HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

A Member of the Law Professor Blogs Network

Friday, June 16, 2006

Chinese Prisoners and Organ Donors

CNN's Anderson Cooper had a story on last night concerning the Chinese use of prisoners as organ donors.  From the Anderson Cooper website:

There are 90,000 people waiting for organs in the United States. Many of them will die before they ever get close to a transplant. Eric DeLeon of San Mateo, California, did not want to be one of them.

Eric was diagnosed with liver cancer last year. Because he had nine tumors, he was taken off the U.S. transplant list. Doctors considered him a poor candidate for survival.

"I just knew that cancer was going to grow and spread throughout my body and I thought I would be another statistic," Eric told me recently.

So Eric and his wife Lori searched the Internet to check out other transplant options. He found a transplant service in China that promised to find him a healthy liver in a matter of weeks. Eric mortgaged his home and paid $110,000 for a new liver. Two weeks later, he arrived in Shanghai. A couple weeks after that, he had his new liver.

Eric is not alone in looking to China for a new organ. We're told that tens of thousands of foreigners are paying for transplant surgery in China. The problem is those organs may be cut from an executed death row prisoner without consent. That's not all. Some organs are said to have been removed before the prisoner took his last breath in order to keep the organs as fresh as possible.

According to a recent editorial, the Chinese government has defended its program.  Thanks to TalkLeft for the heads up on this story.  Truly the wrong answer to the organ shortage. 

June 16, 2006 | Permalink | Comments (0) | TrackBack (0)

Thursday, June 15, 2006

Colombo on Hospital Property Tax Exemption in Illinois

Courtesy of Paul Caron & TaxLawProf blog:

Jcolombo_5John D. Colombo (Illinois) has published  Hospital Property Tax Exemption in Illinois: Exploring the Policy Gaps, 37 Loy. U. Chi. L.J. 493 (2006).  Here is the Conclusion:

The analysis presented in Part IV of this Article illustrates that the question of what doctrinal tests the court should employ to govern property tax exemption for hospitals and other health care providers is far more complex than popular press accounts might lead one to believe or than the Illinois courts may have realized. One can hardly blame the courts, however, for lacking the expertise in health care or tax policy to appropriately recognize the pitfalls inherent in interpreting property tax exemption rules. Even the Internal Revenue Service, whose job it is to think more comprehensively about tax policy and its far-reaching effects, has fallen into a similar trap.

But the policy problems identified above are real, and they demand the serious attention of the legislature, rather than piecemeal attention by courts followed by a spasm of legislative action when newspaper headlines roar. Without such consideration, the process of individual adjudication by litigation almost certainly will result in ill-conceived tax and health policy as a by-product of defining charitable property tax exemption. The people of Illinois (and other states where these issues may arise) and the uninsured who are directly affected by these policy decisions deserve better.

[tm]

June 15, 2006 | Permalink | Comments (0) | TrackBack (0)

Wednesday, June 14, 2006

AMA: Policing Salt

The American Medical Association wants the food instrustry to reduce the amount of sodium in processed foods by at least 50 percent and and wants the Food and Drug Administration to place warning labels on foods that are high in salt.  According to an article at cnn.com:

On a voice vote, AMA delegates adopted the policy at their five-day annual meeting, which ends Wednesday. Getting the food industry to gradually reduce sodium content in foods by at least half over the next decade is the goal of the new policy.

The policy also calls for the AMA to ask the FDA to revoke the "generally recognized as safe" (GRAS) status of salt.  . . . .

The American Heart Association recommends limiting sodium intake to less than 2,300 milligrams daily, or less than about one teaspoon, but the average daily intake among U.S. adults is nearly double that amount, the report said.

The AMA report said there is overwhelming evidence that excessive sodium intake is a risk factor for hypertension and may be an independent risk factor for other cardiovascular problems.

More than 30 percent of U.S. adults have high blood pressure, and cardiovascular disease is the nation's leading cause of death.

For an overview of some of the other policy positions the AMA adopted at its annual conference, including increasing mental health services on college campuses, promoting new methods to increase organ donation, and a temporary moratorium on direct-to-consumer advertising on new prescription drugs, click here. [bm]

 

June 14, 2006 | Permalink | Comments (0) | TrackBack (0)

Emergency-Care Shortage

The Institute of Medicine issued several reports on its recent major investigation concerning the nation's emergency-care system and concluded the system is "at its breaking point."  From the Institute's website:

The Institute of Medicine's Committee on the Future of Emergency Care in the United States Health System was convened in 2003 to examine the state of emergency care in the U.S., to create a vision for the future of emergency care, including trauma care, and to make recommendations to help the nation achieve that vision.  Their findings and recommendations are presented in three reports::

  1. Hospital-Based Emergency Care: At the Breaking Point explores the changing role of the hospital emergency department and describes the national epidemic of overcrowded emergency departments and trauma centers.
  2. Emergency Medical Services At the Crossroads describes the development of Emergency Medical Services (EMS) systems over the last forty years and the fragmented system that exists today.
  3. Emergency Care for Children: Growing Pains describes the unique challenges of emergency care for children.

The Associated Press summary of the reports states:

That ERs are overburdened isn't new. But the probe by the IOM, an independent scientific group that advises the government, provides an unprecedented look at the scope of the problems — and recommends urgent steps for health organizations and local and federal officials to start fixing it.

Topping that list is a call for coordinating care so that ambulances don't waste potentially lifesaving minutes wandering from hospital to hospital in search of an ER with room. The idea is to set up regionalized systems that manage the flow much like airports direct flight traffic. That also should direct patients not just to the nearest ER but to the one best equipped to treat their particular condition — making sure stroke victims go to stroke centers, for example.

Other recommendations:

_Congress should establish a pool of $50 million to reimburse hospitals for the unpaid emergency care they provide to the poor and uninsured.

_Congress should ensure that more of the nation's disaster-preparedness funding goes to the hospitals and emergency workers who will provide that care. Typical government grants to hospitals for bioterrorism preparation are $5,000 to $10,000 — not enough to equip one critical-care room. When it comes to getting ready for a bird flu outbreak, few hospitals even have the ventilation equipment needed to isolate patients. And emergency medical services received only 4 percent of the $3 billion distributed by the Department of Homeland Security in 2002 and 2003 for emergency preparedness.

_The board that accredits the nation's hospitals should establish strong guidelines to reduce crowding and ambulance diversion.

The report states that the demand for emergency care has increased dramatically over the past decade while the number of ambulance services, hospital capacity and emergency workers dropped.

I am not hopeful that Congress will act on this report -- seems that flag burning prevention is a bigger priority  -- but perhaps I will be pleasantly surprised.  [bm]

June 14, 2006 | Permalink | Comments (0) | TrackBack (0)

Tuesday, June 13, 2006

Health News for Alcohol and Coffee Lovers

Scientists published a study in this  Monday's Archives of Internal Medicine demonstrating that coffee may help offset liver damage caused by alcohol abuse.  Heavy drinkers of alcoholic beverages who also drank lots of coffee were less likely to develop cirrhosis.  According to an AOL news report:

In a study of more than 125,000 people, one cup of coffee per day cut the risk of alcoholic cirrhosis by 20 percent. Four cups per day reduced the risk by 80 percent. The coffee effect held true for women and men of various ethnic backgrounds.

It is unclear whether it is the caffeine or some other ingredient in coffee that provides the protection, said study co-author Dr. Arthur Klatsky of the Kaiser Permanente Division of Research in Oakland, Calif.

Of course, there is a better way to avoid alcoholic cirrhosis of the liver, Klatsky said.

"The way to avoid getting ill is not to drink a lot of coffee, but to cut down on the drinking" of alcohol, he said.

The participants ranged from teetotalers, who made up 12 percent of the total, to heavy drinkers, who made up 8 percent. The researchers calculated the risk reductions rate for the whole group, not just the drinkers.

NPR's morning edition reports further on this study  Researchers are attempting to find out what about coffee provides protection for the liver and to discover why certain heavy drinkers are more likely to develop the liver disease than others.  Finally, the researchers warn that coffee drinking does not eliminate all the harms of heavy drinking. [bm]

June 13, 2006 | Permalink | Comments (0) | TrackBack (0)

Selecting and Ranking Physicians

    Kent Sepkowitz, a physician writing for Slate.com, discusses magazine rankings of doctors that seem to be growing in popularity.  Although perhaps not as controversial as the US News and World report rankings of law schools, he provides some critique of the ranking process for physicians and also then gives his own commonsense selection critieria when looking for a doctor.  He states,

About this time every year, doctors across New York City begin to cast a wary eye at local newsstands. When the bundle of New York magazine's "Best Doctors" issue drops onto the pavement, torture commences for the city's prim and laconic physician class. (Other cities get their chance at other times of year.) It's high school all over again, a life lived at the mercy of cruel arbiters of who is up and who is down. To their credit, I suppose, the compilers of the Best Doctors list define worthiness with more objectivity: They poll local doctors and ask whom they would refer a family member to. With this quasi-statistical information in hand, they go behind closed doors and construct the dreaded list.

To my expert eye, every year the New York survey gets it about half right: Half of the selections are first-rate doctors, no doubt about it. Another 25 percent are people whom I don't know well (though I have my doubts), and 25 percent are certifiable duds—doctors who (hopefully) haven't seen a patient in years but have risen to the lofty realm of high society and semi-celebrityhood. . . .

What's so bad about this sort of thing? After all, Who's Who and its progeny operate a similar scam. I would argue, though, that by adopting the guidebook approach, Best Doctors (or Best Lawyers or Best Dentists) fails the public by making a false promise. The real problem at hand—how do you find a reliable professional whose services you very much need—can't be solved as readily as picking a restaurant or health club. You can't run a Zagat-style survey and get worthwhile results. Nor can you pay people to crash the car and then rate the product. The Best Doctors approach—asking other doctors to name the colleagues they trust enough to send a family member to—sounds like it ought to work. But it doesn't.

To begin with, the list is heavily influenced by backslapping, back-stabbing, and old-fashioned old-boyism. Powerful medical departments are too generously represented while oddball offices or people are gone with the wind. Even if that weren't the case, however, the list would be mostly useless.

How do I know? Friends and family are always asking me for the name of a good doctor. I think long and hard. I consider their ages, sexes, the doctor's experience and office location and background, the doctor's and the putative patient's outside interests, the ages of their respective children and the careers of their respective spouses, their hair color, office color, office furniture. I think of everything I can think of.

And still, almost every time, my friends and relatives rue my choice. The endeavor is like setting up a blind date. It should work, right? You know the guy a long time, your wife knows the woman a long time; everybody likes everybody. But then comes the date and splat!—a disaster—plus the original friendships become frayed with silent accusation: You thought I would like her?

The doctor-patient relationship is just that, a relationship, full of all the nonsense and idiosyncrasy that defines the genre. It's why good doctoring has a magic quality, like a good friendship. The intricacy of this symbiosis also is why a "best doctor" can't be determined by asking a bunch of professors whom they might send their brother-in-law to.

Which is not to say the search for a solid doctor is hopeless—just that the guidebook approach has made the task more complicated than it needs to be. Below is my simple one-two-three approach. It's even in glossy-magazine format.

1) Trust your instincts: There are lots of rotten doctors, really really lousy ones, wretched souls you wouldn't want to know as people, much less trust with your health. But they aren't any harder to suss out than the schmucks you meet in everyday life. If your gut says run, then run.

2) Don't trust your instincts if a scalpel is involved: Subjective impression is meaningless when selecting a surgeon. Craft should trump your desire to like them; in fact, it's OK to hate your surgeon. You simply need him to cut and sew very intelligently. So always select the surgeon who has already done the most iterations of whatever procedure you need. Stated in Zagat-ian terms: Which restaurant do you want to go to—the one with the line or the one that sits empty?

3) Shop around: Diagnosticians, sensitive (and craftless) souls that we are, succeed only if we connect. A doctor who is beloved by one person can be a disaster for the next. Think of who ended up marrying whom—there simply is no accounting for taste. So look before you buy. Yes, it takes time, it takes money, it is humiliating and ridiculous and maybe just a sinister plot to give doctors more business. Do it anyway, and do it when you are well.

Magazine "best" lists are a good read for choosing things that don't much matter, like fitness clubs and pizza and a summer vacation spot. But when it comes to the basics—health, education, and welfare—no one but a best-list maniac would seek counsel from the printed page. And for the maniacs, well, we can only hope that someone out there is polishing up a survey on the 10 best ways to cure a best-list addiction.

[bm]

June 13, 2006 | Permalink | Comments (0) | TrackBack (0)

Monday, June 12, 2006

50-State Legislative Survey

Here's the current issues survey of state legislative activities of interest to state medical boards, courtesy of the Federation of State Medical Boards.  Covered issues:

  • Continuing Medical Education
  • Criminal Background Checks
  • Laser Regulation
  • Medical Director Overview by State
  • Medical errors/patient safety
  • Pain management
  • Physician profiling
  • Regulation of office-based surgery
  • Resident Licensure and Post Graduate Training Programs
  • Telemedicine licensure

  [tm]

June 12, 2006 | Permalink | Comments (0) | TrackBack (0)

The Donut Hole

No, not the yummy kind, unfortunately the donut hole in the Medicare Part D program (as you may recall, the program provides coverage for a subscriber's prescription drugs until he reaches a certain dollar limit, then it pays nothing (the hole), the program does start paying again but only after the subscriber has paid several thousand dollars of his own money to cover the costs of his prescription drugs) is about to become apparent to many new subscribers -- I don't think the result will be a pleasant one.  The New York Times has an article by Robert Pear on the impact of the donut hole  on Texas residents -

On May 2, Mr. Flores paid $20 for Plavix, a blood thinner used to reduce the risk of heart attack and stroke, and Medicare paid $109.62. But when he refilled the prescription at the end of May, he was in the coverage gap, so he had to pay the full amount, $129.62.

Mr. Flores is angry with Medicare, with his drug plan and even with the pharmacists who try to help him. He says no one told him about the coverage gap when he signed up.

Vanessa M. Recio, a pharmacist at Saenz Medical Pharmacy in Mission, Tex., said: "All I do all day is talk to angry patients. I process insurance claims and try to solve problems with Medicare."

The Times piece points out some of the other difficulties that individuals continue to have with Part D - including immigrants and pharmacists who have problems processings claims.  The Washington Monthly has a further examination of the politics of the  donut hole issue.  [bm]   

June 12, 2006 | Permalink | Comments (0) | TrackBack (0)

Sunday, June 11, 2006

Hospital Disaster Preparedness Hearings

It's not technically new, but it's new to me: from the Subcommittee on Oversight and Investigations of the House Committee on Energy and Commerce, hearings on January 26 on "Hospital Disaster Preparedness: Past, Present and Future."  No transcript available yet, but the link will appear on the hearing page when it is; meanwhile, filed testimony is available.  Interesting stuff for you public health law classes.  [tm]

June 11, 2006 | Permalink | Comments (0) | TrackBack (0)

Saturday, June 10, 2006

The Market for Cadaveric Tissue

AP (Yahoo) has a story about the poorly unregulated market in cadaveric tissue that will curdle your blood.  I am stunned that the FDA has done as poor a job of oversight as it has:

The federal agency responsible for tissue safety, the

Food and Drug Administration, is well aware of the problems. Yet, many experts believe the rules the FDA enacted last year as a long-promised overhaul fall short of providing the level of oversight needed.

Each year, another germ is found to spread through tissue. Each year, the FDA inspects a smaller percentage of tissue businesses. Each year, another germ is found to spread through tissue. Each year, the FDA inspects a smaller percentage of tissue businesses.

When it does inspect, public health isn't always protected. In 2003, an FDA inspector saw that Biomedical Tissue Services — the now-notorious New Jersey company — wasn't documenting what it did with tissue unsuitable for transplant. The FDA let the matter drop after the company sent a letter saying it had fixed the problem. For two more years, thousands of people received tissue.

"I'm not surprised that a BTS (incident) occurred. And there will be others," said Areta Kupchyk, a former FDA lawyer who drafted rules that ultimately were adopted in watered-down form. "We continue to be at risk."

In a related AP story, you can read more about the potholes that plague this industry. [tm]

June 10, 2006 | Permalink | Comments (0) | TrackBack (0)

New Twist on Unauthorized Practice of Medicine

This item is from the Federation of State Medical Board's newsletter [links added by me]:

The executive directors of the Texas and Mississippi medical boards testified on June 6 before a U.S. House subcommittee investigating public health issues in the wake of a court ruling that found medical screening companies and physicians were diagnosing patients with silicosis for the purpose of referring them to law firms as plaintiffs in mass tort litigation.

The House Energy and Commerce Oversight Subcommittee is investigating screening practices for silicosis, a lung disease caused by the inhalation of silica dust, which occurs during mining and other industrial processes. Subcommittee members criticized the practices of RTS, Inc., N&M Inc., and Occupational Diagnostics, which conducted the screenings addressed in the June 2005 U.S. District Court opinion In Re: Silica Products Liability Litigation, MDL Docket No. 1553 (S.D. Tex., June 30, 2005).

Donald Patrick, M.D., J.D., executive director of the Texas Medical Board, testified to the issue regarding unlicensed practice of medicine. In Texas, he said, making a diagnosis falls under the definition of practicing medicine. Physicians seeing patients for screening companies who made the diagnosis of silicosis in those patients were practicing without a license. In Texas, Dr. Patrick emphasized, such practice is a felony. Mallan Morgan, M.D., executive director of the Mississippi State Board of Medical Licensure, testified the screening companies were operating without permission from their states.

In her opinion, U.S. District Court Judge Janis Graham Jack noted that only 12 doctors were responsible for the silicosis diagnoses of more than 9,000 plaintiffs involved in the case, nearly all of whom the physicians neither met, treated nor physically examined.

Other hearing dates on this topic are March 31 and March 8[tm]

June 10, 2006 | Permalink | Comments (0) | TrackBack (0)

Friday, June 9, 2006

New CLIA Brochure Available

Some news from CMS (this looks pretty good) . . . .

The Clinical Laboratory Improvement Amendments (CLIA) brochure has been updated and is now available in downloadable format on the Medicare Learning Network’s (MLN) Products page located at   http://www.cms.hhs.gov/MLNProducts/downloads/CLIABrochure.pdf .

The brochure includes an overview of CLIA, why it is important, how test methods are categorized, enrollment information, as well as information regarding the five types of laboratory certificates.  A hard copy of the brochure will be available early this summer and will be available for ordering on the MLN Publications Page at http://www.cms.hhs.gov/MLNProducts/MPUB/list.asp .

[tm]

June 9, 2006 | Permalink | Comments (0) | TrackBack (0)

Thursday, June 8, 2006

New Report on Universal Health Care Coverage

According to a recent interim report of the Citizens' Health Care Working Group,  a 14-member committee representing consumers, the disabled, business and labor, and health care providers, Americans believe that "all Americans should have a set of health coverage benefits guaranteed by law." Those benefits should be "portable and independent of health status, working status, age (and) income."  The Citizens' Health Care Working Group was created by Congress in late 2003 and funded with $5.5 million.  Beginning in February of last year, the group traveled to 50 communities and heard from 23,000 people.  The Group's interim recommendations may be found here.  According to the Associated Press:

The committee describes its recommendations as a framework. The recommendations don't say who would pay for universal health coverage or how much it would cost. The concept of government-guaranteed coverage runs counter to the Bush administration's position that consumers should bear more responsibility for their initial medical expenses.

The group's findings will be officially presented to the president and Congress in the fall, but first comes 90 days of public comment. The president will submit to Congress his response, and then five congressional committees will hold hearings.

Some organizations are already suspicious of the Group's recommendations:

"It implies massive new funding sources, massive new laws would be needed," said Sarah Berk, executive director of Health Care America, an advocacy group that pushes free market approaches to health coverage. "We want universal access, but this report just pushes all the difficult problems onto somebody else's plate. It says government needs to do it all."

George Grob, the executive director of the Citizens' Health Care Working Group, said the group was not asked to say specifically how to get to universal coverage. However, the group did recommend that financing strategies be based on principles of fairness and shared responsibility. The strategies should draw on revenue streams such as enrollee contributions, income taxes, so-called "sin taxes" and payroll taxes, the report said.

"We're already paying for health care for everybody who gets it, including people who don't have health insurance coverage who are taken care of when they go to the hospital," Grob said.

[bm]

June 8, 2006 | Permalink | Comments (0) | TrackBack (0)

FDA Approves Cervical Cancer Vaccine

Today, the FDA aproved the cervical cancer vaccine, Gardasil, for use in girls and women ages 9 to 26 (oops - I am out-of-luck).  The Associated Press reports,

The vaccine works by preventing infection by four of the dozens of strains of the human papillomavirus, or HPV, the most prevalent sexually transmitted disease.

By age 50, some 80 percent of women have been infected.

Gardasil protects against the two types of HPV responsible for about 70 percent of cervical cancer cases. The vaccine also blocks infection by two other strains responsible for 90 percent of genital wart cases. The vaccine will be available by the end of the month, with a three-shot series costing $360.

Its manufacturer, Merck & Co. Inc., seeks similar approval elsewhere around the world. Each year, cervical cancer kills an estimated 240,000 women worldwide, including 3,700 in the United States.

"FDA approval of the HPV vaccine, the first vaccine targeted specifically to preventing cancer, is one of the most important advances in women's health in recent years," said Dr. Carolyn Runowicz, president of the American Cancer Society.  The vaccine developed for hepatisis B has been shown to protect against liver cancer.

Clinical trials showed Gardasil prevented 100 percent of cervical cancer related to the two HPV strains in women who had not been previously infected, Merck said. It also prevented 99 percent of the cases of genital warts caused by the two other strains. . . . .

Gardasil works best when given to girls before they begin having sex and run the risk of HPV infection. The vaccine does not protect those already infected.

Of course, some controversy remains ---

The national Advisory Committee on Immunization Practices will decide June 29 whether to endorse routine vaccination with Gardasil. That endorsement is critical if a vaccine is to become a standard of care.

Sen. Frank Lautenberg, D-N.J., urged the panel to put "science and women's health ahead of ideological opposition" in considering a recommendation.

It then will be up to individual states to decide whether to add the vaccine to the list of others required before students may attend public schools.

Conservative groups like Focus on the Family support availability of the vaccine but oppose making it mandatory, saying the decision to vaccinate should rest with a child's parents or guardians. It promotes abstinence as the best way to prevent infection by HPV and other STDs.

Inda Blatch-Geib, an Akron, Ohio mother of four, said she'd consider vaccinating her daughters, ages 9 and 16. Blatch-Geib, 41, doesn't think it would signal a parental OK for her girls to have sex.

"Giving the vaccine goes with a conversation. We are pretty open with our children, so it wouldn't be an issue. It would lead to conversations," Blatch-Geib said.

The vaccine does not eliminate the need for regular Pap tests, which can detect precancerous lesions and early cancer. Merck has said Gardasil could cut the number of abnormal Pap results due to HPV infection. . . . .

The cost of Gardasil and the difficulty of getting young girls in to see a doctor three times in six months to receive the vaccine could pose problems, said Cynthia Dailard, senior public policy analyst at the Guttmacher Institute, which focuses on sexual and reproductive health. Ensuring its availability to poor and minority girls and women — and others less likely to receive regular Pap exams — also will be difficult. Merck plans to provide Gardasil for free to the poor and uninsured.

"This is an incredibly exciting breakthrough, but at the same time, it presents some major challenges, some the likes of which we have never confronted before," Dailard said.

[bm]

June 8, 2006 | Permalink | Comments (0) | TrackBack (0)

Wednesday, June 7, 2006

Just for Fun

I enjoy watching the Colbert Report.  I recently located this clip from the show containing a gravitas competition between Stone Phillips and Stephen Colbert.  The competition revolved around who could display the most gravitas when reading bizarre news headlines.  Well, there has been a re-match, so here is clip 2.  Thanks to the website onegoodmove for posting the videos.  I wonder if any of my students ever feel that they are forced to assume the gravitas tone exhibited in these clips when representing their clients. 

[bm]

June 7, 2006 | Permalink | Comments (0) | TrackBack (0)

Sperm Donor Issues

This week's New York Times Science section has an interesting article on some of the concerns raised by anonymous sperm donors.  The article reports,

Sperm donor No. F827 aced all the tests. He was healthy, and he said his parents and grandparents were, too. Under a microscope, his chromosomes looked perfect. He also turned out to be quite prolific: his deposits to a Michigan sperm bank during the 1990's produced 11 children.

   

But he passed a serious gene defect to five of those children, a blood disease that leaves them at risk for leukemia and in need of daily shots of an expensive drug to prevent infections. They also have a 50-50 chance of passing the disease to their children.

Shouldn't the sperm bank have detected the bad gene and rejected the donor?

Geneticists say no, because the disease is extremely rare and sperm banks cannot be expected to test for every possible mutation.

But that bit of uncertainty raises other questions. Should any donor produce so many children, when they will be scattered far and wide, making it harder to recognize a pattern of illness than it would be if they all lived under one roof? It's also worth asking whether damage could be limited by requiring sperm banks to keep track of donors' babies so that if one or more got sick, other families who had used the same donor could be warned, sale of the sperm stopped and the donor notified.

The Michigan case, described last month in The Journal of Pediatrics, could be a warning signal to sperm banks and their customers — or it could be just a fluke, such a weird set of circumstances that it has no bearing on anyone else. It's hard to tell for sure, because the buying and selling of sperm is an intensely private, largely unregulated business. A lot is not known, and many participants want it that way. . . . . . .

Still, sperm banking seems to have a good track record, at least as far as anybody can tell. Donors are tested repeatedly for H.I.V., hepatitis and other infections. As for genetic disorders, there have been few other published reports of problems traced back to donors. The known cases include a donor in California who passed on a hereditary kidney disease and one in the Netherlands who fathered 18 children and was later found to have a serious neurological disease that his offspring have a 50-50 chance of inheriting.

The Food and Drug Administration has tissue-banking rules that apply to sperm banks, but those rules concern infectious diseases rather than genetics, and do not limit the number of pregnancies per donor or require tracking of the children's health. A trade group, the American Association of Tissue Banks, accredits sperm banks that meet its standards, but few banks participate in the program.

The Michigan cases came to light only because all four families with sick children happened to consult the same specialist at the University of Michigan, Dr. Laurence A. Boxer. The disorder, severe congenital neutropenia, is so rare — it affects only one child in five million — that when Dr. Boxer suddenly saw several cases in one year he suspected that something strange was going on.

Although the tone of the entire article appears to be quite positive about the safety of sperm banks, some greater regulations may be necessary in the future.   The lack of information and tracking seems to create a potential for future problems.  [bm]

June 7, 2006 | Permalink | Comments (0) | TrackBack (0)

Suits Seek Recoupment of Medicare Funds

As reported by Kaiser Family Foundation's Daily Health Policy Report:

     Two law firms have filed lawsuits in multiple states over allegations that a number of hospitals have improperly billed Medicare for treatment of injuries or illnesses caused by medical errors, the Los Angeles Times reports. According to the Times, the lawsuits, which "could potentially win millions of dollars," do not involve specific allegations of wrongdoing "but seek instead to find evidence of such treatments, arguing that Medicare should be reimbursed" (Yi, Los Angeles Times, 6/7). Florida-based law firm Wilkes & McHugh has filed such lawsuits in U.S. District Court in Arkansas against Colorado-based Catholic Health Initiatives, Texas-based Triad Hospitals and their malpractice insurers. The lawsuit alleges that the companies "breached their duties to Medicare" when they accepted "millions of dollars in payments" for treatment of injuries or illnesses caused by medical errors (Baskin, Arkansas Democrat-Gazette, 6/7). Wilkes & McHugh also has filed such lawsuits in California, New Jersey and Florida. The California lawsuits, filed on Friday in Los Angeles County Superior Court, name Adventist Health, County Villa Service, Catholic Healthcare West, Kindred Healthcare, Longwood Management, Mariner Health Care and Tenet California as defendants.

Comments
Tenet California spokesperson David Langness said, "These are the kinds of baseless lawsuits that contribute to the high cost of health care today" (Los Angeles Times, 6/7). Attorneys at Wilkes & McHugh offices in Florida and Arkansas declined to comment on the lawsuits. A spokesperson for CMS, which is not involved in the lawsuits, also declined to comment. However, CMS Administrator Mark McClellan last month said that Medicare should not have to reimburse hospitals for treatment of injuries or illnesses caused by 27 categories of medical errors. In addition, CMS last month in a statement said that Medicare reimbursements to hospitals for treatment of infections will decrease in October 2007, with additional reductions in reimbursements for treatment of injuries or illnesses caused by medical errors likely in the future (Arkansas Democrat-Gazette, 6/7).

[tm]

June 7, 2006 | Permalink | Comments (0) | TrackBack (0)

Tuesday, June 6, 2006

A Shortage of Doctors"

Ezra Klein has an excellent post on a recent LA Times story entitled, "Needs of Patients Outpace Doctors."  The article reports,


Twelve states — including California, Texas and Florida — report some physician shortages now or expect them within a few years. Across the country, patients are experiencing or soon will face shortages in at least a dozen physician specialties, including cardiology, radiology, and several pediatric and surgical subspecialties.

The shortages are putting pressure on medical schools to boost enrollment, and on lawmakers to lift a cap on funding for physician training and to ease limits on immigration of foreign physicians, who already constitute 25% of the white-coated workforce.

But it may be too late to head off havoc for at least the next decade, experts say, given the long lead time to train surgeons and other specialists.

"People are waiting weeks for appointments; emergency departments have lines out the door," said Phil Miller, a spokesman for Merritt, Hawkins & Associates, a national physician search firm. "Doctors are working longer hours than they want. They are having a hard time taking vacations, a hard time getting their patients in to specialists."

North Hollywood resident Anneliese Ohler, who had a cancerous lesion removed from her face several years ago, had to wait two months recently to see a dermatologist after her hairdresser — and then her primary doctor — told her they saw worrisome spots on the top of her head.

"I was lucky it was not cancer," said Ohler, 83. "But what if it had been?"

Experts say her wait was a symptom of a wider problem: Demand for doctors is accelerating more rapidly than supply.

The article continues and provides some reasons for the shortage of physicians.  Should be interesting to see if anyone involved in public policy decides to address this issue.  Hopefully someone will take note.  [bm]

June 6, 2006 | Permalink | Comments (0) | TrackBack (0)

No Plan B?

On Sunday the Washington Post ran an article witten by a woman concerning her recent experience in attempting and failing to obtain Plan B.  Dana L. writes:

I am a 42-year-old happily married mother of two elementary-schoolers. My husband and I both work, and like many couples, we're starved for time together. One Thursday evening this past March, we managed to snag some rare couple time and, in a sudden rush of passion, I failed to insert my diaphragm.

The next morning, after getting my kids off to school, I called my ob/gyn to get a prescription for Plan B, the emergency contraceptive pill that can prevent a pregnancy -- but only if taken within 72 hours of intercourse. As we're both in our forties, my husband and I had considered our family complete, and we weren't planning to have another child, which is why, as a rule, we use contraception. I wanted to make sure that our momentary lapse didn't result in a pregnancy.

The receptionist, however, informed me that my doctor did not prescribe Plan B. No reason given. Neither did my internist. The midwifery practice I had used could prescribe it, but not over the phone, and there were no more open appointments for the day. The weekend -- and the end of the 72-hour window -- was approaching.

But I needed to meet my kids' school bus and, as I was pretty much out of options -- short of soliciting random Virginia doctors out of the phone book -- I figured I'd take my chances and hope for the best. After all, I'm 42. Isn't it likely my eggs are overripe, anyway? I thought so, especially since my best friend from college has been experiencing agonizing infertility problems at this age.

Weeks later, the two drugstore pregnancy tests I took told a different story. Positive. I couldn't believe it.

I'm still in good health, but unlike the last time I was pregnant, nearly a decade ago, I'm now taking three medications. One of them, for high cholesterol, is in the Food and Drug Administration's Pregnancy Category X -- meaning it's a drug you shouldn't take if you're expecting or even planning to get pregnant. I worried because the odds of having a high-risk pregnancy or a baby born with serious health issues rise significantly after age 40. And I thought of the emotional upheavals that an unplanned pregnancy would cause our family. My husband and I are involved in all aspects of our children's lives, but even so, we feel we don't get enough time to spend with them as it is.

I felt sick. Although I've always been in favor of abortion rights, this was a choice I had hoped never to have to make myself. When I realized the seriousness of my predicament, I became angry. I knew that Plan B, which could have prevented it, was supposed to have been available over the counter by now. But I also remembered hearing that conservative politics have held up its approval.

My anger propelled me to get to the bottom of the story. It turns out that in December 2003, an FDA advisory committee, whose suggestions the agency usually follows, recommended that the drug be made available over the counter, or without a prescription. Nonetheless, in May 2004, the FDA top brass overruled the advisory panel and gave the thumbs-down to over-the-counter sales of Plan B, requesting more data on how girls younger than 16 could use it safely without a doctor's supervision.

Apparently, one of the concerns is that ready availability of Plan B could lead teenage girls to have premarital sex. Yet this concern -- valid or not -- wound up penalizing an over-the-hill married woman for having sex with her husband. Talk about the law of unintended consequences. . . . .

Unfortunately her story gets worse as she has additional problems locating a doctor who will perform an abortion for her.   Thanks to pandagon for the cite. [bm]

 

June 6, 2006 | Permalink | Comments (0) | TrackBack (0)

Monday, June 5, 2006

More Access to Mental Health

The KaiserNetwork.Org has a new video (also available as a podcast or transcript) entitled, 'Mental Health  Care," which  has several experts discussing access and financing of mental health care in the United States.  The program overview follows:

A significant number of people suffering from mental disorders in the United States do not receive the treatment they need. Join "Ask the Experts" to discuss the financing and delivery of mental health care in the U.S.

Moderator:

  • Jill Braden Balderas, managing editor, kaisernetwork.org

Panelists:

The website also contains some helpful links containing more helpful information on this topic.  [bm]

 

June 5, 2006 | Permalink | Comments (0) | TrackBack (0)