HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

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Saturday, August 18, 2007

Genetic Discrimination in the Army

The LA Times has a detailed article on the Army's use of genetic information - and surprise, surprise, it isn't using this information to try to to help its soldiers.  It reports,

Eric Miller's career as an Army Ranger wasn't ended by a battlefield wound, but his DNA. Lurking in his genes was a mutation that made him vulnerable to uncontrolled tumor growth. After suffering back pain during a tour in Afghanistan, he underwent three surgeries to remove tumors from his brain and spine that left him with numbness throughout the left side of his body.   So began his journey into a dreaded scenario of the genetic age. Because he was born with the mutation, the Army argued it bore no responsibility for his illness and medically discharged him in 2005 without the disability benefits or health insurance he needed to fight his disease.  "The Army didn't give me anything," said Miller, 28, a seven-year veteran who is training to join the Tennessee Highway Patrol. . . . .

"You could be in the military and be a six-pack-a-day smoker, and if you come down with emphysema, 'That's OK. We've got you covered,' " said Kathy Hudson, director of the Genetics and Public Policy Center at Johns Hopkins University."But if you happen to have a disease where there is an identified genetic contribution, you are screwed."  Representatives from the Pentagon declined multiple requests to discuss the policy.

A high cost

The regulation appears to have stemmed from an effort to protect the armed services from becoming a magnet for people who knew they would come down with costly genetic illnesses, according to Dr. Mark Nunes, who headed the Air Force Genetics Center's DNA diagnostic laboratory at Keesler Air Force Base in Mississippi.

The threat is almost certainly small. A 1999 military analysis estimated that about 250 service members are discharged each year for health problems involving a genetic component. Disability payments for them would amount to $1.7 million the first year and rise each year after that as more veterans join the rolls. Healthcare expenditures would have added to the tab.

"Maybe they didn't want to foot the bill for my disability," said Miller, whose rare genetic disease is called Von Hippel-Lindau syndrome. "It's saving money for them. I'm just one less soldier that they have to dish out compensation to."

But the cost for individuals medically discharged can be high. While some eventually receive benefits from Veterans Affairs or private insurers, the policy leaves Miller and others scrambling to find treatment for complex medical conditions at the same time they are reestablishing their lives as civilians without having the benefit of Tricare, the military's health insurance.

"It seems particularly draconian to say, 'Well, you're out with no benefits,' whereas another person with the same injury gets the coverage simply because we don't know there's a gene in there that's causing this," said Alex Capron, a professor who studies healthcare law, policy and ethics at USC.

The entire article is worth the read and provides another example of how we need to reform our health care system. 

August 18, 2007 | Permalink | Comments (0) | TrackBack (0)

Friday, August 17, 2007

Embryo Culture by Beth Kohl

Salon.com has an interview with Beth Kohl, the author of Embryo Culture.  The book discusses not only the new reproductive technologies but also many of the moral concerns that individuals have concerning the use of these technologies.  Here is the introduction to the interview:

After a year of trying to get pregnant in the time-tested manner (intercourse with mate, slow jams and cocktails optional), Beth Kohl discovered that, like 6.1 million of her fellow Americans, she was clinically infertile. So she and her husband, Gary, then 29 and 32 years old, respectively, embarked on a different, but increasingly common, baby-making journey -- one using assisted reproductive technology (ART) to conceive.

But along with prenatal vitamins and baby-name books, Kohl found a mess of ethical questions. Why spend so much time and money conceiving bio-kids when many already-born babies could benefit from the same resources? How many embryos is it OK to transfer, given that later a mother might be faced with the decision to selectively reduce (read: abort) one or more of her fetuses? Are IVF kids the same -- healthwise, soulwise -- as naturally conceived children? What about the risk of pregnancy complications, premature birth, and the host of long-term problems that come along with them? Can "man-made" babies ever be reconciled with religious faith? And the biggie: What should would-be parents do with their leftover embryos?

Kohl, who grew up in a conservative Jewish household in suburban Milwaukee, tackled her ethical and reproductive journey with a typically Midwestern work ethic, digging for answers in sources ranging from the Bible to congressional testimonies about forced abortion in China. Now she chronicles her struggle, both with fertility and morality, in a new book, "Embryo Culture: Making Babies in the Twenty-First Century." The bones of "Embryo Culture" is Kohl's own story of two IVF-assisted pregnancies, but she beefs it up with an impressive amount of research on the technical matters and moral questions facing would-be parents, clinicians and the government.

While the subject is serious, her touch is light. Trying to find a metaphor for their infertility, her husband suggests "botanists in the Arctic Circle" -- and Kohl replies: "That is better. Not only does it suggest that my uterus is inhospitable to life, it also manages to hint of my frigidity." She's compassionate, but unsentimental (especially when you compare "Embryo Culture's" language to the banter in infertility chat rooms and blogs. Kohl reports that some women refer to their frozen embryos as "embies" and nickname the eight-cell clusters "Frosty" and "Snow White"). And she never claims to have all the answers.

August 17, 2007 | Permalink | Comments (0) | TrackBack (0)

Tobacco Regulation

William Saletan has a piece in Slate.com this week discussing the "Tobacco Jihad."  Although he dislikes smoking and notes that it is an extremely unhealthy habit, he also states that perhaps other "drugs" need to be viewed more cautiously as well,

Likewise, the point of recognizing tobacco as a drug was to regulate it as strictly as comparable drugs, not more so. Five months ago, a report by a British commission found that the financial health costs of alcohol and tobacco were equal. Tobacco was by far the bigger killer, but when the analysis moved beyond self-destruction to harming others, the annual death toll from alcohol-related car accidents exceeded the toll from secondhand smoke in the workplace. Drinking, unlike smoking, played a role in 78 per cent of assaults and 88 per cent of criminal damage. The commission concluded that if legal drugs were classified like illegal ones, alcohol would be judged more serious than tobacco. Instead, British law allows advertising of booze but not cigarettes.

The strangest thing about the current round of smoking bans is its focus on pubs. All over the world, reporters have been interviewing bar patrons about the merits of expelling tobacco. "It means I can drink and not come out [of] the bar stinking like an ash-tray," one guy in Hong Kong told Agence France-Presse after a night of partying. There's nothing more annoying than a stinking cigarette when you're trying to get stinking drunk.

Tobacco myopia isn't just a British problem. In South Korea, a university president has proposed to permit booze but "remove smoking students from our school." In Amsterdam, coffee-shop patrons will soon be allowed to smoke marijuana but not tobacco, despite evidence that two joints cause as much non-cancerous lung damage as five to 12 cigarettes.

I understand that alcohol is also a danger to public health, however, I don't think that regulation of alcohol means that we should cut back on our regulation of tobacco.   I am sure that there are healthy vices - perhaps dog walking - that people could take up without the associated downsides of tobacco and alcohol.

August 17, 2007 | Permalink | Comments (0) | TrackBack (0)

Thursday, August 16, 2007

Interesting Health Care Discussion

Kevin Drum at the Washington Monthly on-line takes a look at Phil Longman's article examining Jonathan Cohn's new book, Sick: The Untold Story of America’s Health Care Crisis—and the People Who Pay the Price.  Both pieces are interesting and provide great discussions and critiques of our current health care system.

August 16, 2007 | Permalink | Comments (0) | TrackBack (0)

Girls with Autism

Bruce Godsey, a guest blogger at Majikthise, has a terrific post examining Emily Bazelon's reporting in the New York Times on girls with autism and the treatment that they receive.  He writes,

In terms of understanding autism, we in 2007 have little right to scoff at our ancestors who treated diseases with leeches, as our understanding of this surprisingly prevalent variety of neurological and development disorders awkwardly called "autism-spectrum disorders" stands at approximately the blood-letting stage. A great deal of misinformation about this "set of disorder sets" is available, some of it pushed by people with well-intentioned and/or venal agendas.  Some have heard that mercury in vaccinations has a scientific causal link to autism; it has no actual link but rather a sloppy pseudo-scientific one, i.e. pure gahhr-bazzh. While a skeptical, evidence-demanding approach to life is always of merit, it is particularly important when one is dealing with disorders about which little is known but a great deal of money and human emotion hangs in the balance.

My interest in the topic is personal, so a little of our personal background.  Both of our sons, Sam 4, Noah 2, are autistic.  Their personalities are quite different; Sam is fairly narrowly focused, quiet verbally and easily frustrated but never manic, whereas Noah is a ball of whining energy and eager beaver chatter to himself  We assume that both boys developed autistic neurology through genetics, though no one else in the family has a diagnosis.  While the adult men of my family, myself included, tend towards "nerdish" ways and are mostly introverted, we do not stand on the autistic spectrum.  Among my wife's family, ditto except perhaps for one uncle.  We do not live in a part of the country where autism is particular prevalent; the highest rates of autism in the U.S. are said to be in Silicon Valley, i.e. Santa Clara County, CA, though the extent to which sample bias, confirmation bias, better testing, a more educated pool of parents or other factors may cast doubt on that statistic's weight is unclear.

It is very likely that different genetic conditions cause the many of the same or similar symptoms of the different autism spectrum disorders.  Autism is more common among boys than among girls but not overwhelmingly so in the manner of, for example, hemophilia, adding to the likelihood that some autism results from Y chromosome recessive genes while other autistic manifestations may not.  It is also possible - indeed practically guaranteed - that our own perceptions are gender-skewed, both on what "normal" [sic] is for either gender or how different autism-spectrum disorders may play out differently (or similarly) for girls and boys.

Also, today on NPR's Morning Edition, there was a brief story about an incredibly dedicated group of women in South Carolina who successfully crafted and helped enact legislation requiring insurance companies to cover autism treatments, which are extremely expensive. 

August 16, 2007 | Permalink | Comments (0) | TrackBack (0)

Wednesday, August 15, 2007

Pharmacists and Plan B in Illinois

In Ethan Vandersand v. Wal-Mart Stores, Inc., an Illinois federal district court has refused to dismiss a suit by Illinois pharmacists that they should not be required to comply with a  2005 rule by Governor Rod Blegojevich requiring Illinois pharmacies to dispense emergency contraception/Plan even if individual pharmacists disprove of the medication for religious or moral reasons.  According to a brief write-up by  PJStar.com,

Several pharmacists employed by Wal-Mart and Walgreen Co. have been disciplined for either refusing to dispense Plan B or for refusing to promise that they would dispense emergency contraception if asked.

U.S. District Judge Jeanne Scott denied a request Tuesday by Wal-Mart to throw out a lawsuit filed by pharmacist Ethan Vandersand. Scott sided with Vandersand, who had claimed he was legally protected from discipline by the Illinois Health Care Right of Conscience Act when he declined to dispense Plan B.

Vandersand, who lives in Bluffs, formerly worked at the pharmacy in Beardstown's Wal-Mart. He was put on unpaid leave after he refused to fill a Plan B prescription requested by a nurse practitioner at Springfield's Planned Parenthood on behalf of a female patient in February 2006.  Wal-Mart had contended the state's right-of-conscience law doesn't cover pharmacists. Walgreen Co. has made the same argument in other Illinois lawsuits filed by fired pharmacists.

But Scott wrote in her ruling, "The statute prohibits discrimination against any person for refusing to provide health care because of his conscience."

August 15, 2007 | Permalink | Comments (0) | TrackBack (0)

Monday, August 13, 2007

Caregiver Syndrome

CNN.com reports on a newly named syndrome,

Do you take care of someone in your family with a chronic medical illness or dementia? Have you felt depression, anger or guilt? Has your health deteriorated since taking on the responsibility of caregiving? If your answer is yes to any one of these, you may be suffering from caregiver stress.

This condition is increasingly being referred to as "caregiver syndrome" by the medical community because of its numerous consistent signs and symptoms. In the pamphlet, "Caring for Persons with Dementia," Dr. Jean Posner, a neuropsychiatrist in Baltimore, Maryland, referred to caregiver syndrome as, "a debilitating condition brought on by unrelieved, constant caring for a person with a chronic illness or dementia."

An increasing number of Americans are finding themselves taking care of someone who's aging or ill or both. According to the American Academy of Geriatric Psychiatrists, one out of every four American families cares for someone over the age of 50. As America's population ages, that number is expected to skyrocket. In 2000, the Census Bureau reported, just under 35 million Americans were 65 or over; by 2030, the number is projected to more than double, to more than 71 million. . . . .

The article provides a quick overview as to why many of these caregivers fail to recognize their own need for help and understanding as they deal with these challenges.

August 13, 2007 | Permalink | Comments (0) | TrackBack (0)

Women Veterans Suffer More PTSD

McClatchy News reports on the women war vets from Iraq and the reasons for their higher incidence of post-traumatic stress disorder.  They discuss a recent article in the Washington Times stating,

'The problem becomes even more complex in the context of women serving in the military. In their combat roles, service women in Iraq are subject to both violence from the war and assault from fellow service members or superiors. According to a 2003 study, about one-third of female veterans visiting the Veterans Administration for health care reported having been subject to rape or attempted rape during their military service.

The combination of sexual assault with the psychological trauma from combat known to contribute to PTSD in military personnel has created an environment in which an estimated 20 percent of servicewomen will develop this condition — 4 times the rate in the civilian population and more than double the rate of PTSD in male soldiers (about 8 percent)' should make people stand up and take notice. [Washington Times].


August 13, 2007 | Permalink | Comments (0) | TrackBack (0)

Sunday, August 12, 2007

Beware of Large Sunglasses

Not surprisingly, wearing sunglasses that block your vision is not good for preventing driving accidents.  The UK DailyMail reports on this latest health danger,

"Wide arms and dark lens tints may be the must-haves of the moment, but fashion- conscious women should put safety ahead of style when in control of a car." The Eyecare Trust examined five styles of fashionable sunglasses and found that only two weresuitable for driving.

Trustee Rosie Gavzey said the darkest shades fail to allow a minimum proscribed eight per cent of visible light through and are illegal. Pink tinted lenses can make it difficult to read road signs or spot hazards by distorting colours and wide-armed glasses create blind spots.

Aviator style glasses that curve around the eyes and have slim arms are recommended, along with anti-reflective lenses coloured in neutral brown or grey shades.

Mrs Gavzey said: "Chunky frames could pose a hazard when driving. Motorists need good all-round vision and a visual range of at least 120 degrees.

The article goes on to note that convertible cars put women at risk for skin cancer.   Being fashionable and safe is so difficult. . . .

August 12, 2007 | Permalink | Comments (0) | TrackBack (0)

Drop in US Life Expectancy Rankings

The Associated Press reports on the latest survey of Life Expectancy rankings - the US ranks 41.  Here is ThinkProgess' take on the survey results:

The AP reports that while Americans are living longer than ever, they are not living as long as people in 41 other countries, including Japan, Guam, Jordan, and most nations in Europe. “A baby born in the United States in 2004 will live an average of 77.9 years. That life expectancy ranks 42nd, down from 11th two decades earlier.”

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A New York Times editorial today writes that the “disturbing truth” is that “by an array of pertinent yardsticks, the United States is a laggard not a leader in providing good medical care.”

August 12, 2007 | Permalink | Comments (0) | TrackBack (0)