The Surgeon General declared teen smoking an epidemic, the FDA is considering another fast-track pathway for certain drugs, and two studies raised questions about government health initiatives.

Youth Smoking Targeted in New Report

More than 3.6 million kids smoke cigarettes, according to a new report from the surgeon general on the scope and health consequences on tobacco use among youth.

“Today, more than 600,000 middle school students and three million high school students smoke,” according to U.S. Surgeon General Regina Benjamin, MD, who called youth smoking an “epidemic.”

The report is the first aimed at children and adolescents since one in 1994 that concluded that if young people don’t try smoking by the age of 18, they’ll likely never start.

FDA Mulls New Fast-Track Pathway

The FDA is considering a new approval pathway for drugs to treat life-threatening conditions for which there are few approved therapies, including certain infections and even morbid obesity.

The new, faster pathway would be a way for antibiotics, weight loss drugs, and other medications to come to the market without the traditional expensive and lengthy clinical trials. But drugs approved this way would have highly restrictive labeling and would initially be restricted to a prespecified, narrow population.

Janet Woodcock, MD, head of the FDA’s Center for Drug Evaluation and Research (CDER) said the pathway would likely have to be approved by Congress, and then the FDA would issue a regulation and request public comment.

Quality Reporting Doesn’t Equal Cost Savings

Medicare’s requirement that hospitals publicly report certain quality measures on the Hospital Compare website has led to a modest reduction in deaths from heart failure, but no reduction in deaths from heart attacks or pneumonia, according to a study in Health Affairs.

The Centers for Medicare and Medicaid Services (CMS) began requiring all U.S. acute-care hospitals to report quality measures for heart attack, pneumonia, and heart failure on the Hospital Compare website in 2005. The site allows patients and physicians to compare adherence to quality measures among hospitals.

Study Finds EHRs May Lead to More Tests

Another study out this week found that doctors who have electronic access to imaging results order more imaging tests. The conclusion of that study, also in Health Affairs, is at odds with claims that electronic health records (EHRs) will lead to less testing.

In a study of nearly 29,000 visits to doctors’ offices, physician access to past computerized imaging results was associated with a 40% to 70% greater likelihood that another study would be ordered, according to the report.

The coordinator of health IT for the government, Farzad Mostashari, MD, dismissed the study’s conclusions in a blog post and said the move to electronic records will save money in other ways that don’t involve diagnostic tests.

Medicare Loses Most Money Through Abuse, Not Fraud

Most of the money bilked from Medicare and Medicaid comes from a “gray area” - abuse of the system - rather than outright fraud, according to a healthcare fraud consultant.

Outright fraud includes deliberately filing false claims or stealing patients’ or doctors’ identity and filing claims for medical services never rendered. Abuse is less clear-cut, and much harder to catch, said Jim Frogue, partner and co-founder of the consulting firm FrogueClark, and former vice president of Newt Gingrich’s Center for Health Transformation.

Abuse includes upcoding, bill-splitting, excessive testing, and what Frogue called waste - including coding errors and duplicate testing.

Frogue suggested that if that money could be recovered, or kept within the system in the first place, it could pay for replacing the sustainable growth rate formula used to calculate Medicare payments for doctors.

Data Lacking on Fecal DNA Test for Colorectal Cancer

There’s not enough evidence to support using fecal DNA tests to screen for colorectal cancer in the average-risk person, according to results of a study commissioned by the Department of Health and Human Services.

“Despite considerable media attention and expert-based clinical recommendations that include fecal DNA testing for [colorectal cancer] screening, at present, fecal DNA tests have insufficient evidence about their clinical validity (diagnostic accuracy) in patients at average risk for [colorectal cancer],” wrote the authors of the report, which was released by the Agency for Healthcare Research and Quality (AHRQ).

Fecal DNA testing is designed to detect molecular abnormalities in cells from cancer or precancerous lesions that are shed into the stool. There are currently no fecal DNA tests available for use in detection of colorectal cancer, but one company has a test in development.

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By Emily P. Walker, Washington Correspondent