Thursday, December 22, 2005
From the Harvard School of Public Health's "World Health News":
Public Health 2005: Year in Review
In this special year-end edition, World Health News reviews the public health issues that shaped 2005.
The Year of Bird Flu
Human cases of influenza A (H5N1) infection have been reported in Cambodia, China, Indonesia, Thailand, and Vietnam.
World Bird Flu Risk Is 'Gravest Possible'
Reported in the International Herald Tribune on February 24, 2005
"The risk that Asia's outbreak of avian influenza could turn into a deadly global pandemic has increased sharply in recent months, a top international health official warned on Wednesday. 'The world is now in the gravest possible danger of a pandemic,' said the official, Dr. Shigeru Omi, Western Pacific director of the World Health Organization. 'We need to consider urgent and decisive action in radical new ways.' Speaking by telephone from the sidelines of an avian flu conference in Vietnam, Omi said that in recent months it had become clear that strains of avian influenza that emerged last year were now entrenched, endemic, versatile and transmitted through animals showing no symptoms of the disease. If mutated to transmit between humans, he said, the deadly strain of influenza could spread quickly around the world and infect millions."
With stories on hunting bird flu in Cambodia; pursuing a bird flu vaccine in the U.S.; the WHO's 'bird flu strike force' in Switzerland; a $7.1 billion flu plan for the U.S.; and the effects bird flu has had on Thailand, Vietnam, and China.
Among the Highlights from 2005:
- The Immediate and Lasting Effects of Hurricane Katrina
Los Angeles Times and The Atlanta Journal-Constitution
- South Korean Stem Cell Research Suffers Major Setback
The New York Times, International Herald Tribune, and The Boston Globe
- The Terri Schiavo Case
St. Petersburg Times, Florida
- Pakistan's Earthquake: The Rescue Effort, the Resulting Homelessness, and the Possibility of 'Donor Fatigue'
The Observer (London) and The Christian Science Monitor
- Refugee Crisis in Sudan
The Washington Post
- Toxic Spill in China Left Over 3 Million Without Running Water for Three Days
International Herald Tribune, The New York Times, and the Los Angeles Times
- AIDS: The Rath Controversy in South Africa, and the WHO's '3x5 Goal' Missed, But Praised
The Guardian (London) and The New York Times
- Bill & Melinda Gates Leave Indelible Mark on Global Health
The Economist and Time magazine
- Tsunami Relief Poses Major Challenges
The Washington Post and The New England Journal of Medicine
- Medicare Drug Benefit Sign-Up Begins
The New York Times and The Washington Post
- The War on Meth
The New York Times, the Des Moines Register (Iowa), and The Oregonian
- In Japan, Deaths from Asbestos Shock the Nation
The Japan Times
- Zimbabwe's 'Operation Clear Out the Trash' Leaves Many Homeless
The Guardian (London)
- Polio Vaccine: 50 Years Later
- A Call to 'End Poverty Now' Grabs the Headlines
The Economist, BBC News Online, and The Washington Post
- Widespread Hunger in Niger
The Guardian (London), BBC News Online, and The Washington Post
- Morning-After Pill & the FDA
The Washington Post, The New England Journal of Medicine, and The New York Times
- Supreme Court Rules on Medical Marijuana, Juvenile Executions
The Washington Post and the San Francisco Chronicle
- Outbreaks: Encephalitis Outbreak Hit India, and a Marburg Virus Outbreak Hit Angola
BBC News Online and The New York Times
- Strides Made in Fight Against Cancer
The Baltimore Sun and The Wall Street Journal
- Renewed Focus on Nutrition & Obesity in the U.S.
The Washington Post, The Boston Globe, The New York Times, The Atlanta Journal-Constitution, The Sacramento Bee
- Merck Research Controversy Over Vioxx
The Boston Globe and the Chicago Tribune
- 'Rx for Survival': An Unprecedented Global Health Media Education Project
- Los Angeles Times Editorial Series, 'Malaria -- The Sting of Death'
- Courier-Journal (Kentucky) Investigation Looks at the State's Poor Health
- Seattle Times Investigation Finds Drug Researchers Leak Secrets to Wall Street
- Rocky Mountain News (Colorado) Juvenile Justice Series, 'Life for Death'
For links to the full text of these reports, go to www.worldhealthnews.harvard.edu.
Contrary to my post yesterday, it appears that last-minute maneuvering in the Senate temporarily blocked passage of the budget bill, S. 1932, that contains the provision that would require HHS to extend the moratorium on new specialty hospitals. That is at least what the N.Y. Times is reporting today. The glitch, which can be tracked in the Congressional Record's rendition of yesterday's events (not available yesterday), occurred because Senate Democrats took out three relatively insignificant provisions from the budget reconciliation bill. That meant that the House would have to re-vote on the budget bill, and because many House members left town for the holidays after their vote on a couple of appropriations bills on the 19th and 20th, it is unclear when that vote will occur -- possibly not until January, according to the Times' report. Accord, Washington Post. [tm]
Here's a terrific article in today's New England Journal of Medicine:
Bottom line: "Thus, an individual physician has no obligation to prescribe oseltamivir in response to a patient's request — a position that discourages prescribing of the drug but does not prohibit it. In contrast, the public health perspective clearly suggests that the physician has an obligation not to prescribe oseltamivir — a position that is tantamount to a prohibition against prescribing it. The public health perspective need not always trump the individual perspective, but since both point in the same direction in this instance, the prohibition should prevail." [tm]
Wednesday, December 21, 2005
S. 1932 passed in the Senate this morning by a vote of 51-50 (with Veep Cheney casting the deciding vote), following the House's passage on Monday (212-206). There are quite a few changes to Medicare and Medicaid tucked away in Conference Report 109-362 (not available on Thomas, but available (presumably for a fee) at the BNA website). One of the more significant developments is the continuation of the moratorium on new specialty hospitals (download specialty_hospitals.pdf). There's also a provision that instructs the Secretary of HHS to conduct a pilot program to evaluate gainsharing. [tm]
Today the Office of the Attorney General posted a new opinion that may be of interest to members of the Health Law Section:
Opinion No. GA-0384
Go to: http://www.oag.state.tx.us/opinions/op50abbott/ga-0384.htm
Re: Whether federal law preempts a portion of Senate Bill 410, enacted during the regular session of the Seventy-ninth Legislature, that purports to authorize the importation of Canadian pharmaceuticals into Texas, and to require the State Board of Pharmacy to assist in such importation (RQ-0355-GA) http://www.oag.state.tx.us/opinions/requests_ga/RQ0355GA.pdf
Summary: Sections 36 through 43 of Senate Bill 410, enacted during the Seventy-ninth regular session of the Texas Legislature, directly conflict with federal law, namely the Federal Food, Drug, and Cosmetic Act, chapter 9 of title 21 of the United States Code (the "FFDCA"), and specifically sections 381 and 384 thereof. The FFDCA makes it an offense not only to import, but to "cause" the importation of prohibited medications. See 21 U.S.C. § 331 (2000 & Supp. 2003). By "designating" certain Canadian pharmacies, promoting them on its website, and expressly permitting Texas consumers to import prescription drugs that cannot be imported under federal law, the Texas State Board of Pharmacy would violate the Federal Food, Drug, and Cosmetic Act, as will Texas consumers and those Texas pharmacies that take part in such transactions.
 Note: 21 USC § 331 has been amended five times since the publication of the 2000 United States Code:
(i) Pub. L. No. 108-136, § 1603(c)
(ii) Pub. L. No. 108-173, § 1121(b)(1)
(ii) Pub. L. No. 108-214, § 2(b)(2)(A)
(iii) Pub. L. No. 108-282, § 102(b)(5)(C) & (D)
(iv) Pub. L. No. 109-59, § 7202(d) & (e).
Sunday, December 18, 2005
The New York Times ran a short but insightful piece today on the exclusion of employer-provided health insurance contributions from employees' taxable income. The amount of the subsidy (in foregone tax collections) is fast approaching $150 billion and is expected to get to $180 billion by 2010. Quoting Harvard economist David Cutler, "If you had $150 billion to play with, you could come very close to universal coverage." Eliminating the tax subsidy, however, would be enormously unpopular with the employed taxpayers who have gotten use to the tax break. And MIT economist Jonathan Gruber sees other problems:
As soon as the tax break was eliminated, company-provided health insurance would be likely to disappear, too. So some mechanism would be needed to pool groups of people and to avoid leaving higher-risk people to face enormous insurance costs. Such a mechanism would probably make health insurance affordable for all. And to make it universal, a mandate would be needed to make people buy it.
This isn't communism. The changes could happen under a public health care system or one that is privately run.
The politics of the issue are such that taking away the tax subsidy would probably be suicidal, despite the impressive bill of particulars against it:
[T]he fiscal incentive isn't helping many of the people who need it most. A report by the Kaiser Family Foundation says two-thirds of the 45.5 million Americans who lacked health insurance in 2004 earned less than twice what the federal government defines as poverty. (For a family of four, the poverty line is about $19,300.) In four of every five cases, the uninsured made less than three times the poverty level.
In addition to going to the wrong people, the subsidy as designed promotes wasteful medical spending, encouraging the wealthy to buy more insurance and to use more health services than they need, according to the president's tax panel. And it may bolster premiums across the board.
Altogether, the health insurance tax break exacerbates America's medical dystopia: while the nation has the highest per-capita spending on health in the world - about $5,400 in 2002 - 18 percent of the population under 65 remains uninsured.
The President's Advisory Panel on Federal Tax Reform's final report (Nov. 1, 2005) addressed the issue and offers a tepid, but politically realistic suggestion (cap the tax benefit at the average cost of family health policyies ($11,500). It would be a start. . . . [tm]