HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

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Wednesday, March 19, 2008

Defeating the SuperBugs - Screenings

LATimes reports discusses a new study on how hospitals have worked to reduce the spread of infections within their walls.  Judith Graham writes,

Adding to the debate over how to control drug-resistant bacteria, researchers reported Monday that screening all hospital patients could sharply reduce hospital-acquired infections.

The study published in the Annals of Internal Medicine comes a week after a well-publicized study in the Journal of the American Medical Assn. concluded that screening of surgical patients for methicillin-resistant staphyloccocus aureus, or MRSA, isn't particularly effective.

The take-home message is that "a very comprehensive, aggressive MRSA screening program can significantly reduce the number of infections," said Dr. Lance Peterson, founder of the MRSA screening program at Evanston Northwestern Healthcare in Illinois, which published the second report. . . .

In August 2005, Evanston Northwestern became the first hospital group in the U.S. to screen all patients for MRSA. This time, the intervention worked, and hospital-acquired MRSA infections plummeted by 70%.

But an editorial in the Annals of Internal Medicine sounded a note of caution.  Dr. Ebbing Lautenbach of the University of Pennsylvania School of Medicine questioned which part of the screening intervention worked. Was it the isolation of affected patients, the use of antibiotic ointments, or other actions?  Until further evidence comes in, "each institution may need to tailor its intervention to its unique needs and resources," he concluded.

"Testing high-risk groups isn't enough," he said. "You stop some [of the bacteria's] spread but not enough" to make a difference in hospital-acquired infections.

March 19, 2008 | Permalink | Comments (1) | TrackBack (0)

Tuskgee Still Has Health Impact . . . .

The Associated Press has a story discussing two recent studies conducted by Johns Hopkins University examining the long-term impacts of the Tuskegee Syphilis Study on health care for African Americans.  The AP reports,

The infamous Tuskegee Syphilis Study, a government experiment that charted the effects of the untreated disease on mostly poor and uneducated Black men, was conducted for 40 years before it was exposed and ended in 1972 amid widespread condemnation.  A number of participants in the study died of the disease, which the men spread to women and to children at birth. But does it still take a toll on the health of new generations of Blacks? Even the experts, apparently, can't agree.

Two separate studies by Johns Hopkins University physicians took opposing sides on whether the Tuskegee experiment remains a significant factor in turning Blacks away from clinical trials at a greater rate than Whites. And both tended to contradict an extensive 2005 National Institutes of Health computer survey that found, in fact, Blacks are no different than Whites in the rate at which they take part in clinical trials when offered the chance.

Despite the different findings, researchers involved in the studies, along with others who work on minority medical issues, said more needs to be done to make sure Blacks have proper access to clinical trials as well as medical care.

In research reported earlier this year, Johns Hopkins University doctors found that Blacks were more reluctant than Whites to take part in medical studies because they fear being improperly used as guinea pigs. Their lack of participation, the authors said, inhibits efforts to develop treatments for diseases that Blacks suffer from in disproportionately large numbers.  “So long as the legacy of Tuskegee persists, African-Americans will be left out of important findings about the latest treatments for diseases,” said senior study author Dr. Neil Powe, a professor at Johns Hopkins School of Medicine.  “There is enormous irony that without African-American subject participation in clinical trials, we are not going to have tested the best therapies we need to treat African-Americans,” Powe said.

But less than three years earlier, researchers from the Johns Hopkins Bloomberg School of Public Health reached a different conclusion about the Tuskegee experiment. Their study published in the July 2005 issue of the Journal of the National Medical Association found that few Blacks had heard of the Tuskegee experiment and fewer knew accurate facts. They agree with Powe that Blacks are significantly more likely than Whites to be mistrustful of medical care and clinical trials. But they don't view the experiment conducted by the U.S. Public Health Service in Macon County, Ala., to be a major reason. Dr. Thomas LaVeist, co-author and director of the Bloomberg School's Center for Health Disparities Solutions, said the Tuskegee study plays only a modest role in producing distrust.

Instead, LaVeist said emphasis should be placed on contemporary factors that may make Blacks less likely to want to participate: They’re more likely to go to lower quality health care facilities, they have more difficulty getting appointments and they experience longer waiting times. All supporting the notion that Blacks aren’t treated the same, he said. . . . .

The study by Powe and other Johns Hopkins physicians, released in the journal Medicine online Jan. 14, involved a random survey of 717 outpatients at 13 cardiology and general medicine clinics in Maryland from April to October 2002. Thirty-six percent of participants were Black, the rest White.

Each participant was asked to enroll in a mock trial to test a heart disease pill and were given an in-depth explanation of risks and benefits by a physician, either Black or White. Only 27 percent of Blacks were willing to participate, as opposed to 39 percent of Whites. Seventy-two percent of Blacks said doctors would use them guinea pigs without their consent, versus 49 percent of Whites.

“The thing we were surprised about was that African-Americans were two times or 200 percent more likely to perceive a chance of harm from participating in medical research,” Powe said. “That perception of harm accounted for why they were less willing to participate in a trial.”

Powe said the study provided several possible remedies, including an increase in the number of minority physicians involved in clinical research studies. Some 12 percent of the U.S. population is Black, but only 4 percent are physicians.

He said health care providers need to do a better job at building trust with patients.  “We need to take time to communicate and explain what the risk and benefits are to participating in research and dispel myths that unrealistic harms could result,” he said.

Dr. Mona Fouad, director of the University of Alabama at Birmingham’s Minority Health and Research Center, said a number of reasons have been reported for low participation by Blacks in clinical research. These include economic barriers, time off to participate, negative experiences in the medical system and the complexity of required procedures such as consent forms.  She said the latest Johns Hopkins study is important in underlining the need to reach out and develop culturally competent recruitment strategies.

March 19, 2008 | Permalink | Comments (0) | TrackBack (0)

Tuesday, March 18, 2008

Utube: Youth Discusses Health Care Reform and Obama's Plan

The New York Times ran an interesting piece yesterday discussing a recent utube video in which a young person discusses the reason that he will vote for Barack Obama.  Much of his discussion concerns some pretty detailed thoughts about our health care system and ways to provide reform.  I was pretty impressed.  You can watch for yourself here.  The article discusses how this interview happened and how it has become a popular view for people.  The article states,

On Jan. 31, Derrick Ashong, a 32-year-old musician, dropped off his pal, Shaunelle Curry, at the Democratic primary debate taking place at the Kodak Theater in Hollywood. After shrugging off her suggestion that he join her in carrying a sign for Barack Obama outside the theater — his band was leaving on tour the next day — he reconsidered and walked back to join her.

Carrying a sign saying “¡Sí, se puede!” (Yes, we can!), he joined a throng that was milling around in the background of the live CNN shot focused on the anchor Wolf Blitzer. Then a guy named Mike carrying a video camera came walking by and began peppering Mr. Ashong with a series of skeptical and very pointed questions.

“So why are you for Obama?” he asked. It was clear from his approach that he expected a dimwitted answer, an expectation that he was about to talk to another acolyte smitten by Senator Obama’s rock star persona.

But, as it turned out, Mr. Ashong, who was raised in Ghana and elsewhere, was glad to be asked. For almost six minutes — about a century in broadcast television years — Mr. Ashong, who has an immigrant’s love of democracy and the furrowed brow of a Brookings fellow, held forth on universal health care, single-payer approaches and public-private partnerships.

“A lot of these H.M.O.’s are publicly traded companies anyway, but I don’t think we want to create a market for health care per se, like we don’t want to create a futures market in health care,” he said. And so on.

Cute stuff. Highly informative. But not the kind of political discourse that generally captures a wider audience.

But here’s the weird part. On Feb. 2, the interview of Mr. Ashong was posted on a YouTube channel called “The Latest Controversy,” where supporters of both Senator Hillary Rodham Clinton and Senator Obama are asked very aggressively to justify their choice of candidates. The video blew up, drawing more than 850,000 views. And after that huge response to his policy analysis, Mr. Ashong decided to double down and explain the emotional component of his support for Obama in a follow-up video that was posted Feb. 11 and received 300,000 views.

Taken together, that means a guy who was looking to (anonymously) show a little love for a candidate was able to look into the camera for more than 13 minutes combined and draw in more than a million clicks with an impassioned but reasoned pitch.

At a time when politics and popular culture are still in an awkward mating ritual, Mr. Ashong inadvertently tapped into the youthquake that is shaking up the campaign. While the clip could have been lost among some of the popular rubble at YouTube (“Let me see, do I watch a tutorial on health care or Tori Spelling on ‘Jimmy Kimmel’?”), Andrew Sullivan at The Atlantic blogged about it, as did Think on These Things, a political blog. Then The Economist chimed in, which led to an editor at The New York Times hearing about it and — well, you get the idea. . . .

I think I might ask my class to watch and discuss when we review different ways to organize and reform our health care system.  It is interesting to see young people discussing this topic with such enthusiasm.

March 18, 2008 | Permalink | Comments (0) | TrackBack (0)

Better Vision Through Stem Cells?

National Public Radio's Morning Edition had an interesting piece this morning on the use of stem cells in China to improve the vision of a number of blind children.   It sounds like a new frontier in medicine - unfortunately without the appropriate testing and protective standards we would hope to see - especially when dealing with children.  The background piece states,

China is gaining popularity among a new breed of travelers: patients with incurable conditions who are visiting the country to receive experimental stem-cell treatments not offered in the United States. One company is now claiming a medical breakthrough, advertising that its treatments are restoring vision to blind children. It has ignited a firestorm of controversy in both China and in the U.S.

Giving Parents a New Option

Jena Teague and her husband Terry Williams are among these new visitors. They traveled to China to seek stem-cell treatment for their blind, 7-month-old baby daughter, Laylah. She was born with optic nerve hypoplasia, or ONH — when the optic nerves fail to develop properly in the womb. Conventional medicine offers no treatment and no cure.  But Teague came across a Web site about stem-cell treatments offered by Beike Biotechnology in China and decided to try it — against advice from specialists at home in Georgia.  "None of the specialists had heard of the stem cells, of what they're doing here. They didn't believe it would work. They told me not to expect anything to happen out of it," Teague says. . . . . They are spending $23,000 for Laylah to have infusions of stem cells harvested from umbilical cords — not the more controversial embryonic stem cells. In the U.S., cord blood stem cells are used for treating blood diseases, but are not used for treating other conditions, such as Laylah's vision problem.

Treatment Seems to Yield Positive Results

After three sessions, Teague and Williams say the therapy is already working.  The doctors have told Laylah's parents that the baby now sees light through one eye, while the other eye is dilating almost to the point where she can see light.  So far, 10 patients suffering from ONH have received the same stem-cell treatment in China, and doctors there claim that the vision of all 10 improved after the therapy.  Dr. Shalesh Kaushal, an eye specialist at the University of Florida, . . . . is now evaluating other patients before and after the stem-cell treatment. But he is not recommending that patients go to China; he says much more research needs to be done.  "It's clearly a provocative result. … If this is a real, reproducible observation or effect in other patients, one may consider it as a fundamental breakthrough," says Kaushal.

Reasons for Improvements Remain a Mystery

Dr. Sean Hu, the 40-year-old chairman of Beike Biotechnology, is a medical doctor-turned-entrepreneur with a doctorate in biochemistry from a Swedish university.  Less than three years ago, he set up Beike. Since then, 3,000 patients — most of them from China — have received Beike's stem-cell treatments for a wide range of conditions. He says 70 percent have seen improvements, but he admits he can't explain why.  "In the clinical areas, we know there are improvements. We don't know the mechanism behind it," Hu says.

That raises many concerns. Any improvement could be due to the placebo effect — or other factors besides the stem-cell therapy — and may not lead to longer-term functional gains. No rigorous, controlled clinical trials were carried out before the treatment was offered to patients. No research has yet been published in established peer-review journals overseas. And no one knows for sure what the possible risks might be.  But Hu isn't worried by the ethical implications of what he's doing.  "I can say I changed the life of these patients. Now they get their vision back. They went from completely blind, now they can see stuff. You think that's ethical or nonethical?" he asks.

Therapies Criticized as 'Extreme Nonsense'

Beike claims to treat a wide range of conditions with stem-cell therapy — from spinal-cord injuries to epilepsy to cerebral palsy to neurodegenerative disorders. But critics have their doubts.

Bruce Dobkin is director of the neurologic rehabilitation and research program at the University of California, Los Angles. In response to questions from NPR, he writes in an e-mail that "it is extreme nonsense to think that cells can be incorporated into the complex nervous system and do so much, when we cannot even get cells in mice and rats to do very much."

Chinese scientists are worried, too.  Dr. Naihe Jing is the deputy director of one of China's top stem-cell research labs and a member of the prestigious Chinese Academy of Sciences. He fears Beike could ruin the reputation of China's entire biotech industry. "We think money is mainly behind this," he says, adding that he is concerned that one company's pursuit of profit will create a bad reputation for the whole country.

Providing Help, Providing Hope

Already, 600 foreigners have come to China and paid about $20,000 each for the stem-cell therapy, while even more Chinese patients are flocking for treatment.  The venture capital is flooding in, too. Hu, Beike's chairman, says he has raised about $15 million in funding, although NPR could not verify the claim. He admits making a calculated decision to go into stem-cell research: As he puts it, you have to choose the area with the best return. . . . .

The results of Beike's experimental therapy may be uneven and unproven. Yet for patients and their families, hope is, perhaps, the most important commodity on sale in China — even if it costs tens of thousands of dollars.

March 18, 2008 | Permalink | Comments (0) | TrackBack (0)

Monday, March 17, 2008

Discipline and Firings After Snooping Through Britney Spears' Records

The LA Times reports on the some recent disciplinary charges and firings that occurred at the UCLA Medical Center after the Center learned of snooping that ccurred into the medical records of Britney Spears.  You would think that people would know better.  Charles Ornstein writes,

UCLA Medical Center is taking steps to fire at least 13 employees and has suspended at least six others for snooping in the confidential medical records of pop star Britney Spears during her recent hospitalization in its psychiatric unit, a person familiar with the matter said Friday.  In addition, six physicians face discipline for peeking at her computerized records, the person said.

Questioned about the breaches, officials acknowledged that it was not the first time UCLA had disciplined workers for looking at Spears' records. Several were caught prying into records after Spears gave birth to her first son, Sean Preston, in September 2005 at Santa Monica-UCLA Medical Center and Orthopaedic Hospital, officials said. Some were fired.

"It's not only surprising, it's very frustrating and it's very disappointing," said Jeri Simpson, the Santa Monica hospital's director of human resources, who handled the discipline in the first instance.  "I feel like we do everything that we possibly can to ensure the privacy of our patients and I know we feel horrible that it happened again."  Simpson said UCLA treats celebrities "all the time and you never hear about this."  "I don't know what it is about this particular person, I don't know what it is about her," she added, referring to Spears. . . .

Such prying is also considered a violation of state and federal laws governing medical privacy. The laws allow for fines of up to $250,000, although such penalties are uncommon. Under different laws, separate fines are allowed if patients are receiving treatment for mental illness or substance abuse.

The state Department of Public Health said late Friday that it had opened an investigation of the hospital.  Klove declined to discuss specifics of the most recent incidents, citing privacy protections for patients and workers. But she did say the hospital began taking disciplinary actions immediately upon discovering each breach.  "Right from the minute she came in, audits were continually being done," she said. "We watch this all the time. We have people dedicated to looking at records to monitor access." . . . .

Medical and nonmedical employees are set to be disciplined, although no doctors were targeted for firing, the person said. There is no evidence that any employee leaked information to the media or sold it -- something that hospitals in a celebrity culture have reason to fear.

Nicole Moore, whose union represents three of the non-physician workers involved, said she is trying to determine whether the discipline was administered fairly. Workers are entitled to contest their proposed termination before it becomes final.  "We believe that the university has a responsibility to their patients but also their employees to administer fair and consistent discipline to everybody, regardless of their position, whether it's a doctor who violated it or a certified nursing assistant," said Moore, lead organizer for the American Federation of State, County and Municipal Employees, Local 3299 at UCLA.

Klove said doctors are overseen differently than other employees. By law, they report to a medical staff governing body, which has the authority to limit, suspend or revoke their practice privileges.In January, Spears was admitted to UCLA under Section 5150 of California's Welfare and Institutions Code, which allows patients to be held against their will for up to 72 hours for evaluation if they are deemed a danger to themselves or others. Her hold was extended and she was released Feb. 6. . . . .




March 17, 2008 | Permalink | Comments (0) | TrackBack (0)

Medicare Strike Force Moving After New Targets

Law.com discusses some of the new geographic targets for the Medicare Strike Force as well as providing a summary of their success in Miami.  Julie Kay writes.

After winning almost all of its cases, the U.S. Department of Justice's Medicare strike force is preparing to move out of Miami and on to the next bastions of Medicare fraud, Los Angeles and then Houston, where it is sure to be greeted with a mixture of pleasure and concern by the defense bars there.

The Medicare strike force set up shop in Miami in March 2007. The plan was to bring a batch of quick cases in seven months, then move on to the next region. Miami was chosen because law enforcement officials consider it ground zero for Medicare fraud. In Miami, an estimated $2 billion is stolen annually from Medicare. The majority of the fraud is billing for nonexistent durable medical equipment and unnecessary infusion therapy for AIDS patients.

With $2 million in funding from both DOJ and the Miami U.S. attorney's office, the strike force was initially staffed by two Miami and two DOJ prosecutors. But the group did so well that seven DOJ prosecutors came down to help.  In Miami, the strike force garnered 90 guilty pleas and 10 convictions out of 120 cases. One client was acquitted, one trial ended in a mistrial, one client died, 13 are fugitives and four are awaiting trial. In the seven-month period, 120 defendants were indicted for allegedly committing $420 million in fraud. Ninety of the defendants pleaded guilty and 10 went to trial so far. A few trials remain. More importantly, though, Medicare billing dropped off in Miami by $1.4 billion during the previous year.

The strike force's conviction rate is an impressive 99.3%. The Miami U.S. attorney's office was so pleased with the results that when the joint strike force ended its run, the office made it permanent, staffed internally. . . .

The strike force's arrival did not go unnoticed by the Miami criminal defense bar. While some attorneys appreciate the business, some take issue with the strike force's tactics.  Jose Quinon, a Miami criminal defense lawyer and solo practitioner, argues that the strike force uses "over-the-top aggressive tactics." For example, he said it files cases on easily proven charges and then throws the kitchen sink at defendants at sentencing.  "You indict someone for spitting on the sidewalk and then at the sentencing hearing, you say, 'We're going to electrocute you,' " he said. . . . .

March 17, 2008 | Permalink | Comments (0) | TrackBack (0)

Friday, March 14, 2008

Terrific Job Opportunity - Southern Illinois University School of Medicine

Assistant Professor in Health Law and Policy Department of Medical Humanities Southern Illinois University School of Medicine Springfield, Illinois

The Department of Medical Humanities at Southern Illinois University School of Medicine invites applications for a full-time, tenure-track faculty position at the assistant professor level in health law and policy. Located in the capital of Illinois, the Department is part of a School of Medicine with a dynamic and collaborative learning and research environment that is internationally known for its medical education innovations and dedication to problem-based learning.

Department faculty, through their teaching, research and service, draw upon expertise in such areas as health policy, law and medicine, ethics, psychosocial care, religious studies, and medical history and literature to foster dialog on health, health care and the human condition. In addition to contributing to the education of medical students, residents and physicians, the Department serves as the medical school home for one of the oldest and most robust M.D./J.D. dual-degree programs in the country. The Department seeks a candidate who can build upon a successful health law and policy program and develop individual and collaborative educational and research initiatives which would help increase understanding of health law and policy issues and improve the health of the people of central and southern Illinois and beyond. The successful candidate can anticipate a cross appointment to the SIU School of Law faculty, and may also have an opportunity for cross appointment at SIU’s Paul Simon Public Policy Institute. He or she would join the Department on or before late Summer/early Fall 2008.

Qualifications for the position include a Juris Doctor (J.D.) or equivalent legal degree from a nationally accredited law school, and additional graduate degree(s) in health policy, public policy (with a health focus), health care finance, health economics, public health, or a related field. Preference will be given to candidates with demonstrated experience teaching medical students, health professions students, or small group teaching in other higher education settings.

Southern Illinois University is an equal opportunity employer and will not discriminate against any person on the basis of race, religion, national origin or sex in violation of Title VII. This position is a security-sensitive position and will require a background investigation. Further details about the position, Department and School can be found at:http://www.siumed.edu/ohr/Recruitments/Faculty/FacultyJobs.htm

Applicants should mail or e-mail a CV and a letter with a detailed statement of interest and area(s) of expertise to: Ross D. Silverman, J.D., M.P.H., Associate Professor and Chair, Department of Medical Humanities, SIU School of Medicine, 913 N. Rutledge St., Room 1116, P.O. Box 19603, Springfield, IL 62794-9603, or medhumsearch@siumed.edu. Applications will be accepted until March 31, 2008, or until the position is filled.

March 14, 2008 | Permalink | Comments (0) | TrackBack (0)

Egyptian Organ Donors: Unfortunately It's All About the Money

The LATimes has an eye-opening and rather depressing piece on organ donors in Egypt. Jeffrey Fleishman and Noha El-Hennawy write,

He sits quietly at the corner cafe, a gold watch flickering on his wrist. If you need a liver, or want to sell a piece of yours, grab a chair and get acquainted with Mustafa Hamed, a 24-year-old ex-bus driver who fell unexpectedly into a life as a broker in human organs.  Hamed's 4-year-old son, Mohamed, was dying of cancer and needed an artery transplant that cost $5,000. The only savings Hamed had was what he fished from his pockets at the end of the day.  There was another way, one whispered about for those with nothing. A man could wager part of himself, slip into a hospital gown, and wake up with an incision above the gut.  Hamed sold a section of his liver for a bit more than the price of his son's operation. The boy died in surgery.   With his scar healing and his son buried, Hamed, whose knowledge of anatomy would perhaps fill a single page, decided that driving a bus was not the fate of the man he wanted to be. He brokered his first liver deal four months ago. He earned $900. Four more sales have followed.

"Things shouldn't be this way, but they are," he says. "I sold part of my liver to save my son. I had to do it. . . . You cut your body and sell your pieces. But some people who come to me aren't that desperate. They could find other solutions. Many men I see now want to sell their organs so they can afford to buy an apartment to get married. That doesn't seem desperate enough to me. I try to tell them: 'Be patient. You don't need to do this.' " . . . .

Similar tales echo around the globe. Human organs are brokered from Pakistan to China; kidney-theft rings have swept through villages in India. The poor in underdeveloped nations, such as Moldova and the Philippines, are offered "transplant tourism" packages that arrange for them to travel to another country and sell their organs to rich patients. It is a market of desperation and ingenuity in which doctors ask few questions and donors often end up ill, and sometimes dead. . . .
Donors and patients in Cairo know where to go. There are cafes near clinics and labs where the brokers sit, stirring tea and smoking, cellphones buzzing like insects on the tables.  Those needing organs are easy to spot. They carry X-rays and blood work charts under their arms. Some are ashen, some drawn; they need what they need quickly. They come from Upper Egypt and the Nile Delta, their purses and wallets bulky with borrowed money, and if they're lucky enough they'll be able to hire the Japanese transplant surgeon who flies in once a month.

"My doctor told me to come to this place," says an agricultural engineer from Upper Egypt who was shopping for a kidney near a lab in Cairo's Dokki neighborhood, where horse carts clatter and puffed bread cools in the breeze.  He will not give his name as he straightens his pressed tunic. "I'm 58 years old. I'm in renal failure and I have no children. I need a donor. Kidneys sell for between 20,000 and 40,000 pounds [about $3,600 to $7,300]. I'm bargaining, but I can't pay more than 30,000 pounds."

The donors face hardships of their own. . . .  "I have two choices: Pay my debts or go to jail," says Abdullah, a heavyset man in a sweater, who sits in a cafe hoping to negotiate part of his liver for 40,000 pounds. "I can't find any other solution. It's either the operation or I lose my freedom. . . . I started looking for ads where kidney patients look for donors, but I realized that the maximum amount of money I could get for a kidney is 20,000 pounds. Then in the same newspaper, I found an ad by a liver patient." . . . .

Mohamed Queita, a member of the Egyptian parliament and the ruling National Democratic Party, has been working for 12 years to pass a law to regulate organ transplants and stop an expanding black market that draws patients from across the Middle East and as far away as Europe.  "It's the worst kind of business in Egypt. It's worse than slavery," says Queita, who has no comprehensive statistics but notes that one Cairo clinic had a waiting list of 1,500 people willing to sell their organs. "I don't want the poor turned into spare parts for the rich. . . . People are coming from all over to buy organs in Egypt. They're mainly gulf Arabs. If you're a rich man from the gulf, you go to a private Egyptian hospital that has contacts with organ brokers. Serious cases of poverty in this country are causing an increase in the theft and sale of organs."

Queita's bill proposes that transplants be limited to family members or to donors who accept no money. The legislation has been stalled by disagreements between Islamic clerics and doctors. Physicians support the harvesting of organs from patients who are clinically brain-dead, but clerics regard the practice as haram (forbidden).

The issue is a strand in a legal and spiritual debate over the definition of death that dates to Pharaonic times. Most clerics agree with Queita that the selling of body parts violates Islamic law.

"But there's no punishment," the lawmaker says. "Nobody goes to jail."   . . . .

March 14, 2008 | Permalink | Comments (0) | TrackBack (0)

Diagnosis v. Treatment: Improving Health Care

Slate.com's Darshak Sanghavi has a brief article on a way to improve the quality of health care - have the doctor focus on the patient's treatment rather than on the diagnosis.  He writes,

. . . . The real trouble is that doctors—somewhat paradoxically—are simply not focused on actually treating disease.

A key indicator of this problem emerged last October, when a team of researchers led by Rita Mangione-Smith reviewed children's medical records from 12 major American cities and found that fewer than half of children got the correct medical care during doctor visits. The researchers asked basic questions such as these: Did doctors properly inform mothers to continue feeding infants who had diarrhea? Was HIV testing offered to all adolescents diagnosed with a sexually transmitted disease? Was a follow-up visit scheduled after a child's medication changed for chronic asthma? These were all simple things doctors should have been doing yet weren't. (A similar study of adult quality of care was published in 2003 with similar results.). . . .

There are at least two explanations. First, clinical training in primary care—including pediatrics, internal medicine, and family practice—excessively focuses on the diagnostic hunt rather than the more routine rounds of treatment that follow. It's tempting to think that most doctors are detectives nailing baffling diagnoses, like Hugh Laurie's character on House. In part, this view of medicine accounts for the success of Jerome Groopman's book How Doctors Think, which explores how wrong diagnoses occur. In almost every educational venue—from morning teaching sessions for residents to the weekly case conference featured in the New England Journal of Medicine—medical trainees spend hours learning about how to diagnose rare ailments. And then, abruptly, discussion ends, as though treatment were an afterthought.

The not-so-subtle subtext: Medicine is about the exciting search for a diagnosis, and any old doctor can write a prescription once the real work is done. This same bias pervades insurance rules. To be paid at the appropriate level, physicians must exhaustively document all sorts of irrelevant diagnostic data—such as a rectal exam in toddlers seen for a comprehensive asthma evaluation—rather than the rationale for the treatment they prescribe.

On a separate but related front, medical education today fixates on acquiring knowledge that is largely unrelated to patient care. Consider the college prerequisites to attend medical school (for example, physics and organic chemistry) and the morass of molecular biology, anatomy lessons, and pharmacology that follows and must be committed to memory. Of course, a general foundation is important. However, the sheer abundance crowds out an important—in fact, the only—skill that matters in treating a patient: how to critically appraise published clinical trials. Few doctors ever read them. In effect, medicine has become a priesthood of practitioners who never review or learn to interpret the Bible to minister to their flock; they instead rely on secondhand wisdom. Or, worse, on Google. . . . .

Even if perfect treatment guidelines were to appear magically, it takes a lot of work to teach doctors to follow them. Consider ear infections in children, which are vastly overtreated with powerful antibiotics. In 2000, a group of Boston researchers created an ambitious three-year program (using sociological methods used by missionaries to score religious converts) to educate local pediatricians about proper ear-infection treatment. They explained how to talk to patients, control symptoms without antibiotics, and create educational handouts for patients. They taught doctors what they should have learned in medical school and, as reported in Pediatrics this year, substantially cut antibiotic use. The only sticking point is that it all took a big investment of time and money.

Treatment neglect has big consequences beyond ear infections. Medical errors may claim almost 100,000 lives each year, often from basic skills like poor handwriting on prescriptions. In her book, Overtreated, Shannon Brownlee explains how ignoring treatment has led to odd discrepancies in medical care; for example, some towns in Vermont had tenfold higher rates of pediatric tonsillectomy than others, despite having the same kinds of patients.

Refocusing doctors on actual treatment, instead of pointy-headed diagnostic puzzles, will take serious effort. In the meantime, patients should ask a simple question: "Can you describe the evidence for my treatment?" For better or worse, the answer will tell you a lot about the care you're getting.

March 14, 2008 | Permalink | Comments (0) | TrackBack (0)

Wednesday, March 12, 2008

Health Care Reform in Chart Form

Ezra Klein brings us the easy-to-read chart version of various plans for health care reform to show how difficult or easy it may be to change our system and provide universal coverage.  He starts with our current system and then examines the Hacker Plan (Economic Policy Institute) and Healthy Americans Act (Sen. Wyden (D)) proprosals.  I have not attached the final two charts but they are available at Ezra Klein's website. 

. . . yesterday, I was working on an article comparing different roads to universal coverage, and looking particularly at the way they sell cost controls politically and implement them in the policy. Now, folks know that I think the single largest factor promoting cost control is integrating the system. So I dug into some of the various plans and tried to figure out how far they'd go towards bringing us under one roof. First, here's what private insurance system currently looks like:

integration_now.jpg

Totally fractured. Remember, in particular, that the big blog of "employer sponsored insurance" is not one system, but hundreds, maybe thousands, of individual insurance systems, split up by region. A more accurate graph would break that into Blue Shield of California, Blue Cross in Massachusetts, etc. 

March 12, 2008 | Permalink | Comments (0) | TrackBack (0)

1 in 4 Teenage American Girls have STD

Yesterday the Centers for Disease Control and Prevention issued a report on sexually transmitted diseases among teenage girls.  Monifa Thomas for the Chicago Sun Times reports on study findings,

One in 4 teenage girls in the United States has at least one sexually transmitted disease, according to a first-of-its-kind study released Tuesday by the Centers for Disease Control and Prevention.  The trend is even worse among African-American girls: Nearly half have one or more STDs, compared with 20 percent of whites.

Human papillomavirus was the most common of the four diseases included in the study, affecting 18 percent of the girls studied. Chlamydia was a distant second at 4 percent, followed by trichomoniasis and genital herpes.   The data is based on a nationally representative sample of 838 young women who participated in the National Health and Nutrition Examination Survey in 2003 and 2004.

Teen health experts say the study, billed as the first to look at common STD rates among young girls, highlights the need for comprehensive sex education that goes beyond the abstinence-only message pushed by the federal government.  "It's a clear sign that something's wrong in terms of the way we teach sex education, the way we talk about it, and the message we send to youth," said Soo Ji Min, executive director of the Illinois Caucus for Adolescent Health. In addition, many teens don't get tested for sexually transmitted diseases because they don't think they're at risk, said Dr. John Douglas, director of the CDC's division of STD prevention.

Douglas said African-American girls are probably more vulnerable to STDs because of higher infection rates among blacks as a whole and less access to health care.  The numbers "[do] not mean African Americans are taking greater behavioral risks. In fact, research suggests the opposite," he said. The CDC says women between the ages of 11 and 26 should be vaccinated against HPV, which can lead to cervical cancer. Annual chlamydia screening is also recommended for women under 26. . . . .

The study did not address young males and STD rates.  NPR's Day to Day did a radio interview with Kevin Fenton of the CDC which discussed these number and the CDC report in general. 

March 12, 2008 | Permalink | Comments (0) | TrackBack (0)

Tuesday, March 11, 2008

Academic Perfomance Enhancements -

First, it was those baseball players named in the Mitchell Report - now it could be your law professor or any random college student who uses performance enhancing drugs.  This past weekend, the New York Times ran an article on the use of certain drugs among students and professors to enhance their scholarly performance - mainly it seems to allow individuals to spend more hours awake.  The New York Times article quotes Dr. Anjan Chatterjee who compares this drug use to cosmetic surgery and is concerned about future use of these drugs  -

Dr. Anjan Chatterjee, an associate professor of neurology at the University of Pennsylvania who foresaw this debate in a 2004 paper, argues that the history of cosmetic surgery — scorned initially as vain and unnatural but now mainstream as a form of self-improvement — is a guide to predicting the trajectory of cosmetic neurology, as he calls it.

People already use legal performance enhancers, he said, from high-octane cafe Americanos to the beta-blockers taken by musicians to ease stage fright, to antidepressants to improve mood. “So the question with all of these things is, Is this enhancement, or a matter of removing the cloud over our better selves?” he said. . . .

Along those same lines, the Neuroethics & Law Blog quotes from a student, Molly, who wrote about her use of Adderall.  The blog quotes Molly saying,

"It is difficult to know whether it is a drug itself or a drug culture that attracts certain people to certain substances. In the case of Adderall, I came for the culture and stayed for the drug. Nothing had ever tempted me before. As an adolescent girl, alcohol was closely allied with promiscuity, and I was a prude. Weed suggested foolishness and snacking, and I was foolish and hungry enough as it was. But then came college, and with it, Adderall—a drug associated with writing, thinking, and joyful, hermetic reading. Adderall Me and Ideal Me were nearly the same person, and I saw no reason not to dabble in my best self."

I don't like to think that I can only find my "deepest" self is by using a drug designed to help with ADHD - however, I do sometimes need my cup of coffee in the morning . . . .

March 11, 2008 | Permalink | Comments (0) | TrackBack (0)

What Patients' Want . . . . It's Pretty Costly

The Wall Street Journal's Health Blog's Theo Francis posts on a potential problem with health reform that was revealed in a recent Mayo Clinic on-line survey.  It is an interesting overview of what some Americans would like to see happen to health care and how some of their goals are contradictory.  Theo Francis writes,

Nine in 10 respondents said health-care costs are too high. But eight in 10 called it very or extremely important that patients should have “freedom of choice” to pick insurers, hospitals and doctors. Some 72% said no one should be denied coverage for pre-existing conditions, and 70% think care should be based on patients’ preferences and needs.

Some currently hot policy ideas got less full-throated — but still solid — support, including a federal health board modeled on the Federal Reserve, mandatory health insurance and encouraging patients to have a “medical home,” or one primary-care provider to coordinate treatment. Nearly two-thirds thought it “important” or “very/extremely important” that the federal government “play an important role in funding health-care.” . . . .

Oh, and the chance of anything actually happening? Just 17% think reform is likely in the next decade. Another 17% are on the fence. We’ll do the math for you: Two-thirds think it ain’t likely.

The online survey was conducted by Harris Interactive for Mayo during the third week of December. Participants included 1,018 U.S. residents, age 25 to 75. They were involved in making health-care decisions for their households.

You can see a presentation of the results here, part of a symposium on health policy the Mayo Clinic Health Policy Center is holding today.

March 11, 2008 | Permalink | Comments (0) | TrackBack (0)

Monday, March 10, 2008

Pfizer and the New England Journal of Medicine's Peer Review

The Independent (UK)  reports today on the decision of Pfizer to sue the New England Journal of Medicine to gain access to the names and comments of its anonymous peer reviewers.  Steven Connor writes,

A multinational drugs company is trying to force a medical science journal to reveal the confidential statements made by the journal's expert reviewers in a test case that could undermine one of the central tenets of the scientific process.

Pfizer, the manufacturer of the anti-impotency drug Viagra, is trying to force the New England Journal of Medicine (NEJM) to release the names and comments of its anonymous peer reviewers who judged a dozen studies into two of the company's pain-killing drugs.  Pfizer has issued a subpoena demanding that the journal release the identities and comments of its referees, who normally remain anonymous so that they will feel free to give their honest opinions.

A US district court judge is expected to rule this week on whether the drug company can force the NEJM to release the information, which some scientists claim would damage the confidential peer-review system that science uses to evaluate the merits of prepublication research.

Pfizer, which is based in New York, is being sued for damages allegedly caused by the drugs Celebrex and Bextra. . . . .   As part of its defence, Pfizer is seeking any additional information that may support its case. "Scientific journals such as NEJM may have received manuscripts that contain exonerating data for Celebrex and Bextra which would be relevant for Pfizer's causation defence," the company says in its motion.

But Donald Kennedy, the editor of the journal Science, said that this amounts to a fishing expedition. "If this motion succeeds, what journal will not then become an attractive target for a similar assault?" he wrote in a signed editorial. At stake is the public's interest in a fair system of evaluating and publishing scientific work.

The motion filed by Pfizer claims that the public has no interest in protecting the editorial process of a scientific journal.

March 10, 2008 | Permalink | Comments (0) | TrackBack (0)

Prescription Drugs in Your Water

The Associated Press reports the results of a recent test of our nation's drinking water and finds that small amounts of a variety of prescription drugs exist in our drinking water supplies.   CNN.Com reports,

A vast array of pharmaceuticals -- including antibiotics, anti-convulsants, mood stabilizers and sex hormones -- have been found in the drinking water supplies of at least 41 million Americans, an Associated Press investigation shows.  To be sure, the concentrations of these pharmaceuticals are tiny, measured in quantities of parts per billion or trillion, far below the levels of a medical dose. Also, utilities insist their water is safe.

But the presence of so many prescription drugs -- and over-the-counter medicines like acetaminophen and ibuprofen -- in so much of our drinking water is heightening worries among scientists of long-term consequences to human health.  In the course of a five-month inquiry, the AP discovered that drugs have been detected in the drinking water supplies of 24 major metropolitan areas -- from Southern California to Northern New Jersey, from Detroit, Michigan, to Louisville, Kentucky. . . .

How do the drugs get into the water?

People take pills. Their bodies absorb some of the medication, but the rest of it passes through and is flushed down the toilet. The wastewater is treated before it is discharged into reservoirs, rivers or lakes. Then, some of the water is cleansed again at drinking water treatment plants and piped to consumers. But most treatments do not remove all drug residue.

And while researchers do not yet understand the exact risks from decades of persistent exposure to random combinations of low levels of pharmaceuticals, recent studies -- which have gone virtually unnoticed by the general public -- have found alarming effects on human cells and wildlife. . . .

The federal government doesn't require any testing and hasn't set safety limits for drugs in water. . . .

Contamination is not confined to the United States. More than 100 different pharmaceuticals have been detected in lakes, rivers, reservoirs and streams throughout the world. Studies have detected pharmaceuticals in waters throughout Asia, Australia, Canada and Europe -- even in Swiss lakes and the North Sea.

In the United States, the problem isn't confined to surface waters. Pharmaceuticals also permeate aquifers deep underground, the source of 40 percent of the nation's water supply. Federal scientists who drew water in 24 states from aquifers near contaminant sources such as landfills and animal feed lots found minuscule levels of hormones, antibiotics and other drugs.

Perhaps it's because Americans have been taking drugs -- and flushing them unmetabolized or unused -- in growing amounts. Over the past five years, the number of U.S. drug prescriptions rose 12 percent to a record 3.7 billion, while nonprescription drug purchases held steady around 3.3 billion, according to IMS Health and The Nielsen Co. . . .

Veterinary drugs also play a role. Pets are now treated for a wide range of ailments -- sometimes with the same drugs as humans. The inflation-adjusted value of veterinary drugs rose by 8 percent, to $5.2 billion, over the past five years, according to an analysis of data from the Animal Health Institute.

Ask the pharmaceutical industry whether the contamination of water supplies is a problem, and officials will tell you no.  "Based on what we now know, I would say we find there's little or no risk from pharmaceuticals in the environment to human health," said microbiologist Thomas White, a consultant for the Pharmaceutical Research and Manufacturers of America.

But at a conference last summer, Mary Buzby -- director of environmental technology for drug maker Merck & Co. Inc. -- said: "There's no doubt about it, pharmaceuticals are being detected in the environment and there is genuine concern that these compounds, in the small concentrations that they're at, could be causing impacts to human health or to aquatic organisms."

Recent laboratory research has found that small amounts of medication have affected human embryonic kidney cells, human blood cells and human breast cancer cells. The cancer cells proliferated too quickly; the kidney cells grew too slowly; and the blood cells showed biological activity associated with inflammation. . . . .

Perhaps some new filtering devices for our drinking water supply are in order.   The CNN.Com site has a helpful map which shows what prescription drugs were found in water supplies in different states.  It is pretty interesting.

March 10, 2008 | Permalink | Comments (0) | TrackBack (0)

Friday, March 7, 2008

Prescription Drug Prices

In response to President Bush's weekend radio address concerning the dangers of purchasing drugs on the internet, David Lazarus of the LA Times writes about the reason people often turn to the internet to purchase drugs - the cost of prescription drugs.

In his weekend radio address, President Bush warned of rogue pharmacists making potentially dangerous prescription drugs readily available online.  "The Internet has brought about tremendous benefits for those who cannot easily get to a pharmacy in person," Bush said. "However, it has also created an opportunity for unscrupulous doctors and pharmacists to profit from addiction."

That's undoubtedly true, as are most observations that the Internet has become a hotbed of fraud and flimflammery. And I think we can all agree that patients should see doctors face to face, rather than via an online chat or survey, before receiving prescriptions for painkillers and other such meds. But Dr. Bush is addressing a symptom and not the cause of one of the country's top medical problems.

Many Americans, including numerous seniors and people with chronic conditions, obtain prescription drugs from international sources not because they're scratching some itch for faraway places. The shameful reality is that they're looking abroad simply because they can't afford U.S. drug prices. "The United States has the most costly medications in the world, and a large percentage of the population either lacks insurance or is underinsured," said Andy Troszok, who runs a Calgary, Canada-based, mail-order drug supplier called Extended Care Pharmacy.  Nearly all his roughly 30,000 customers are Americans, he said. And increasingly, the people seeking cut-rate meds aren't retirees on fixed incomes but working people in their 30s. . . .

Bush illustrated his concern about online drug sales with the story of San Diego teenager Ryan Haight, who died after overdosing on the painkiller Vicodin in 2001. Bush noted that "with only a few clicks of the mouse, Ryan was able to get a prescription from a doctor he had never met and have the pills sent to his front door."  The president didn't mention that Haight purchased the pills by faking his age, an ailment and a doctor's name. In any case, a very sad story. But what about the thousands if not millions of other people forced to buy their meds online not because they're looking for a buzz but just to stay alive? Forty-seven million Americans lack health insurance and millions more do not have coverage for prescription drugs. . . . .  Any attempt to shut down such "illegal" online drug sales could result in cutting off medical supplies to Americans in need.

What's the answer? Clearly there need to be safeguards to prevent situations like what happened to Ryan Haight, as well as to protect people from possibly dangerous concoctions offered by fly-by-night pharmacies in Southeast Asia and elsewhere.  But until the U.S. can extend health coverage to everyone and limit drug prices to reasonable levels, many Americans will have no choice but to seek the best possible deal for their meds, and this will often require them to look beyond our borders, via the Internet.  . . . .


March 7, 2008 | Permalink | Comments (0) | TrackBack (0)

More on Autism/Vaccine Case

The Wall Street Journal's Health Blog provides some background on the recent case involving the girl who received childhood vaccines and developed autism-like symptoms.  Jacob Goldstein writes,

The father of a girl who developed autism-like symptoms after receiving several vaccinations in a single sitting doesn’t oppose vaccines.   “I want to make it clear I am not anti-vaccine,” Jon Poling, who has an MD and a PhD, told WebMD. “Vaccines are one of the most important, if not the most important advance, in medicine in at least the past 100 years.” But, he added, “every treatment has a risk and a benefit. To say there are no risks to any treatment is not true.”

The federal government conceded that the vaccines Poling’s daughter Hannah received as an infant may have combined with an underlying disorder to contribute to her neurological problems. The family will receive a payment from a special vaccine court that reimburses people who have been harmed by vaccines.

Hannah Poling has a disorder of the mitochondria, the part of the cell that provides energy. It is common for infants and toddlers with mitochondrial disorders to appear healthy, then develop problems when placed under certain kinds of common physical stress, such as dehydration or fever. Because the brain is such a heavy user of cellular energy, those problems are often neurological.

“Children who have mitochondrial disorders, even though they may appear normal initially, are actually somewhat pre-destined to have a regression of neurological function when placed under stress,” Edwin Trevathan, who runs the CDC’s Center on Birth Defects and Developmental Disabilities, said during a press call yesterday. . . . .

“The government has made absolutely no statement indicating that vaccines are a cause of autism,” CDC chief Julie Gerberding said. “This does not represent anything other than a very special situation and a very sad situation for the family and the child.”

March 7, 2008 | Permalink | Comments (0) | TrackBack (0)

Thursday, March 6, 2008

Autism and Childhood Vaccine Case

Law.com picks up an Associated Press account of an interesting case involving a girl for whom mandatory childhood vaccines worsened a genetic condition she had which led to 'autism-like symptoms."  Marilynn Marchione of the Associated Press writes,

Government health officials have conceded that childhood vaccines worsened a rare, underlying disorder that ultimately led to autism-like symptoms in a Georgia girl, and that she should be paid from a federal vaccine injury fund.   Medical and legal experts say the narrow wording and circumstances probably make the case an exception -- not a precedent for thousands of other pending claims.

The government "has not conceded that vaccines cause autism," said Linda Renzi, the lawyer representing federal officials, who have consistently maintained that childhood shots are safe.  However, parents and advocates for autistic children see the case as a victory that may help certain others. Although the science on this is very limited, the girl's disorder may be more common in autistic children than in healthy ones. . . . .

A lawyer for the 9-year-old girl has scheduled a news conference in Atlanta on Thursday. Her parents have declined to comment in the meantime because the case is not final and the payment amount has not been set.  Nearly 5,000 families are seeking compensation for autism or other developmental disabilities they blame on vaccines and a mercury-based preservative, thimerosal. It once was commonly used to prevent bacterial contamination but since 2001 has been used only in certain flu shots. Some cases contend that the cumulative effect of many shots given at once may have caused injuries.

The cases are before a special "vaccine court" that doles out cash from a fund Congress set up to pay people injured by vaccines and to protect makers from damages as a way to help ensure an adequate vaccine supply. The burden of proof is lighter than in a traditional court, and is based on a preponderance of evidence. Since the fund started in 1988, it has paid roughly 950 claims -- none for autism.

Studies repeatedly have discounted any link between thimerosal and autism, but legal challenges continue. The issue even cropped up in the presidential campaign, with Republican John McCain asserting on Friday that "there's strong evidence" autism is connected to the preservative.

The girl has a disorder involving her mitochondria, the energy factories of cells. The disorder -- which can be present at birth from an inherited gene or acquired later in life -- impairs cells' ability to use nutrients, and often causes problems in brain functioning. It can lead to delays in walking and talking. . . .   According to the document, five vaccines the girl received on one day in 2000 aggravated her mitochondrial condition, predisposing her to metabolic problems that manifested as worsening brain function "with features of autism spectrum disorder." In the 1990s, the definition of autism was expanded to take in a group of milder, related conditions, which are known as autism spectrum disorders.  The document does not address whether it was the thimerosal -- or something else entirely in the vaccines -- that was at fault.

A Portuguese study suggested that 7 percent of autistic children might also have the mitochondrial disorder, versus one in 5,000 people -- or 0.02 percent -- in the general population, said Dr. Marvin Natowicz, a Cleveland Clinic geneticist.  "Even if they're off by a factor of seven" and only 1 percent are afflicted, "it's still a striking statistic," he said.

Others said they doubt the Georgia case will have much effect.  "No link between mitochondrial disorders and autism spectrum disorder has been made in mainstream medicine," said Dr. Michael Pichichero of the University of Rochester in Rochester, N.Y., who has consulted for the government on vaccines and has received speaking fees from vaccine makers. . . .

March 6, 2008 | Permalink | Comments (0) | TrackBack (0)

House Passes Wellstone Mental Health and Addiction Equity Act

Yesterday, the House of Representatives passed the Paul Wellstone Mental Health and Addiction Equity Act.  The gavel describes the Act as follows:   

The House has just passed H.R. 1424, the Paul Wellstone Mental Health and Addiction Equity Act by a vote of 268-148. This bipartisan legislation will end discrimination against patients seeking treatment for mental illnesses by prohibiting insurers and group health plans from imposing treatment or financial limitations when they offer mental health benefits that are more restrictive from those applied to medical and surgical services.

More precisely, the Act:

Requires equity in financial requirements. Under the bill, an insurer or group health plan must ensure that any financial requirements – such as deductibles, copayments, coinsurance, and out-of-pocket expenses – applied to mental health and addiction benefits are no more restrictive or costly than the financial requirements applied to comparable medical and surgical benefits that the plan covers.

Requires equity in treatment limits. Under the bill, a group health plan must ensure that the treatment limitations – such as frequency of treatment, number of visits, and days of coverage – applied to mental health and addiction benefits are no more restrictive than the treatment limitations applied to comparable medical and surgical benefits that the plan covers.

Does not mandate mental health benefits. The bill does not mandate insurers or group health plans to provide any mental health coverage. The bill’s provisions only apply to plans that choose to offer mental health coverage.

Exempts certain businesses. The bill exempts small businesses with 50 or fewer employees. It also exempts those businesses that experience an overall premium increase of 2 percent or more in the first year and 1 percent in subsequent years.

Covers same mental illnesses and addiction disorders as FEHBP. The bill ensures that group health plans cover the same range of mental illnesses and addiction disorders covered by the Federal Employees Health Benefits Program – i.e., the mental illnesses and addiction disorders included in the mental health practitioner’s guide, the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Does not mandate out-of-network benefits. The bill simply states that if a plan already offers out-ofnetwork benefits, it must offer out-of-network benefits on the same terms for mental health services as it does for medical and surgical services.

Does not pre-empt stronger state parity laws. The bill establishes a federal standard, a floor of protections that would apply to job-based health coverage, but allows states to be more protective of their residents with stronger parity laws.

Explicitly permits medical management of health benefits. The bill allows the use of medical management tools that are based on valid medical evidence and pertinent to the patient’s medical condition so that specific coverage is not arbitrary in its application and more transparent to the patient.

Provides for enforcement. The bill provides remedies to protect beneficiaries’ rights and permits enforcement of the bill’s equity requirements by the Internal Revenue Service, the Department of Health and Human Services, and the Department of Labor.

The Senate had already passed a mental health parity bill earlier.  The New York Times has a more detailed discussion of the politics behind the Act's passage and the ability of the House and Senate to reach a compromise and send the Act to the President.

March 6, 2008 | Permalink | Comments (0) | TrackBack (0)

Wednesday, March 5, 2008

Genetic Testing and Genetic Discrimination

A contributor to mydisabilityblog posts about recent announcements of new blood tests that reveal that an an individual has a mental illness.  The contributor finds some excitement in the news but also much worry: 

Recently, I read an article about a blood test that may have the capability of revealing mental illness and I must say that the possibility both excited and worried me. Speaking as a daughter and mother of bipolar individuals, the thought that medical professionals would be better equipped to diagnose my loved one’s mental status through a blood test excited me. It is often difficult for medical professionals to assess the severity of their patients’ moods by observations and conversations with them. . . .

Presently, medical professionals relay upon their observations and the patient’s statements, consequently the severity of an individual’s illness is easily underestimated or overestimated by their treating physician. Dr. Alexander Niculescu, III, the lead researcher of the study, which was published recently in the Journal of Molecular Psychiatry, believes that an objective test that enables a medical professional to determine mental status, severity of illness, and assessment of response to treatment is a huge step in the right direction. Other medical professionals are rightly concerned about the possible ethical questions that a blood test for mental illness would raise. For instance, insurance companies to deny benefits to potential clients could use these same blood tests; blood tests could be used to determine an individual’s competence, enrollment in college, to screen potential employees, or a myriad of other controversial ways.

After considering all of the above, I have to say that I would not wish for my child to be denied access to educational or employment opportunities because of a blood test. I worry that blood tests used to assess mental illness may become a weapon for employers, law enforcement, and insurance companies. In fact these blood tests will most likely be used for the reasons listed above as much or more than as a tool for improved assessment of the severity of an individual’s bipolar disorder, depression, schizophrenia, or anxiety disorders. As with so many other medical advancements, we as a society must be careful not to open a Pandora’s box.

March 5, 2008 | Permalink | Comments (0) | TrackBack (0)