Senator Gerald Dial supporting specialized medicine for premature infants
by Patrick McCreless
Jan 24, 2013 | 4429 views |  0 comments | 10 10 recommendations | email to a friend | print
A local lawmaker has proposed legislation to increase the use of a drug to help premature infants, though at least one group of physicians is opposed to the change.

The lawmaker, Sen. Gerald Dial, R-Lineville, received at least $500 in campaign contributions in 2010 from the drug’s manufacturer.

Dial has pre-filed a bill that requires the Alabama Medicaid Agency to ensure medications given to premature infants are dosed according to Food and Drug Administration guidelines, which recommends doses for the drug in question higher than those Medicaid currently uses. And though the bill doesn’t mention a drug by name, its requirements fit only a single pharmaceutical called Synagis — manufactured by Maryland-based MedImmune, which made at least one campaign contribution to Dial in 2010.

According to records from the Alabama Secretary of State’s office, MedImmune donated $500 to Dial in October 2010. Dial has received several contributions from the pharmaceutical industry over the years, including $1,000 from the Alabama Pharmacy Association in 2011 and $500 from Takeda Pharmaceutical last year.

Dial said he did not remember receiving any money from MedImmune but that the bill is targeted at the use of Synagis.

“I’ve been in this way too long so I don’t let money impact me … this is just something I feel passionately about,” Dial said of his efforts to help premature infants.

The bill would also require the Alabama Medicaid Agency to develop and implement policies that would deliver care to premature infants more quickly as a way to lower the state’s high infant mortality rate. Synagis is a drug used to treat respiratory synctytial virus or RSV, a lung ailment that spreads among infants every winter.

“This is the only drug that they give that keeps an infant’s lungs from collapsing and fluids from collecting,” Dial said.

According to the Alabama Department of Public Health, the state’s infant mortality rate is 8.1 infant deaths per 1,000 births — higher than the national average of 6.1 deaths per 1,000 births.

“We feel like the problem we have is with premature babies in rural areas,” Dial said. “If they get sick and are taken to the hospital, by then it’s too late.”

To Dial, use of Synagis under federal guidelines will help more premature infants get more of the drug.

“Medicaid is not following the federal guidelines on this,” Dial said. “I just want them to follow the federal guidelines like other states do.”

Still, one state organization, the Alabama chapter of the American Academy of Pediatrics, said use of Synagis under federal guidelines could actually harm infants.

Grant Allen, president of the Alabama Chapter of the American Academy of Pediatrics, said in a Tuesday email to The Star that his organization opposed the FDA guidelines requirement in Dial’s bill. Allen wrote that the Alabama Medicaid Agency currently follows guidelines for use of the drug in infants listed in the AAP Redbook, which has more up-to-date medical recommendations than the FDA. The AAP Redbook is produced by the American Academy of Pediatrics.

“The guidelines … more than adequately protect the population with RSV while balancing the high cost of expanded use of this drug to the state Medicaid program,” Allen wrote. “These guidelines are based on the recommendations of dozens of our country’s top pediatric infectious disease experts who have carefully deliberated on how best to use it.”

Linda Lee, executive director of the Alabama Chapter of the American Academy of Pediatrics, concurred with Allen during a Thursday phone interview. She said the Redbook guidelines show what dosage of the drug should be used based on up-to-date clinical analysis.

“The FDA approves the drug for legal use … that’s what they do,” Lee said. “But the Redbook guidelines are based off the very latest research.”

Dr. Don Williamson, state health officer, said he has discussed the legislation with Dial and supports efforts to lower the state’s infant mortality rate.

“Whether or not this legislation makes a difference, I just don’t know,” Williamson said. “What we’ve got to do is make sure of what the cost is going to be and if this legislation passes, that we have adequate funding to do it.”

According to the Alabama Medicaid Agency, doses of the drug cost about $1,200 each.

Dial said the legislation might result in greater costs in the short run but it will be worth it if it lowers the infant mortality rate. He added that the success of the bill will be evaluated after a year and that changes can be made accordingly.

“We can run it and see if this makes a difference and then check — I think that’s a reasonable plan,” Williamson said.

Dr. Jeff Collins, president of Anniston OB-GYN and vice chair of medical staff at Regional Medical Center in Anniston, said infant deaths are tied to premature births.

“Our pre-term delivery rate is higher than the nation’s,” Collins said.

Collins said several factors are responsible for premature births in the state, including smoking, insufficient prenatal care, obesity and teen pregnancy. According to the Centers for Disease Control and Prevention, Alabama is ranked 42nd among states with the highest prevalence of cigarette smoking — with 1 being the lowest and 50 being the highest. The CDC also states that Alabama has the fourth-highest ranking of obesity in the country. Alabama Department of Public Health data shows that in 2011, the state’s teenage birth rate was 20.9 per 1,000 females between 10 and 19 years old.

“There are big risks that are associated with premature births,” Collins said. “Expectant mothers should quit smoking, try to keep closer to a healthy bodyweight and use prenatal care providers.”

Staff writer Patrick McCreless: 256-235-3561. On Twitter @PMcCreless_Star.

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