescriptions, decisions that could have health consequences.

On the other hand, if the generic prescription rate were increased by 10%, it would save the beneficiaries a mean amount in the range of $41–$55 in out-of-pocket costs and would decrease the amount spent by Medicare on each beneficiary by $62 to $71.

Extrapolating that to 33 million beneficiaries, Medicare could reduce its spending by $2 billion to $2.3 billion annually, Mr. Roebuck said.

The 10% increase in the use of generics would also reduce the number of these beneficiaries who would get into the doughnut hole by 1%–2%.

The so-called doughnut hole—where Medicare Part D stops coverage—kicks in when a patient has spent $2,250 on drugs and lasts until they have spent $5,100, at which point coverage begins again.

SEATTLE — With generic prescribing, a little can go a long way. In fact, by using generics 10% of the time, the Medicare Part D program could reduce drug spending by as much as $2.3 billion, according to an analysis presented at the annual research meeting of Academy Health.

That could be important because the analysis also showed that about 22% of Medicare beneficiaries who used to receive a $600 subsidy for prescription drugs under the previous Medicare program will no longer qualify for a subsidy and 16%–23% will probably end up in what is called the “doughnut hole” of Medicare Part D, where they will have no drug coverage, said M. Christopher Roebuck, an economist with CareMark, Hunt Valley, Md., a leading pharmacy-benefits management company.

To conduct the analysis, Mr. Roebuck and colleagues used data from 37,425 individuals enrolled in Medicare drug discount card programs for at least 6 months, and who had filled at least one prescription. The researchers then assumed those same usage patterns, with some increase in usage when out-of-pocket costs go down, and applied a 3.5% annual rate for inflation.

“We think one of the strong points of our research is that it is based on actual claims data,” he said.

The enrollees filled a mean of 19 prescriptions per year, 10 of which were for generic medications and 9 for brand name. The mean total cost for their prescriptions was $849, of which they paid a mean $538 out of pocket.

Depending on the assumption used to estimate how the new coverage might increase use, the analysis suggests that out-of-pocket costs could increase for these beneficiaries by $38 to $187 annually.

Those beneficiaries who are low income and currently qualify for the $600 subsidy could face an increase in out-of-pocket costs in the range of $58 to $86 annually, provided they still qualified for the subsidy.

Those increased costs could mean that some would choose to forgo some prescriptions, decisions that could have health consequences.

On the other hand, if the generic prescription rate were increased by 10%, it would save the beneficiaries a mean amount in the range of $41–$55 in out-of-pocket costs and would decrease the amount spent by Medicare on each beneficiary by $62 to $71.

Extrapolating that to 33 million beneficiaries, Medicare could reduce its spending by $2 billion to $2.3 billion annually, Mr. Roebuck said.

The 10% increase in the use of generics would also reduce the number of these beneficiaries who would get into the doughnut hole by 1%–2%.

The so-called doughnut hole—where Medicare Part D stops coverage—kicks in when a patient has spent $2,250 on drugs and lasts until they have spent $5,100, at which point coverage begins again.

SEATTLE — With generic prescribing, a little can go a long way. In fact, by using generics 10% of the time, the Medicare Part D program could reduce drug spending by as much as $2.3 billion, according to an analysis presented at the annual research meeting of Academy Health.

That could be important because the analysis also showed that about 22% of Medicare beneficiaries who used to receive a $600 subsidy for prescription drugs under the previous Medicare program will no longer qualify for a subsidy and 16%–23% will probably end up in what is called the “doughnut hole” of Medicare Part D, where they will have no drug coverage, said M. Christopher Roebuck, an economist with CareMark, Hunt Valley, Md., a leading pharmacy-benefits management company.

To conduct the analysis, Mr. Roebuck and colleagues used data from 37,425 individuals enrolled in Medicare drug discount card programs for at least 6 months, and who had filled at least one prescription. The researchers then assumed those same usage patterns, with some increase in usage when out-of-pocket costs go down, and applied a 3.5% annual rate for inflation.

“We think one of the strong points of our research is that it is based on actual claims data,” he said.

The enrollees filled a mean of 19 prescriptions per year, 10 of which were for generic medications and 9 for brand name. The mean total cost for their prescriptions was $849, of which they paid a mean $538 out of pocket.

Depending on the assumption used to estimate how the new coverage might increase use, the analysis suggests that out-of-pocket costs could increase for these beneficiaries by $38 to $187 annually. Those who are low income and currently qualify for the $600 subsidy could face an increase in out-of-pocket costs in the range of $58 to $86 annually, provided they still qualified for the subsidy.

Those increased costs could mean that some would choose to forgo some prescriptions, decisions that could have health consequences.

On the other hand, if the generic prescription rate were increased by 10%, it would save the beneficiaries a mean amount in the range of $41 to $55 in out-of-pocket costs and would decrease the amount spent by Medicare on each beneficiary by $62 to $71.

Extrapolating that to 33 million beneficiaries, Medicare could reduce its spending by $2 billion to $2.3 billion annually, Mr. Roebuck said.

The 10% increase in the use of generics would also reduce the number of these beneficiaries who would get into the doughnut hole—where Medicare Part D stops coverage until the patient has spent $2,850 on drugs—by 1%–2%.

SEATTLE — With generic prescribing, a little can go a long way. In fact, by using generics 10% of the time, the Medicare Part D program could reduce drug spending by as much as $2.3 billion, according to an analysis presented at the annual research meeting of Academy Health.

That could be important because the analysis also showed that about 22% of Medicare beneficiaries who used to receive a $600 subsidy for prescription drugs under the previous Medicare program will no longer qualify for a subsidy and 16%–23% will probably end up in what is called the “doughnut hole” of Medicare Part D, where they will have no drug coverage, said M. Christopher Roebuck, an economist with CareMark, Hunt Valley, Md., a leading pharmacy-benefits management company.

To conduct the analysis, Mr. Roebuck and colleagues used data from 37,425 individuals enrolled in Medicare drug discount card programs for at least 6 months, and who had filled at least one prescription. The researchers then assumed those same usage patterns, with some increase in usage when out-of-pocket costs go down, and applied a 3.5% annual rate for inflation.

“We think one of the strong points of our research is that it is based on actual claims data,” he said.

The enrollees filled a mean of 19 prescriptions per year, 10 of which were for generic medications and 9 for brand name. The mean total cost for their prescriptions was $849, of which they paid a mean $538 out of pocket.

Depending on the assumption used to estimate how the new coverage might increase use, the analysis suggests that out-of-pocket costs could increase for these beneficiaries by $38 to $187 annually. Those who are low income and currently qualify for the $600 subsidy could face an increase in out-of-pocket costs in the range of $58 to $86 annually, provided they still qualified for the subsidy.

Those increased costs could mean that some would choose to forgo some prescriptions, decisions that could have health consequences.

On the other hand, if the generic prescription rate were increased by 10%, it would save the beneficiaries a mean amount in the range of $41 to $55 in out-of-pocket costs and would decrease the amount spent by Medicare on each beneficiary by $62 to $71.

Extrapolating that to 33 million beneficiaries, Medicare could reduce its spending by $2 billion to $2.3 billion annually, Mr. Roebuck said.

The 10% increase in the use of generics would also reduce the number of these beneficiaries who would get into the doughnut hole—where Medicare Part D stops coverage until the patient has spent $2,850 on drugs—by 1%–2%.

SEATTLE — With generic prescribing, a little can go a long way. In fact, by using generics 10% of the time, the Medicare Part D program could reduce drug spending by as much as $2.3 billion, according to an analysis presented at the annual research meeting of Academy Health.

That could be important because the analysis also showed that about 22% of Medicare beneficiaries who used to receive a $600 subsidy for prescription drugs under the previous Medicare program will no longer qualify for a subsidy and 16%–23% will probably end up in what is called the “doughnut hole” of Medicare Part D, where they will have no drug coverage, said M. Christopher Roebuck, an economist with CareMark, Hunt Valley, Md., a leading pharmacy-benefits management company.

To conduct the analysis, Mr. Roebuck and colleagues used data from 37,425 individuals enrolled in Medicare drug discount card programs for at least 6 months, and who had filled at least one prescription. The researchers then assumed those same usage patterns, with some increase in usage when out-of-pocket costs go down, and applied a 3.5% annual rate for inflation.

“We think one of the strong points of our research is that it is based on actual claims data,” he said.

The enrollees filled a mean of 19 prescriptions per year, 10 of which were for generic medications and 9 for brand name. The mean total cost for their prescriptions was $849, of which they paid a mean $538 out of pocket.

Depending on the assumption used to estimate how the new coverage might increase use, the analysis suggests that out-of-pocket costs could increase for these beneficiaries by $38 to $187 annually. Those who are low income and currently qualify for the $600 subsidy could face an increase in out-of-pocket costs in the range of $58 to $86 annually, provided they still qualified for the subsidy.

Those increased costs could mean that some would choose to forgo some prescriptions, decisions that could have health consequences.

On the other hand, if the generic prescription rate were increased by 10%, it would save the beneficiaries a mean amount in the range of $41 to $55 in out-of-pocket costs and would decrease the amount spent by Medicare on each beneficiary by $62 to $71.

Extrapolating that to 33 million beneficiaries, Medicare could reduce its spending by $2 billion to $2.3 billion annually, Mr. Roebuck said.

The 10% increase in the use of generics would also reduce the number of these beneficiaries who would get into the doughnut hole—where Medicare Part D stops coverage until the patient has spent $2,850 on drugs—by 1%–2%.

SEATTLE — With generic prescribing, a little can go a long way. In fact, by using generics 10% of the time, the Medicare Part D program could reduce drug spending by as much as $2.3 billion, according to an analysis presented at the annual research meeting of Academy Health.

That could be important because the analysis also showed that about 22% of Medicare beneficiaries who used to receive a $600 subsidy for prescription drugs under the previous Medicare program will no longer qualify for a subsidy and 16%–23% will probably end up in what is called the “doughnut hole” of Medicare Part D, where they will have no drug coverage, said M. Christopher Roebuck, an economist with CareMark, Hunt Valley, Md., a leading pharmacy-benefits management company.

Mr. Roebuck and colleagues used data from 37,425 people enrolled in Medicare drug discount card programs for at least 6 months, and who had filled at least one prescription. The researchers assumed those same usage patterns, with some increase in usage when out-of-pocket costs go down, and applied a 3.5% annual rate for inflation.

Enrollees filled a mean of 19 prescriptions per year, 10 of which were for generic drugs and 9 for brand name. The mean total cost for their drugs was $849, of which a mean of $538 was out of pocket.

The analysis suggests that out-of-pocket costs could increase for these beneficiaries by $38–$187 annually. Those who are low income and currently qualify for the $600 subsidy could face an increase in out-of-pocket costs in the range of $58–$86 annually.

If the generic prescription rate were increased by 10%, it would save the beneficiaries a mean amount in the range of $41–$55 in out-of-pocket costs and would decrease the amount spent by Medicare on each beneficiary by $62–$71.

That increase in the use of generics would also reduce the number of beneficiaries who would get into the doughnut hole by 1%–2%. The doughnut hole—where Medicare Part D stops coverage—kicks in when a patient has spent $2,250 on drugs and lasts until they have spent $5,100, at which point coverage begins again.

SEATTLE — With generic prescribing, a little can go a long way. In fact, by using generics 10% of the time, the Medicare Part D program could reduce drug spending by as much as $2.3 billion, according to an analysis presented at the annual research meeting of Academy Health.

That could be important because the analysis also showed that about 22% of Medicare beneficiaries who used to receive a $600 subsidy for prescription drugs under the previous Medicare program will no longer qualify for a subsidy and 16%–23% will probably end up in what is called the “doughnut hole” of Medicare Part D, where they will have no drug coverage, said M. Christopher Roebuck, an economist with CareMark, Hunt Valley, Md., a leading pharmacy-benefits management company.

Mr. Roebuck and colleagues used data from 37,425 people enrolled in Medicare drug discount card programs for at least 6 months, and who had filled at least one prescription. The researchers assumed those same usage patterns, with some increase in usage when out-of-pocket costs go down, and applied a 3.5% annual rate for inflation.

Enrollees filled a mean of 19 prescriptions per year, 10 of which were for generic drugs and 9 for brand name. The mean total cost for their drugs was $849, of which a mean of $538 was out of pocket.

The analysis suggests that out-of-pocket costs could increase for these beneficiaries by $38–$187 annually. Those who are low income and currently qualify for the $600 subsidy could face an increase in out-of-pocket costs in the range of $58–$86 annually.

If the generic prescription rate were increased by 10%, it would save the beneficiaries a mean amount in the range of $41–$55 in out-of-pocket costs and would decrease the amount spent by Medicare on each beneficiary by $62–$71.

That increase in the use of generics would also reduce the number of beneficiaries who would get into the doughnut hole by 1%–2%. The doughnut hole—where Medicare Part D stops coverage—kicks in when a patient has spent $2,250 on drugs and lasts until they have spent $5,100, at which point coverage begins again.

SEATTLE — With generic prescribing, a little can go a long way. In fact, by using generics 10% of the time, the Medicare Part D program could reduce drug spending by as much as $2.3 billion, according to an analysis presented at the annual research meeting of Academy Health.

That could be important because the analysis also showed that about 22% of Medicare beneficiaries who used to receive a $600 subsidy for prescription drugs under the previous Medicare program will no longer qualify for a subsidy and 16%–23% will probably end up in what is called the “doughnut hole” of Medicare Part D, where they will have no drug coverage, said M. Christopher Roebuck, an economist with CareMark, Hunt Valley, Md., a leading pharmacy-benefits management company.

Mr. Roebuck and colleagues used data from 37,425 people enrolled in Medicare drug discount card programs for at least 6 months, and who had filled at least one prescription. The researchers assumed those same usage patterns, with some increase in usage when out-of-pocket costs go down, and applied a 3.5% annual rate for inflation.

Enrollees filled a mean of 19 prescriptions per year, 10 of which were for generic drugs and 9 for brand name. The mean total cost for their drugs was $849, of which a mean of $538 was out of pocket.

The analysis suggests that out-of-pocket costs could increase for these beneficiaries by $38–$187 annually. Those who are low income and currently qualify for the $600 subsidy could face an increase in out-of-pocket costs in the range of $58–$86 annually.

If the generic prescription rate were increased by 10%, it would save the beneficiaries a mean amount in the range of $41–$55 in out-of-pocket costs and would decrease the amount spent by Medicare on each beneficiary by $62–$71.

That increase in the use of generics would also reduce the number of beneficiaries who would get into the doughnut hole by 1%–2%. The doughnut hole—where Medicare Part D stops coverage—kicks in when a patient has spent $2,250 on drugs and lasts until they have spent $5,100, at which point coverage begins again.

SEATTLE — The rate of opioid use varies considerably from state to state, federal prescription claims data show.

That variation is inexplicable medically, suggesting that opioids are being used too liberally in some states, or not enough in others, or both, Dr. Judy T. Zerzan said in a poster presentation at the annual research meeting of Academy Health.

Medicare and Medicaid prescribing figures from the start of 1996 to the end of 2002 show that opioid prescribing nationally increased a mean of 24% per year, noted Dr. Zerzan of the division of general internal medicine at the University of Washington, Seattle.

The 10 states with the highest rates were Alaska, Indiana, Louisiana, Maine, Maryland, Missouri, Mississippi, Montana, North Carolina, and West Virginia. The eight states with the lowest rates were California, Minnesota, New Jersey, New Mexico, New York, Pennsylvania, Tennessee, and Vermont. States may differ in terms of prescription benefit policies, marketing of the drugs, and physician attitudes toward opioids, Dr. Zerzan said.

SEATTLE — The rate of opioid use varies considerably from state to state, federal prescription claims data show.

That variation is inexplicable medically, suggesting that opioids are being used too liberally in some states, or not enough in others, or both, Dr. Judy T. Zerzan said in a poster presentation at the annual research meeting of Academy Health.

Medicare and Medicaid prescribing figures from the start of 1996 to the end of 2002 show that opioid prescribing nationally increased a mean of 24% per year, noted Dr. Zerzan of the division of general internal medicine at the University of Washington, Seattle.

The 10 states with the highest rates were Alaska, Indiana, Louisiana, Maine, Maryland, Missouri, Mississippi, Montana, North Carolina, and West Virginia. The eight states with the lowest rates were California, Minnesota, New Jersey, New Mexico, New York, Pennsylvania, Tennessee, and Vermont. States may differ in terms of prescription benefit policies, marketing of the drugs, and physician attitudes toward opioids, Dr. Zerzan said.

SEATTLE — The rate of opioid use varies considerably from state to state, federal prescription claims data show.

That variation is inexplicable medically, suggesting that opioids are being used too liberally in some states, or not enough in others, or both, Dr. Judy T. Zerzan said in a poster presentation at the annual research meeting of Academy Health.

Medicare and Medicaid prescribing figures from the start of 1996 to the end of 2002 show that opioid prescribing nationally increased a mean of 24% per year, noted Dr. Zerzan of the division of general internal medicine at the University of Washington, Seattle.

The 10 states with the highest rates were Alaska, Indiana, Louisiana, Maine, Maryland, Missouri, Mississippi, Montana, North Carolina, and West Virginia. The eight states with the lowest rates were California, Minnesota, New Jersey, New Mexico, New York, Pennsylvania, Tennessee, and Vermont. States may differ in terms of prescription benefit policies, marketing of the drugs, and physician attitudes toward opioids, Dr. Zerzan said.

ASPEN, COLO. — Can patients with repeated Staphylococcus aureus infections be decolonized to prevent recurrences?

The evidence supporting this approach is not very good, but it is always worth a try, Dr. Sarah K. Parker said at a meeting on pediatric infectious diseases sponsored by the Children's Hospital, Denver.

Community-acquired staphylococcal infections are on the rise, even in normal, healthy children. Now, many of the organisms seen in the community—as well as in the hospital—are methicillin resistant, said Dr. Parker, of the pediatric infectious diseases department at the hospital.

She said that two or three times a week, she sees a child with a small, pustular lesion (often on the buttocks) that the child's primary-care physician has called a bug bite, but which turns out to be a S. aureus infection.

That's a common misdiagnosis of these infections. It is one that has been noted by other infectious disease specialists and that illustrates not just how common the misdiagnosis has become, but also how common the infections are, Dr. Parker said.

Some individuals have recurrences that may be the result of incomplete treatment, but it also seems that some just may be prone to repeated infections.

The Cochrane Collaboration recently reviewed evidence on methods for decolonizing patients with antibiotic treatment, Dr. Parker noted. It concluded that the practice of treating patients prophylactically with antibiotics or mupirocin to reduce nasal carriage of S. aureus is not supported by enough good evidence.

The exception may be for the use of mupirocin, which has been the subject of various studies. In general, that research shows that, if patients are treated twice daily for 5–7 days, then 85% of them will be culture negative at about 14 days. However, 25% of those will be recolonized by 30 days, and 50%–70% will be recolonized by 6 months, Dr. Parker said.

In addition, about 60% of individuals with staphylococcus in the nares also are colonized at other sites, and 20% of those colonized in sites other than the nose are not colonized in the nose.

One placebo-controlled study that used mupirocin in 32 normal individuals with recurrent infections for 5 days each month for 12 months reported that infections were reduced by about 50%, but not totally (Arch. Int. Med. 1996;65:109–13).

In addition, in that study and others, resistance developed. Therefore, given the questionable efficacy that prophylactic mupirocin treatment is likely to have and the resistance, Dr. Parker said she focuses on education for patients and families that have recurrent infections and resorts to a single, twice-daily course of mupirocin for 5 days only on occasion in those who have already been educated.

Included in her education measures are suggestions that:

▸ Parents inspect the child carefully and often, because frequently the sites of infections are in places on the body that are covered by clothing.

▸ Nails be kept clean and short to prevent scratches.

▸ Bathing with an antimicrobial soap, such as hexachlorophene or chlorhexidine, can be 20%–50% effective at decolonizing extranasal sites in the short term.

▸ Towels and underwear be changed and washed often.

Some recommend that patients could bathe with bleach in the water, about 1 tablespoon per gallon, which is not much more than is found in a chlorinated swimming pool.

For the physicians who see these infections, surgical treatment is most important. “Incise these lesions and drain them very early … as soon as you see a little head, get this thing open,” Dr. Parker said. “Scrub it, clean it, and even use a topical antistaph [treatment] on it.”

ASPEN, COLO. — Can patients with repeated Staphylococcus aureus infections be decolonized to prevent recurrences?

The evidence supporting this approach is not very good, but it is always worth a try, Dr. Sarah K. Parker said at a meeting on pediatric infectious diseases sponsored by the Children's Hospital, Denver.

Community-acquired staphylococcal infections are on the rise, even in normal, healthy children. Now, many of the organisms seen in the community—as well as in the hospital—are methicillin resistant, said Dr. Parker, of the pediatric infectious diseases department at the hospital.

She said that two or three times a week, she sees a child with a small, pustular lesion (often on the buttocks) that the child's primary-care physician has called a bug bite, but which turns out to be a S. aureus infection.

That's a common misdiagnosis of these infections. It is one that has been noted by other infectious disease specialists and that illustrates not just how common the misdiagnosis has become, but also how common the infections are, Dr. Parker said.

Some individuals have recurrences that may be the result of incomplete treatment, but it also seems that some just may be prone to repeated infections.

The Cochrane Collaboration recently reviewed evidence on methods for decolonizing patients with antibiotic treatment, Dr. Parker noted. It concluded that the practice of treating patients prophylactically with antibiotics or mupirocin to reduce nasal carriage of S. aureus is not supported by enough good evidence.

The exception may be for the use of mupirocin, which has been the subject of various studies. In general, that research shows that, if patients are treated twice daily for 5–7 days, then 85% of them will be culture negative at about 14 days. However, 25% of those will be recolonized by 30 days, and 50%–70% will be recolonized by 6 months, Dr. Parker said.

In addition, about 60% of individuals with staphylococcus in the nares also are colonized at other sites, and 20% of those colonized in sites other than the nose are not colonized in the nose.

One placebo-controlled study that used mupirocin in 32 normal individuals with recurrent infections for 5 days each month for 12 months reported that infections were reduced by about 50%, but not totally (Arch. Int. Med. 1996;65:109–13).

In addition, in that study and others, resistance developed. Therefore, given the questionable efficacy that prophylactic mupirocin treatment is likely to have and the resistance, Dr. Parker said she focuses on education for patients and families that have recurrent infections and resorts to a single, twice-daily course of mupirocin for 5 days only on occasion in those who have already been educated.

Included in her education measures are suggestions that:

▸ Parents inspect the child carefully and often, because frequently the sites of infections are in places on the body that are covered by clothing.

▸ Nails be kept clean and short to prevent scratches.

▸ Bathing with an antimicrobial soap, such as hexachlorophene or chlorhexidine, can be 20%–50% effective at decolonizing extranasal sites in the short term.

▸ Towels and underwear be changed and washed often.

Some recommend that patients could bathe with bleach in the water, about 1 tablespoon per gallon, which is not much more than is found in a chlorinated swimming pool.

For the physicians who see these infections, surgical treatment is most important. “Incise these lesions and drain them very early … as soon as you see a little head, get this thing open,” Dr. Parker said. “Scrub it, clean it, and even use a topical antistaph [treatment] on it.”

ASPEN, COLO. — Can patients with repeated Staphylococcus aureus infections be decolonized to prevent recurrences?

The evidence supporting this approach is not very good, but it is always worth a try, Dr. Sarah K. Parker said at a meeting on pediatric infectious diseases sponsored by the Children's Hospital, Denver.

Community-acquired staphylococcal infections are on the rise, even in normal, healthy children. Now, many of the organisms seen in the community—as well as in the hospital—are methicillin resistant, said Dr. Parker, of the pediatric infectious diseases department at the hospital.

She said that two or three times a week, she sees a child with a small, pustular lesion (often on the buttocks) that the child's primary-care physician has called a bug bite, but which turns out to be a S. aureus infection.

That's a common misdiagnosis of these infections. It is one that has been noted by other infectious disease specialists and that illustrates not just how common the misdiagnosis has become, but also how common the infections are, Dr. Parker said.

Some individuals have recurrences that may be the result of incomplete treatment, but it also seems that some just may be prone to repeated infections.

The Cochrane Collaboration recently reviewed evidence on methods for decolonizing patients with antibiotic treatment, Dr. Parker noted. It concluded that the practice of treating patients prophylactically with antibiotics or mupirocin to reduce nasal carriage of S. aureus is not supported by enough good evidence.

The exception may be for the use of mupirocin, which has been the subject of various studies. In general, that research shows that, if patients are treated twice daily for 5–7 days, then 85% of them will be culture negative at about 14 days. However, 25% of those will be recolonized by 30 days, and 50%–70% will be recolonized by 6 months, Dr. Parker said.

In addition, about 60% of individuals with staphylococcus in the nares also are colonized at other sites, and 20% of those colonized in sites other than the nose are not colonized in the nose.

One placebo-controlled study that used mupirocin in 32 normal individuals with recurrent infections for 5 days each month for 12 months reported that infections were reduced by about 50%, but not totally (Arch. Int. Med. 1996;65:109–13).

In addition, in that study and others, resistance developed. Therefore, given the questionable efficacy that prophylactic mupirocin treatment is likely to have and the resistance, Dr. Parker said she focuses on education for patients and families that have recurrent infections and resorts to a single, twice-daily course of mupirocin for 5 days only on occasion in those who have already been educated.

Included in her education measures are suggestions that:

▸ Parents inspect the child carefully and often, because frequently the sites of infections are in places on the body that are covered by clothing.

▸ Nails be kept clean and short to prevent scratches.

▸ Bathing with an antimicrobial soap, such as hexachlorophene or chlorhexidine, can be 20%–50% effective at decolonizing extranasal sites in the short term.

▸ Towels and underwear be changed and washed often.

Some recommend that patients could bathe with bleach in the water, about 1 tablespoon per gallon, which is not much more than is found in a chlorinated swimming pool.

For the physicians who see these infections, surgical treatment is most important. “Incise these lesions and drain them very early … as soon as you see a little head, get this thing open,” Dr. Parker said. “Scrub it, clean it, and even use a topical antistaph [treatment] on it.”

ATLANTA — Current data on sexually abusive adolescents who molest others are consistent with those of previous studies, which showed that they tend to have been molested before the age of 9 years, two researchers said at a meeting of the National Adolescent Perpetration Network.

Among girls who were abused and became abusers, a common characteristic is that they were abused by a woman, reported Dr. Gene G. Abel and Nora Harlow of the Child Molestation Research & Prevention Institute, Atlanta.

Perhaps one of the most important findings of the latest investigation for males who have been abused and become abusers is that they report knowing almost nothing about sex before their molestation, Ms. Harlow said at the conference.

That finding suggests that early sex education might have an impact on reducing sex offenses, she said.

The research presented by Dr. Abel and Ms. Harlow was an investigation of more than 10,000 adolescents who took the Abel Assessment for Sexual Interest for Boys and Girls, a test designed by Dr. Abel, a past president of the Society of Behavioral Medicine. The test, administered at more than 500 sites, can be administered for a variety of reasons, including self-referral.

Of the more than 10,000 adolescents in the study, 5,678 had sexually abused younger children. Analysis of the 2,811 boys in the study who had been child victims of sexual abuse revealed that 2,034 had abused others. Among the 390 sexually abused adolescent females, 187 had abused others.

Because the research had been put together only recently before the conference, Dr. Abel said, the researchers did not have much information on the characteristics of the sexually abused adolescents who had not abused anyone, such as why they had taken the test. However, the researchers did present the molestation factors that were significantly associated with becoming an abuser and their rank of importance.

Some of those attending the conference were bothered by the lack of detail.

“I think a lot of it probably is useful,” but it is difficult to judge without information on who constituted the comparison group and little information on the strength of association, said Michael H. Miner, Ph.D., a psychologist with the Center for Sexual Health at the University of Minnesota, Minneapolis, in an interview.

Ms. Harlow said many of the factors identified by their analysis seemed to reflect that it was the “inner experience” of the molestation that appeared to be a determining factor. For example, those who had abused others tended to still be tormented by the experience, had experienced sexual arousal, and, for the males at least, had tended to be molested by someone they looked up to, she noted.

Dr. Abel said it is not surprising that the children reported experiencing arousal, because abusers generally want the child to be compliant and to believe that the child is enjoying the experience. As a result, the abusers work hard to stimulate the child.

Among the other survey findings:

▸ The number of times the child was molested correlated significantly with the number of victims they abused. Among the male abusers who were not molested themselves, the average number of victims they had was three, but it was eight for those who had been molested 50 times or more. The pattern was the same for females.

▸ The data from 16,000 adult males who also have taken the test show that 70% of adult men who molest boys score as being heterosexual on the Kinsey Scale. That is the exact percentage of men in the general population who score as heterosexual on the Kinsey Scale, Dr. Abel said.

▸ Of the adolescent boys who were abused, 55% were abused by an older boy, 40% by a man, 27% by an older girl, and 14% by a woman.

Of the adolescent females who were abused, 66% were abused by a man, 63% by an older boy, 20% by an older girl, and 13% by a woman.

Common Patterns Among Abusers

For males, 10 factors were found to have a significant association with abuse of others. They are, in order by P value:

I was less than 9 years old when sexually abused.

I knew nothing about sex before I was sexually abused.

I wish the molestation did not bother me so much.

I was abused by my idol.

Sometimes I got a strong sexual feeling between my legs when I was being sexually abused.

I was touched by a boy more than 3 years older than me.

I took baths or showers with my sexual abuser.

The abuser put their tongue in my mouth.

The abuser was a relative living in my house.

I was molested by more than one person.

For females, fewer factors were identified, perhaps because there were fewer subjects. They are, in order by P value:

I was less than 9 years old when sexually abused.

I was touched by a woman.

Sometimes when my girlfriend or boyfriend rubs my chest, I have flashbacks of when I was abused.

Sometimes I got a strong sexual feeling between my legs when I was being sexually abused.

Source: Dr. Abel and Ms. Harlow

ATLANTA — Current data on sexually abusive adolescents who molest others are consistent with those of previous studies, which showed that they tend to have been molested before the age of 9 years, two researchers said at a meeting of the National Adolescent Perpetration Network.

Among girls who were abused and became abusers, a common characteristic is that they were abused by a woman, reported Dr. Gene G. Abel and Nora Harlow of the Child Molestation Research & Prevention Institute, Atlanta.

Perhaps one of the most important findings of the latest investigation for males who have been abused and become abusers is that they report knowing almost nothing about sex before their molestation, Ms. Harlow said at the conference.

That finding suggests that early sex education might have an impact on reducing sex offenses, she said.

The research presented by Dr. Abel and Ms. Harlow was an investigation of more than 10,000 adolescents who took the Abel Assessment for Sexual Interest for Boys and Girls, a test designed by Dr. Abel, a past president of the Society of Behavioral Medicine. The test, administered at more than 500 sites, can be administered for a variety of reasons, including self-referral.

Of the more than 10,000 adolescents in the study, 5,678 had sexually abused younger children. Analysis of the 2,811 boys in the study who had been child victims of sexual abuse revealed that 2,034 had abused others. Among the 390 sexually abused adolescent females, 187 had abused others.

Because the research had been put together only recently before the conference, Dr. Abel said, the researchers did not have much information on the characteristics of the sexually abused adolescents who had not abused anyone, such as why they had taken the test. However, the researchers did present the molestation factors that were significantly associated with becoming an abuser and their rank of importance.

Some of those attending the conference were bothered by the lack of detail.

“I think a lot of it probably is useful,” but it is difficult to judge without information on who constituted the comparison group and little information on the strength of association, said Michael H. Miner, Ph.D., a psychologist with the Center for Sexual Health at the University of Minnesota, Minneapolis, in an interview.

Ms. Harlow said many of the factors identified by their analysis seemed to reflect that it was the “inner experience” of the molestation that appeared to be a determining factor. For example, those who had abused others tended to still be tormented by the experience, had experienced sexual arousal, and, for the males at least, had tended to be molested by someone they looked up to, she noted.

Dr. Abel said it is not surprising that the children reported experiencing arousal, because abusers generally want the child to be compliant and to believe that the child is enjoying the experience. As a result, the abusers work hard to stimulate the child.

Among the other survey findings:

▸ The number of times the child was molested correlated significantly with the number of victims they abused. Among the male abusers who were not molested themselves, the average number of victims they had was three, but it was eight for those who had been molested 50 times or more. The pattern was the same for females.

▸ The data from 16,000 adult males who also have taken the test show that 70% of adult men who molest boys score as being heterosexual on the Kinsey Scale. That is the exact percentage of men in the general population who score as heterosexual on the Kinsey Scale, Dr. Abel said.

▸ Of the adolescent boys who were abused, 55% were abused by an older boy, 40% by a man, 27% by an older girl, and 14% by a woman.

Of the adolescent females who were abused, 66% were abused by a man, 63% by an older boy, 20% by an older girl, and 13% by a woman.

Common Patterns Among Abusers

For males, 10 factors were found to have a significant association with abuse of others. They are, in order by P value:

I was less than 9 years old when sexually abused.

I knew nothing about sex before I was sexually abused.

I wish the molestation did not bother me so much.

I was abused by my idol.

Sometimes I got a strong sexual feeling between my legs when I was being sexually abused.

I was touched by a boy more than 3 years older than me.

I took baths or showers with my sexual abuser.

The abuser put their tongue in my mouth.

The abuser was a relative living in my house.

I was molested by more than one person.

For females, fewer factors were identified, perhaps because there were fewer subjects. They are, in order by P value:

I was less than 9 years old when sexually abused.

I was touched by a woman.

Sometimes when my girlfriend or boyfriend rubs my chest, I have flashbacks of when I was abused.

Sometimes I got a strong sexual feeling between my legs when I was being sexually abused.

Source: Dr. Abel and Ms. Harlow

ATLANTA — Current data on sexually abusive adolescents who molest others are consistent with those of previous studies, which showed that they tend to have been molested before the age of 9 years, two researchers said at a meeting of the National Adolescent Perpetration Network.

Among girls who were abused and became abusers, a common characteristic is that they were abused by a woman, reported Dr. Gene G. Abel and Nora Harlow of the Child Molestation Research & Prevention Institute, Atlanta.

Perhaps one of the most important findings of the latest investigation for males who have been abused and become abusers is that they report knowing almost nothing about sex before their molestation, Ms. Harlow said at the conference.

That finding suggests that early sex education might have an impact on reducing sex offenses, she said.

The research presented by Dr. Abel and Ms. Harlow was an investigation of more than 10,000 adolescents who took the Abel Assessment for Sexual Interest for Boys and Girls, a test designed by Dr. Abel, a past president of the Society of Behavioral Medicine. The test, administered at more than 500 sites, can be administered for a variety of reasons, including self-referral.

Of the more than 10,000 adolescents in the study, 5,678 had sexually abused younger children. Analysis of the 2,811 boys in the study who had been child victims of sexual abuse revealed that 2,034 had abused others. Among the 390 sexually abused adolescent females, 187 had abused others.

Because the research had been put together only recently before the conference, Dr. Abel said, the researchers did not have much information on the characteristics of the sexually abused adolescents who had not abused anyone, such as why they had taken the test. However, the researchers did present the molestation factors that were significantly associated with becoming an abuser and their rank of importance.

Some of those attending the conference were bothered by the lack of detail.

“I think a lot of it probably is useful,” but it is difficult to judge without information on who constituted the comparison group and little information on the strength of association, said Michael H. Miner, Ph.D., a psychologist with the Center for Sexual Health at the University of Minnesota, Minneapolis, in an interview.

Ms. Harlow said many of the factors identified by their analysis seemed to reflect that it was the “inner experience” of the molestation that appeared to be a determining factor. For example, those who had abused others tended to still be tormented by the experience, had experienced sexual arousal, and, for the males at least, had tended to be molested by someone they looked up to, she noted.

Dr. Abel said it is not surprising that the children reported experiencing arousal, because abusers generally want the child to be compliant and to believe that the child is enjoying the experience. As a result, the abusers work hard to stimulate the child.

Among the other survey findings:

▸ The number of times the child was molested correlated significantly with the number of victims they abused. Among the male abusers who were not molested themselves, the average number of victims they had was three, but it was eight for those who had been molested 50 times or more. The pattern was the same for females.

▸ The data from 16,000 adult males who also have taken the test show that 70% of adult men who molest boys score as being heterosexual on the Kinsey Scale. That is the exact percentage of men in the general population who score as heterosexual on the Kinsey Scale, Dr. Abel said.

▸ Of the adolescent boys who were abused, 55% were abused by an older boy, 40% by a man, 27% by an older girl, and 14% by a woman.

Of the adolescent females who were abused, 66% were abused by a man, 63% by an older boy, 20% by an older girl, and 13% by a woman.

Common Patterns Among Abusers

For males, 10 factors were found to have a significant association with abuse of others. They are, in order by P value:

I was less than 9 years old when sexually abused.

I knew nothing about sex before I was sexually abused.

I wish the molestation did not bother me so much.

I was abused by my idol.

Sometimes I got a strong sexual feeling between my legs when I was being sexually abused.

I was touched by a boy more than 3 years older than me.

I took baths or showers with my sexual abuser.

The abuser put their tongue in my mouth.

The abuser was a relative living in my house.

I was molested by more than one person.

For females, fewer factors were identified, perhaps because there were fewer subjects. They are, in order by P value:

I was less than 9 years old when sexually abused.

I was touched by a woman.

Sometimes when my girlfriend or boyfriend rubs my chest, I have flashbacks of when I was abused.

Sometimes I got a strong sexual feeling between my legs when I was being sexually abused.

Source: Dr. Abel and Ms. Harlow

SEATTLE — Colonoscopy for the evaluation of acute lower gastrointestinal bleeding has several potential advantages and may be growing in popularity, Dr. Charles Whitlow said at the annual meeting of the American Society of Colon and Rectal Surgeons.

The burgeoning literature indicates that colonoscopy makes a successful diagnosis 80%–90% of the time and that a bleeding source amenable to colonoscopic intervention is identified about 10%–15% of the time, said Dr. Whitlow of the colon and rectal surgery department at the Ochsner Clinic Foundation, New Orleans.

“There's some opportunity for us to rethink the role of colonoscopy in acute lower GI bleeding pretty much at every step of the way in the algorithm,” he said.

In the time it takes for a nuclear medicine specialist to see a patient with acute bleeding and do scintigraphy and/or angiography, the patient can be readied for colonoscopy with a rapid purge. And if the source of the bleeding is found, it can be treated immediately, thereby reducing hospital costs, he added.

Guidelines are evolving to suggest the merits of colonoscopy for these evaluations, but Dr. Whitlow said he had little experience with using it until Hurricane Katrina hit New Orleans, disrupting medical supplies and preventing his clinic from obtaining radioactive tracer for nuclear medicine studies.

The bowel preparation for colonoscopy for an acute bleed can be done in 3–4 hours.

Because the procedure may have to be done at an unusual location, however, it is important to have all the routine tools at hand before starting, including those needed for irrigation and suction.

If a fresh clot is found, it may be advisable to remove the clot to see what is underneath, Dr. Whitlow said. He recommended the use of a submucosal epinephrine injection around the clot for safety before the removal, which can be done with a snare.

Diverticula or vascular ectasias and malformations, the most common sources of lower GI bleeds, reportedly occur at 30%–40% of identified bleeds.

For bleeding diverticula, treatment modalities include epinephrine injection followed by electrocautery, hemostatic clips, and more recently, band ligation.

Dr. Whitlow commented that he does not recommend using band ligation, even though it is highly successful in the upper GI tract, because a recent ex vivo study of its use in the colon found that specimens that were removed appeared to show evidence of injury, including serous membrane thickening.

The advantage of using the clips is that they can be seen with radiography and found again, he noted.

Rebleeding rates appear to be about the same—anywhere from 0% to 30%—for the different techniques.

For vascular malformations, the three commonly used techniques are epinephrine injection, contact thermal coagulation, and argon plasma coagulation.

The technical consideration in treating these lesions is that one should start at the periphery, with the feeder vessels, and then work in toward the center of the lesion, Dr. Whitlow said.

For radiation proctitis, plasma argon coagulation has recently become the preferred method of treatment. But because multiple procedures are needed, some surgeons have done only a colonic irrigation rather than a complete bowel preparation, and there have been three reports of colonic explosions, Dr. Whitlow noted.

Of the other possible indications for intervention, postpolypectomy bleeding is sometimes just left alone, depending on severity.

Bleeding related to colon cancer has been treated with a laser, but few reports have appeared in the literature.

More experience is needed to identify the scenarios in which colonoscopy is most advantageous relative to other approaches, Dr. Whitlow said.

SEATTLE — Colonoscopy for the evaluation of acute lower gastrointestinal bleeding has several potential advantages and may be growing in popularity, Dr. Charles Whitlow said at the annual meeting of the American Society of Colon and Rectal Surgeons.

The burgeoning literature indicates that colonoscopy makes a successful diagnosis 80%–90% of the time and that a bleeding source amenable to colonoscopic intervention is identified about 10%–15% of the time, said Dr. Whitlow of the colon and rectal surgery department at the Ochsner Clinic Foundation, New Orleans.

“There's some opportunity for us to rethink the role of colonoscopy in acute lower GI bleeding pretty much at every step of the way in the algorithm,” he said.

In the time it takes for a nuclear medicine specialist to see a patient with acute bleeding and do scintigraphy and/or angiography, the patient can be readied for colonoscopy with a rapid purge. And if the source of the bleeding is found, it can be treated immediately, thereby reducing hospital costs, he added.

Guidelines are evolving to suggest the merits of colonoscopy for these evaluations, but Dr. Whitlow said he had little experience with using it until Hurricane Katrina hit New Orleans, disrupting medical supplies and preventing his clinic from obtaining radioactive tracer for nuclear medicine studies.

The bowel preparation for colonoscopy for an acute bleed can be done in 3–4 hours.

Because the procedure may have to be done at an unusual location, however, it is important to have all the routine tools at hand before starting, including those needed for irrigation and suction.

If a fresh clot is found, it may be advisable to remove the clot to see what is underneath, Dr. Whitlow said. He recommended the use of a submucosal epinephrine injection around the clot for safety before the removal, which can be done with a snare.

Diverticula or vascular ectasias and malformations, the most common sources of lower GI bleeds, reportedly occur at 30%–40% of identified bleeds.

For bleeding diverticula, treatment modalities include epinephrine injection followed by electrocautery, hemostatic clips, and more recently, band ligation.

Dr. Whitlow commented that he does not recommend using band ligation, even though it is highly successful in the upper GI tract, because a recent ex vivo study of its use in the colon found that specimens that were removed appeared to show evidence of injury, including serous membrane thickening.

The advantage of using the clips is that they can be seen with radiography and found again, he noted.

Rebleeding rates appear to be about the same—anywhere from 0% to 30%—for the different techniques.

For vascular malformations, the three commonly used techniques are epinephrine injection, contact thermal coagulation, and argon plasma coagulation.

The technical consideration in treating these lesions is that one should start at the periphery, with the feeder vessels, and then work in toward the center of the lesion, Dr. Whitlow said.

For radiation proctitis, plasma argon coagulation has recently become the preferred method of treatment. But because multiple procedures are needed, some surgeons have done only a colonic irrigation rather than a complete bowel preparation, and there have been three reports of colonic explosions, Dr. Whitlow noted.

Of the other possible indications for intervention, postpolypectomy bleeding is sometimes just left alone, depending on severity.

Bleeding related to colon cancer has been treated with a laser, but few reports have appeared in the literature.

More experience is needed to identify the scenarios in which colonoscopy is most advantageous relative to other approaches, Dr. Whitlow said.

SEATTLE — Colonoscopy for the evaluation of acute lower gastrointestinal bleeding has several potential advantages and may be growing in popularity, Dr. Charles Whitlow said at the annual meeting of the American Society of Colon and Rectal Surgeons.

The burgeoning literature indicates that colonoscopy makes a successful diagnosis 80%–90% of the time and that a bleeding source amenable to colonoscopic intervention is identified about 10%–15% of the time, said Dr. Whitlow of the colon and rectal surgery department at the Ochsner Clinic Foundation, New Orleans.

“There's some opportunity for us to rethink the role of colonoscopy in acute lower GI bleeding pretty much at every step of the way in the algorithm,” he said.

In the time it takes for a nuclear medicine specialist to see a patient with acute bleeding and do scintigraphy and/or angiography, the patient can be readied for colonoscopy with a rapid purge. And if the source of the bleeding is found, it can be treated immediately, thereby reducing hospital costs, he added.

Guidelines are evolving to suggest the merits of colonoscopy for these evaluations, but Dr. Whitlow said he had little experience with using it until Hurricane Katrina hit New Orleans, disrupting medical supplies and preventing his clinic from obtaining radioactive tracer for nuclear medicine studies.

The bowel preparation for colonoscopy for an acute bleed can be done in 3–4 hours.

Because the procedure may have to be done at an unusual location, however, it is important to have all the routine tools at hand before starting, including those needed for irrigation and suction.

If a fresh clot is found, it may be advisable to remove the clot to see what is underneath, Dr. Whitlow said. He recommended the use of a submucosal epinephrine injection around the clot for safety before the removal, which can be done with a snare.

Diverticula or vascular ectasias and malformations, the most common sources of lower GI bleeds, reportedly occur at 30%–40% of identified bleeds.

For bleeding diverticula, treatment modalities include epinephrine injection followed by electrocautery, hemostatic clips, and more recently, band ligation.

Dr. Whitlow commented that he does not recommend using band ligation, even though it is highly successful in the upper GI tract, because a recent ex vivo study of its use in the colon found that specimens that were removed appeared to show evidence of injury, including serous membrane thickening.

The advantage of using the clips is that they can be seen with radiography and found again, he noted.

Rebleeding rates appear to be about the same—anywhere from 0% to 30%—for the different techniques.

For vascular malformations, the three commonly used techniques are epinephrine injection, contact thermal coagulation, and argon plasma coagulation.

The technical consideration in treating these lesions is that one should start at the periphery, with the feeder vessels, and then work in toward the center of the lesion, Dr. Whitlow said.

For radiation proctitis, plasma argon coagulation has recently become the preferred method of treatment. But because multiple procedures are needed, some surgeons have done only a colonic irrigation rather than a complete bowel preparation, and there have been three reports of colonic explosions, Dr. Whitlow noted.

Of the other possible indications for intervention, postpolypectomy bleeding is sometimes just left alone, depending on severity.

Bleeding related to colon cancer has been treated with a laser, but few reports have appeared in the literature.

More experience is needed to identify the scenarios in which colonoscopy is most advantageous relative to other approaches, Dr. Whitlow said.

SEATTLE — Patients taking antidepressants and cholesterol-lowering drugs who are in pharmacy-capped plans, like the new Medicare Part D drug benefit, often stop taking their drugs when they reach the cap, Geoffrey Joyce, Ph.D., said at the annual research meeting of Academy Health.

According to his research, anywhere from 6% to 11% of patients in the Medicare Part D program are likely to hit what is known as the “doughnut hole” of coverage in any given year, said Dr. Joyce, a senior economist with the RAND Corp., Santa Monica, Calif.

The so-called doughnut hole is the gap in coverage that goes into effect during a coverage year when a patient's drug expenditures reach $2,250, and continues until the expenditures reach $5,100. Prior to reaching the doughnut-hole gap, beneficiaries have a $250 annual deductible and pay 25% of their drug costs. After expenditures have reached $5,100, catastrophic coverage kicks in and patients pay only 5% of costs. Within the doughnut hole, patients pay 100% of their drug costs.

Many health economists and others have worried that the Medicare Part D patients most likely to spend their way into the doughnut hole are the sickest patients, and that those patients might become noncompliant with their medication regimens when they surpass their $2,250 limit.

Dr. Joyce and colleagues looked at two employer health plans with drug benefits that had a cap on coverage of $2,500, in order to get an idea of what is likely to happen with the Medicare plan.

In the years considered (2003 and 2004), 7% of beneficiaries in one plan and 11% in the other plan hit the cap.

The median time of year when patients hit the cap was September. However, one quarter of the patients who hit the cap did so in June, meaning they had no drug coverage for a full 6 months, Dr. Joyce said.

Patients did not appear to switch from brand-name drugs to generic drugs in any appreciable degree when they reached the cap. However, some patients did stop taking certain drugs. The most common medications the patients stopped taking were antidepressants and cholesterol-lowering drugs.

What was most concerning about those who stopped was that only about 40% of those who stopped then restarted those drugs at the beginning of the new year, Dr. Joyce said.

Previous studies of drug benefit caps have shown that they do reduce plan costs significantly. In one study of a Kaiser Permanente plan, a cap resulted in 31% lower drug costs. Overall, the Kaiser study found that the capped plan did not result in higher medical care costs. But there were more hospitalizations and more emergency department visits in the capped plan, compared to a noncapped plan. There was also a 22% higher mortality among patients in the capped plan.

SEATTLE — Patients taking antidepressants and cholesterol-lowering drugs who are in pharmacy-capped plans, like the new Medicare Part D drug benefit, often stop taking their drugs when they reach the cap, Geoffrey Joyce, Ph.D., said at the annual research meeting of Academy Health.

According to his research, anywhere from 6% to 11% of patients in the Medicare Part D program are likely to hit what is known as the “doughnut hole” of coverage in any given year, said Dr. Joyce, a senior economist with the RAND Corp., Santa Monica, Calif.

The so-called doughnut hole is the gap in coverage that goes into effect during a coverage year when a patient's drug expenditures reach $2,250, and continues until the expenditures reach $5,100. Prior to reaching the doughnut-hole gap, beneficiaries have a $250 annual deductible and pay 25% of their drug costs. After expenditures have reached $5,100, catastrophic coverage kicks in and patients pay only 5% of costs. Within the doughnut hole, patients pay 100% of their drug costs.

Many health economists and others have worried that the Medicare Part D patients most likely to spend their way into the doughnut hole are the sickest patients, and that those patients might become noncompliant with their medication regimens when they surpass their $2,250 limit.

Dr. Joyce and colleagues looked at two employer health plans with drug benefits that had a cap on coverage of $2,500, in order to get an idea of what is likely to happen with the Medicare plan.

In the years considered (2003 and 2004), 7% of beneficiaries in one plan and 11% in the other plan hit the cap.

The median time of year when patients hit the cap was September. However, one quarter of the patients who hit the cap did so in June, meaning they had no drug coverage for a full 6 months, Dr. Joyce said.

Patients did not appear to switch from brand-name drugs to generic drugs in any appreciable degree when they reached the cap. However, some patients did stop taking certain drugs. The most common medications the patients stopped taking were antidepressants and cholesterol-lowering drugs.

What was most concerning about those who stopped was that only about 40% of those who stopped then restarted those drugs at the beginning of the new year, Dr. Joyce said.

Previous studies of drug benefit caps have shown that they do reduce plan costs significantly. In one study of a Kaiser Permanente plan, a cap resulted in 31% lower drug costs. Overall, the Kaiser study found that the capped plan did not result in higher medical care costs. But there were more hospitalizations and more emergency department visits in the capped plan, compared to a noncapped plan. There was also a 22% higher mortality among patients in the capped plan.

SEATTLE — Patients taking antidepressants and cholesterol-lowering drugs who are in pharmacy-capped plans, like the new Medicare Part D drug benefit, often stop taking their drugs when they reach the cap, Geoffrey Joyce, Ph.D., said at the annual research meeting of Academy Health.

According to his research, anywhere from 6% to 11% of patients in the Medicare Part D program are likely to hit what is known as the “doughnut hole” of coverage in any given year, said Dr. Joyce, a senior economist with the RAND Corp., Santa Monica, Calif.

The so-called doughnut hole is the gap in coverage that goes into effect during a coverage year when a patient's drug expenditures reach $2,250, and continues until the expenditures reach $5,100. Prior to reaching the doughnut-hole gap, beneficiaries have a $250 annual deductible and pay 25% of their drug costs. After expenditures have reached $5,100, catastrophic coverage kicks in and patients pay only 5% of costs. Within the doughnut hole, patients pay 100% of their drug costs.

Many health economists and others have worried that the Medicare Part D patients most likely to spend their way into the doughnut hole are the sickest patients, and that those patients might become noncompliant with their medication regimens when they surpass their $2,250 limit.

Dr. Joyce and colleagues looked at two employer health plans with drug benefits that had a cap on coverage of $2,500, in order to get an idea of what is likely to happen with the Medicare plan.

In the years considered (2003 and 2004), 7% of beneficiaries in one plan and 11% in the other plan hit the cap.

The median time of year when patients hit the cap was September. However, one quarter of the patients who hit the cap did so in June, meaning they had no drug coverage for a full 6 months, Dr. Joyce said.

Patients did not appear to switch from brand-name drugs to generic drugs in any appreciable degree when they reached the cap. However, some patients did stop taking certain drugs. The most common medications the patients stopped taking were antidepressants and cholesterol-lowering drugs.

What was most concerning about those who stopped was that only about 40% of those who stopped then restarted those drugs at the beginning of the new year, Dr. Joyce said.

Previous studies of drug benefit caps have shown that they do reduce plan costs significantly. In one study of a Kaiser Permanente plan, a cap resulted in 31% lower drug costs. Overall, the Kaiser study found that the capped plan did not result in higher medical care costs. But there were more hospitalizations and more emergency department visits in the capped plan, compared to a noncapped plan. There was also a 22% higher mortality among patients in the capped plan.