In its recent report on the status of retail-based health clinics, the Commonwealth Fund suggests that overall utilization remains low, but a recent slowdown in new openings may disproportionately impact uninsured Americans who lack affordable primary care alternatives.

This post and another tomorrow provide a quick update on key findings from the Commonwealth Fund’s report on retail clinics.

Retail clinics are located inside supermarkets, pharmacies and retailers. They provide simple preventive services such as vaccinations and are equipped to diagnose and treat simple health conditions like sore throats and minor rashes.

They are usually staffed by nurse practitioners and remain open during evenings and weekends. Their fee schedules are easy to see and understand, and they tend to keep prices low. They work almost exclusively on a walk-in basis; no appointments are required.

The number of retail clinics exploded from 60 in mid-2005 to more than 1,100 by mid-2008, but virtually all this growth occurred in the first half of this period.

About 3.4 million families have used a retail clinic at least once. That’s 2.3% of all US families. There are wide variations in retail clinic utilization across states however. Minnesota boasts the highest utilization: 6.4% of families in that state have used retail clinics at least once.

Uninsured families (those with at least one member who lacks insurance) comprise 27% of retail clinic users. Overall, 17% of US families are uninsured, meaning that uninsured families use retail clinics more frequently than those with insurance.

Insured families report that half the time their carriers paid for at least some of the fees they incurred during a visit to a retail clinic. Fully 85% of retail clinics now accept insurance, a marked change from the cash-only business model that dominated just a few years ago.

Days before the New Year, Abdullahi Yusuf Ahmed resigned from his position as president of Somalia’s transitional government. No one knows what will happen next, but many say it can’t get much worse.

Yusuf had been holding up a peace deal with the nation’s increasingly powerful Islamist groups which is odd since his government controlled no more than a few city blocks in a country the size of New Mexico. 

That’s quite a come down for one of Somalia’s original warlords who tends to approach political challenges with rocket-propelled grenades.

Rashid Abdi, who analyzes Somalia for the International Crisis Group believes Yusuf’s resignation is “good news” according to the New York Times, because “it may create the opportunity to put a more conciliatory figure in charge.”

But who might that be? The transitional government is a power-sharing deal involving 4 clans, and the moderate Islamic cleric that many believe can unite the country comes from the same clan as the prime minister. That’s a non-starter for the other clans.

It probably doesn’t matter though because it’s not clear anyone wants a job that involves staring down famine poised once again to engulf millions and mediating the grievances of multiple Islamist factions that have been duking it out for 2 years, displacing one in 9 Somalis in the process. 

Not to mention those friggin’ pirates off the coast.

Radical Islamic militias like the Shabab control most of Somalia right now. These lunkheads behead enemies, beat people that don’t attend Friday prayers and stone to death girls claiming to have been raped.

That’s exactly what the US was trying to prevent 2 years ago when it backed an Ethiopian invasion of Somalia. As of today however, the Ethiopians have packed up and are outta’ there.

The FDA approved ImClone’s Erbitux and Amgen’s Vectibix in 2004 and 2006 respectively for the treatment of colorectal cancer.

Then, research findings published last year revealed the 2 monoclonal antibodies only work in 60% of the population whose tumors do not have a mutation in the so-called K-RAS gene.

So in a meeting last month with the FDA’s Oncology Drugs Advisory Committee, the drug companies pressed the agency to alter their drugs’ labels so as to warn physicians not to treat patients with the mutant K-RAS gene.

The research prompting the request was a large, multinational trial presented at the American Society of Clinical Oncology meetings by Eric Van Cutsem of University Hosptial, Leuven, Belgium.

At the meeting, ImClone’s Sr. VP Hagop Youssoufian described the findings as “nothing less than transformational.”

In fact, the trial results compelled the European Medicines Agency to recommend that physicians establish patients’ K-RAS status before prescribing the drugs, and just yesterday the American Society of Clinical Oncologists made a similar recommendation.

Meanwhile, Amgen had cut a deal with UK-based DxS to provide its K-RAS mutation screening kit in conjunction with Vectibix in the US. The deal could translate to more revenue for Amgen if the FDA changes the drug label.

More than $600 million dollars per year in completely worthless treatments, if the above study is right, would be saved if the drugs were not given to patients having the mutation.
 
The Advisory Committee’s response was the scientific version of “whoa Nelly!”

It wants more data before it recommends companion diagnostics for targeted cancer drugs in general, and claims to have issues with retrospectively identified biomarkers.
 
Such studies can introduce bias, the Committee asserted.