August 4, 2007
Oscar: The Amazing Kitty in the NEJM
I am sure that you have all heard the story of the cat. Oscar, who seems to know when someone at the nursing home where he lives is going to die. (I have always been more of dog person). No, this wasn't a story that I came across reading the magazines in the grocery store check-out line. The New England Journal of Medicine covered the story. It briefly reports on the daily life of Oscar:
Oscar arrives at Room 313. The door is open, and he proceeds inside. Mrs. K. is resting peacefully in her bed, her breathing steady but shallow. She is surrounded by photographs of her grandchildren and one from her wedding day. Despite these keepsakes, she is alone. Oscar jumps onto her bed and again sniffs the air. He pauses to consider the situation, and then turns around twice before curling up beside Mrs. K.
One hour passes. Oscar waits. A nurse walks into the room to check on her patient. She pauses to note Oscar's presence. Concerned, she hurriedly leaves the room and returns to her desk. She grabs Mrs. K.'s chart off the medical-records rack and begins to make phone calls.
Within a half hour the family starts to arrive. Chairs are brought into the room, where the relatives begin their vigil. The priest is called to deliver last rites. And still, Oscar has not budged, instead purring and gently nuzzling Mrs. K. A young grandson asks his mother, "What is the cat doing here?" The mother, fighting back tears, tells him, "He is here to help Grandma get to heaven." Thirty minutes later, Mrs. K. takes her last earthly breath. With this, Oscar sits up, looks around, then departs the room so quietly that the grieving family barely notices.
August 3, 2007
Just for Fun on a Friday
I don't know how many of you have explored the YouTube website but it definitely can be fun. Here is one of my latest finds: click here for a quick history of music.
SCHIP Clears Senate
The Senate passed an expanded version of the SCHIP program yesterday. The LA Times reports,
Defying President Bush, the Senate on Thursday voted decisively to expand a popular health insurance program for children of the working poor and to more than double tobacco taxes to pay for it. Senators of both parties banded together in the 68-31 vote for the State Children's Health Insurance Program — 18 Republicans joined all 48 of the chamber's Democrats who voted and both of its independents. That's one vote more than the 67 needed to override Bush's threatened veto.
Under the Senate plan, smokers would foot the bill for covering 3 million children more than the 6 million already covered: The federal cigarette tax would jump from 39 cents a pack to $1, and the tax would reach $10 for luxury cigars with a wholesale price of $19 or more apiece.
The Senate action followed a House vote Wednesday approving an ambitious package that would cover about 5 million more children but would also make changes to Medicare that many Republicans say are unacceptable, such as cutting payments to managed-care plans. Lawmakers will face a challenge reconciling the bills. . . .
If congressional negotiators can strike a bipartisan deal, some senior Republicans suggest, the White House may have to back down on its veto threat. "I hope to be able to talk to the president and just show how common sense dictates not vetoing this," said Sen. Charles E. Grassley (R-Iowa), who worked with Baucus to craft the bill. Sen. Orrin Hatch (R-Utah), who helped create the insurance program in 1997, said: "In the final analysis, I don't think this president will veto this bill." . . .
"This bill essentially extends a welfare benefit to middle-class households," said a White House statement on the legislation. Hatch took strong exception to the use of the word "welfare." "These aren't people on welfare," he said. "These are children of working-poor parents who are trying to work but don't have the money to get health insurance. It's hardly welfare."
For some other thoughts on the potential political fall-out to Bush's threatened veto, click here
August 2, 2007
House Passes Expanded SCHIP Program
The Washington Post reports on the House passage of the expanded SCHIP program last evening. It states,
House Democrats pushed through legislation Wednesday to add 6 million lower-income children to a popular health insurance program while making deep cuts in federal payments to Medicare HMOs, defying a veto threat from President Bush.On a 225-204, mostly party-line vote, the House passed the legislation, which would add $50 billion to the decade-old State Children's Health Insurance Program and roll back years of Republican-driven changes to Medicare
The bill would slash federal payments to private insurance companies that cover elderly and disabled patients under Medicare and shift money to doctors and benefits for lower-income beneficiaries. The rest of the children's health increase would come from hefty increases in taxes on tobacco products.
The legislation sparked a bitterly partisan health care battle on the eve of Congress' monthlong summer recess, complete with parliamentary fireworks by angry Republicans. The back-and-forth engulfed a broadly supported program to insure working poor kids in a larger argument over whether the government or the private sector should provide health insurance to the nation's most vulnerable populations.
In the Senate, a more limited, $35 billion expansion of the children's health care program without broader Medicare changes appeared headed for a bipartisan endorsement by the end of the week, despite another threatened veto. Bush has proposed spending half as much on the program _ scheduled to expire Sept. 30 _ over the next five years.
In a veto threat of the House bill issued Wednesday, the administration said the legislation "clearly favors government-run health care over private health insurance," and spends far too much.
For more information about the bill and its passage, see National Public Radio
and for a different view, see Firedoglake (which provides some historical perspective through links and also critiques the Newshour coverage of the issue).
United Press International reports on a new initiative by the Department of Defense:
The U.S. Department of Defense awarded Clemson University a $1.6 million contract for implantable biochip research. The award given the university's Center for Bioelectronics, Biosensors and Biochips is for an implantable biochip that can relay vital health information if a soldier is wounded in battle or a civilian is hurt in an accident.
The biochip, about the size of a grain of rice, is to be designed to measure and relay such information as blood lactate and glucose levels in the event of a major hemorrhage. Professor Anthony Guiseppi-Elie, the center's director, said the biochip device has other potential applications, such as monitoring astronauts' vital signs during space flights.
"We now lose a large percentage of patients to bleeding and getting vital information such as how much oxygen is in the tissue back to ER physicians and medical personnel can often mean the difference between life and death," he said. "Our goal is to improve the quality and expediency of care for fallen soldiers and civilian trauma victims." The biochip also might be injected as a precautionary measure in anticipation of future traumas, he said.
August 1, 2007
Transplant Surgeon Charged with Murder
Unfortunately, this is not the title of a recent episode of Law and Order but I true story concerning charges brought against a surgeon for allegedly hastening the death of several patients.
San Luis Obispo County prosecutors charged a San Francisco transplant surgeon with three felonies Monday, alleging he attempted to hasten the death of a 26-year-old disabled man last year at Sierra Vista Regional Medical Center in an attempt to harvest his organs.
Prosecutors are charging Dr. Hootan Roozrokh, 33, with dependent adult abuse, administering a harmful substance, Betadine, and unlawful prescribing of sedatives to a severely disabled man, Ruben Navarro. If convicted of all charges he could face up to eight years in prison. . . .
The local case is the first of its kind against a transplant surgeon and has vast implications for the nation's organ donor system because it casts doubts on organ donation after cardiac death, or heart failure. That's less common than donation after brain death, but increasingly seen as a way to help alleviate the national organ shortage. In 2006, for example, organs were recovered from 645 donors nationwide after cardiac death, representing 8 percent of all deceased donors. That's up from 189 in 2002.
Prosecutors allege that Roozrokh violated the law on Feb. 3, 2006, when he took control of Navarro's care before he was dead, and that he mistreated him by ordering excessive amounts of sedatives "to accelerate Mr. Navarro's death in order to recover his organs," a statement said. Navarro's organs were not harvested because he did not die within 30 minutes — the timeframe under which his organs remained viable for transplant.
"The central issue of the case is the mistreatment of a person who was still alive," said Stephen Brown, chief deputy district attorney. . . . .
Donation after cardiac death is more complex and controversial than donation after brain death, when the patient has already been declared legally dead before being removed from breathing machines. In the former situation, once a patient is removed from machines and declared dead due to heart failure, there is only a five-minute interval to observe death before surgeons begin recovering organs.
Cardiac death donations fall within ethical guidelines if strict protocols are followed. The medical community's paramount rules and state law say that transplant surgeons should have no contact with the patient until the attending physician declares death and any attempts to hasten death are prohibited. An alleged breach of those protocols led to the charges against Roozrokh.
Navarro was taken by ambulance to Sierra Vista on Jan. 29, 2006, after he was found in a coma at the residential care home where he lived in San Luis Obispo. The patient, who at 10 was diagnosed with a rare degenerative disease, was placed on life support, but not declared brain dead because he had minimal brain function. Navarro's mother then agreed to donate his organs, according to a police investigation.
The Oakland, Calif.-based Organ Transplant Donor Network dispatched a surgical team, which included Roozrokh, from San Francisco to recover Navarro's organs. Navarro was taken into the operating room and removed from life support, but he did not die within 30 minutes.
Violating the hospital's protocol and state law, Roozrokh took over caring for Navarro before he was declared dead and ordered a nurse to give Navarro abnormally high doses of morphine and Ativan to hasten death, according to an investigation by the U.S. Centers for Medicare and Medicaid Services. Prosecutors also allege that Roozrokh injected Betadine, a topical antiseptic, into Navarro's stomach. The attempted organ donation occurred on a Friday night. Navarro died the next day at 8 a.m. Operating room nursing staff alerted hospital administrators the following Monday about the incident. The hospital then notified police and state and federal health officials.
None of the other six nurses, doctors and technicians who were in the operating room and did not intervene will face criminal charges, Brown said.
San Luis Obispo police turned the case over to the county District Attorney's Office in March. The rare circumstances and the fact that there is no case precedent slowed the investigation, prosecutor Brown said. "Dr. Roozrokh and his wife have suffered immeasurably as a result of the dissemination of false accusations and the interminable delay in the investigation of this case," according to the statement from his attorney. . . .
Great Election Year Website for Health Care Issues
The Kaiser Family Fund has launched a new and extremely useful website that provides details on each presidential candidates and their views on health policy. I think it may be worth adding it to your favorites list.
July 31, 2007
Autism and Pesticides
Pregnant women from the Central Valley who were exposed to high levels of pesticides were up to six times more likely to give birth to a child with autism or a related disorder, state health officials said Monday.
California Department of Public Health researchers studied 465 children with autism spectrum disorders in 19 counties born between 1996 and 1998, comparing them with a control group of nearly 7,000 other children.
They found that women who lived close to fields with the highest use of a group of pesticides known as organochlorines were the most likely to bear children with the disorders, which range from mild to severe and cover a wide array of neurological and developmental problems, including difficulties with speaking, social interaction and motor skills.
Of 19 pesticides studied, only the organochlorines had a significant association with autism disorders. Organochlorines include endosulfan and dicofol, two pesticides whose use, primarily on cotton crops, has declined "dramatically" in the past few years in favor of newer, less toxic, pesticides, said Glenn Brank, a spokesman for the California Department of Pesticide Regulation.
Although scientists have previously linked certain other pesticides to neurological problems and developmental delays in children, this is the first study to examine possible connections between pesticides and autism disorders, said Dr. Mark Horton, director of the Department of Public Health.
Horton emphasized that the study does not prove pesticides actually caused the autism disorders, but that there is a possible link that merits further study. The study also suffers from a small sample size: The researchers identified 29 women at the highest-risk of exposure and found that eight of them gave birth to children with autism or a related disorder.
Still, the study's conclusions, while tentative, are important, Brank said, noting that the pesticide regulation agency already is studying whether to further restrict already tightly controlled endosulfan. A similar review of dicofol is planned. The agency will be working closely with public health officials to share information, he said.
"The implications of this study we are taking very seriously," Brank said. . . . .
The Environmental Health Perspectives article is available at www.ehponline.org.
Yesterday an advisory committee of the FDA recommended that Avandia remain on the market with new warnings. The New York Times reports today
Panel members said that studies concerning Avandia were too murky to merit drastic regulatory action and that other diabetes medicines might have similar risks. The votes — 20 to 3 on the heart attack risk and 22 to 1 on the marketing — were cast after an extraordinary meeting in which officials from the Food and Drug Administration, which brought the committee together, openly disagreed with one another on the course to take.
Dr. David Graham, a drug safety officer at the federal agency, called for withdrawing the drug and estimated that its toxic effects on the heart had caused up to 205,000 heart attacks and strokes, some fatal, from 1999 to 2006. For every month that Avandia is sold, Dr. Graham said, 1,600 to 2,200 patients will suffer more of those problems.
Dr. Robert Meyer, director of the F.D.A. office that approved the initial Avandia application, immediately disagreed. “I think it’s important that the committee understand there’s a fundamental disagreement” within the agency, Dr. Meyer said. Other diabetes drugs also have risks, he added, and doctors and patients need a variety of options.
After the votes, Rebecca Killion of Bowie, Md., a patient representative on the advisory panel, said, “My feeling here is that we’re being asked to take a very draconian action based on studies that are very inadequate for us to make that kind of decision.”
The panel did say the agency should require strict warnings on Avandia labels. . . .
The division in the agency reflects a fierce debate among diabetes experts since The New England Journal of Medicine published a study in May suggesting that Avandia, made by GlaxoSmithKline, increased the risks of heart attacks. In a cascade of reports since then, agency officials have said that GlaxoSmithKline told the agency about this risk nearly two years ago but that because of internal disagreements, it never warned patients. In Europe, regulators required that the drug label reflect some concerns about the risks.
The lack of action here helped persuade some lawmakers to support a measure giving the agency more money and power to police drug safety. That bill has passed both houses of Congress and is expected to go to President Bush in days.
July 30, 2007
The New York Times reports on the FDA's recent results from testing Avandia, a diabetes drug.
A federal drug safety official recommended during an advisory committee hearing today that Avandia, a controversial diabetes medicine made by GlaxoSmithKline, be withdrawn from the market because it increases heart risks.
Dr. David Graham noted in a written preview of his presentation that Avandia is no better at controlling blood sugar levels than similar diabetes medicines like Actos, made by Takeda. With a clear risk to the heart, and nothing to recommend it over other therapies, Avandia should be withdrawn, Dr. Graham argued in written remarks.
Dr. Graham is scheduled to speak to the committee later today. But it is not clear that the advisory committee, or indeed the Food and Drug Administration itself, will agree with Dr. Graham, a drug safety official at the F.D.A. who has a long history of arguing against the use or marketing of some widely-used drugs.
The committee may instead recommend that Avandia’s label include stronger warnings about its heart risks.
A committee vote is scheduled for later this afternoon.
Ezra Klein points to a recent article in the New Republic (subscribe free) by Arnold Relman detailing some of the operations of America's pharmaceutical companies. At least one commenter is critical of some of the research and notes that other industries do not face the same scrutiny that the pharmaceutical companies do.
Poverty and Health Care
Firedoglake has a wonderfully moving post on the price some people pay for the lack of access to health care. The piece looks at the moment in last week's Democratic debate (the YouTube debate) in which a man reveals that he spent his first fifty years with a cleft palate and only recently received surgery , allowing him to speak, after a benefactor paid. There must be a better way! Unfortunately, as Paul Krugman notes in today's New York Times (subscription required), this message doesn't seem to be making it to the current administration.