Coming To A Clinic Near You: The $50 IUD With A Fascinating Backstory

The new Liletta intra-uterine device (Courtesy of Medicines360)

The new Liletta intra-uterine device (Courtesy of Medicines360)

Zoe Reiches got her first IUD this August — a new model with the lilting name Liletta.

Reiches, 25 and a human resources specialist in Boston, is now happily set for birth control for at least three years. “It’s convenient, I don’t have to worry about it, and I didn’t have to pay for it because of insurance,” she said. “I’m lucky in that sense.”

Millions more American women share her luck now that Obamacare has mandated birth control coverage with no co-pays for most insurers.

But the Liletta, which is just starting to roll out at clinics and hospitals here in Boston and around the country, is not only a device for the lucky — quite the opposite.

Its whole reason for being is to serve poor and uninsured women, to make IUDs — which can cost $1,000 or more — affordable to all, and available on demand at publicly funded health centers.

“This has never been done before,” said Jessica Grossman, the new CEO of Medicines360, the nonprofit pharmaceutical company behind the Liletta. “Our whole mission is to offer this low-cost product.”

Very low cost, compared to the usual thousand-plus dollars. At least until the end of the year, a special program guarantees that insured women who get a Liletta will pay no more than $75 out of pocket for it, Grossman said. A permanent patient assistance program will also provide Lilettas for free to women who qualify.

‘Hey, I want an IUD and I want it now. I want it to be available to me today. I don’t want to come back.’

And, behind the scenes but even more important, public health clinics can order the Liletta for a mere $50 each.

In Massachusetts, all six Planned Parenthood clinics have begun to stock the Liletta, and it’s starting to enter “formularies” — the approved prescription lists — from major hospitals to cash-strapped community health clinics. Medicines360 reports shipping Liletta to 49 states, with more than half of the devices going to clinics that serve low-income patients.

The idea is to make the devices affordable enough that clinics can stock plenty, Grossman said, so that a woman can come in and say, “’Hey, I want an IUD and I want it now. I want it to be available to me today. I don’t want to come back.’ ”

The Anonymous Donor

The Liletta is the latest chapter in the story of the great resurgence of IUDs in the United States, featuring billionaire investor Warren Buffett in a key cameo.

A New York City subway sign that is part of the new "Maybe the IUD" campaign (Courtesy of Dr. Deborah Kaplan)

A New York City subway sign that is part of the new “Maybe the IUD” campaign (Courtesy of Dr. Deborah Kaplan)

After the 1970s debacle of the Dalkon shield, which caused infections and even a few deaths, IUDs fell almost completely out of use among American women. Then, in 2001, a new, hormone-emitting device came on the market — the Mirena.

IUDs steadily gained popularity as a relatively safe, set-and-forget, long-acting but reversible option for many women. (As a no-complaints Mirena user for a decade, I’m one of them.)

More than 10 percent of American women who use birth control now choose IUDs, the most recent data show — the Mirena or the Skyla, which emit tiny amounts of hormones, or a simpler copper IUD, the Paragard.

The latest evidence of the IUD’s full rehabilitation: New York City’s Health Department this week launched its “Maybe the IUD” campaign to encourage New York women to consider an IUD.

The campaign talks about “reproductive justice,” reflecting in part a troubling trend: Unintended pregnancy is increasingly a poor woman’s problem. Look at the trend in the Guttmacher chart below: Continue reading


AG Lynch, Speaking In Massachusetts, Sees Doctors As Partners In Addiction Fight

U.S. Attorney General Loretta Lynch addresses the Opioid Misuse and Addiction Summit sponsored by the Massachusetts Medical Society in Waltham Friday. (Michael Dwyer/AP)

U.S. Attorney General Loretta Lynch addresses the Opioid Misuse and Addiction Summit sponsored by the Massachusetts Medical Society in Waltham Friday. (Michael Dwyer/AP)

U.S. Attorney General Loretta Lynch told a gathering of Massachusetts physicians and pharmacists that they are critical partners with law enforcement in the fight against prescription painkiller and heroin abuse.

Lynch, speaking Friday at the Massachusetts Medical Society headquarters in Waltham, said by harnessing “the expertise, the passion and the conviction” of health care professionals, “I have no doubt that we can preserve opportunity, strengthen families and save lives.”

Lynch credited the Massachusetts medical community “for leading a truly comprehensive campaign to reduce prescription drug abuse in” the state.

She also highlighted the Justice Department’s efforts in battling drug abuse.

Continue reading


How Childhood Stress May Lead To Disease Later In Life

(Thomas Haynie/Flickr)

(Thomas Haynie/Flickr)

What are the childhood origins of adult disease? Might there be certain developmental periods in a child’s life when he or she is particularly vulnerable to stress? And might psychological distress early in life lead to heart and other health problems later in adulthood, even after that stress is gone?

A recent study on early childhood stress published this week in the Journal of the American College of Cardiology doesn’t definitively answer these questions. But it does suggest that a high level of psychological distress in childhood may lead to a heightened risk of disease in adults, even if the stress doesn’t linger on.

The study, led by researchers at the Harvard School of Pubic Health, concludes:

Psychological distress at any point in the life course is associated with higher [cardiovascular and metabolic disease] risk. This is the first study to suggest that even if distress appears to remit by adulthood, heightened risk of cardiometabolic disease remains.

An editorial accompanying the study notes “the possibility that there are sensitive periods in childhood during which some seemingly irreversible physiological, emotional, or behavioral processes are established that affect [cardiometabolic risk]. That is, perhaps there are critical windows of risk linking childhood distress and [cardiometabolic risk] that point to windows of opportunity for intervention.”

The new study was based on an analysis of data from the 1958 British Birth Cohort Study, a longitudinal look at people born in Great Britain during a single week in March 1958. Individuals completed measures of psychological distress and a biomedical survey when they were 45 years old after repeated assessments over the course of their lives, from age 7 to 42.

I asked the new study’s lead researcher, Ashley Winning, a postdoctoral research fellow in the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health, some followup questions. Here, edited, are her answers:

RZ: In this study were you able to determine what, exactly, constituted “stress” for these children? Trauma, illness, abuse? If not, might you speculate on what types of stressors might be linked to later heart problems?

AW: High levels of distress in childhood may be the result of early life adversity (such as trauma, illness, abuse, neglect, poverty) and this may be one reason children in these environments are at heightened risk of poor health. However, symptoms of distress may be in response to less dire exposures too — chaotic environments, parental discord, stressful circumstances — normative responses to difficulties that may become chronic in the absence of appropriate adult capacity to help the child learn to navigate these challenges.

It’s also possible symptoms of distress are early signs of an underlying mental disorder in childhood (which may or may not have a hereditary component). We suspect that distress occurs in response to a range of difficult circumstances but what other research has suggested is that ongoing distress is less likely to occur when there is a nurturing adult or supportive environment available. Continue reading

Majority Of Young People With Depression Don’t Get Treatment, Report Finds

A new national snapshot of the state of mental health across America is, frankly, a little discouraging, especially when it comes to young people.

One startling finding from the annual report produced by the nonprofit Mental Health America: “[S]ixty-four percent of youth with depression do not receive any treatment.”

In addition, the report found:

Even among those with severe depression, 63 percent do not receive any outpatient services. Only 22 percent of youth with severe depression receive any kind of consistent outpatient treatment (7-25+ visits in a year).

I asked one of our frequent contributors, child psychiatrist Dr. Eugene Beresin, executive director of the Massachusetts General Hospital Clay Center for Young Healthy Minds and professor of psychiatry at Harvard Medical School, for his thoughts on the report.

Here, lightly edited, is his response:

First, I am not surprised. There are a number of issues not emphasized by this summary:

1. There is a huge shortage of child and adolescent psychiatrists in the U.S. Currently there are about about 7,000.

So while many parents seek help, the access to care is severely limited. Primary care pediatricians are inadequately trained in psychiatry and this has been addressed by the American Academy of Pediatrics. Their graduate training requires only two months in developmental behavioral pediatrics and few have any significant training in psychiatry. They are desperate to make referrals and often are at a loss to find qualified clinicians. Some states such as Massachusetts and New York have statewide efforts to assist them through consultation and education in psychiatry, but this only scratches the surface. Continue reading

Why To Exercise Today: It May Make Bullied Adolescents Feel Less Suicidal

How much better can exercise make you feel?

A new study suggests that the mood boost may be profound.

The nitty gritty of the study is that researchers at the University of Vermont report a 23 percent reduction in both suicidal thoughts and suicide attempts among bullied students who exercise four or more days a week. The analysis of national data from the Centers for Disease Control and Prevention showed that across the board, frequent exercise was associated with improved mood for adolescents, both bullied and not.

It’s important to note that the study shows an association only between exercise and improved mental health. Still, lead author Jeremy Sibold, an associate professor at the University of Vermont, and chairman of its Department of Rehabilitation and Movement Science, says this is an important first step. It…”shows a critical relationship between exercise and mental health in bullied adolescents,” he says. “These data do not prove that exercise will reduce sadness or suicidality, but certainly support more research in this area.”

(Nick Tonkin/Flickr)

(Nick Tonkin/Flickr)

The study, published online in the Journal of the American Academy of Child & Adolescent Psychiatry, concludes:

Physical activity is inversely related to sadness and suicidality in adolescents, highlighting the relationship between physical activity and mental health in children, and potentially implicating physical activity as a salient option in the response to bullying in schools.

An accompanying editorial, by Dr. Bradley D. Stein and Tamara Dubowitz of The Rand Corporation in Pittsburgh, says,

“…the evolving literature suggests that physical activity interventions appear to be potentially promising as preventive interventions for some children and adolescents at risk for developing mental health disorders and for augmenting more traditional interventions for children and adolescents being treated for depressive and anxiety disorders and attention deficit/hyperactivity disorder.

The “side effects” of such physical activity interventions are likely to be more positive for many children than those of many other therapeutic interventions and potentially less costly…”

I asked Sibold a few questions about the study. Here, via email, are his answers:

RZ: What’s the biggest surprise in the findings?

JS: We were not surprised really that exercise was associated with less sadness, etc., as exercise has been widely reported to have robust positive effects on a range of mental health markers.

However, our statistics were quite rigorous, and to see the positive associations extend to victims of bullying, including those who report suicidal behavior, was certainly a pleasant surprise and a first in the field we believe. It is also quite concerning that 25 percent of students overall report being bullied in the last year. This is a concern we cannot ignore in our schools. Continue reading

Mass. Doctors Join To Vent Frustrations With Electronic Health Records

(, posted with AMA permission)

(Courtesy Medical Association)

“Imagine,” said Dr. Steven J. Stack, president of the American Medical Association. “In a world where a 2-year-old can operate an iPhone, you have graduate-educated physicians brought to their knees by electronic health records.”

Has anyone ever summed up better the monumental frustrations that many doctors encounter when grappling with electronic medical records?

And those frustrations have only been growing as federal requirements for electronic medical records have kicked in and grown teeth — to the point that the AMA has now launched a campaign — called Break the Red Tape — to call for a pause on new medical-record rules.

As part of that campaign, the Massachusetts Medical Society has called a town hall meeting at its Waltham headquarters Tuesday night to let doctors vent.

Not that it’s a Boston Tea Party kind of thing.

“It’s not that every physician wants to throw their electronic medical records into Boston Harbor,” said Dr. Dennis Dimitri, president of the Massachusetts Medical Society. “In fact, physicians have been incredibly rapid in their uptake of implementation of electronic medical records. We have over 80 percent in the state now having implemented electronic medical records. But the dissatisfaction comes around the fact that the electronic medical record has not been the panacea that many might have hoped it to be.

“In fact,” Dimitri continued, “it has added significant time to the daily life of most physicians in their practices. It has not necessarily lived up to expectations in terms of its ability to provide cues to physicians to make sure that necessary treatments are not being missed. It has certainly not been able to swiftly disseminate information from one clinical setting to another. So those are some of the things we hope we’ll hear about, better understand the problems that face physicians, and then come away from this with a plan of how we ask for help in solving these problems.”

That inability to cross from one clinical setting to another that Dimitri mentioned is known by the cumbersome term “interoperability,” and even Sen. Elizabeth Warren is talking about it these days. Continue reading

‘Dealing With The Immediate Crisis': What It's Like For EMTs Responding To Overdose

Boston Emergency Medical Services Deputy Superintendent Edmund Hassan (Jesse Costa/WBUR)

Boston Emergency Medical Services Deputy Superintendent Edmund Hassan and his colleagues regularly revive people struggling with drug addiction from overdose. (Jesse Costa/WBUR)

His ambulance sirens blaring and several police scanners transmitting information simultaneously, Boston Emergency Medical Services Deputy Superintendent Edmund Hassan is speeding to a call that someone is unconscious. Because his workers administer the overdose reversal drug naloxone (more commonly known by its brand name, Narcan) about three times a night, he suspects it’s an opioid overdose.

The radios crackle, and it’s confirmed: an overdose. Additional workers are dispatched to the scene.

Hassan stops at a single-family home in South Boston. A team of emergency workers and firefighters is already there. Several people are running to the back of the house and down some steps into the basement. In the far corner, a middle-aged man is on the ground, two people are sobbing nearby. The crew rushes to administer the Narcan, squirting it into the man’s nose.

“OK, he’s getting some Narcan now,” Hassan explains to a woman standing nearby clenching her arms around her body. “You just found him here?” he asks.

“Yes,” she says, tears in her eyes. “He’s my husband.”

Continue reading


Cancer Drug Mark-Ups: Year Of Gleevec Costs $159 To Make But Sells For $106K

A new study finds that a year's supply of Gleevec (imatinib), a leukemia drug, costs about $159 to make, but the yearly price tag is $106,322 in the U.S. and $31,867 in the U.K. (Wikimedia Commons)

A new study finds that a year’s supply of Gleevec (imatinib), a leukemia drug, costs about $159 to make, but the yearly price tag is $106,322 in the U.S. and $31,867 in the U.K. (Wikimedia Commons)

By Richard Knox

The rocketing cost of prescription drugs garners almost daily attention lately. Polls say it’s high on the list of Americans’ health care worries; presidential candidates are calling for sweeping reform; a storm erupts when one company jacks up the price of an HIV drug by 5,000 percent.

And now, research reveals the yawning gap between the price of widely used cancer drugs and their actual cost.

The true cost — what drug makers have to spend to get those pills to your local pharmacy — is made up of the active ingredient and other chemicals, their formulation into a pill, packaging, shipping and a profit margin.

British researchers, in a report to be delivered this weekend at a European cancer conference, say the price of five common cancer drugs is more than 600 times higher than they cost to make.

For instance, the analysis figures the true cost of a year’s supply of Gleevec (generic name imatinib), used to treat certain kinds of leukemia, at $159.

“This is a ginned-up pricing structure that isn’t a product of careful analysis. It’s not a bunch of guys in green eye-shades but a bit of dart-throwing and chutzpah.”

– Dr. Peter B. Bach

But the yearly price tag for Gleevec is $106,322 in the U.S. and $31,867 in the U.K. A generic version costs about $8,000 in Brazil.

“We were quite surprised just how cheap a lot of these cancer drugs really are,” pharmacologist Andrew Hill of the University of Liverpool said in an interview. “There’s a lot of scope for prices to come down.”

Hill’s team got the ingredient costs from a public data base called The Liverpool group did the same analysis for four other drugs in the same class, called tyrosine kinase inhibitors, or TKIs. They’re used to treat lung, breast, liver, pancreas and thyroid cancer as well as leukemias. Their names are Tarceva (erlotinib), Nexavar (sorafenib), Tykerb (lapatinib) and Sprycel (dasatinib).

The true yearly cost of these four drugs ranges from $236 for Tarceva to $4,022 for Tykerb. But their U.S. sticker prices range from $78,797 to $135,679.

The analysis has implications beyond the United States. Hill says more than a million cancer patients around the world meet criteria for taking the five TKI pills. “Very few of them are being treated now,” he says, because the drugs are so expensive.

A 100-Fold Rise

And the implications stretch way beyond these specific cancer drugs. Overall prices for cancer medications have been going up at a fast clip. Dr. Peter B. Bach of Memorial Sloan Kettering Cancer Center in New York has documented a nearly 100-fold increase in cancer drug prices since 1965 after adjusting for inflation.

“The rate of rise exceeds the rise in benefits from these drugs,” Bach says. “This is a ginned-up pricing structure that isn’t a product of careful analysis. It’s not a bunch of guys in green eye-shades but a bit of dart-throwing and chutzpah. And if there’s a critical Op Ed piece or a Twitter avalanche [in response to a high price] they’ll lower it.” Continue reading

To Help Combat Drug Abuse, Drop Off Your Old Medications At Drug Take-Back Day Saturday

Gov. Charlie Baker is urging residents to take part in Saturday’s national drug take-back day by dropping off their old or unused prescription medications at one of the state’s 170 participating sites. (e-MagineART via Flickr)

Gov. Charlie Baker is urging residents to take part in Saturday’s national drug take-back day by dropping off their old or unused prescription medications at one of the state’s 170 participating sites. (e-MagineART via Flickr)

Gov. Charlie Baker wants you to clean out your medicine cabinet this weekend.

Baker is urging residents to take part in Saturday’s national drug take-back day by dropping off their old or unused prescription medications at one of the state’s 170 participating sites.

Across the state Saturday, sites from schools to police stations to senior centers will be accepting prescription drop-offs from 10 a.m. to 2 p.m. Collection sites can accept any pills or patches, but no liquids or needles.

“I urge the Commonwealth to open their medicine cabinets and take advantage of this convenient and effective program in your communities,” Baker said in statement released Friday. “Medications can be misused, and as we’ve seen with the opioid crisis, the results can be deadly.”

Holding and promoting drug take-back events was one of several recommendations from the governor’s Opioid Working Group, which was charged with coming up with ways to help stem the opioid addiction crisis in the state.

“Certain medicines that are left lying around, such as painkillers, are highly susceptible to being stolen and sold on the street,” Lt. Gov. Karyn Polito said in the statement. “This free service addresses a vital public safety issue. Old prescription drugs can be dropped off — no questions asked.”

A full list of participating sites is available here.

How I Was Seduced By Cigarettes, And What Set Me Free

By David C. Holzman
Guest Contributor

More than half a century has passed since Luther Terry released the landmark U.S. surgeon general’s report on smoking and health.

Since then, smoking in the U.S. has declined dramatically. Nonetheless, roughly 50 million Americans still smoke.

Tobacco’s ‘Fantastic Voyage’

If anyone should have been immune to taking up smoking, it was me.

As a prepubescent child, I absorbed the lessons about the importance of living healthily that my parents instilled. At age 10, I got them to quit smoking after the first surgeon general report came out — although I’m sure they would have done it on their own, if not quite as quickly. Early on in my writing career, I wrote a “fantastic voyage” article about all the carcinogens in tobacco, where they went in the body, and what nefarious things they did when they got there. Little did I ever suspect I would become briefly but definitely addicted.

The germ of the habit occurred when I was medical writer for Insight Magazine. Dennis, the head copy editor, smoked like a chimney.

The author, smoking at his sister's wedding in June 1991 (Photo illustration courtesy of the author)

The author, smoking at his sister’s wedding in June 1991 (Photo illustration courtesy of the author)

“How’s that cigarette?” I’d tease him every morning when I arrived at work. “Not long enough!” he’d say. Or, “Not as good as the first one.” It became our way of bonding.

One day he said, “You want to try it?”

Curious, I took a puff. It gave a powerful kick, like a turbocharger. But it was not something I felt I needed.

But one Sunday, a few years later, I needed it. I’d gone to the car races at Summit Point, West Virginia, with my friend, Don, a former racer, and his wife Eva, who smoked. I’d slept little the week before, and D.C., where I lived at the time, was being its usual oppressively hot, humid summer self. By mid-afternoon I’d gotten so sleepy that I was getting ready to curl up in the back of my car and snooze. Then I remembered Dennis’ cigarette. I asked Eva if I could finish one of hers. A couple of puffs, and I was wide awake, once again enjoying being with my friends.

My FDA Cigarette

Around this time, I was working for daily biotech news publication, regularly covering meetings of the Advisory Committee to the head of the Food and Drug Administration. These meetings were boring. They took place in a windowless room of the incredibly ugly, mid-’50s institutional style Parklawn building. As soon as they started, off went the lights, and on went the Powerpoints.

At that point, no matter how much coffee I’d had, my head would start to sag.

So the next time I had to cover one of these meetings, I bummed a cigarette. I took several puffs, and then tossed it. This time, I remained painlessly alert after the lights went out.

I took to bumming cigarettes while I waited for the FDA meetings to start, and ultimately I bought my own pack. Continue reading