Friday, April 29, 2011

Health - More Doubts Cast on a Hotly Debated Lung Cancer Study

Health - More Doubts Cast on a Hotly Debated Lung Cancer Study

More Doubts Cast on a Hotly Debated Lung Cancer Study

Posted: 29 Apr 2011 09:54 AM PDT

In medical experiments on human beings, every patient must sign an “informed consent” form acknowledging the risks, and researchers are required to keep track of those statements.

But the doctors who conducted a controversial, widely publicized lung cancer study involving more than 50,000 patients at numerous hospitals were unable to locate 90 percent of the consent forms, according to a confidential review provided to The New York Times.

The finding casts further doubt on a clinical trial that made headlines in 2006 when it concluded that fully 80 percent of lung cancer deaths could be prevented through widespread use of CT scans.

That trial, led by Dr. Claudia I. Henschke at Weill Cornell Medical College in New York City, drew sharp criticism from skeptics of cancer screening; the criticism intensified when The Times reported in March 2008 that the research was being financed in part by $3.6 million in grants from the parent company of the Liggett Group, a cigarette maker.

The confidential report on patient consent, dated Oct. 7, 2008, recommended that the trial be stopped. But it continues to this day, although not at Weill Cornell.

Several ethicists said the hospital was legally required to disclose the ethical problems documented by the secret review. That has not happened either.

The confidential report was commissioned by Weill Cornell in the wake of The Times’s 2008 article and other revelations about the study in the newsletter The Cancer Letter. The hospital hired four prominent professors from other universities to undertake an independent review of Dr. Henschke’s research, known as the International Early Lung Cancer Action Program, or I-Elcap.

In their report, the reviewers scolded Weill Cornell administrators for failing to supervise the research more closely, “especially knowing that scientific controversy has surrounded I-Elcap almost from its inception.”

One of the reviewers, Dr. David P. Carbone, a professor of medicine and cancer biology at Vanderbilt, said in an interview that he and the other reviewers never found out “whether these consents were obtained and lost or whether they weren’t obtained at all.”

He said that Dr. Henschke acted with the best of intentions, “but there’s no way for me to justify any of the problems” documented by the group’s review.

Dr. Henschke, who has since left Weill Cornell for Mount Sinai Medical Center, also in New York, declined to respond to the findings of the 2008 review, saying it was confidential. But in an e-mail, she said the responsibility for keeping track of consent forms lay with all the hospitals where the experiments were done.

“I-Elcap is a non-federally funded academic consortium of independent, autonomous sites that share certain data,” she wrote.  “Accountability and responsibility for human protection lie at the local level.”

But Dr. Henschke’s research has been supported by grants from the National Institutes of Health, and federal rules governing research conducted at multiple sites have long required that the coordinating center either collect copies of patient consent forms or ensure that they are being kept appropriately.

“The responsible conduct of a study requires that informed consent documents be kept on file,” said Dr. P. Pearl O’Rourke, director of human research affairs at Partners HealthCare, part of Harvard University. “There should be a system so that every consent form can be found no matter if individuals were enrolled at a single site or multiple sites.”

John D. Rodgers, a spokesman for Weill Cornell, wrote in an e-mail that the medical school followed federal research regulations “and there were no issues regarding the safety of the research subjects.”

Dr. Bruce A. Chabner, director of clinical research at Massachusetts General Hospital Cancer Center and editor in chief of The Oncologist journal, said he would ask Weill Cornell for an explanation of the problems outlined in the 2008 scientific review, as well as a follow-up to the report.

His journal has published research by Dr. Henschke, and “if we find there was no informed consent for those patients, the paper would have to retracted,” he said.

The American Cancer Society helped to finance Dr. Henschke’s research, and some of her work was published in cancer journals owned by the society. Dr. Otis W. Brawley, the society’s chief medical officer, said any study underwritten by the organization must conform to federal research rules, including those that require that problems with informed consent be reported to federal science agencies.

He added that the society’s journals might have to correct or retract any study that proved unable to document that patients had given informed consent. “But I don’t want to prejudge the case,” Dr. Brawley said.

In November, a huge federal study found that annual CT scans of current and former heavy smokers reduced their risk of death from lung cancer by 20 percent and, even more surprising, seemed to reduce the risks of death from other causes as well.

Although the scale of the benefit was substantially less than Dr. Henschke claimed her research showed, the federal study was widely interpreted as confirming her longtime contention that CT screening can save lives from lung cancer, which kills more than 150,000 people each year in the United States. Most patients discover their disease too late for treatment, and 85 percent die from it.

Dr. Carbone, the reviewer, said he believed that Dr. Henschke was so convinced that CT screening would prove beneficial against lung cancer that she cut corners in her research.

“Claudia was so dedicated to this concept and underfunded in a lot of ways so that there was no way for her to do it properly,” he said. “But the ends don’t always justify the means, and doing things wrong can really backfire.”

Patient Money: Containing Costs for Pet Care

Posted: 29 Apr 2011 10:42 AM PDT

DEBORAH NOCELLA, a 43-year-old mother in Park Slope, says she feels as if she takes the family’s two dogs to the vet almost as often as she takes them to the neighborhood dog run.

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Pokie, a pit bull mix, ran up a $2,300 vet bill after swallowing some Advil and going into renal failure.

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Last year the Nocella family adopted two puppies, a pit bull mix named Pokie and a “puggle” named Browny. Since then, Ms. Nocella estimates, the family has spent as much as $5,000 on veterinarian bills.

The dogs have had routine checkups and shots, of course. But then there were unexpected costs: Pokie arrived with a bad case of worms and kennel cough; some strange bumps on her paws turned out, after $700 worth of tests, to be warts. Browny has severe allergies and requires frequent trips to the vet.

Last November, Pokie swallowed Advil pills, which are toxic to dogs. She went into renal failure and required emergency treatment overnight in a nearby animal hospital. The treatment was successful and Pokie is fine, but the incident set the Nocellas back $2,300.

Pet owners like Ms. Nocella are spending more on veterinarian bills than ever before. The American Pet Products Association estimates that Americans will spend $12.2 billion on veterinary care this year, up from $11 billion last year and $8.2 billion in 2006.

Advances in veterinary medicine mean more extensive, and expensive, treatments are available for animals, but even ordinary costs like flea and tick protection can add up quickly. Here are some ways to curb those costs while still giving your pet the best of care.

LOW-COST ALTERNATIVES Local shelters often offer free or low-cost spaying and neutering for dogs and cats, said Dr. Louise Murray, vice president at the American Society for the Prevention of Cruelty to Animal’s Bergh Memorial Animal Hospital in New York and author of “Vet Confidential.” To find a shelter near you, check the A.S.P.C.A. Web site at www.aspca.org/pet-care/spayneuter.

Shelters where pets can be adopted may offer low-cost vaccinations and checkups. Mobile clinics, usually sponsored by local governments or animal protection agencies, also provide routine pet care for far less than a traditional vet would charge.

Veterinarian schools are another good source of low-cost care. Students are carefully supervised by qualified veterinarians, so pets receive quality care — everything from heartworm tests to major surgery, often for as little as a third of the price at a veterinarian’s office.

THE RIGHT VACCINES Keeping up with a pet’s shots will save money, not to mention misery, in the long run by preventing many serious illnesses. But that does not mean a pet needs every vaccine available.

“A corgi who lives on the Upper East Side doesn’t need the same protocol as a Labrador in Connecticut,” Dr. Murray said. “Your veterinarian should customize a vaccine plan that fits your pet.”

A HEALTHY DIET Many vets sell prescriptions and high-quality pet food, but the same brands are sold for much less at many pet supply stores or Web sites. Still, do not skimp on quality.

“Cats, for example, are carnivores and aren’t meant to eat carbohydrates,” Dr. Murray said. “Feeding them only the cheap dried food can lead to diabetes or blockages that will cost you a lot more in the long run than the price you’ll pay for the right food.”

DRUG DISCOUNTS If a pet needs regular medication, discount chains such as Costco can be cheaper than a regular drug store or the vet’s office, said Dr. Sharon Friedman, a veterinarian at the Berkley Animal Clinic in Berkley, Mich. But consult a veterinarian first, she advised, to be sure to buy the right medicine at the right dosage.

On the other hand, do not assume that tick and flea treatments or heartworm medications are cheaper at the big discount chains. Manufacturers want to distribute these medicines through veterinarians’ offices, so they often offer promotions and discounts there that are not available elsewhere.

“One company recently offered two free tick and flea treatments if you bought six doses. That worked out to be less expensive than PetMeds, a popular online store, or Costco,” Dr. Friedman said. “It often pays to ask.”

Many Web sites sell high-quality pet medications at good prices, but a recent Food and Drug. Administration. investigation caught some sites selling counterfeit, unapproved or expired drugs. Beware of any site that sells medications without requiring a veterinarian’s prescription.

The F.D.A. also recommends that consumers look for sites accredited as a Veterinary-Verified Internet Pharmacy Practice Site, part of a voluntary accreditation program.

CONSIDER INSURANCE Pet health insurance is a booming industry, growing more than 20 percent every year, although only an estimated 3 percent of pet owners have bought policies. While Ms. Nocella has never seriously considered buying pet insurance, she does acknowledge it might have come in handy the day Pokie ate the Advil.

But like health insurance for humans, pet insurance can be complicated and highly restricted. Some policies will not cover older pets or genetic conditions that certain breeds are known to have, such as hip dysplasia in retrievers.

Others limit coverage to only one treatment per illness. So if your dog develops asthma, for instance, some policies will cover just the first trip to the vet although treatment will require multiple visits.

Prices for pet insurance can range from $12 to $50 a month, depending on the type and age of the pet and any pre-existing conditions. In almost all cases the pet owner pays up front, then files a claim for reimbursement.

Costs are higher to insure older, sicker pets, or for policies that cover preventive care, such as vaccines and veterinarian office visits.

Many pet owners prefer to save for unexpected vet expenses in an emergency fund instead of paying premiums for coverage they may not use. Dr. Murray suggested putting away a little each week until savings reach $2,000 to $3,000.

“That’s the minimum you’ll need if a serious situation arises and your pet needs lifesaving care,” she said.

U.S. Seeks New Limits on Food Ads for Children

Posted: 28 Apr 2011 10:20 PM PDT

Will Toucan Sam go the way of Joe Camel?

The federal government proposed sweeping new guidelines on Thursday that could push the food industry to overhaul how it advertises cereal, soda pop, snacks, restaurant meals and other foods to children.

Citing an epidemic of childhood obesity, regulators are taking aim at a range of tactics used to market foods high in sugar, fat or salt to children, including the use of cartoon characters like Toucan Sam, the brightly colored Froot Loops pitchman, who appears in television commercials and online games as well as on cereal boxes.

Regulators are asking food makers and restaurant companies to make a choice: make your products healthier or stop advertising them to youngsters.

“Toucan Sam can sell healthy food or junk food,” said Dale Kunkel, a communications professor at the University of Arizona who studies the marketing of children’s food. “This forces Toucan Sam to be associated with healthier products.”

The guidelines, released by the Federal Trade Commission, encompass a broad range of marketing efforts, including television and print ads, Web sites, online games that act as camouflaged advertisements, social media, product placements in movies, the use of movie characters in cross-promotions and fast-food children’s meals. The inclusion of digital media, such as product-based games, represents one of the government’s strongest efforts so far to address the extension of children’s advertising into the online world, which children’s health advocates say is a growing problem.

The guidelines are meant to be voluntary, but companies are likely to face heavy pressure to adopt them. Companies that choose to take part would have five to 10 years to bring their products and marketing into compliance.

“There’s clearly a demand hidden behind the velvet glove of the voluntary language,” said Dan Jaffe, an executive vice president of the Association of National Advertisers, a trade group that represents marketers like Kraft Foods and Campbell Soup.

By explicitly tying advertising to childhood obesity, the government is suggesting there is a darker side to cuddly figures like Cap’n Crunch, the Keebler elves, Ronald McDonald and the movie and television characters used to promote food. It also raises the question of whether they might ultimately share the fate of Joe Camel, the cartoon figure used to promote Camel cigarettes that was phased out amid allegations that it was meant to entice children to smoke.

“Our proposal really covers all forms of marketing to kids, and the product packaging and the images and themes on the cereal boxes have tremendous appeal to kids,” said Michelle K. Rusk, a lawyer with the trade commission. “The goal is to encourage children to eat more healthy foods because obesity is a huge health crisis.”

The F.T.C. said that in 2006, food companies spent nearly $2.3 billion to advertise to children.

The food industry immediately criticized the proposal, saying that it had already taken significant steps to improve recipes and change the way it advertises to children.

Kellogg, the company that makes Froot Loops, said in a statement that it would review the proposal and that it was committed to improving “the nutrition credentials” of its products. “We have very specific criteria, based on a broad review of scientific reports, that determine how and what products we market to children,” the company said. The company has already reduced sugar and added whole grains in many cereals.

Scott Faber, a vice president of the Grocery Manufacturers Association, a group that represents food makers, said that ads for packaged foods on television shows aimed at children 2 to 11 had dropped significantly since 2004, and that the ads more often showed healthier types of foods. He said companies had also changed many recipes to reduce salt, sugar and fat and add healthful ingredients like whole grains. “The rate of reformulation is going to increase, not as a result of the principles that were announced today but because consumers are demanding changes in the marketplace,” Mr. Faber said.

Many food companies participate in an industry-led effort, the Children’s Food and Beverage Advertising Initiative, to restrict some marketing activities. But each company that takes part is allowed to set its own nutritional criteria, which critics say undermine the program’s effectiveness.

Regulators said it was important for the entire industry to adhere to a uniform set of standards.

The guidelines were created at the request of Congress and written by the commission, the Food and Drug Administration, the Agriculture Department and the Centers for Disease Control. Regulators said they would take comments and consider changes before submitting a final report to Congress.

The guidelines call for foods that are advertised to children to meet two basic requirements. They would have to include certain healthful ingredients, like whole grains, fresh fruits and vegetables, or low-fat milk. And they could not contain unhealthful amounts of sugar, saturated fat, trans fat and salt.

The sugar requirement would limit cereals to eight grams of added sugar a serving, far less than many popular cereals have today. Froot Loops and Cap’n Crunch, for example, contain 12 grams of sugar a serving.

The salt restrictions are particularly stringent, and many packaged foods on the shelves today would have a hard time meeting them. In an initial phase-in period, the guidelines call for many foods to have no more than 210 milligrams of sodium a serving, while main dishes and meals, including both restaurant food and packaged food, could have no more than 450 milligrams. Today, a 15-ounce can of Chef Boyardee beef ravioli has two servings, with 750 milligrams of sodium per serving. The sodium restrictions would get tougher over time.

The federal agencies acknowledged that a “large percentage of food products currently in the marketplace would not meet the principles.”

The guidelines would apply to both young children and teenagers. The industry has said it should have greater leeway for teenagers, and Ms. Rusk said the agencies would consider those arguments.

Margo Wootan, director of nutrition policy for the Center for Science in the Public Interest, an advocacy group, predicted that the guidelines would force many companies to accept great restrictions and improve recipes.

“With all the concern about childhood obesity, I think there’s a lot of pressure on companies to do the right thing and follow these standards,” she said.

Jeffrey Chester, executive director for the Center for Digital Democracy, a group that focuses on Internet marketing to children, said the F.T.C. proposal had broader implications. “The youth obesity issue has placed all digital marketing in the regulatory cross hairs,” Mr. Chester said.

Matt Richtel contributed reporting.

Cheaper Drug to Treat Eye Disease Is Effective

Posted: 28 Apr 2011 10:03 PM PDT

A drug that costs about $50 a dose is just as effective at preserving and improving vision in elderly people with an age-related eye disease as one that costs $2,000 a dose, according to the results of a government-sponsored clinical trial released Thursday.

The trial compared the effectiveness of Lucentis, a drug approved to treat one form of macular degeneration, with Avastin, a cancer drug that many eye doctors have been using off-label instead of Lucentis because of its far lower cost. The drugs, both made by Genentech, work in a similar manner.

The findings could possibly save Medicare hundreds of millions of dollars a year — and cost Genentech an equivalent amount in lost sales — if more doctors begin using Avastin instead of Lucentis.

Macular degeneration is the leading cause of severe vision loss among the elderly. More than 250,000 Americans get treated for it each year. The wet form of the disease, for which Lucentis is approved, is characterized by abnormal blood vessels in the back of the eye that leak fluid, obstructing the vision essential for reading, driving, watching TV and recognizing faces.

“Health care providers and payers worldwide will now have to justify the cost of using” Lucentis, Dr. Philip J. Rosenfeld, a retina specialist at the University of Miami, wrote in an editorial in The New England Journal of Medicine, which published the trial results online Thursday.

Still, supporters of Lucentis said there are benefits of the drug. Lucentis was better at drying the fluid in the eye that is believed to be the cause of vision loss from the disease. While this did not translate into a difference in vision at the end of one year, the time point measured in the trial, it might do so over longer time periods, they said.

Moreover, 24 percent of the patients who received Avastin had a serious health complication compared with 19 percent of those who got Lucentis, the trial showed. However, the complications were varied and not those typically seen when Avastin is used, at much higher doses, as a cancer treatment. The authors of the study said there were too few patients in the trial to resolve the safety issue.

Both Lucentis and Avastin are meant to stop blood vessel formation and leaks. Lucentis was created specifically for use in the eye, but many doctors have used Avastin because when a vial of that drug meant for cancer treatment is divided into tiny doses for the eye, each injection costs much less than Lucentis.

Despite the widespread use of Avastin, the drug had never been thoroughly tested in treating the eye disease. So the National Eye Institute, part of the National Institutes of Health, sponsored a study involving 1,200 patients.

In the trial, patients who got Avastin every month could read an average of 8 more letters on an eye chart after one year — about the same improvement as patients using Lucentis, who were able to read 8.5 more letters a year later. The percentages of patients who had gains or losses of vision of more than 15 letters, equivalent to three lines on the eye chart, were also similar for the two drugs.

Avastin and Lucentis also were equivalent when the drugs were given as needed, depending on the course of a patient’s disease, rather than on a fixed monthly schedule. However, it was unclear if Avastin given as needed was as good as Avastin given monthly.

Still, the authors of the study said that giving the drugs as needed, which resulted in average vision gains around six letters, could be an acceptable alternative. It would mean an average of four or five fewer injections per year, reducing the cost of treating a patient with Lucentis by about $10,000 a year.

In 2008, Medicare paid for 480,000 injections of Avastin to treat macular degeneration and for 337,000 injections of Lucentis, according to a study done by Medicare researchers and by Dr. Rosenfeld of the University of Miami. Yet Medicare paid only $20 million for the Avastin compared with $537 million for the smaller number of Lucentis injections.

Genentech, which is owned by Roche, said in a statement on Thursday that it continued to believe that Lucentis was safer and better. The company sells Lucentis in the United States while Novartis sells it elsewhere. Each company had sales of roughly $1.5 billion year.

The trial results are also likely to affect Regeneron Pharmaceuticals and Bayer, which are trying to win approval of another drug to treat macular degeneration.

Earnings Rise for Procter and Colgate

Posted: 28 Apr 2011 11:43 PM PDT

The Procter & Gamble and Colgate-Palmolive companies posted increases in profit and sales for their most recent quarters on Thursday, but warned that rising costs would affect their results and lead to higher prices for consumers.

Procter & Gamble lowered the high end of its profit forecast for the year after posting a profit that fell a penny short of analysts’ average estimate. Colgate said that rising costs hurt its profit margins in its last quarter but that the income still met forecasts.

Procter & Gamble, the world’s largest maker of household goods, now expects its costs to rise about three times as much at it had at the start of the year, with increases in diesel, resin and other materials, the chief financial officer, Jon R. Moeller, said.

Procter has implemented or announced increases across brands representing about 50 percent of United States sales but is not raising prices as much as it did in 2008, the chief executive, Robert A. McDonald, said.

Procter & Gamble earned $2.87 billion, or 96 cents a share, up from $2.59 billion, or 83 cents a share, a year earlier. Revenue in the period, which ended March 31 and was the third quarter of the company’s fiscal year, rose to $20.23 billion from $19.18 billion.

Stock in Procter, which is based in Cincinnati, rose 48 cents, to $64.50 a share.

Colgate, which was reporting results for its first quarter, said it earned $576 million, or $1.16 a share, up from $3.57 million, or 69 cents a share, a year earlier. Sales rose to $3.99 billion from $3.83 billion.

Excluding one-time items from the year-earlier period, its net income was down 8 percent.

The chief executive, Ian M. Cook, said Colgate raised prices in many categories and in all its markets, and will keep doing so, but he declined to provide details.

Stock in Colgate, which is based in New York, rose $1.91, to $82.97 a share.

Well: Mango for Dinner and Dessert

Posted: 29 Apr 2011 12:40 PM PDT

Well: How to Lower Your Vet Bill

Posted: 29 Apr 2011 10:53 AM PDT

The New Old Age: Cheaper Treatment for Macular Degeneration

Posted: 29 Apr 2011 12:15 PM PDT

The New Old Age: Shifting to a Nursing Home

Posted: 29 Apr 2011 07:39 AM PDT

Prescriptions: Big Tobacco Wins Missouri Case

Posted: 29 Apr 2011 11:37 AM PDT

Prescriptions: Shareholders Give Thumbs Up to J.&J. Executive Pay

Posted: 28 Apr 2011 03:59 PM PDT

Your Money: Making Sure a Plan for Long-Term Care Adds Up

Posted: 29 Apr 2011 12:33 PM PDT

One of Senator Edward M. Kennedy’s final acts as a legislator was to try to make it easier to buy insurance that could help pay for assistance in your home if an injury or illness made it hard to live life normally.

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One of Senator Edward M. Kennedy's final priorities as a legislator was the Class Act, which provides benefits for in-home health-care assistance.

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The Class Act and Your Long-Term Care Plans

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In fact, he spent about a decade working on it, finally succeeding when the Class Act, short for Community Living Assistance Services and Support, became law as part of last year’s landmark health insurance package.

The Class Act promises a lot: eligibility for most people, no matter their health status, as long as they are working at least a little; a benefit of at least $50 or so a day that lasts until death if necessary; and a premium structure that will offer big discounts for lower-income people but still won’t require any federal money.

This all turned out to be a bit too optimistic. In recent months, Kathleen Sebelius, the secretary of health and human services, has said that it will be difficult to make the offering both affordable and actuarially sound without some alterations.

She and her staff are making some changes, and the law gives them a certain amount of leeway. Their ultimate challenge is to make sure that the premium is not so low that there won’t be enough money to pay claims. But it also cannot be so high that it will scare off the young, healthy people who could subsidize all of the infirm people attracted to the plan’s generous eligibility rules (or frighten the employers of younger adults, who might encourage them to sign up).

Plenty of politicians are furious about the fact that something like this became law without the long-term numbers adding up. The far more interesting question, however, is why Senator Kennedy felt this law was necessary in the first place.

Here’s the blunt truth: Medicare generally won’t pay for as much nursing home or in-home care as many people think it will. Your cash savings may well be insufficient, especially if you want to leave plenty of money for a spouse who may outlive you. Your family may not be willing or able to take care of you. And if you do spend all of your assets to qualify for Medicaid, there’s no guarantee Medicaid will pay for the quality of care you want and do so close to friends or family.

So we better hope that the Class Act works and helps lots of Americans. Because if it doesn’t, plenty of people will be right back in denial-land again.

That said, there are some people who have already purchased long-term care insurance from a commercial company. Limra, a market research firm, figures there are about seven million of them.

Some buy it out of an abundance of caution, while others do it because their employers offer subsidized premiums as a benefit. Many others have seen family members spend hundreds of thousands of dollars on care or struggled to provide care themselves when there was no money left.

Even so, the insurance companies can make this a tough product to love, given their unexpected price jumps or occasional outright abandonment of the business.

How can the federal government possibly hope to do better? There are at least three ways.

First, it can enlist the help of employers, who could each make the government plan available to many thousands of employees.

According to an Aon Hewitt survey of over 1,300 large employers, 50 percent already made long-term care insurance available in 2010. But would those employers really want to replace what they have with a government program that would probably offer a lower level of benefits? Or would they offer it alongside their current plans?

As for the half of employers who do not offer any plan now, will their wary human resources executives really be first in line for a new government program?

The second way to potential success here is through automatic enrollment: getting those employers who do sign on to put every employee in the government plan and let individuals opt out later if they so choose.

The Class Act specifically mentions this possibility, though it does not seem to require it. The idea comes straight from the 401(k) playbook. According to an estimate from David L. Wray, president of the Profit Sharing/401k Council of America, which represents the interests of employers, about 38 percent of employees who have access to 401(k) plans work for employers who automatically enroll new workers.

Nobody, however, currently makes their employees buy long-term care insurance, according to Guy Bertsch, vice president for long-term care operations at Unum, which claims to sell far more policies through the workplace than any other company.

The authors of the Class Act were clearly worried about what would happen if employers did not sign everyone up automatically, though. Indeed, at employers that do not provide long-term care insurance free to everyone but still make it available for employee purchase, voluntary buy-in tends to be below 10 percent, Mr. Bertsch said.

Finally, there’s the possibility of rebranding the product to make it more relevant to young adults. Connie Garner, a former member of Senator Kennedy’s staff who worked closely with him on the Class Act, says she believes long-term care insurance has an image problem. “People think it’s for the lady with the blue hair in a wheelchair,” she said.

Ms. Garner, who is a nurse practitioner and now runs an advocacy group called AdvanceClass, speaks to groups about the fact that young adults who see themselves as invincible are only one dive into shallow water away from needing in-home care for the rest of their lives. That, she said, often moves parents in the audience to volunteer to pay for any premiums for their children, given that they would be discounted in the Class Act’s plan.

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