Monday, May 23, 2005
The Journal of the American Medical Association has an article by Lucian L. Leape, MD; Donald M. Berwick, MD., which provides a commentary on the five years since the "To Err is Human" report by the Institute of Medicine. They argue that the report has not dramatically improved health care safety although they are somewhat hopeful about future trends.
USA Today ran a brief story on this article. As Professor Ross Silverman (who kindly pointed out these articles to me) noted, however, the USA Today piece misrepresents the nature of Leape's piece, which is a commentary and not a study. Thank you to Professor Silverman and a big congratulations on his tenure!! [bm]
The Supreme Court this morning granted cert. in a 1st Circuit case that declared a New Hampshire parental-notification statute unconstitutional. The case is Ayotte v. Planned Parenthood, No. 04-1144. The First Circuit's opinion is here. According to the Associated Press story on the case, the case raises two issues: (1) whether a parental-notification statute must contain an explicit exception to protect the minor's health in the event of a medical emergency, and (2) what is the legal standard to be applied in assessing the constitutionality of a state abortion statute. The First Circuit applied the "undue burden" standard announced by the plurality opinion in Casey.
Judicial nominations, a true blood sport in recent times, have become vicious in the past couple of months as the Senate debates changes in the Senate's rules and the possibility of a "nuclear option." Much of the reason for the heat is ascribed to the expected announcement by Chief Justice Rehnquist of his retirement or resignation from the Court, as well as the politics of abortion. With this grant, the latter just got a lot more immediate. If the other shoe falls and the Chief announces his departure at the end of the Term, expect all hell to break loose.
Update: Here's some additional commentary from Scotusblog . . .
The Supreme Court on Monday agreed to decide a long-unsettled issue of abortion law: the standard to be used in judging the constitutionality of a restriction on a women's right to end a pregnancy. The question is whether such a restriction is to be upheld if there is any circumstance in which it could be applied constitutionally. The Court for some time has not followed that approach in abortion cases, but has never explicitly repudiated it. The working standard the Court has applied is whether a restriction, as written, would put a burden on the abortion rights of a significant number of women.
According to the N.Y. Times, the Bush Administration is revising the 2006 Medicare Handbook due to inaccurate, misleading, or unclear statements in the new benefits guide. The handbook fails to mention the gap in coverage (the infamous "doughnut hole") and inaccurately emphasizes the private fee-for-service option without clearing distinguishing it from traditional Medicare. According to the Washington Post, the Medicare prescription drug benefit will costing senior citizens an average of $772 annually, and those with chronic conditions will probably pay double that amount and will have 5 month gaps in coverage. The gap in coverage may induce many with chronic conditions to forego filling prescriptions, which will have significant negative health implications. However, most Medicare recipients should have some savings.
The Arizona Republic reports that Medicare recpients that make less than $14,364 a year may be eligible for a subsidy of up to 95% for their premiums and co-pays as long as their assets are not too high. Generally this low-income subsidy has been seen as very good, however issues such as recipients being ineligible for other federal programs further complicates the decision a Medicare recipient will have to make.
Thanks to research assistant Lindley Bain for her help in preparing this post. [tm]
The Associated Press reports that the American Psychiatric Association has approved a statement urging legal recognition of gay marriage. The statement supports same-sex marriage "in the interest of maintaining and promoting mental health" and cites the "positive influence of a stable, adult partnership on the health of all family members." According to the news report, if the APA's directors vote approval in July, the measure would make it the first major medical group to take such a stance. [bm]
Sunday, May 22, 2005
On the heels of the recent announcement of the breakthrough by South Korean researchers, who reported the relative ease with which human embryos can be cloned in order to produce new stem-cell lines, President Bush told reporters in the Oval Office Friday that he would veto any legislation that attempts to make federal funding more readily available for stem-cell research:
Q Mr. President, on stem cells, specifically, would you veto legislation that loosened the requirement on federal funding for stem cell research? And secondly --
PRESIDENT BUSH: Deb --
Q -- what is your reaction to the news about the South Koreans on embryonic --
PRESIDENT BUSH: I'm -- first, I'm very concerned about cloning. I worry about a world in which cloning becomes acceptable. Secondly, I made my position very clear on embryonic stem cells. I'm a strong supporter of adult stem cell research, of course. But I made it very clear to the Congress that the use of federal money, taxpayers' money to promote science which destroys life in order to save life is -- I'm against that. And therefore, if the bill does that, I will veto it.
The President's comments appear to have been directed at H.R. 810 ("The Stem Cell Research Enhancement Act of 2005"), a bipartisan bill with 147 House sponsors. According to the Congressional Research Service's summary, the bill would "[a]mend . . . the Public Health Service Act to require the Secretary of Health and Human Services to conduct and support research that utilizes human embryonic stem cells, regardless of the date on which the stem cells were derived from a human embryo. Limits such research to stem cells that meet the following ethical requirements: (1) the stem cells were derived from human embryos donated from in vitro fertilization clinics for the purpose of fertility treatment and were in excess of the needs of the individuals seeking such treatment; (2) the embryos would never be implanted in a woman and would otherwise be discarded; and (3) such individuals donate the embryos with written informed consent and receive no financial or other inducements." [tm]
Doctor and author Robin Cook has a interesting editorial in today's New York Times. In the editorial, he argues that the increased understanding of the human genome creates the need for universal health insurance. He states,
In this dawning era of genomic medicine, the result may be that the concept of private health insurance, which is based on actuarially pooling risk within specified, fragmented groups, will become obsolete since risk cannot be pooled if it can be determined for individual policyholders. Genetically determined predilection for disease will become the modern equivalent of the "pre-existing condition" that private insurers have stringently avoided.
As a doctor I have always been against health insurance except for catastrophic care and for the very poor. It has been my experience that the doctor-patient relationship is the most personal and rewarding for both the patient and the doctor when a clear, direct fiduciary relationship exists. In such a circumstance, both individuals value the encounter more, which invariably leads to more time, more attention to potentially important details, and a higher level of patient compliance and satisfaction - all of which invariably result in a better outcome.
But with the end of pooling risk within defined groups, there is only one solution to the problem of paying for health care in the United States: to pool risk for the entire nation. (Under the rubric of health care I mean a comprehensive package that includes preventive care, acute care and catastrophic care.) Although I never thought I'd advocate a government-sponsored, obviously non-profit, tax-supported, universal access, single-payer plan, I've changed my mind: the sooner we move to such a system, the better off we will be. Only with universal health care will we be able to pool risk for the entire country and share what nature has dealt us; only then will there be no motivation for anyone or any organization to ferret out an individual's confidential, genetic makeup.