HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

A Member of the Law Professor Blogs Network

Monday, June 30, 2008

Women and Health Insurance

Ezra Klein reports on the findings of Jon Cohn regarding the health insurance industry and women  He writes, 

Jon Cohn peers into insurance price differentials and comes back with a depressing, but unsurprising, finding: Insurers charge women more than they charge men. I'd add to this that studies show the effect is all the more pronounced when you're dealing with health savings accounts and other forms of high-deductible coverage. A Harvard study from a year or so back ran the numbers and found that men under 45 racked up about $500 in yearly, out-of-pocket costs, while women spent closer to $1,200. Dr. Steffie Woolhandler, the lead author of the study, summed up the findings starkly. "When an employer switches all his employees into a consumer-driven health plan, it's the same as giving all the women a $1,000 pay cut, on average, because women on average have $1,000 more in health costs than men."

Here's why: For most of their lives, men and women use health care very differently. Men seek episodic care: I sawed off my thumb, fell off a mountain, tried to stop an SUV with my Civic. . . . Conversely, women seek a lot of routine care. Check-ups, pap-smears, reproductive health care, etc. The expenses are small, but they're regular. So when you move towards health coverage where small, regular expenses come out of pocket, you're erecting financial barriers to the type of care sought by women. . . .

June 30, 2008 | Permalink | Comments (1) | TrackBack (0)

FDA - More Bad Produce?

The Washington Post reports that it may be more than just tomatoes that contain the salmonella  that has sickened more than 810 across the United States.  Annys Shin reports,

Tomatoes carrying a rare form of salmonella that has sickened more than 800 people may still be on the market, federal officials said yesterday, two weeks after they first warned consumers about the risk.  Investigators are considering the possibility that other produce may be spreading the bacteria.

"We continue to see a strong association with tomatoes, but we are keeping an open mind about other ingredients," said Patricia Griffin, a top epidemiologist with the Centers for Disease Control and Prevention

The FDA has not changed its guidelines that it is safe to eat Roma, red plum and red round tomatoes not attached to a vine that were grown in certain areas. All cherry tomatoes, grape tomatoes and tomatoes attached to the vine are also okay. (For a list of safe areas, go to http://www.fda.gov.) . . .

With reports of more recent cases coming in daily, investigators are questioning some of their working assumptions about the likely source of the outbreak. "We have to re-examine the whole thing," David Acheson, a top food safety official with the Food and Drug Administration said. "We are concerned there is something out there still exposing people to this salmonella saintpaul strain.". . . .

June 30, 2008 | Permalink | Comments (0) | TrackBack (0)

Sunday, June 29, 2008

CT Scans and New Health Technologies: A Cost/Benefit Analysis

The New York Times has a long front page article today on the value of CT scans and other new technologies that doctors feel they need to use for patient health without much proof that they promote and health.  There is also that little problem of the financial incentives involved with the use of such technologies.  Alex Berenson and Reed Abelson report,

A group of cardiologists recently had a proposition for Dr. Andrew Rosenblatt, who runs a busy heart clinic in San Francisco: Would he join them in buying a CT scanner, a $1 million machine that produces detailed images of the heart? The scanner would give Dr. Rosenblatt a new way to look inside patients’ arteries, enable his clinic to market itself as having the latest medical technology and provide extra revenue. Although tempted, Dr. Rosenblatt was reluctant. CT scans, which are typically billed at $500 to $1,500, have never been proved in large medical studies to be better than older or cheaper tests. And they expose patients to large doses of radiation, equivalent to at least several hundred X-rays, creating a small but real cancer risk.

Dr. Rosenblatt worried that he and other doctors in his clinic would feel pressure to give scans to people who might not need them in order to pay for the equipment, which uses a series of X-rays to produce a composite picture of a beating heart.  “If you have ownership of the machine,” he later recalled, “you’re going to want to utilize the machine.” He said no to the offer.

And yet,  more than 1,000 other cardiologists and hospitals have installed CT scanners like the one Dr. Rosenblatt turned down. Many are promoting heart scans to patients with radio, Internet and newspaper ads. Time magazine and Oprah Winfrey have also extolled the scans, which were given to more than 150,000 people in this country last year at a cost exceeding $100 million. Their use is expected to soar through the next decade. But there is scant evidence that the scans benefit most patients. . . .

No one knows exactly how much money is spent on unnecessary care. But a Rand Corporation study estimated that one-third or more of the care that patients in this country receive could be of little value. If that is so, hundreds of billions of dollars each year are being wasted on superfluous treatments.  At a time when Americans are being forced to pay a growing share of their medical bills and when access to medical care has become a major political issue for states, Congress and the presidential candidates, health care experts say it will be far harder to hold down premiums and expand insurance coverage unless money is spent more wisely.

The problem is not that newer treatments never work. It is that once they become available, they are often used indiscriminately, in the absence of studies to determine which patients they will benefit. . . .

June 29, 2008 | Permalink | Comments (2) | TrackBack (0)

Saturday, June 28, 2008

Informed Consent or Compelled Speech

The Eighth Circuit has overturned an injunction granted to Planned Parenthood that prevented the South Dakota informed consent abortion statute from going into effect. The ASCBlog reports on the case and states,

An en banc panel of the U.S. Court of Appeals for the Eighth Circuit voted 7-4 to overturn a preliminary injunction against South Dakota’s statute requiring “informed consent” prior to an abortion. Among other things, the statute requires physicians to provide a written statement to a patient declaring “the abortion will terminate the life of a whole, separate, unique, living human being.”

Majority Opinion

The majority opinion in Planned Parenthood Minnesota v. Rounds recognized a higher standard of review for preliminary injunctions that enjoin the enforcement of a state statute. The opinion by Judge Raymond Gruender, instead of using the “fair chance” standard, which requires plaintiffs to show they have a fair chance of prevailing on the merits, now requires district courts to find that “a party is likely to prevail on the merits.” . . .

Dissenting Opinion

The dissent, written by Judge Diana Murphy, argued that the court “bypassed important principles of Constitutional law” as well as “depart[ed] from established practice by not remanding for the district court to have the opportunity to apply the new standard.” The Court characterized [the statute's requirements] saying “the obvious objective of the Act . . . is to use the concept of informed consent to eliminate abortions.”

Judge Murphy concluded the law “more than likely violates constitutionally recognized fundamental rights of women seeking an abortion and of attending physicians.” It “compel[s] doctors to communicate the state’s ideology,” and interferes “with the doctor patient relationship.” . . .

June 28, 2008 | Permalink | Comments (0) | TrackBack (0)

Friday, June 27, 2008

Medicare Delayed

The New York Times reported yesterday on the delay in the Senate's consideration of the Medicare Bill which would have blocked the 10 percent automatic cut in Medicare payments to physicians scheduled to begin in July.  Now, those cuts are back, and Robert Pear reports, no one is terribly happy about it.  He writes,

Doctors face a 10 percent cut in Medicare payments next week, following the Senate’s failure on Thursday to take up legislation that would have averted the cuts. Republican senators blocked efforts by Democrats to call up the bill, which was approved Tuesday in the House by an overwhelming bipartisan vote of 355 to 59. In the Senate, supporters fell two votes short of the 60 needed to close debate. The vote was 58 to 40.

      

Senator Charles E. Schumer, Democrat of New York, said, “We have to pass this bill to avoid catastrophic cuts to doctors.”  Dr. Nancy H. Nielsen, president of the American Medical Association, said the cuts would force many doctors to “limit the number of new Medicare patients they treat.”   The bill would cancel the 10 percent cut scheduled to occur on Tuesday and would increase Medicare payments to doctors by 1.1 percent in January.

President Bush had threatened to veto the bill, in part because it would reduce federal payments to private Medicare Advantage plans, offered by insurers like Humana, UnitedHealth and Blue Cross and Blue Shield companies. The 10 percent cut occurs automatically because of a statutory formula that reduces Medicare payments to doctors when spending would otherwise exceed certain goals.

Senator Mitch McConnell of Kentucky, the Republican leader, said: “We offered to negotiate. We offered to extend current law.” But, Mr. McConnell said, Democrats refused.  Lawmakers are leaving town this week for the Fourth of July holiday. When they return, they could increase doctors’ payments retroactively. But there is no guarantee.  The Senate majority leader, Harry Reid, Democrat of Nevada, said: “Senate Republicans are playing a dangerous game of chicken. The only losers will be Medicare patients, old people.” . . .

Here is the earlier NYT article discussing the House passage of the Bill earlier this week.

June 27, 2008 | Permalink | Comments (0) | TrackBack (0)

Some Happiness for Your Day

Please click here --- I want that guy's job - fun dancing, travel and opportunity to show how much we all have in common with each other.  More information about Matt and his mission can be found here.

June 27, 2008 | Permalink | Comments (0) | TrackBack (0)

Thursday, June 26, 2008

American Poor and Exotic Illnesses

The LA Times reports on a number of exotic illnesses that strike the poor living in the United States.  Perhaps if they had some health coverage  this wouldn't be happening . . .    Wendy Hansen writes,

Despite plummeting mortality rates for most infectious diseases over the last century, a group of largely overlooked bacterial, viral and parasitic infections is still plaguing the nation's poor, according to a report released this week.  Many of the diseases are typically associated with tropical developing countries but are surprisingly common in poor regions of the United States, according to the analysis, published in the Public Library of Science journal PLoS Neglected Tropical Diseases.

On its list of 24 "neglected infections of poverty" are schistosomiasis, a parasitic infection common in Africa; brucellosis, a bacterial infection from unsanitary dairy products; and dengue fever, a viral infection common in tropical Asia and South America.   

Many of the diseases have become significant public health problems in the United States. In the Los Angeles area, a pork tapeworm infection called cysticercosis which spreads in crowded, unsanitary conditions, accounts for 10% of seizures resulting in emergency room visits, according to the report. Worm cysts in the brain cause the seizures and can lead to permanent epilepsy.  The 24 diseases afflict at least 300,000 Americans, and possibly millions, according to study author Dr. Peter Hotez, chairman of George Washington University's department of microbiology, immunology and tropical disease.  . . .

The diseases are largely concentrated in poverty-stricken regions, including Appalachia, inner cities, the Mississippi Delta and the border with Mexico.  Often the result of poor sanitation or inadequate healthcare, they can hinder child development and worker productivity, exacerbating poverty, the study says.

Yet many of the diseases have received little attention, Hotez said. For example, nearly every hospital screens infants for the genetic disease phenylketonuria, but only two states require screening for toxoplasmosis, a parasitic infection passed from mother to child at birth. Both diseases cause mental retardation. Toxoplasmosis affects 10 times as many newborns as phenylketonuria does, but toxoplasmosis is mostly limited to inner cities and poor Southern areas.

The first step in combating the diseases is more closely monitoring their prevalence and transmission routes, Hotez said.  Though the conditions are often preventable or easily curable, many sufferers never receive medical attention. "We do monitoring for all those diseases," said Dr. Jonathan Fielding, Los Angeles County public health director. "Whether there's 100% reporting is another issue." . . . .

June 26, 2008 | Permalink | Comments (0) | TrackBack (0)

Privacy Standards for Online Health Records

The Wall Street Journal Health Blog has a helpful overview of the new privacy framework agreed to by some internet folks for protecting privacy of online health records.

Google, Microsoft and a bunch of other organizations said yesterday they have agreed to a set of privacy standards for online health records. You can read all about the framework here.

It’s pretty clear that there’s a lot of upside from having peoples’ health records online — less redundancy, fewer missing tests, no more faxing records from one doctor to another. But privacy is a big concern; a recent article in the NEJM pointed out that tech shops such as Google and Microsoft don’t have to abide by HIPAA, the federal law that covers patient privacy. . . .

   

June 26, 2008 | Permalink | Comments (0) | TrackBack (0)

Wednesday, June 25, 2008

Checklists Adopted by WHO

The New York Times reports on the adoption by the WHO of a series of checklists to help reduce injuries and deaths during surgery.  Lawrence Altman writes,

The World Health Organization issued its first guidelines on Tuesday aimed at reducing complications and deaths from the rising numbers of operations now being performed.  The guidelines are a list of simple safety checks that the health organization said could halve the rate of surgical complications. The list is intended to improve anesthetic safety practices, avoid infections and improve communication among members of surgical teams.  For example, one guideline calls for all members of the masked surgical team to identify themselves and their roles and ask simple questions like, “Does everyone agree that this is Patient X, undergoing a hernia repair?”

Other recommendations call for marking the correct site for surgery to avoid operating on the wrong patient or performing the wrong procedure; giving an antibiotic within 60 minutes of making an incision, to reduce infections; checking for allergies to drugs; inserting two intravenous lines for operations involving substantial blood loss; and counting sponges and needles to ensure that none are left in a patient.

Dr. E. Patchen Dellinger, vice chairman of surgery at the University of Washington, which took part in the W.H.O. research, said that when the checklist was discussed with nonmedical people, “the most common reaction is the question: ‘You mean you haven’t been doing this all along?’ ”

The surgical guidelines grew out of a similar checklist aimed at reducing infections in hospitals. The infection guidelines were developed by Dr. Peter J. Pronovost of Johns Hopkins University, who borrowed the idea from the aviation industry, said Dr. Atul Gawande, of the Harvard School of Public Health.  Dr. Gawande and his team at Harvard had been asked by the W.H.O. to develop a method to reduce surgical deaths, and he said they used the infection guidelines as a model.

Three countries — Britain, Ireland and Jordan — have said they will put the surgery guidelines in force in all hospitals, Dr. Gawande said. Professional groups endorsing checklists include the American College of Surgeons, the American Society of Anesthesiology and the Association of Perioperative Registered Nurses. . . .

These checklists seem to be overdue and hopefully the fear that such helpful lists will create a standard for liability will not deter others from adopting such lists for their practices.

June 25, 2008 | Permalink | Comments (0) | TrackBack (0)

Practicing Medicine without a License

From my local paper,

A Hamilton County grand jury indicted a Fort Mitchell man today, accusing him of treating patients at a medical clinic even though he’s not a doctor.  Jack Lee Readnour, 64, was indicted on one count of possessing criminal tools and four counts of practicing medicine without a license. The charges carry a maximum prison sentence of five years.  Because the charges are the lowest-level felonies in Ohio, the charges carry the presumption of probation unless Readnour has a criminal history.

Readnour, 64, was arrested June 13 after a relative of a Readnour patient became suspicious and called authorities.  Readnour operated the Monfort Heights Family Clinic where police said he performed numerous medical procedures, including immunizations for children, mammograms and colonoscopies. Police don’t believe he performed surgeries.

Ohio’s medical board discovered Readnour never had applied for a medical license. He also doesn’t have a license to practice medicine in Kentucky.  The possession of criminal tools charges stems from the allegation that Readnour used computers, EKG machine and medical equipment to treat patients.

I am always surprised to read that individuals act in this manner.  How do think that they will get away with this?  Although I am also surprised that this individual seems to have been able to pass himself off as a doctor for so long. 

June 25, 2008 | Permalink | Comments (1) | TrackBack (0)

Monday, June 23, 2008

God Committees and Organ Shortages

Slate.com's Sally Satel has a short piece on "God Committees," and the history of how these committees operated and how decisions were and are now being made about the appropriate distribution of human organs among many needy individuals.  Ms. Satel argues for compensation for organs as a potential solution to the lack of organs which continues to exist despite educational efforts and more.    She writes,

According to a recent investigation by the Los Angeles Times, four members of the yakuza, the Japanese mafia, received liver transplants at the UCLA medical center between 2000 and 2004. Two of the four men later gave a $100,000 contribution to the medical center, prompting speculation that a cash promise got them bumped to the head of the transplant waiting list. The story suggested that this revelation could "have a chilling effect on organ donation." That worry already seems well-founded. "I'd say kill the gang members and take their organs to give to law-abiding citizens," read one of the hundreds of hostile posts on the Times' Web site. "You're not getting mine!" said another. "I'm removing my name from the Donor list immediately." A third charged that UCLA actually stands for "Universally Corrupt Liver Auctioneers."

In an op-ed, UCLA tried to defend itself. Dr. Gerald S. Levey, dean of the David Geffen School of Medicine at the university, denied that the men had been whisked in for operations ahead of others. As for the public outcry surrounding the moral standing of the Japanese men, he said, "those who argue that criminals should not get transplants are on shaky ethical ground. Do we want to force caregivers to make a life-or-death decision based on whether a patient is a 'good' or 'bad' person?"

It's a perfect storm of ethical anxieties: good organs going to bad people; medical professionals (perhaps) on the take; and, not least, a shudder of xenophobia. Levey is, of course, on entirely safe ground in arguing that physicians should not withhold vital treatment from their patients. But when resources are scarce—transplantable organs being the classic example—should some institution pass judgment when facts about a patient's criminality are known? No, says the United Network for Organ Sharing, which coordinates procurement and distribution of organs from the newly deceased. As Mark Fox, former head of the UNOS ethics committee, told me, "Once patients have been placed on the waiting list, the list itself is blind to whether you are a saint or sinner, a celebrity or a derelict."

There was a time, however, when character did determine access to scarce treatment. In devising a way to select patients, physicians imagined that the public preferred to think of decision-makers as wise stewards of scarce resources. In 1962, Seattle's Swedish Hospital established what later came to be called the "God Committee." Formally known as the Admissions and Policy Committee of the Seattle Artificial Kidney Center at Swedish Hospital, its task was to decide which terminal patient would get access to scarce dialysis machines, or artificial kidneys, as they were called then . . . .

Critics of the God Committee charged that rationing by measure of human worth was an affront to the ideal of equality. But in the face of scarcity, choices need to be made. . . .  This meant that the selection committees took nonmedical traits into account. For example, some tested IQ, personality, and the vocational skills of dialysis candidates. The Peter Bent Brigham dialysis program considered the likelihood of a return to productivity and cooperation with care. The Los Angeles County Dialysis Center screened for a group of medically, psychologically, and socially optimum candidates and then selected among them by lottery. The Cleveland Clinic allowed patients access to dialysis on a first-come, first-served basis and culled only if some proved unwilling or unable to cooperate once they had begun the therapy. Only a few centers explicitly disqualified candidates because of criminal records, spotty employment, or indigence. But the chances of being chosen if you fell into these categories were not good, because the traits in question suggested a lack of the material and emotional wherewithal to comply with the demands of lifelong dialysis treatment. . . .

No one wants to return to the days of the character biopsy—judging a patient's social value—in deciding who gets access to rare treatments. But the UCLA story and others like it will continue to offend our sense of fairness as long as the nation's dire organ shortage persists. The only way to dispel the ethical quandaries that stem from rationing is to expand the pool of organs so that more people can receive lifesaving transplants.

So far, we have failed on this front. After decades of public education about organ donation, the gap between supply and demand grows ever wider. Last year, more than 6,000 people died waiting for an organ that never came. Out of desperation, some patients travel abroad for transplants. They do so with the sickening knowledge that their new kidneys or livers will come from a poor native exploited by brokers in the underground organ bazaars that flourish across the globe.

It is time for the federal government to acknowledge that altruistic giving has not produced enough organs. Repealing the ban on donor compensation would permit the federal or state governments to devise a safe, regulated system in which would-be donors are rewarded for giving an organ to the next stranger on the list. If only the organ shortage itself provoked as much outrage as the UCLA mobster transplants.

June 23, 2008 | Permalink | Comments (0) | TrackBack (0)

Summer Reading

Perhaps you have some extra time this summer and are looking for an informative book about the corruptin of medical research, your search is over --  Professors Thomas O. McGarity and Wendy Wagner have written a new book entitled Bending Science:  How Special Interests Corrupt Public Health Research.   From the University of Texas Law School website,

Using alarming stories drawn from the public record, The University of Texas law professors Thomas O. McGarity and Wendy Wagner describe in a new book how advocates for special interests employ a range of devious tactics to manipulate or suppress research on potential human health hazards.  Harvard University Press is publishing the book, Bending Science: How Special Interests Corrupt Public Health Research. It is scheduled for release on May 31, 2008.

In their book, McGarity and Wagner describe how scientists can find their research blocked, or find themselves threatened with financial ruin. Corporations, plaintiff attorneys, think tanks, even government agencies have been caught suppressing or distorting research on the safety of chemical products.

Bending Science reveals that ideological and economic attacks on research are part of an extensive pattern of abuse and corruption, and the authors make a compelling case for reforms to safeguard both the integrity of science and the public health . . . .

To read an excerpt from the book on-line or order a book from Harvard University Press go to http://www.hup.harvard.edu/catalog/MCGBEN.html.

Thanks to Brian Leiter for the link.

June 23, 2008 | Permalink | Comments (0) | TrackBack (0)

Friday, June 20, 2008

Genetic Testing Regulation and Inspection

Earlier this week, California started inspecting genetic testing companies.  The LATimes reported,

California health regulators have dealt a blow to direct-to-consumer genetic testing start-ups by demanding that 13 companies halt sales in the state until they prove they have met quality and reliability standards.

The Department of Public Health sent the cease-and-desist letters last week, after an investigation spurred by consumer complaints about the tests' accuracy and costs, a department spokeswoman said Monday. The department said it would not identify the companies involved until it confirmed they had received the letters. It said they all advertised on the Internet. Two of the best-known companies to offer consumer genetic tests, Navigenics Inc. and 23andMe Inc., both confirmed receiving the letters.

All the companies have two weeks to demonstrate to regulators that their laboratories are certified by the state and federal governments, said department spokeswoman Lea Brooks.
They must also show that the tests currently being sold to California residents have been ordered by a doctor, as required by state law.  Companies face fines of as much as $3,000 a day if they don't comply.  The New York State Department of Health issued similar notices to nearly two dozen testing companies in April. . . .

The Food and Drug Administration does not evaluate the tests for accuracy, though a federal panel recently recommended stepped-up oversight to ensure their validity.

Many individuals have responded to the new genetic testing companies and the required inspections and certifications California requires.  The LATimes has collected some of the results and writes,

. . . .   Should a doctor's authorization be required for someone to obtain personal genetic testing? So far, California and New York state authorities say yes. But this debate is just beginning. The controversy is being played out this week on the many genetic medicine blogs. Daniel at Genetic Future writes:

"To a large extent what's going on here is a turf war between proponents of the old-school medical regulation model and upstart advocates of the free information paradigm of the Google generation."

Jason at TechCrunch suggests the lack of professional medical advice accompanying personal gene testing is troublesome, too:

"The problem with this kind of casual DNA testing is that it almost trivializes the importance of genetic information." . . .   

June 20, 2008 | Permalink | Comments (1) | TrackBack (0)

Superhero Quiz

Happy Friday and Longest Day of the Year.  Just for fun - Take the Superhero Quiz to find out your inner superhero personality. 

Thanks to Shakespeare's Sister for the quiz.

June 20, 2008 | Permalink | Comments (0) | TrackBack (0)

Thursday, June 19, 2008

AMA - Home Births Resolution

The AMA passed a resolution to introduce legislation to regulate home births.  Women's Health News provides some background on the resolution and states,

 The AMA did recommend for adoption an amended resolution (205) on home birth, as follows:

“That our AMA support state legislation that helps ensure safe deliveries and healthy babies by acknowledging of the concept that the safest setting for labor, delivery and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.”

Aren’t they just saying that certain types of trained professionals should be the only ones to attend home births?

Not exactly. There were also two resolutions on the table (204 & 239) that were combined and adopted as amended. They stated that the AMA should “support state legislation regarding appropriate physician and regulatory oversight of midwifery practice, under the jurisdiction of either state nursing and/or medical boards.” . .

The resolution also asks that the “American Medical Association only advocate in legislative and regulatory arenas for the for the licensing of midwives who are certified by the American College of Nurse-Midwives.”  In other words, the AMA is formalizing in the form of a resolution the notion that CNMs and CMs recognized by the ACNM should be the only legally practicing midwives, and that “lay” midwives (there is a lot of term confusion here, but CPMs, direct-entry, that type of thing) who are not regulated by a nursing/medical board (because they are not doctors or nurses by training/certification) should not be allowed to be licensed to practice under state regulations. . . .

In effect, encouraging states to explicitly make non-ACNM-certified midwives illegal would probably reduce the pool of available homebirth providers in a given state considerably, even though this particular resolution doesn’t specifically address home births. . . .

Midwives and some lay health care providers groups are quite concerned by the resolution as seen in this article at RH Reality Check.  Amie Newman writes,   

       

In an unmistakably insecure and aggressive move, the American Medical Association (AMA) adopted a resolution at its annual meeting last weekend to introduce legislation outlawing home birth - according to The Big Push for Midwives. . . .

"It's unclear what penalties the AMA will seek to impose on women who choose to give birth at home, either for religious, cultural or financial reasons-or just because they didn't make it to the hospital in time," said Susan Jenkins, Legal Counsel for The Big Push for Midwives 2008 campaign. "What we do know, however, is that any state that enacts such a law will immediately find itself in court, since a law dictating where a woman must give birth would be a clear violation of fundamental rights to privacy and other freedoms currently protected by the U.S. Constitution." . . . .

What the AMA's resolution and these other kinds of potential and actual legislation do is to open the door to penalizing motherhood, in effect. Because most of these legislative attempts do not directly address the issue, they leave the door dangerously open to criminalizing women for making the decisions they feel are best for themselves, their fetuses and their families.

Proposing this kind of legislation would also force women to birth in government-approved settings, a scenario that seems almost unbelievable. According to the Big Push for MIdwives:

Until the AMA proposed ‘Resolution 205 on Home Deliveries,' no state had considered legislation forcing women to deliver their babies in the hospital or limiting the choice of birth setting. Instead, states have regulated the types of midwives that may legally provide care. Currently, 22 states already license and regulate CPMs, who specialize in out-of-hospital maternity care and have received extensive training to qualify as experts in the types of risk assessment and preventive care necessary for safe and high-quality care for women who choose give birth at home. Certified Nurse Midwives (CNMs), who are trained primarily as hospital-based providers, are licensed in all 50 states and the District of Columbia.

The resolution did not offer any science-based information for the AMA's anti-midwife or anti-home birth position.  Steff Hedenkamp, Communications Coordinator for The Big Push for Midwives says, "Maternity care is a multi-billion dollar industry in the United States. So it's no surprise to see the AMA join the American College of Obstetricians and Gynecologists in its ongoing fight to corner the market and ensure that the only midwives able to practice legally are hospital-based midwives forced to practice under physician control. I will say, though, that I'm shocked to learn that the AMA is taking this turf battle to the next level by setting the stage for outlawing home birth itself-a direct attack on those families who choose home birth, who could be subject to criminal prosecution if the AMA has its way." . . . .

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

Health Reform and the Senate Finance Committee

Ezra Klein continues his praise for Prepare to Launch and Senator Max Baucus' efforts to raise awareness of health reform and what type of support such reform needs from the Senate Finance Committee.  He writes,

Whether anyone is actually more prepared today than they were two days ago is debatable. The various sessions of the Senate Finance Committee's "Prepare for Launch" Health Summit were informative enough but offered nothing the senators hadn't heard in previous testimony or read in memos from staff. No legislation was proposed, and no votes were taken. None of the senators set forth their reform plans or laid out the considerations that would drive their decisions.

Even so, it was arguably the most promising day for health reformers in a decade. The Finance Committee asserted its jurisdiction over crafting and passing a health-reform bill. And the committee's centrist chair, Max Baucus, asserted his commitment to the effort. If health reform is to pass, both of those things will need to be more than assertions; they will need to be proven true. . . .

So health-care reform requires a Finance Committee -- and a Finance Committee chairman -- interested and invested in passing a bill. In 1993, there was no such chairman. Many think that the original sin of the Clinton health-reform effort was Clinton's decision to choose Lloyd Bentsen, the canny chair of the Finance Committee, as his secretary of the Treasury, thus depriving the committee of his leadership. In his place came the mercurial, touchy Daniel Patrick Moynihan. Moynihan had many virtues, but he did not like the Clintons and did not want to do health reform. His intransigence and general lack of enthusiasm was crucial to emboldening the opposition and killing the bill. When Moynihan appeared on "Meet the Press" on September 19, 1993, three days before President Clinton was to give his speech calling for universal health care, and flatly stated that "there is no health-care crisis" and Clinton was using "fantasy numbers," it was an early sign that the effort was doomed. . . .

This time around, however, Baucus has given health reformers reason for optimism. He has staffed up, hiring Liz Fowler, a well-regarded health-policy staffer with immense Hill experience. He's held a series of hearings on the need to reform the system, inviting experts to testify on everything from the explosion in costs to the failures of the insurance market. More importantly, his statements at these hearings have been invariably action-oriented. He opened a recent session by saying, "Today let us talk again about health-care reform. Let us hear from the experts about how to do it right. And let us plan, next year, to actually do something about it."

Yesterday's "Prepare to Launch" event was his initiative and served as another opportunity for him to signal that he wanted to pass health reform through his committee. "Congress must prepare for the work of reforming the health-care system," he said in his opening statement. "We must develop common understandings of our system, the good and the bad, so we're ready to work towards reform." Questioning Federal Reserve Chairman Ben Bernanke after Bernanke's bloodless presentation, Baucus asked him to "drill down" on what would happen if the Senate didn't get health costs under control, prompting Bernanke to offer a dark vision of fiscal meltdown. Where most of the panel sessions featured two senators presiding over a panel of experts, Baucus hosted a viewing of the PBS Frontline documentary, Sick, which looks at other nations' health care systems and declares "When it comes to providing health care for people our nation is a fourth-rate power." Introducing the film, Baucus mused, "We Americans can be a bit smug. We figure we can't learn from everyone else because we're the biggest and the best. But I think the time has come for America to learn a bit from these other countries."

The final event of the day was a roundtable discussion among the members that was, by turns, hopeful, tetchy, and constructive. The content, however, was secondary to the optics. This was the whole of the relevant committee, sitting in a single room, talking through health reform. It was a photo op, yes, but a promising one. By publicly asserting jurisdiction on health reform, the Finance Committee is also taking responsibility for it. If the effort fails, it will be on their heads. And none will receive more blame then Baucus. Summing it up, Baucus said, "I don't know of anything more daunting than trying to solve health care. But hey, we're masochists! It's why we signed up for this job." . . .

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

Wednesday, June 18, 2008

ADHD as a Beneficial Adaptive Trait?

Slate.com's WIlliam Saletan has a brief article discussing ADHD and its evolutionary origins.  He writes that an understand of its potential usefulness in the past may help our society to adopt to ADHD rather than forcing individuals with ADHD to adopt to our societal standards.  He says,

. . . . A new study suggests that this ADHD-friendly world may actually be part of our past.
The study, led by Dan Eisenberg of Northwestern University and published in BMC Evolutionary Biology, examined a Kenyan tribe called the Ariaal. Part of the tribe has recently settled into an agricultural community. Another part remains nomadic. The tribesmen were tested for DRD4 7R, a genetic variant that, Eisenberg notes, "has been linked to greater food and drug cravings, novelty-seeking, and ADHD symptoms." He and his colleagues report:

DRD4 7R+ genotypes were associated with indices of better nutritional status among nomads, particularly higher fat free mass, but worse indices in the settled individuals. This suggests that the 7R allele confers additional adaptive benefits in the nomadic compared to sedentary context. . . . .

But how would the gene help nomads? The authors speculate:

Increased impulsivity, ADHD-like traits, novelty-seeking like traits, aggression, violence and/or activity levels may help nomads obtain food resources, or exhibit a degree of behavioral unpredictability that is protective against interpersonal violence or robberies. …

I don't know whether the speculated reasons for the gene's benefits will pan out. But the benefits do seem real. And that finding suggests two things. First, we should be careful about designating diseases and disease genes. Traits that are harmful in one setting can be helpful in another. Advantages or "defects" that we think of as natural may actually be products of our cultural decisions. As Eisenberg puts it, we might "begin to view ADHD as not just a disease but something with adaptive components."

Second, our society may be the wrong place to assess a gene's evolutionary harm or benefit. As the authors note, "[N]on-industrialized or subsistence environments … may be more similar to the environments where much of human genetic evolution took place." . . . .

The lesson of the Ariaal study is simply that society can adapt to genes instead of the other way around. Maybe we don't have to screen and chuck embryos for every "disease" gene, or drug the kids once they're born. Maybe we can put ADHD kids in educational settings more like the dynamic environment of our nomad forebears. And maybe we can raise kids with fat-storage genes in settings less full of food. . . .

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

Searching for a New Surgeon General

McClatchy News reports that Dr. James W. Holsinger is unlikely to be the next Surgeon General.  Halimah Abdullah writes,

Sen. Jim Bunning, one of Dr. James W. Holsinger Jr.'s staunchest supporters in his bid to become U.S. surgeon general, suggested Tuesday that the physician's quest for the nation's top medical post is at an end.  During a telephone press conference Tuesday, Bunning said he doubts Holsinger's nomination will move forward. Bunning cited the Democratic leadership's blockage of several Bush administration-backed judicial appointments -- a move that has rankled both of Kentucky's senators. . . .   Meanwhile, both the White House and Senate Minority Leader Mitch McConnell said Holsinger's nomination is still alive. . . .

Holsinger served as Gov. Ernie Fletcher's secretary for health and family services from 2003 through 2005, was a professor and chancellor of the University of Kentucky's medical center for nine years in addition to other academic and administrative medical school posts across the country, and served for 26 years in the Department of Veterans Affairs. He also served for more than 30 years in the U.S. Army Reserve.  He has a master's degree in biblical studies from Asbury Theological Seminary in Wilmore. He obtained his medical degree in 1964 and a doctorate in anatomy in 1968, both from Duke University. . . .

From the moment his name emerged as a potential U.S. surgeon general, Holsinger's nomination was rife with controversy. Last year, Holsinger faced a firestorm of criticism from gay rights groups, the National Organization for Women, the American Public Health Association and some public health experts for a Methodist church paper he wrote in 1991 titled "Pathophysiology of Male Homosexuality," which described same-sex intercourse as incompatible with Christian teaching.

Holsinger distanced himself from the paper during a July Senate hearing, saying the comments don't reflect his current views. However, Senate Democrats refused to move forward with a confirmation until Holsinger completed written responses to questions posed by members of the Senate Health, Education, Labor and Pensions Committee. Democrats stayed in session over December's holiday break to prevent President Bush from naming the physician to the post in a recess appointment.

Dr. Steven Galson, a rear admiral in the U.S. Public Health Service, was named acting surgeon general last fall. . . .

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

Tuesday, June 17, 2008

Medicare Fraud - Too Easy

The Washington Post reported on last Friday some rather shocking facts about Medicare Fraud - and how easy it appears to be.  Carrie Johnson writes,

All it took to bilk the federal government out of $105 million was a laptop computer.  From her Mediterranean-style townhouse, a high school dropout named Rita Campos Ramirez orchestrated what prosecutors call the largest health-care fraud by one person. Over nearly four years, she electronically submitted more than 140,000 Medicare claims for unnecessary equipment and services. She used the proceeds to finance big-ticket purchases, including two condominiums and a Mercedes-Benz.

Health-care experts say the simplicity of Campos Ramirez's scheme underscores the scope of the growing fraud problem and the need to devote more resources to theft prevention. Law enforcement authorities estimate that health-care fraud costs taxpayers more than $60 billion each year.

A critical aspect of the problem is that Medicare, the health program for the elderly and the disabled, automatically pays the vast majority of the bills it receives from companies that possess federally issued supplier numbers. Computer and audit systems now in place to detect problems generally focus on overbilling and unorthodox medical treatment rather than fraud, scholars say.

"You should be able to spot emerging problems quickly and address them before they do much harm," said Malcolm Sparrow, a Harvard professor and author of "License to Steal," a book about health-care fraud that advocates for greater federal vigilance. "It's a miserable pattern, a cycle of neglect followed by a painful and dramatic intervention."

Fallout from the Campos Ramirez case continues. After pleading guilty to filing false claims, she has helped authorities win indictments against more than half a dozen doctors and patients who allegedly accepted kickbacks for pretending to receive costly HIV drug therapy. With cooperation from Campos Ramirez, FBI agents this week arrested three Miami-area men who, the government alleges, financed sham clinics that billed the government more than $100 million.

Daniel R. Levinson, the inspector general of the Department of Health and Human Services, has warned repeatedly that the Medicare program is "highly vulnerable" to fraud, particularly in South Florida, where schemes center on expensive, infusion-based HIV medications and on equipment such as wheelchairs, walkers, canes and hospital beds.

Officials from the Centers for Medicare and Medicaid Services (CMS), which oversees federally funded health programs, say they have stepped up their efforts to combat fraud over the past year by working closely with investigators, removing the requisite billing numbers of nearly 900 companies and imposing new standards in high-fraud areas that would prevent people convicted of felonies from ever receiving a Medicare number. . . . .   

Officials who oversee the Medicare program say they are vigilant despite time pressure and limited resources. Employees review fewer than 5 percent of the nearly 1 billion claims filed each year. The vast majority of claims shuttle through computer systems that are tweaked when authorities notice fraud patterns. This year, CMS is working to finalize a rule that would prevent convicted felons from obtaining Medicare billing numbers. At present, that regulation applies only in a few high-fraud regions.  "It's a big volume," Brandt said. "No matter how hard we try to get people trained, there's always going to be a margin of error."

Sentenced to 10 years, Campos Ramirez, 60, may yet reduce her prison term by helping authorities unwind "the large web of medical clinics, doctors, nurses, money laundering companies and HIV clinic financiers who participated in this massive fraud," prosecutors wrote earlier this year in court papers. Her lawyer did not return calls seeking comment. . . . 

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

Harriet McBryde Johnson

A little over a week ago, disability rights activist, Harriet McBryde Johnson passed away at age 50.  The New York Times reports,

Harriet McBryde Johnson, a feisty champion of the rights of the disabled who came to prominence after she challenged a Princeton professor’s contention that severely disabled newborns could ethically be euthanized, died on Wednesday at her home in Charleston, S.C. She was 50.

No cause has been determined, her sister, Beth Johnson, said, while pointing out that her sister had been born with a degenerative neuromuscular disease. “She never wanted to know exactly what the diagnosis was,” Beth Johnson said.  The condition did not stop Harriet Johnson from earning a law degree, representing the disabled in court, lobbying legislators and writing books and articles that argued, as she did in The New York Times Magazine in February 2003, “The presence or absence of a disability doesn’t predict quality of life.” . . .

“Her impact came mostly from her writing,” said Laura Hershey, a disability rights activist with several organizations, including Not Dead Yet. “Millions of people by now have read that article, and it was reprinted in her book. Dozens of people who read the article told me, ‘Wow, I never thought about it that way.’ ”  Ms. Johnson’s memoir, “Too Late to Die Young,” was published in 2005. Her novel, “Accidents of Nature,” about a girl with cerebral palsy who had never known another disabled person until she went to camp, was published in 2006.

Born in Laurinburg, N.C., on July 8, 1957, Ms. Johnson was one of five children of David and Ada Johnson. Her parents taught foreign languages at colleges. Besides her parents and her sister, Ms. Johnson is survived by three brothers, Eric, McBryde and Ross.

The fact that her parents could afford hired help was a salient point in another Times Magazine article Ms. Johnson wrote in November 2003, “The Disability Gulag.” Describing institutions where “wheelchair people are lined up, obviously stuck where they’re placed” while “a TV blares, watched by no one,” she called for a major shift from institutionalizing people to publicly financing home care provided by family, friends or neighbors.

“I sometimes dare to dream that the gulag will be gone in a generation or two,” she wrote. “But meanwhile, the lost languish in the gulag.”

Early on, Ms. Johnson was a troublemaker. At 14, at a school for the disabled, her sister said, “Harriet tried to get an abusive teacher fired; the start of her hell raising.” In her memoir, Ms. Johnson describes how, after watching a Jerry Lewis muscular dystrophy telethon while in her teens, she turned against “the charity mentality” and “pity-based tactics.”

Ms. Johnson graduated from Charleston Southern University in 1978, then earned a master’s degree in public administration from the College of Charleston. She graduated from the University of South Carolina School of Law in 1985 and soon went into private practice. . . .

More on Ms. Johnson's life can be found here

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