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Discount retailers and grocers including Wal-Mart, Target, Kroger and Giant Food, have been making a push to offer cheaper prices on prescription drugs, especially generics. Does that have big pharmacy chains like Walgreen, which make big profit margins from generics, back on their heels?

During an earnings conference call with analysts this morning, Walgreen President Gregory Wasson noted that “the competitive environment has clearly changed” as the economy has been slowing and “discount retailers and grocery chains are pushing harder on promotional pricing, especially in the pharmacy, which they use to build foot traffic.”

Never fear. Wasson added, according to a transcript from Thomson Reuters: “Our advantages are that in addition to being price competitive, we’re better positioned with more convenient locations and enjoy a powerful brand reputation. I’d like to put it this way. While many of our competitors have a pharmacy department, Walgreens is a pharmacy.”

Later in the call, UBS analyst Neil Currie pressed the issue, asking what kind of impact Wal-Mart’s $4 generic drug program and others like it have had on Walgreen’s sales to the uninsured. Walgreen CEO Jeffrey Rein said that such competition is a reason Walgreen came out with its own prescription savings club card, which costs individuals $20 a year and families $35, entitling them to discounts including $12.99 for a three-month supply of more than 400 generics. Lots of people are signing up, he said.

But then he repeated a common refrain from Walgreen during the call: “When you come back to our convenience and the stores that we have opened and the hours we have opened, we will definitely win out.”

Attempts to create popular alternatives to nursing homes have realized mixed results, but the Robert Wood Johnson Foundation is betting on an eight-year-old movement called “Green Houses,” a WSJ Page One story reports.

The foundation is investing $15 million over five years on Green Houses, which aim to replace large nursing homes with small, homelike facilities for 10 to 12 residents. The foundation hopes Green Houses will soon be in all 50 states, up from the 41 Green Houses now in 10 states.

“We want to transform a broken system of care,” says Jane Isaacs Lowe, who oversees the foundation’s Vulnerable Populations portfolio. “I don’t want to be in a wheelchair in a hallway when I am 85.”

The Green Houses face several obstacles, including regulatory issues. But some say they also face resistance from existing nursing homes, which are based on an economies-of-scale model — the larger the home, the cheaper it is to care for each individual resident.

While some nursing-home operators welcome the idea of Green Houses, others are reluctant to help pay for them, says Susan Reinhard, who heads the AARP’s Public Policy Institute. “You have owners who have their personal wealth invested in a model that was requested by society way back,” she says.

A significant challenge is convincing the nursing-home operators that Green Houses aren’t too expensive. “The biggest criticism I hear is, ‘How do you make it work financially?’” adds Larry Minnix, CEO of the American Association of Homes and Services for the Aging, which represents not-for-profits nursing homes as well as assisted-living and retirement communities.

The foundation says it’s studying the financial sustainability, but early indications do show it’s financially doable.

The FDA was supposed to decide this week whether to approve Eli Lilly’s blood thinner prasugrel, but the agency said yesterday that the decision would take another three months. It’s a complicated decision — in a big study, prasugrel was more effective than Plavix at preventing blood clots, but it also carried a greater risk of causing internal bleeding.

Blood thinners are tricky that way. Greater effectiveness is often tied to greater risk of side effects. Plavix, co-marketed by Bristol-Myers Squibb and Sanofi-Aventis, has grown to be an $8 billion a year drug as doctors have grown comfortable with the risks and benefits.

If prasugrel (brand name: Effient) wins approval, sales will be affected by doctors’ comfort level with the drug, as compared to Plavix. Getting docs to switch from Plavix to prasugrel (at least for some patients) could grow even tougher in 2011, when cheap, generic versions of Plavix are expected to become available in the U.S.

So Eli Lilly and its prasugrel partner Daiichi Sankyo must be eager to get the drug to market ASAP.

Anthony Ware, who is in charge of prasugrel for Lilly, told the WSJ that the FDA has “asked for additional analyses, not new data per se … They’ve asked for additional ways of slicing our data, and we’ve presented that to them in addition to a large application.”

In today’s tough FDA safety climate, a three-month delay seems pretty minor — less serious, for example, than an “approvable letter” that could have forced the company to gather more data or even conduct an entirely new study.

Congress is trying to figure out how to block the 10% Medicare pay cut to doctors set to go into effect on July 1. To do so, they may cut some funding from Medicare Advantage plans, which come through private insurers and cost the government more than traditional Medicare plans.

Scott Gottlieb (pictured), a doctor who is a former FDA official and current scholar at a free-market-oriented think tank, lands on the WSJ’s op-ed page this morning singing the praises of the plans. Central to his thesis is the notion that Medicare’s staff of clinically trained decision-makers is thin compared with private insurers.

Medicare has about 20 doctors and 40 total clinicians working in its coverage office, Gottlieb writes, and fewer than a dozen in the office that sets doctors’ reimbursement rates. Private insurers, on the other hand, employ thousands of doctors and nurses. That allows the private plans to make more nuanced and better informed decisions, he argues.

“The crucial question is where the controls should be – with patients working through private plans or with government agencies,” writes Gottlieb, who has advised private health plans. “While private health insurance is imperfect, there’s a misguided faith in Medicare’s superiority that rests on flawed assumptions.”

There are lots of drugs out there to treat high blood pressure — old and new, cheap and expensive, available in all sorts of combinations and permutations. But for about 25% of patients, drugs don’t seem to help. That’s a big problem, because lots of people have high blood pressure (aka hypertension), and it’s a key risk factor for heart attacks and strokes.

A scientific statement out this month from the American Heart Association says the problem is likely to grow as the nation becomes older and the rate of obesity rises.

“It’s becoming more difficult to treat and it’s requiring more and more medications to do so,” David A. Calhoun told the New York Times.  Calhoun, a cardiologist at the University of Alabama at Birmingham, headed the panel that wrote the guidelines.

Resistant hypertension is different than uncontrolled hypertension. Plenty of people have uncontrolled hypertension, for example, because they don’t stick to their drug regimen. Resistant hypertension is when a patient is following a doctor’s directions and taking as many as three different drugs without getting blood pressure under control.

The AHA statement calls for more study of the phenomenon, but adds a list of reasons why such research is tough. It’s highly complicated to launch studies comparing various three- or four-drug combinations. And patients with resistant hypertension often have multiple health problems, such as diabetes and atherosclerosis, which can make it hard to interpret study results.

Radio-frequency identification — a system of using tiny tags to track all sorts of products — could be a smart way for hospitals to keep tabs on everything from surgical sponges to patient beds. Indeed, some hospitals have already started adopting the technology.

RFID tags. Photo: Associated Press

But a study out today in JAMA suggests RFID systems can cause “potentially hazardous incidents in medical devices.”

Researchers took two standard RFID systems and examined whether they interfered with 41 different medical devices. Each system comprised a tag (which attaches to the object being tracked) and a “reader” that communicates with tags.

Out of a total of 123 tests (there were multiple tests with each system on each device), there were 34 incidents of electromagnetic interference. The median distance at which the systems caused interference was 30 cm (about 12 inches).

A panel of medical specialists determined that 22 of these incidents were potentially hazardous; among other things, interference changed breathing machines’ ventilation rates and caused syringe pumps to stop.

The research was conducted by Dutch investigators as part of a broader project looking at using RFID to track blood and medical supplies.

In an editorial that accompanies the story, Donald Berwick of the Institute for Healthcare Improvement says hospitals should consider internal surveillance, especially in critical care units, for problems related to electrical interference. And he suggests that regulators should weigh in on whether they need to provide safety guidance.

The findings, Berwick continues, suggest a broader lesson for health-care technology: In a system as complicated as a hospital, technical innovations are bound to have surprising results.

“Safety is not a condition, it is a process,” he writes. “It can only emerge continually in a culture that is alert, cooperative, transparent, and resilient when the unexpected happens, as it always will.”

Correction: An earlier version of this post gave an incorrect centimeters-to-inches conversion.