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By Susan Heavey

WASHINGTON, Nov 20 (Reuters) - It's not just spending on U.S. healthcare that is breaking records. Drugmakers, insurers and industry groups are on track to spend an all-time high of more than $500 million this year to influence Congress' revamp of the healthcare system.
Lobbyists for the healthcare sector will likely smash previous spending records by tens of millions of dollars this year as Democratic lawmakers try to reshape the industry by expanding coverage and shaving costs.
"If current trends continue, the health sector is likely to spend more than a half-billion dollars on lobbying in 2009," said The New England Journal of Medicine's Dr. Robert Steinbrook.
As Congress makes a final push for a bill to overhaul the $2.5 trillion healthcare system that fuels one-sixth of the U.S. economy, health companies and industry groups are trying to shape the outcome.
The Senate is headed for a test vote on Saturday that will determine if it can proceed to three weeks of floor debate followed by a final vote on an $849 billion, 10-year bill. The House of Representatives has already approved its $1 trillion version of healthcare reform.
Differences between the two bills would have to be reconciled in a long negotiation process and lobbyists have been jockeying for time with members of Congress and their staff.
Lawmakers, especially Democratic Senators up for re-election next year, have seen a flood of campaign donations from hospitals, device makers and others with billions at stake.

$400 MILLION IN NINE MONTHS
The healthcare sector spent $486 million on lobbying last year and nearly $400 million through September of this year, according to the non-profit Center for Responsive Politics.
For drugmakers, always among the top spenders in Washington, reform could mean higher sales because more Americans will have insurance coverage to pay for medications.
Drug companies like Pfizer Inc, Merck & Co Inc and others spent $237 million on lobbying in 2008 which they nearly surpassed in nine months to end-September.
"They're on pace to obliterate their totals ... due to health reform undoubtedly," said Dave Levinthal, a spokesman for the Center for Responsive Politics.
The Pharmaceutical Research and Manufacturers of America, which represents big drugmakers, is on track to spend more than $30 million this year, Levinthal said.
"It should come as no surprise to anyone that we stepped up our efforts this year," said Ken Johnson, senior vice president of the group which backs most of the Democrats' measures and cemented a $80 billion, 10-year deal of rebates and discounts to help pay for it.
"We have a lot at stake right now. We're talking about fundamentally changing our healthcare system," said Johnson.
Insurers such as UnitedHealth Group Inc and WellPoint Inc also ramped up spending to oppose Democrats' plan for a public insurance option that could rival private plans. Insurers along with other health service companies spent $52.8 million on lobbying so far this year after spending $63.1 million in all of 2008.
"In all cases, these would be record annual expenditures," said the New England Journal of Medicine's Steinbrook.
The U.S. healthcare sector has generally favored Republican candidates in doling out political campaign cash.
That trend changed in the 2008 election that ushered Democrat Barack Obama into the White House with his party controlling the House and the Senate.
The industry gave 54 percent of its political contributions to Democrats in the 2008 cycle, up from 37 percent just two years earlier, according to the Center for Responsive Politics. For the cycle under way ahead of next year's mid-term elections, 59 percent has gone to Democrats.
"They're trying to influence the people who have the power," said Josh Israel, a campaign finance expert at the nonprofit Center for Public Integrity.

(Editing by Chris Wilson) Keywords: USA HEALTHCARE/LOBBYING (sheavey@thomsonreuters.com; +1 202-354-5848; Reuters Messaging: susan.heavey.reuters.com@reuters.net)

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LONDON, Nov 20 (Reuters) - British health officials are investigating the likely person-to-person spread of a drug-resistant strain of swine flu, the Health Protection Agency said on Friday.
There have been five confirmed cases in Wales of patients infected with H1N1 resistant to oseltamivir -- the generic name of Roche AG and Gilead Sciences Inc's antiviral drug Tamiflu, the agency said.
Four other patients are infected with H1N1 with the same genetic mutation but one was helped by Tamiflu and the status of three others is not clear. Another antiviral, GlaxoSmithKline and Biota Inc's Relenza, was effective in the patients, the HPA said.
The patients had serious conditions that suppressed their immune systems, which can give the virus a better than usual opportunity to develop resistance, the HPA added.

"Although further epidemiological investigation is underway, it would seem likely that transmission of oseltamivir-resitant H1N1 virus has taken place," it said in a statement. "At present we believe the risk to the general healthy population is low."
John McCauley of the Medical Research Council said the patients involved were in an at-risk group.
"It is well established that patients with immunodeficiency do have problems with eliminating virus, giving it a greater chance to acquire resistance," he said in a statement.
The World Health Organisation has reported 57 cases of Tamiflu resistance worldwide. There have not yet been any confirmed cases of person-to-person transmission, although a possible case in the United States is under investigation.
The British government launched a national pandemic flu service in July to allow people to get a diagnosis and prescription online or over the phone without visiting a doctor.
It said on Friday it was taking the development of a Tamiflu-resistant strain seriously but it would continue to offer the antiviral to all patients.
"Our strategy to offer antivirals to all patients with swine flu is the right one, to help prevent complications and reduce the severity of the illness," the Department of Health said in a statement.
British officials have confirmed the H1N1 virus has killed 214 people, but experts note that most people who are made sick by the virus are not tested.
A nationwide vaccination programme began last month, initially targeting those considered high risk, such as pregnant women and front-line healthcare workers.
Norwegian health authorities reported a mutation of H1N1 in some patients with severe disease but other officials noted quickly that other patients infected with the same mutant have had mild disease.
(Reporting by Kylie MacLellan; editing by David Stamp) Keywords: FLU BRITAIN/STRAIN

(kylie.maclellan@thomsonreuters.com; +44 207 542 0401)

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Copyright Thomson Reuters 2009. All rights reserved. The copying, republication or redistribution of Reuters News Content, including by framing or similar means, is expressly prohibited without the prior written consent of Thomson Reuters.

LONDON, Nov 20 (Reuters) - British health officials are investigating the likely person-to-person spread of a drug-resistant strain of swine flu, the Health Protection Agency said on Friday.
There have been nine confirmed cases of an H1N1 variant among patients on a ward in a hospital in Wales, it said, five of which are known to be resistant to oseltamivir -- the generic name of Roche AG's antiviral drug Tamiflu.
The cases occurred in people with a serious underlying health condition that is known to cause Tamiflu resistance in flu cases, the HPA added.

"Although further epidemiological investigation is underway, it would seem likely that transmission of oseltamivir-resistant H1N1 virus has taken place," it said in a statement.
The HPA said the swine flu variant remained sensitive to alternative antiviral drug Relenza, made by GlaxoSmithKline , and that patients were responding well to it.
"At present we believe the risk to the general healthy population is low," it said.
The World Health Organisation has reported 57 cases of Tamiflu resistance worldwide. There have not yet been any confirmed cases of person-to-person transmission, although a possible case in the United States is under investigation.
The British government launched a national pandemic flu service in July to allow people to get a diagnosis and prescription online or over the phone without visiting a doctor.
It said on Friday it was taking the development of a Tamiflu-resistant strain seriously but it would continue to offer the antiviral to all patients.
"Our strategy to offer anti-virals to all patients with swine flu is the right one, to help prevent complications and reduce the severity of the illness," the Department of Health said in a statement.
The H1N1 virus has so far killed 214 people in the United Kingdom.
A nationwide vaccination programme began last month, initially targeting those considered high risk, such as pregnant women and front-line healthcare workers.
Norwegian health authorities have discovered a potentially significant mutation of H1N1 that they said could be responsible for causing the most severe symptoms among those infected but that they do not believe has any implication for the effect of flu vaccines or antiviral drugs.

(Reporting by Kylie MacLellan; editing by Philippa Fletcher)

((kylie.maclellan@thomsonreuters.com; +44 207 542 0401))

Keywords: FLU BRITAIN/STRAIN

(Adds details and reaction)
* Five H1N1 patients resistant to Tamiflu
* Possible person-to-person spread of resistant strain

LONDON, Nov 20 (Reuters) - British health officials are investigating the likely person-to-person spread of a drug-resistant strain of swine flu, the Health Protection Agency said on Friday.
There have been five confirmed cases in Wales of patients infected with H1N1 resistant to oseltamivir -- the generic name of Roche AG and Gilead Sciences Inc's antiviral drug Tamiflu, the agency said.
Four other patients are infected with H1N1 with the same genetic mutation but one was helped by Tamiflu and the status of three others is not clear. Another antiviral, GlaxoSmithKline and Biota Inc's Relenza, was effective in the patients, the HPA said.
The patients had serious conditions that suppressed their immune systems, which can give the virus a better than usual opportunity to develop resistance, the HPA added.

"Although further epidemiological investigation is underway, it would seem likely that transmission of oseltamivir-resitant H1N1 virus has taken place," it said in a statement. "At present we believe the risk to the general healthy population is low."
John McCauley of the Medical Research Council said the patients involved were in an at-risk group.
"It is well established that patients with immunodeficiency do have problems with eliminating virus, giving it a greater chance to acquire resistance," he said in a statement.
The World Health Organisation has reported 57 cases of Tamiflu resistance worldwide. There have not yet been any confirmed cases of person-to-person transmission, although a possible case in the United States is under investigation.
The British government launched a national pandemic flu service in July to allow people to get a diagnosis and prescription online or over the phone without visiting a doctor.
It said on Friday it was taking the development of a Tamiflu-resistant strain seriously but it would continue to offer the antiviral to all patients.
"Our strategy to offer antivirals to all patients with swine flu is the right one, to help prevent complications and reduce the severity of the illness," the Department of Health said in a statement.
British officials have confirmed the H1N1 virus has killed 214 people, but experts note that most people who are made sick by the virus are not tested.
A nationwide vaccination programme began last month, initially targeting those considered high risk, such as pregnant women and front-line healthcare workers.
Norwegian health authorities reported a mutation of H1N1 in some patients with severe disease but other officials noted quickly that other patients infected with the same mutant have had mild disease.
(Reporting by Kylie MacLellan; editing by David Stamp) Keywords: FLU BRITAIN/STRAIN

(kylie.maclellan@thomsonreuters.com; +44 207 542 0401)

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Copyright Thomson Reuters 2009. All rights reserved. The copying, republication or redistribution of Reuters News Content, including by framing or similar means, is expressly prohibited without the prior written consent of Thomson Reuters.

OSLO, Nov 20 (Reuters) - Norwegian health authorities said on Friday they have discovered a potentially significant mutation in the H1N1 influenza strain that could be responsible for causing the severest symptoms among those infected.
"The mutation could be affecting the virus' ability to go deeper into the respiratory system, thus causing more serious illness," the Norwegian Institute of Public Health said in a statement.
There was no reason to believe the mutation had any implication for the effectiveness of flu vaccines or antiviral drugs made by groups such as Roche, GlaxoSmithKline , Novartis and AstraZeneca, the authorities said.
The World Health Organisation said that the mutation did not appear to be widespread in Norway and the virus in its mutated form remained sensitive to antivirals and pandemic vaccines.
A similar mutation had been detected in H1N1 viruses circulating in several other countries, including China and the United States, in severe as well as in some mild cases, it said.
"Although further investigation is under way, no evidence currently suggests that these mutations are leading to an unusual increase in the number of H1N1 infections or a greater number of severe or fatal cases," the WHO said in a statement.
H1N1, a mixture of swine, bird and human viruses, has killed at least 6,770 people globally, according to its latest update.
In Norway the mutation was found in the bodies of two people killed by the virus and of one person made seriously ill. The two infected by the mutated virus who died were among the first fatalities from the H1N1 pandemic in Norway, the institute said.
It was unclear whether the mutated virus was transmitted among humans, the health authorities said.
"Based on what we know so far, it doesn't seem like the mutated virus is circulating in the population, but rather that spontaneous changes have happened in the three patients," director Geir Stene Larsen at the public health institute said in the statement.
Norway has seen relatively more fatalities in the flu pandemic compared to the size of the population versus other European countries, with 23 confirmed deaths.
Public health authorities have said this could be due to the country being hit early in the pandemic's northern hemisphere winter wave, before a mass vaccination programme got underway.

"Nevertheless, it is important to study if there's still something about the Norwegian fatalities that separate us from other countries, and that make us learn something that strengthens our treatment of the seriously ill," director Bjorn-Inge Larsen at the Norwegian Directorate of Health said.
Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention said, "This mutation has been seen sporadically."
She said it is sometimes seen in patients who have mild influenza symptoms.
"I think it is just too soon to say what this might mean long term," Schuchat told reporters in a telephone briefing.

(Reporting by Richard Solem; Additional reporting by Stephanie Nebehay in Geneva and Maggie Fox in Washington; Editing by Matthew Jones and Louise Ireland) Keywords: FLU NORWAY/ (richard.solem@thomsonreuters.com; +47 22 93 69 71; Reuters Messaging: richard.solem.reuters.com@reuters.net)

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Copyright Thomson Reuters 2009. All rights reserved. The copying, republication or redistribution of Reuters News Content, including by framing or similar means, is expressly prohibited without the prior written consent of Thomson Reuters.