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NPR’s Ari Shapiro talks with Ezekiel Emanuel, a senior fellow at the Center for American Progress and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, about his opinion piece in the Washington Post that argues the cheap price of antibiotics has led to their overuse and has also discouraged drug companies from developing new antibiotics.

Transcript

ARI SHAPIRO: Unless we shift course, superbugs will become a fact of life. That line come from Zeke Emanuel, chair of the Department of Medical Ethics And Health Policy at the University of Pennsylvania. In The Washington Post, he lays out a four-pronged approach to avoid what he calls this nightmare scenario. Part of his argument is that antibiotics right now are too cheap, and he joins us to discuss the problem. Welcome to the program.

ZEKE EMANUEL: Nice to be here with you.

SHAPIRO: So there was news last week that a woman in Pennsylvania had a bacteria that was resistant to what’s known as an antibiotic of last resort, and that’s hit off this latest wave of concern about superbugs. Explain why you believe the price of antibiotics is partly to blame.

EMANUEL: Well, you know, the course of new, quote, unquote, “expensive antibiotics” might be $4,500 or $5,000. But a course of course of chemotherapy drug for cancer or a drug to fight multiple sclerosis can be $75,000, $100,000, $150,000 for a year of treatment.

And if you’re a drug company thinking about, where do I invest in terms of research and development – do I develop a $5,000, or do I developed $150,000 drug – you’re almost naturally going to go to the $150,000 drug. And so I think that’s a, you know – a major, major reason that we only have 37 antibiotics now in clinical development.

SHAPIRO: Could raising the prices of antibiotics have negative consequences as well?

EMANUEL: Well, of course. It’s going to happen (laughter). Everything has a positive and negative consequence. The negative consequence is it’s more expensive to treat these infections. Some people might not get them because the drugs are too expensive, although that’s pretty unlikely in the United States.

But I think in general, we have to shift the incentive structure for researchers and drug companies. Otherwise we’re just not going to have enough development.

SHAPIRO: Now, you’ve proposed that governments offer a $2 billion prize to drug companies for developing new antibiotics. Is this something that had been tried with other drugs before? Are prizes an effective motivator?

EMANUEL: I don’t know that they’ve been tried with any other drugs before. But we know in the past that prizes have worked. Napoleon offered a prize for someone who could preserve food for his army, and he got a guy who figured out how to sterilize food in a bottle and then a tin can. There was a prize by the British government to figure out naval navigation to go across the ocean. And Netflix offered a prize – actually, a very modest prize (laughter) – for figuring out people’s movie preferences.

So prizes have worked and have stimulated a lot of people to think about solutions. And from the perspective of the health system just in America – forget the rest of the world – we spend $20 billion on treating people with antibiotic-resistant infections.

So this is a small fraction of that, and it’s absolutely vital because if we have bacteria that we can’t treat, there are going to be a lot of people dying for lack of antibiotics. And that is not a scenario we can put up with.

SHAPIRO: So as you say, the numbers of antibiotics being developed are far lower than the numbers of, for example, cancer drugs being developed. And you also say that doctors over prescribe these drugs. Explain what’s going on.

EMANUEL: Yeah. We know from reports of antibiotic prescribing practices in hospitals that 20 to 50 percent of the antibiotics that are prescribed are either inappropriate for the actual organism or absolutely unnecessary to treat it.

And we know that produces side effects like C. difficile and other infection and that in the outpatient setting, in the physician’s office, about a third of the antibiotics are inappropriate or unnecessary because they’re treating viral infections, or they’re treating self-limited infections. That breeds a lot of resistance in the bacteria in the community, and that is a huge problem.

SHAPIRO: One thing you don’t mention in this piece is the role of patients. Is there something that patients should be doing differently in this problem?

EMANUEL: So there are two main things patients should be doing differently. One – don’t demand antibiotics for sore throats, runny noses, ear infections and put your doctor in the unfortunate circumstance of satisfying your demand and violating what he or she thinks is an appropriate care.

And the second is, when you do get a prescription for antibiotics, we know that a lot of patients do not complete the course of antibiotics. Instead of taking the full 10 days of an antibiotic, you take three or four. You’re feeling better. You stop. Well, then you’ve just bred some resistant organisms that are then going to proliferate, and the antibiotics that we have will not be as effective. And that is also a very big problem out there.

SHAPIRO: Doctor Zeke Emanuel is chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, and he’s also a senior fellow at the Center for American Progress. Thanks for joining us.

EMANUEL: Thank you for having me and talking about superbugs and antibiotics.

Copyright © 2016 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

People are supposed to get vaccine boosters for tetanus and diphtheria once every 10 years. But researchers in Oregon say that’s overkill: For adults, one booster every 30 years might be good enough.

Transcript

STEVE INSKEEP, HOST:

People are supposed to get boosters for tetanus and diphtheria once every 10 years. Now researchers in Oregon say that’s too much. NPR’s Rae Ellen Bichell reports on the case for once every 30 years.

RAE ELLEN BICHELL, BYLINE: Tetanus and diphtheria are extremely rare in the U.S.

MARK SLIFKA: There’s more cases of anthrax every year than there are of diphtheria. That’s how rare that disease has become because of vaccinations.

BICHELL: That’s Mark Slifka, an immunologist at Oregon Health and Science University. Children get a series of vaccines to protect against the bacteria. And adults are supposed to get a booster shot every 10 years to keep up their immunity. But when Slifka and his colleagues studied about 500 people in Washington and Oregon, they concluded that almost all of them would likely remain protected for at least 30 years.

SLIFKA: So you could have one vaccination at the age of 30 and one vaccination at the age of 60. Then you don’t have to try and remember – how long ago was it when I had my last shot? Instead you just say, oh, it’s my 30th birthday. I should get my tetanus and diphtheria shot.

BICHELL: Slifka says cutting down on adult vaccination could save about $280 million a year. Dr. Flor Munoz, an infectious disease specialist at Baylor College of Medicine, says the study is compelling.

FLOR MUNOZ: The rationale, I think, is very sound for looking at this data.

BICHELL: But the big question is – do these results from Oregon apply to the whole country? It would take a bigger study to figure that out. And there’s another thing.

MUNOZ: One of the assumptions here is that all children received their vaccines and you have this protection. And we know that’s not true. Many children are not vaccinated. And we have, actually, increasing pockets of unvaccinated young children that might be at risk.

BICHELL: If people don’t get the full vaccine series as children and then miss their boosters as adults, that could be bad. After the Soviet Union fell, child vaccination dropped, adults stopped getting boosters and after years with few cases, thousands of people got diphtheria. Slifka says it was like taking a match to a forest. Rae Ellen Bichell, NPR News.

Copyright © 2016 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

NPR’s Audie Cornish talks with Rep. Tom Cole of Oklahoma about why the House funding package is enough for now to confront the spread of the Zika virus in the U.S.

Transcript

AUDIE CORNISH, HOST:

The head of the Centers for Disease Control and Prevention said today that he hopes Congress does the right thing to support fighting the Zika virus without diverting money from other efforts, including Ebola. And Congress is having trouble getting on the same page about Zika. The Senate passed a bill last week that would provide $1.1 billion for mosquito control and vaccine research.

The House version provides around $620 million, which would be redirected from an Ebola fund, among other sources. Now, this split comes as we learned in the last week that nearly 300 pregnant women in the U.S. and its territories have the Zika virus. Republican Congressman Tom Cole of Oklahoma is a cosponsor of the House bill.

Welcome to the program.

TOM COLE: Hey, it’s great to be with you.

CORNISH: Earlier this week, we heard from Ron Klain, who led the White House response to Ebola. And he said this, it’s not a question of whether babies will be born in the U.S. with microcephaly as a result of Zika. It’s a question of when and how many? And he said for years to come, these children will be a human reminder of the cost of absurd wrangling in Washington.

What is your response to that?

COLE: Well, frankly, I think he’s misinformed. The $600 million has already been appropriated. That somehow gets lost in the process. And the moment the president declared emergency, he was informed by the House Appropriations Committee, spend whatever you need. You’ve got plenty of money in various funds. We will backfill and replace that money as needed.

This bill is an additional $620-odd million, so roughly two thirds of the $1.9 billion that the president’s requested. The rest will be provided in the normal appropriations process. The only real dispute here is do you simply charge this to the national credit card, that is, not offset it – just go borrow additional money?

Or do you use existing funds and the normal funds and appropriations to take care of what’s genuinely an emergency and ought to get top priority in terms of funding?

CORNISH: Do you have any concerns about appropriations being held up this fall and holding up this effort?

COLE: Not in terms of this because first of all, the administration literally has billions of dollars, unobligated dollars, set aside to use and the assurance that the money, as used, will be replaced as needed.

CORNISH: There’s been some talk of a public health emergency response fund, sort of like a FEMA for public health emergencies. We’ve had the head of the CDC, Tom Friedan, say that he’s heard from both Republicans and Democrats that this could be helpful in cases like this where time is of the essence. Where do you stand on that idea?

COLE: I think there’s considerable merit in that proposal. We have that with FEMA, and it’s big enough to take care of, quote, “an average disaster.” It’s not big enough, for instance, to take care of something like a Hurricane Sandy or Katrina. So I think that’s something we ought to look at. We are looking at it, and I would just ask people to look at the track record here.

We’ve put more money in CDC than the president asked for, more money in NIH than he asked for. We will do that again this year, and we will take care of Zika. As a matter of fact, we’ll now start negotiations with the Senate. We had that vote today in the House of Representatives to begin what’s called a conference.

So we sit down with our colleagues in the Senate and come to a common agreement.

CORNISH: Oklahoma has had four Zika cases so far. These are all travel related. What are you hearing from your constituents? What are your concerns about that?

COLE: Well, the concerns are real. Sooner or later, we’re going to have a local outbreak – probably won’t have anything as massive as the affected countries because this mosquito isn’t as prevalent. But there’s certainly plenty of mosquitoes. And my constituents, I think, honestly have pretty good confidence when they’re not alarmed unduly by a lot of demagoguery that the government will do the right thing in the end.

And I think it will. It has – it certainly did in Ebola, it’s done in other outbreaks. But doing it prudently, using the money that you have, replacing it in future accounts that are not going to be spent for years seems like the wise thing to do.

CORNISH: Republican Congressman Tom Cole of Oklahoma, thank you for speaking with us.

COLE: Oh, thank you. It was my great pleasure.

Copyright © 2016 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

A growing number of hospitals offer state of the art technology. But what that means varies widely from hospital to hospital and in fact, many hospitals continue to grapple with how to upgrade and innovate in traditional systems. NPR’s Ari Shapiro talks to Dr. Neal Sikka, who works on innovation and technology at George Washington University Hospital.

Transcript

ARI SHAPIRO, HOST:

American hospitals promise patients state-of-the-art technology. The definition varies, though. Technology could mean electronic record-keeping or robotic surgery. Hospitals are all over the place and many still grapple with how to innovate.

Joining us now is Dr. Neal Sikka. He works on innovation and technology at George Washington University Hospital, and he’s chief medical officer for a start-up that provides virtual medical coaching to patients called 22otters. Welcome.

NEAL SIKKA: Thank you.

SHAPIRO: Do you see a disconnect between, on one hand, the rhetoric and ambitions that we hear from hospitals and on the other hand the reality of cutting-edge technology and innovation?

SIKKA: Well, I think the disconnect comes just because of timing. You know, innovators move really, really rapidly. And the health care system, very highly regulated as it is and life and death – right? – everyone – everything you do could impact someone’s life. It has to be very careful to adopt new technologies.

SHAPIRO: Is there a technological innovation that you think really ought to have caught on by now but because of whatever bureaucratic hurdles exist in the health care system hasn’t?

SIKKA: The development of EMRs is a really interesting…

SHAPIRO: What are EMRs?

SIKKA: Electronic health records or electronic medical records.

SHAPIRO: Oh, sure.

SIKKA: The HITECH Act incentivized hospitals to adopt health records. And they’ve gone from really low adoption – I think at around 10 percent to over 80 percent of hospitals having electronic health records. But even though a lot of these technologies exist and hospitals are incentivized to provide them, if you look at patient portals, their utilization rate among patients is really, really low. And so we need to do a better job of educating patients about the types of information that are available to them and how they can use them to manage their health care better.

SHAPIRO: At the moment, if I get medical treatment from five different facilities, my electronic medical records might be affiliated with those five different places. Do you foresee a patient-centric future for electronic medical records, where no matter where you go to get treatment your records are associated with you and not with the facility where you’re treated?

SIKKA: Well, I think that’s the goal. The future is definitely having the patient control their own medical record and take it with them where they want it to go.

SHAPIRO: Are there other examples you can give me from your work at George Washington University Hospital that you think really shows the way technology is changing, the way medical care is administered?

SIKKA: Well, we really are focused on trying to improve the patient experience and patient access. And telemedicine, I think, is one of those areas that’s really powerful. I’ve been practicing telemedicine for almost 15 years…

SHAPIRO: Telemedicine meaning being able to remotely consult with a doctor or nurse…

SIKKA: That’s right. And we really started in the maritime industry. So…

SHAPIRO: You mean, like people on boats?

SIKKA: Exactly. So if you think about a mariner who’s on a ship in the middle of the ocean, they have no access to care, right? And so they can reach out to one of our emergency physicians and talk to them through phone or sat phone, through email or through video. And we can diagnose a large majority of their problems.

We can help the medical officer on that ship manage that disease process until we get them to a definitive care. And so we’re trying to take those same lessons and apply them to domestic care. And we think that this long history of learning how to interact with patients at a distance can be really powerful.

SHAPIRO: It’s funny when I think about hospital innovation, I think about, you know, advanced cancer treatment or something like that. But just being able to get an appointment more easily and not have to wait in a drab waiting room and, like, all of those really mundane things seem like they could actually have a significant impact.

SIKKA: Absolutely. Those are part of the patient experience, right? You don’t want to lose time at work sitting in a waiting room. You don’t want to, you know, sit in traffic when you don’t feel well. And there are lots of different scenarios where you don’t need to waste that time. You can have much more convenient care.

SHAPIRO: That’s Dr. Neal Sikka who works on innovation and technology at George Washington University Hospital. Thanks a lot.

SIKKA: Thank you.

Copyright © 2016 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Oklahoma Gov. Mary Fallin vetoed a controversial abortion bill Friday. The measure would have made it a felony for doctors to perform abortions.

Transcript

AUDIE CORNISH, HOST:

Late today, the governor of Oklahoma did something she’s never done before. She vetoed an abortion bill. Republican governor Mary Fallin describes herself as the most pro-life governor in the nation. She’s signed 18 anti-abortion laws. But this latest one even she agreed would’ve been struck down by the courts.

We’re joined now by reporter Rachel Hubbard of member station KOSU in Oklahoma City. And Rachel, first just tell us about the bill and what made it specifically controversial.

RACHEL HUBBARD, BYLINE: Well, Audie, let me just read part of the bill. And I’m quoting here. (Reading) No person shall perform an abortion upon a pregnant woman. A person that violates this section shall be guilty of a felony punishable by imprisonment for not less than one year in the state penitentiary.

And that bill goes on to say any physician that does perform an abortion won’t be able to renew a medical license or ever get one again in the state of Oklahoma. And as you can imagine, some doctors in the state weren’t too happy about this. Doug Cox is a physician who says criminalizing doctors is outrageous.

(SOUNDBITE OF ARCHIVED RECORDING)

DOUG COX: As a physician, I’ve dealt with things that the Legislature never deals with – real-life conversations that take place behind closed doors. And I resent the Legislature trying to step in and interfere, put the government standing between me and my patients.

HUBBARD: Now, Audie, here’s the thing about Doug Cox. Not only is he a doctor. He’s also a Republican lawmaker who serves in the State House. He describes himself as pro-life and says he’s never performed an abortion he doesn’t plan to. But he was still against this bill.

CORNISH: So help us understand how this bill got passed by the Republican-led legislature in Oklahoma.

HUBBARD: Well, Oklahoma is a super conservative, very pro-God, very pro-gun state, and they really value state’s rights. People here just don’t like anybody to tell them what to do. One of the authors of the bill is State Representative David Brumbaugh. He says since the Legislature approved this bill yesterday, there’s been a frenzy and frankly a misunderstanding. He says the bill is about licensing, and licensing of physicians is a state’s right, he says.

DAVID BRUMBAUGH: We’re trying to, you know, weather this storm by doing the right things because it’s not a federal issue. It’s a state issue. And the state has an interest in the public safety and health of its citizens, and that’s what this bill’s about.

HUBBARD: Now, Audie, the Center for Reproduction Rights was quick to weigh in on this bill when it passed yesterday. It’s sued Oklahoma eight times over its abortion laws in the past few years and has threatened to do so again if the governor had signed the bill.

CORNISH: Now, why did governor Fallin decide to veto this abortion bill? As we said, this not something she’d been known to do.

HUBBARD: Right. The governor released as statement this afternoon after she vetoed the bill. She didn’t disagree with the principle of making abortion illegal. In her carefully worded message, she said two things. One – the definition of a felony was so vague that it couldn’t withstand a constitutional legal challenge. And second was that she does support a reexamination of the landmark 1973 Supreme Court decision of Roe versus Wade which legalized abortion, but she conceded that this legislation just couldn’t accomplish that, saying only the appointment of a conservation pro-life justice to the U.S. Supreme Court could get that done.

CORNISH: So what happens next?

HUBBARD: Well, the Oklahoma Legislature can try to override the veto, but that’s not likely to happen. It really didn’t have a lot of support in the House of Representatives initially. Some 30 lawmakers abstained from the first vote. And the Oklahoma Legislature is winding down anyway. It ends a week from today. There’s still no budget. They’re likely headed to a special session. So we’ll have to wait and see if this bill makes a return appearance.

CORNISH: That’s Rachel Hubbard of member station KOSU. She joined us from Oklahoma City. Thanks so much.

HUBBARD: You’re welcome.

Copyright © 2016 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.