Those hoping that community-level initiatives can make significant inroads into the problem of the uninsured may be in for a disappointment, according to a package of five papers published April 11 on the Health Affairs Web site. The papers demonstrate the creativity of community officials in seeking to improve care and expand coverage for the uninsured, but they also illustrates the political and financial obstacles communities face, especially when they seek to expand coverage.

Twenty-five large pharmaceutical companies reported spending 0.3 percent of sales on post-approval drug safety in 2003, David Ridley and coauthors write in the March/April Health Affairs. While this might seem small as a percentage of sales, it would amount to $800 million in spending by the top twenty drugmakers in a year when the FDA Office of Drug Safety spent only $22.1 million, the authors point out. Post-approval safety spending was correlated with total sales, new products, blockbuster products, and adverse event reports.

Also in the March/April Health Affairs, Helen Halpin and coauthors report that, between 1998 and 2003, thirteen state Medicaid programs added coverage for at least one evidence-based tobacco cessation treatment, and five states expanded coverage for these treatments. The authors say this reflects a growing awareness of the cost of tobacco-related illness and the importance of treatment, but they note that states still favor pharmacotherapies for tobacco cessation despite clinical evidence showing that counseling is effective.