Why Sanofi’s Zaltrap Deal Won t Help Patients
















Nurse administers chemotherapy to patient. Credit: National Cancer Institute.

I got excited when I read the New York Times story Nov. 9 (“Sanofi Halves Price of Cancer Drug Zaltrap After Sloan-Kettering Rejection)”. Zaltrap is an intravenous infusion colon cancer drug for metastatic colorectal cancer that is resistant to or has progressed with platinum-based chemotherapy. With a list price of $ 11,000 per patient per month, Zaltrap is about double the cost of Genentech’s Avastin. Sloan Kettering doctors rejected Zaltrap, claiming it offered no added value over Avastin, because it works no better than Avastin, and costs twice as much. Doctors from Sloan-Kettering Cancer Center, one the United States flagship cancer hospitals, published an op-ed in the NYTimes Oct. 14, titled “In Cancer Care, Cost Matters,” arguing that hospitals need to put their foot down when drugs are outrageously expensive with no added value. They wrote: “Soaring spending has presented the medical community with a new obligation. When choosing treatments for a patient, we have to consider the financial strains they may cause alongside the benefits they might deliver.” The importance of getting bang for your buck, or value in healthcare, has been a huge point in health policy circles in the United States. In fact, politicians of all stripes are quick to point to health outcomes data that show that despite the United States spending in the top tier of all nations for healthcare, health outcomes are far lower. What Sanofi announced in its response Nov. 8 to Sloan-Kettering, one could have easily thought that it was a victory for patients. However, the New York Times headline stating “Sanofi halves price…” is misleading. Sadly, the Zaltrap half-off deal is not a list price reduction at all. It is just a business discount plan for hospitals and oncologists. As Lisa Jane Hubbell, who uses high-cost disease modifying drugs for a noncancerous, chronic condition told me: “It won’t help patients, will it? Our copay will be based on full price, the docs will pocket the extra from insurance companies. It doesn’t really help anyone who is in need of help paying for healthcare.” Another woman with stage IV breast cancer says that she has been deemed ineligible for any discount for her high-priced cancer drugs because she is insured. In general, drug discount plans go to the uninsured. She emailed me: “The drug I took for five years was re-patented three times while I was on it, as I recall. It was orders of magnitude more expensive than the old standby tamoxifen for only a slight advantage in efficacy.” As The Times points out, Medicare patients are unlikely to see a lower price for Zaltrap for a long while until the discount is incorporated into Medicare payment calculations for Part B, which covers physician-administered drugs. In addition, oncologists have long marked up drugs that they administer for insurers and patients. Fortunately, Sloan-Kettering doctors are on the patients’ side and question whether Sanofi’s discount will make Zaltrap more affordable for patients. Peter Bach, MD, told me: “I don’t know if they’re going through steps to ensure reimbursement goes down to follow price or not. I’m hoping that is in their plans. If not, then yes, the windfall goes to providers, and our concern is the costs passed on to patients.” Leonard Saltzman, MD, the op-ed coauthor, and gastroenterology oncologist, from Sloan Kettering also called Sanofi to task for missing the boat in making Zaltrap affordable for patients. But pharmaceutical price fixing is nothing new, according to Frederic Kaye, MD, professor of hematology and oncology at the University of South Florida in Gainesville, Florida. “I saw this happen for the first time in the late 1980s when a veterinary pill levamisole, which cost pennies for the treatment of heartworm, underwent a 100 times price escalation when it was used for treating colon cancer. There was outrage at the time over lack of regulations for price fixing, but you see almost 25 years later, it is the same.” Sanofi’s drug discount plan is clearly a business imperative. If one of the US flagship cancer treatment centers says that they will not use Zaltrap, others could follow. But the refusal to lower Zaltrap’s list price is worrisome because patient copays are based on price. More importantly, if the Sanofi plan becomes the pharmaceutical industry’s modus operandi to the era of value-based healthcare, patients will still remain out in the cold, without any added relief for the high cost of drugs. Value-based healthcare will be something for facilities and hospitals and leave patients out in the cold. These days, you have to critically review the hoopla about “patient-centered health care” and the allegedly positive partnerships shaping healthcare. Were patients included when it really mattered in drafting this drug discount program? We need to maintain a high level of skepticism about deals made strictly between drug companies and hospitals, or arrangements made between industry and physicians, or industry and health plans. It’s been said before and it must be said again: “Nothing about me [the patient] that pertains to me should be done without me at the table.”  












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China approves Land Rover deal

















Jaguar Land Rover is to make vehicles in China for the first time after Beijing approved a £1bn joint venture.













The West Midlands-based luxury carmaker agreed a “milestone” deal with Chery Automobile and will build a plant near Shanghai, which is due to open in 2015.


JLR said any cars produced would be in addition to its existing output, and it had no intention of moving its manufacturing base out of Britain.


Sales of JLR models in China have risen by 80% so far this year.


The company, owned by India’s Tata Motors, began talks with Chery months ago, but had been awaiting approval.


A joint statement released by the Chinese and British companies said: “We are delighted to have reached this milestone, achieved thanks to the understanding and foresight of the Chinese authorities and we want to thank them for recognising the potential of our joint venture in the fast-growing Chinese market.


“Together, we will now begin working in close collaboration on our partnership plans to harness the capabilities of our respective companies, to produce relevant, advanced models for Chinese consumers.”


JLR has not said officially which model would be built at the factory, although the company has said in the past that is likely to be either the Land Rover Freelander or Evoque.


A research and development facility and engine production plant will also built as part of the venture, with the main manufacturing plant expected to be completed during 2014, with production starting the following year.


With China now a crucial market for JLR, building vehicles in the country means it can avoid import duties.


However, JLR says that being in China will enable it to build vehicles designed specifically for the Chinese market.


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Summary: A look at the 4 new Kindle Fire models
















Amazon.com Inc. started shipping a large-screen version of its Kindle Fire tablet computer on Thursday, ahead of schedule. Here is a look at the new Fires announced in September:


— Kindle Fire, with 7-inch screen, 1024 by 600 pixels. $ 159, with 8 gigabytes of storage. Weighs 14.1 ounces. Battery life of 8.5 hours. Started shipping Sept. 14.













Kindle Fire HD, with 7-inch screen, 1280 by 800 pixels. $ 199 with 16 GB of storage or $ 249 with 32 GB of storage. Weighs 13.9 ounces. Battery life of 11 hours. Started shipping Sept. 14.


— Kindle Fire HD 8.9″, with 8.9-inch screen, 1920 by 1200 pixels. $ 299 with 16 GB of storage or $ 369 with 32 GB of storage. Weighs 20 ounces. Battery life of 10 hours. Started shipping Thursday.


— Kindle Fire HD 8.9″ 4G LTE Wireless, with 8.9-inch screen, 1920 by 1200 pixels. $ 499 with 32 GB of storage or $ 599 with 64 GB of storage. Can connect to AT&T Inc.‘s 4G LTE wireless network. Weighs 20 ounces. Battery life of 10 hours. Will start shipping Tuesday.


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‘Twilight’ finale dawns with $141.3M weekend
















LOS ANGELES (AP) — The sun has set on the “Twilight” franchise with one last blockbuster opening for the supernatural romance.


The Twilight Saga: Breaking Dawn — Part 2″ sucked up $ 141.3 million domestically over opening weekend and $ 199.6 million more overseas for a worldwide debut of $ 340.9 million.













The finale ranks eighth on the list of all-time domestic debuts, and leaves “Twilight” with three of the top-10 openings, joining 2009′s “New Moon” (No. 7 with $ 142.8 million) and last year’s “Breaking Dawn — Part 1″ (No. 9 with $ 138.1 million).


Last May’s “The Avengers” is No. 1 with $ 207.4 million. “Batman” is the only other franchise with more than one top-10 opening: last July’s “The Dark Knight Rises” (No. 3 with $ 160.9 million) and 2008′s “The Dark Knight” (No. 4 with $ 158.4 million).


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Questions of Blame Linger 34 Years After Jonestown
















From the age of 13, Leslie Wagner Wilson had been indoctrinated in the California-based Peoples Temple, led by the charismatic Jim Jones, whose mission was to foster racial harmony and help the poor.


But on Nov. 18, 1978, she and a handful of church members fought their way through thick jungle in the South American country of Guyana, escaping a utopian society gone wrong where followers were starved, beaten and held prisoner in the Jonestown compound.













She walked 30 miles to safety with her 3-year-old son, Jakari, strapped to her back and a smaller group of defectors. But just hours later, the mother, sister and brother and husband she left behind were dead.


“I was so scared,” said Wagner, now 55. “We exchanged phone numbers in case we died. I was prepared to die. I never thought I would see my 21st birthday.”


Today, on the 34th anniversary, Wilson said it’s important to remember the California-based Peoples Temple Jonestown massacre, especially the survivors who have wrestled with their consciences for decades.


PHOTOS: Jonestown Massacre Anniversary


Nine members of her family were among the 918 Americans who died that day, 909 of them ordered by Jones to drink cyanide-laced Kool-Aid in the largest ritual suicide in history.


Her husband, Joe Wilson, was one of Jones’ top lieutenants who helped assassinate congressman Leo Ryan and his press crew when they tried to free church members who were being held against their will.


After arriving back in the United States, Wilson said she “went through hell” — three failed marriages, drug use and suicidal thoughts she describes in her 2009 book, “Slavery of Faith.”


“I was like Humpty Dumpty, but you couldn’t put me back together again,” she said.


Survivors, many of them African-American like Wilson, say they felt guilt and shame and faced the most agonizing question surrounding the nation’s single largest loss of life until 9/11: Was it suicide or murder?


Full Coverage: Jonestown Massacre


In the now-famous “death tape,” supporters clapped and babies cried as Jones instructed families to kill the elderly first, then the youngest in protest against capitalism and racism. Mothers poisoned 246 children before taking their own lives.


“We really can’t understand the Peoples Temple without looking at the historical time period when it arose,” said Rebecca Moore, a professor of religious studies at San Diego State University.


“With the liberation movements of the ’60s and ’70s, the collapse of the black-power movement, the Peoples Temple was the main institution in the San Francisco Bay area that promoted a message of integration and racial equality.”


Moore lost her two sisters and her nephew, the son of Jim Jones. “They were hardcore believers,” she said of her siblings.


Jim Jones, who was white, came from a “wrong side of the tracks,” poor background in Indiana where in the 1950s he became known as a charismatic preacher with an affinity for African-Americans.


“A number of survivors, including those who defected, believe to this day he had paranormal abilities,” said Moore, who met him years later. “He could heal them and read their minds.”


In the 1960s, Jones moved to San Francisco, where at the height of the Peoples Temple there were about 5,000 members.


WATCH: A Look Back at Jonestown Massacre


“They wanted my parents to join,” she said. “Like most outsiders, we didn’t have any idea what was happening outside closed doors.”


Jones ingratiated himself with celebrities and politicians, mobilizing voters to help elect Mayor George Moscone in 1975 and becoming chairman of the city’s housing authority.


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Death of the McMansion Has Been Greatly Exaggerated
















Who says Americans have fallen out of love with McMansions? It’s true that the housing bust shaved a few square feet off the average size of new homes in the U.S. But new single-family homes built last year were still 49 percent bigger than those built in 1973, according to Census Bureau data.  And it’s worth remembering that family sizes have shrunk over that period.


The peak size for new homes was an average of 2,521 square feet in 2007. By 2010 it was down to 2,392. That statistic fed into a slew of stories about the “new frugality.” A survey of builders conducted in December 2010 by the National Association of Home Builders predicted that the shrinkage would continue, with the average getting down to 2,152 by 2015.













But then a funny thing happened. In 2011, according to the Census Bureau, the average ticked up a bit, to 2,480 square feet.


That’s partly because mortgages were so hard to get that only the well-to-do, who buy bigger houses, were able to buy new homes in 2011, according to Stephen Melman, the director of economic services for the National Association of Home Builders. But it could also be that the “new frugality” story was somewhat oversold.


The NAHB is conducting another survey now. This time it’s interviewing potential buyers, instead of builders—who were deeply depressed when interviewed at the end of 2010, with housing starts down three-quarters from their peak.


Beneath the average, whatever it is, is a swirl of conflicting demographic trends. On one hand, boomers are aging and downsizing, and more people are living alone. On the other hand, there’s a rise in the number of households with more than one adult generation present. Those families need bigger houses. (You can sometimes cram a couple of kids into the same bedroom; try doing that with Grandpa and little Jimmy.)


The one-big-happy-family uptrend is amplified by immigration of Hispanics and Asians, where multigenerational households are more common. “They’re doing well economically, too,” says Melman. “There’s real buying power there.”


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The Allure of Mass Apple Gadget Thefts


















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“Sister” Director Tackles Taboo of Switzerland’s Class Divide With Her Oscar Contender
















LOS ANGELES (TheWrap.com) – Director Ursula Meier can hardly believe that her film “Sister” – which depicts tenements, poverty and a seemingly rigid class system in lovely Switzerland – has made it over the Alps to Hollywood for Academy consideration.


“It shows a not-very-usual aspect of Switzerland,” Meier told the audience at a showing of “Sister” Thursday night at the Landmark, part of TheWrap’s Academy Screening Series. “We don’t show the beautiful mountains and the green and the lush life … For me it was important to show another point of view on this country to the world. Because usually it’s Montblanc, chocolate, and Swatch.”













Indeed, with her second film, Meier has given international audiences something else to associate with Switzerland: larcenous snow urchins.


“Sister” centers mostly around 12-year-old Simon (Kacey Mottet Klein), who lives in a high-rise tenement in a not-so-snowy valley far below a ski resort and takes gondolas to the top to steal wealthy tourists’ skis right out from under their goggles.


Wily Simon is financing not just his own existence but that of Louise (Lea Seydoux), the title character, who just might be the worst parental figure or caretaker in a cinematic year that did, after all, include “Beasts of the Southern Wild.”


It would involve spoilers to explain why Simon’s older sis is not everything she’s cracked up to be. But there’s nothing misleading about this boy-crazy, substance-abusing twentysomething gal’s unfitness to watch over Simon, the breadwinner of their sad two-person family.


He has to empty out his cash drawer to bribe Louise into snuggling with him, and when he entrusts her with the mere task of waxing skis, she can’t even do that without spilling cigarette ashes on the stolen merchandise.


“It was important for me, when we were at the ski resort, to showing the back door of the restaurant, and the workers inside … And it’s just at the end, when it’s finished, when there is no more snow and the ski resort is closed, for the first time Simon looks at the landscape. And we can see how beautiful this place is, but it’s too late now.”


Meier worked with her young leading man on her first theatrical feature, 2009′s “Home,” where he played Isabella Huppert’s son when he was just 7. She’s emphatic that Klein is not the kind of child actor who has to be tricked into giving a performance.


“During the first casting, I ask him, ‘What do you like to do in your life, Kasey?’ And he told me, ‘Thinking.’ So I said ‘OK, think,’ and I turned on the camera, and he was amazing … He understands that acting is to be, not to look like. So I really wanted to write for him with this film, because it was such an amazing experience on my first film.”


The role of the severely neglectful “sister” was tougher to nail down, both for the director and her leading actress.


“This character was the challenge of the film,” Meier said. “Because Kacey’s character is a child, so for the spectator, of course he’s a victim. But with the character of Louise, for Lea as an actress, at the beginning for her it was very hard to find the fragility of the character. I showed her a lot of films like ‘Vagabond’ … I explained to her, you were 14 when you were pregnant; it was too young for a girl, and you stopped your studies and got bad jobs you cut with your family.”


Sometimes, she said, they’d fight because “she couldn’t find the fragility of the character, and suddenly, months later, wow – it was like we cut something open and all the emotion that came out from her was very deep. I was afraid of the spectators judging the character. It was not easy, in the writing, or in the directing with the actors, because I wanted that they would love these characters, even if they’re sometimes terrible. But I like terrible characters.”


Pond told Meier that when it came to supporting actress Gillian Anderson, of “X-Files” fame, “the first time I watched, I didn’t realize it was her till the end credits” – an experience probably shared by most of those in attendance at the screening.


“I’m very happy that you say that,” said Meier, “because if you recognize the actress, you think about the actress.” But the director did want Armstrong to provoke a where-have-I-seen-you-before vibe.


“I really wanted to be played by a star – not to have a star in my film, but because it was important for Simon to have a kind of phantasma this lady, of what he wants as a mother.


And as a spectator, you can have a phantasma on the star. So I like that she came from another country, and not speak French, because she’s almost an apparition.”


Meier admitted she was frightened before the Swiss premiere – before “Sister” went on to play various fests and win the special Golden Bear award at the Berlin Film Festival.


“When I had the first screening in Switzerland, a lady came back to me and was very moved by the film, because it’s usually a taboo to show poverty in Switzerland. She cried and told me, ‘I grew up in exactly the same place. My father was a worker in the factory we saw in the film, and as a child we never had the money to go up.’ I liked that she just said up.”


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Tulsa Town Hall: Nutrition a valuable tool in health care

















Weil spoke as part of the Tulsa Town Hall series of speakers.













The United States has an expensive health-care system that doesn’t produce good results, he said.


“Something is very wrong with this picture,” he said. “We’re spending more and more and we have less and less to show for it.”


Changes in diet can be an effective treatment for many conditions, but American physicians are functionally illiterate in nutrition, he said.


“The whole subject of nutrition is omitted in medical education,” he said.


There are many ways of managing diseases other than drugs, he said. Integrative medicine, which can include dietary supplements and practices like meditation, is the future of health care, he said.


The health system is resistant to change because of entrenched vested interests. That includes pharmaceutical companies that do direct-to-consumer advertising, which should be stopped, he said.


“As dysfunctional as our health-care system is at the moment – and it is very dysfunctional – it is generating rivers of money,” he said. “That money is going into very few pockets.”


Weil has developed an anti-inflammatory diet based on the Mediterranean diet but with Asian influences.


Inflammation is associated with some heart disease, Alzheimer’s disease and some cancers, he said. And as a result, people should be eating real, unprocessed foods and whole grains. They should stay away from sugar-sweetened beverages, including fruit juice, he said.


“The new research that’s being done on sugar is not very comforting,” he said.


The aging process can’t be avoided, but age-related diseases can be avoided by proper care, he said.


“The goal should be to live long and well with a big drop off at the end,” he said.


Weil is the director of the University of Arizona’s Center for Integrative Medicine.


Tickets to the Tulsa Town Hall series are sold as a $ 75 subscription and cover five lectures. Tickets for individual lectures are not available.


To subscribe, visit tulsaworld.com/tulsatownhall, call 918-749-5965 or write to: Tulsa Town Hall, Box 52266, Tulsa, OK 74152.


Future speakers include journalist Ann Compton on Feb. 8; author James B. Stewart on April 5; historian and cinematographer Rex Ziak on May 10.


Original Print Headline: Speaker highlights nutrition



Shannon Muchmore 918-581-8378
shannon.muchmore@tulsaworld.com3ed48  basic Tulsa Town Hall: Nutrition a valuable tool in health care
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Wall Street cuts losses after constructive talk on fiscal cliff
















NEW YORK (Reuters) – Stocks pared losses on Friday, with the Dow and the S&P 500 turning positive, after congressional leaders said their meeting with President Obama about the “fiscal cliff” was constructive.


The Dow Jones industrial average <.DJI> was up 15.59 points, or 0.12 percent, at 12,557.97. The Standard & Poor’s 500 Index <.SPX> was up 0.89 points, or 0.07 percent, at 1,354.22. The Nasdaq Composite Index <.IXIC> was down 3.98 points, or 0.14 percent, at 2,832.95.













(Editing by James Dalgleish)


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