Saturday, November 25, 2006
PLEASE SAVE THE DATE: On May 31 - June 2, 2007, The National Health Law Professors Conference will return to Boston University Law School. (Yes, the conference name is slightly different – but since we teach primarily graduate students rather than undergrads, the annual gathering sponsored by the American Society of Law, Medicine & Ethics will henceforth be known as the Health Law Professors - rather than Teachers - Conference.)
If you would be interested in presenting your work at the conference, in either a regular or a poster session (pls specify which one), please e-mail Fran Miller at firstname.lastname@example.org with your title and a 2 or 3 sentence description of your project as soon as possible. We would like to get to work on figuring out how to structure the concurrent panels and plenary sessions by the beginning of December, if possible.
Diane Hoffmann, Dean Karen Rothenberg, and all their wonderful colleagues at the University of Maryland School of Law did a terrific job hosting the conference in Baltimore this past year, and Diane’s post-conference session on “ideas for next time” came up with some interesting new directions and subjects people would like to explore, and we plan to follow up on many of them. We also have several innovations planned, including a session on “News You Can Use” (with suggestions for supporting materials) to provoke classroom discussion (The Polyheme study of blood substitutes on unconscious accident victims, or Senator Grassley's request for a complete FDA/HHS review/investigation might be examples, but if you have other topics to suggest we’d love to hear them).
We’ve booked 100 rooms for attendees at the 4-star Hotel Commonwealth in Kenmore Square, plus another 30 rooms at the Hyatt across the Charles River from the law school, both at very attractive rates for Boston, so you may want to reserve a room early when the official conference brochure comes out.
Best regards, and we look forward to hearing from you all soon.
Fran Miller, George Annas and Wendy Mariner,
Boston University Schools of Law & Public Health
Ezra Klein has a helpful graph demonstrating the problem with health spending that he found at the Kaiser website. Kaiser posted more information on who spends how much on their health care. There is quite a large diffential between consumers. As Mr. Klein notes, to lower health care costs, those individuals who spend so much on health care should be targeted for assistance - assistance that probably won't come in the form of Health Savings Accounts.
Friday, November 24, 2006
The Kaiser Family Foundation released last month several reports that examine the rising number of uninsured. One of these reports addresses, in part, the decline of employer sponsored health care. The report summary states,
This paper examines the underlying reasons behind the decline in employer coverage among employees from 2001 to 2005. The paper finds that almost half of the decline in employer-sponsored coverage was due to a loss of employer sponsorship. Another quarter of the decline was due to lost eligibility for benefits or losing access as a dependent of another employee. The remaining quarter of the decline was due to employees not participating in the offer of coverage.
Law.com has an interesting article with advice to employers on ways to comply with the Americans with Disabilities Act when responding to employees who have a mental illness. The author, Jonathan O. Hafen states,
As the stigma of mental illness lessens, employers are handling more frequent requests for accommodation under the Americans with Disabilities Act. Because serious physical impairments are often easier to identify and accommodate, learning to handle the gray areas of mental disorders as they relate to the ADA can be a challenge for employers.
As defined by the ADA, a qualifying disability is "a physical or mental impairment that substantially limits one or more of the major life activities of such individual." 42 U.S.C. 12102(2)(B), (C). The ADA regulations define disabilities broadly, including a specific reference to "neurological systems, mental or psychological disorders." (29 C.F.R §1630.2 (h).)
Because the ADA only provides such general guidance, litigation continues to arise as parties try to refine the concepts presented in the Act, such as whether a mental disorder is a qualifying impairment, whether an employee with a qualifying mental illness can perform essential job functions, and how the limitation of a major life activity caused by a qualifying mental illness can be reasonably accommodated in the workplace. As the contours of these issues sharpen, the employer's pathway to compliance, without "overcomplying," is becoming more clear.
The article provides a quick overview of some of the issues employers face when an employee with a mental illness.
Thursday, November 23, 2006
I hope that everyone is enjoying a happy and healthy Thanksgiving with family and friends and also hope that this past year has brought you much to be thankful for in your lives! Here is a fun story about the importance of all your senses to the enjoyment of your Thanksgiving meal. Apparently those taste buds just aren't all we might think -- our brains are more amazing than we know.
Ezra Klein breaks down the tax problem for providing universal health care coverage. He compares approaches in several states. It is an interesting an informative read and we hopefully will have some more discussion in this new Congress on how to solve our health care access and cost issues.
Wednesday, November 22, 2006
Shakespeare's Sister has a piece on a recent death of a Brazilian model who had a body mass index of 13.4. The blogger says that articles like this are "why I sometimes write about eating disorders and their relationship to the images of extreme female thinness that our print and electronic media fire at young people all day long." The news article states,
A 21-year-old anorexic model who weighed only 88 pounds has died of generalized infection, a hospital said. Ana Carolina Reston, who had worked in China, Turkey, Mexico and Japan for several modeling agencies, died Tuesday, according to Sao Paulo's Servidor Publico Hospital.
The hospital said the infection that killed the 5-foot-8-inch model was caused by anorexia nervosa, a disorder characterized by an abnormal fear of becoming obese, an aversion to food and severe weight loss.
Ezra Klein has an interesting response to recent news about the use and value of stints and angioplasties. He writes:
Just to freak folks out a bit, angioplasties and stents -- two canonical treatments for blocked arteries -- are rapidly being proven worthless. Not totally worthless in every case, but given their frequency, pretty damn worthless. A similar thing, incidentally, is happening to bypass surgeries, which don't exhibit anything near an efficacy justifying their ubiquity.
Libertarian response: If consumers had more "skin in the game" (and by skin we don't mean actual skin, which is already "in the game," but more financial vulnerability), they'd demand more comparative studies and begin weeding out such ineffective treatments.
Paternalistic liberal response: It's been so hard to conduct studies on these treatments precisely because desperate patients adore their promise and doctors know they'd be considered monsters if they put unsuspecting individuals in a "control group" that was denied a treatment that soon proved effective. Patients are terrible at evaluating care -- look at the holistic health industry, and the limitless range of unproven supplements and treatments -- and skin in the game will always be overwhelmed by lives-on-the-line. On the other hand, if doctors lacked their current incentives for providing such intensive medical procedures, we could begin to make a dent.
Bipartisan response: In 100 years, a good half of our medical treatments will look to our descendants like leeches look to us.
Update response: And yes, leeches are back in use in very limited contexts. Much as the research shows angioplasties should be.
Tuesday, November 21, 2006
CNN.Com reports on individuals who take anti-depressants who do not appear to need them.
Troy Dayton pops a little white pill every morning. He's one of the 10 million Americans taking a daily antidepressant. But in his case, he says he was never depressed in the first place. This 29-year-old political lobbyist is one of the happiest people you'll ever meet. He's constantly smiling, and says he wakes up belly-laughing two or three times a week. Dayton says he's an optimist by nature, and that his daily dose of Wellbutrin makes him feel even better.
"Wellbutrin makes me feel great," Dayton told CNN. "Wellbutrin made me feel clear-headed, much more able to focus. I don't think it means that I don't ever experience any sadness, but I think it makes me experience sadness in a very healthy way." . . .
Psychiatrists tell CNN that Dayton's use of Wellbutrin as a lifestyle drug is potentially dangerous, although little is known about the long-term effects. "These medicines are not harmless," said Dr. Peter Kramer, author of "Listening to Prozac." Kramer said some doctors think that if you stay on antidepressants long enough, you'll come to rely on them. Other doctors believe they might trigger manic-depressive illness in susceptible people, he said. . . .
Chemically, there's little difference between good feelings induced by medication and those occurring naturally. But the use of antidepressants by those who don't need them raises, for many, not just medical concerns but ethical flags as well. The concerns grow larger when the subject turns to illegal drugs. Millions of Americans take them, but few are willing to admit it. Once again, Troy Dayton is a rare exception. He told CNN he takes Ecstasy, also known as MDMA, about once a year. . . .
Dr. Julie Holland, a psychiatrist at New York University, says MDMA holds promise as an aid to psychotherapy for some patients, if taken under the guidance of a trained therapist under tightly controlled conditions. The federal government has approved early human trials. "Our understanding of the brain is still in its infancy," says Holland. "The SSRIs that I like to prescribe take really about two or three weeks before people start to feel them. The full effects won't kick in until about four to six weeks, or six to eight weeks." By contrast, illicit drugs kick in almost immediately. Dr. Nora Volkow, director of the National Institute on Drug Abuse, says they produce pleasure - and often lead to addiction - using the same neural pathways that light up when people have sex or enjoy a good meal. She says these pathways also guide primal emotions like the satisfaction a mother gets from nurturing her infant.
"It's not that drugs create a new landscape in our brains," Volkow said. "Drugs hijack those landscapes that are there [already], that are extraordinarily important to motivate our behaviors." Volkow says Ecstasy users are risking serious physical harm, including damaged neurons and deep depression. Government statistics show Ecstasy is linked to about 8,000 emergency room visits every year, mostly for overheating and dehydration.
Dayton is unrepentant about his drug use. "If we have the ability to have something better, then why not?" he asks. "However someone can sustain a certain level of happiness without hurting someone else, should be celebrated and not questioned." Where antidepressants are concerned, Holland agrees. "I think it's sort of this puritanical mind set. You're supposed to sort of go it alone, and you don't need crutches unless your leg is broken," she said.
"[But] short of doing very advanced PET scans, where you're looking at receptors and neurotransmitters and things like this, it's hard to say who really deserves to take antidepressants and for whom it's a luxury. Having a private practice in New York City, I have a lot of luxury-minded patients who just know if they take something they'll feel a little bit better. And I'm okay with that."
Monday, November 20, 2006
Thompson, who will turn 65 on Sunday, spent nearly four decades in politics and government, including 14 years as governor. He resigned as HHS secretary in December 2004 shortly after Bush won a second term. His tenure at HHS was marked by anthrax attacks, a flu vaccine shortage and passage of the Medicare prescription law.
"We touched the third rail of politics and delivered on our promise to modernize Medicare with prescription drug coverage," Thompson said. During his stop in Iowa, Thompson argued that his background as a Midwest governor and HHS secretary would appeal to voters. "The three big issues in 2008 are going to be health, energy independence and the war in Iraq," he said.
Kevin Drum at the Washington Monthly discusses the future effort of the new Congress to permit the government to negotiate prescription drug prices with the pharmaceutical companies who provides drugs under the new Medicare drug benefit. He cites to a recent Jonathon Cohn article in the New Republic and discusses his belief that such negotiations and resulting lower prices will not doom the industry.
But wait. If the feds negotiate prices, then prices will go down. And if prices go down, pharmaceutical companies might make less money. And if pharmaceutical companies make less money, they'll do less basic research and churn out fewer lifesaving drugs. As Jonathan Cohn says in The New Republic, this is "a potent argument." It's also probably wrong:
The most important basic medical and scientific research that leads to major medical breakthroughs usually takes place under government auspices — typically, through grants from the National Institutes of Health. In other words, taxpayers — not drug companies — are the ones financing the most important drug research today. So, even if the pharmaceutical industry did reduce its research and development investment because of declining revenues, what we'd lose probably wouldn't be the next cure for cancer — it would be the next treatment for seasonal allergies, and likely no better than the ones we have already.