HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

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Saturday, November 8, 2008

New U.S. Rule Pares Outpatient Medicaid Services

The New York Times reports that in the first of an expected avalanche of post-election regulations, the Bush administration on Friday narrowed the scope of services that can be provided to poor people under Medicaid's outpatient hospital benefit.  Robert Pear writes,

Stethescope3In the first of an expected avalanche of post-election regulations, the Bush administration on Friday narrowed the scope of services that can be provided to poor people under Medicaid’s outpatient hospital benefit.

Public hospitals and state officials immediately protested the action, saying it would reduce Medicaid payments to many hospitals at a time of growing need.

The new rule conflicts with efforts by Congressional leaders and governors to increase federal aid to the states for Medicaid as part of a new economic action plan.

President-elect Barack Obama has endorsed those efforts. At a news conference on Friday, he said that legislation to stimulate the economy should include “assistance to state and local governments” so they would not have to lay off workers or increase taxes.

In a notice published Friday in the Federal Register, the Bush administration said it had to clarify the definition of outpatient hospital services because the current ambiguity had allowed states to claim excessive payments.

“This rule represents a new initiative to preserve the fiscal integrity of the Medicaid program,” the notice said.

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November 8, 2008 | Permalink | Comments (0) | TrackBack (0)

Army General Defies Culture of Silence on Mental Health

The Washington Post reports on an Army General who spoke out from the culture of silence on mental health by seeking treatment and advocating for others to do the same.  Pauline Jelinek writes,

HelicopterIt takes a brave soldier to do what Army Maj. Gen. David Blackledge did in Iraq.

It takes as much bravery to do what he did when he got home.

Blackledge got psychiatric counseling to deal with wartime trauma, and now he is defying the military's culture of silence on the subject of mental health problems and treatment.

"It's part of our profession ... nobody wants to admit that they've got a weakness in this area," Blackledge said of mental health problems among troops returning from America's two wars.

"I have dealt with it. I'm dealing with it now," said Blackledge, who came home with post-traumatic stress. "We need to be able to talk about it."

As the nation marks Veterans Day on Tuesday, thousands of troops are returning from Iraq and Afghanistan with anxiety, depression and other emotional problems.

As many as one-fifth of the more than 1.7 million who have served in the wars are estimated to have symptoms. In a sign of how tough it may be to change attitudes, roughly half of those who need help are not seeking it, studies have found.

Despite efforts to reduce the stigma of getting treatment, officials say they fear generals and other senior leaders remain unwilling to go for help, much less talk about it, partly because they fear it will hurt chances for promotion.

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November 8, 2008 | Permalink | Comments (2) | TrackBack (0)

Friday, November 7, 2008

At the End of Life, a Delicate Calculus

The New York Times reports on Tuesdays election, where Washington State joined Oregon as the second in the nation to allow physicians to prescribe lethal doses of medication to terminally ill men and women who want to hasten their own deaths.  Jane Gross writes,

Stethescope4The Washington State proposition, Initiative 1000 (PDF), passed by a margin of 59 to 41 percent, and like the Oregon measure, which withstood several legal challenges, contains many safeguards intended to prevent hasty and ill-considered decisions. Patients requesting this assistance must be mentally competent, residents of the state, have six months or less to live according to two physicians, wait 15 days after their initial request and then repeat that request both orally and in writing. They must be capable of administering the lethal medication themselves and agree to counseling if their physicians request it. In addition, these patients also must be informed by their health care providers of other feasible alternatives.

In the view of Dr. Timothy E. Quill, director of the palliative care program at the University of Rochester, these options have expanded and gained acceptance in medical circles over the past decade. In 1997, in two important cases (Dr. Quill was a plaintiff in one), the U.S. Supreme Court ruled there was no constitutional right to physician-assisted suicide and upheld a prohibition against it. But in the same ruling, the justices conceded that terminally ill patients are entitled to aggressive pain management, even if high doses of opiates or barbiturates have the “double effect” of hastening death.

That seemed a footnote at the time to the larger issue, but it arguably cracked open the door to those other feasible options, which Dr. Quill and other end-of-life experts refer to as “last resorts” in jurisdictions where it is a crime for physicians to assist in dying.

Dr. Quill’s views on physician-assisted death — a term preferred by many palliative care doctors and right-to-die organizations — are outlined in two essays published by the Hastings Center, the nation’s oldest bioethics research institute. One, entitled “Physician-Assisted Death in the United States: Are the Existing ‘Last Resorts’ Enough?” appeared in the center’s bimonthly report this fall. The other, intended to be a resource for policymakers, political candidates and journalists, is one of 36 topics framed and amplified in the center’s more recent “Bioethics Briefing Book.”

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November 7, 2008 | Permalink | Comments (1) | TrackBack (0)

Hospitals See Drop in Paying Patients

The New York Times reports that in another sign of the economy’s toll on the nation’s health care system, some hospitals say they are seeing fewer paying patients even as greater numbers of people are showing up at emergency rooms unable to pay their bills.  Reed Abelson writes,

Stethescope_7While the full effects of the downturn are likely to become more evident in coming months as more people lose their jobs and their insurance coverage, some hospitals say they are already experiencing a fall-off in patient admissions.

Some patients with insurance seem to be deferring treatments like knee replacements, hernia repairs and weight-loss surgeries — the kind of procedures that are among the most lucrative to hospitals. Just as consumers are hesitant to make any sort of big financial decision right now, some patients may feel too financially insecure to take time off work or spend what could be thousands of dollars in out-of-pocket expenses for elective treatments.

The possibility of putting off an expensive surgery or other major procedure has now become a frequent topic of conversation with patients, said Dr. Ted Epperly, a family practice doctor in Boise, Idaho, who also serves as president of the American Academy of Family Physicians. For some patients, he said, it is a matter of choosing between such fundamental needs as food and gas and their medical care. “They wait,” he said.

The loss of money-making procedures comes at a difficult time for hospitals because these treatments tend to subsidize the charity care and unpaid medical bills that are increasing as a result of the slow economy.

“The numbers are down in the past month, there’s no question about it,” said Dr. Richard Friedman, a surgeon at Beth Israel Medical Center in New York, although he said it said it was too early to call the decline a trend.

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

Thursday, November 6, 2008

D.C. Hospital Sues to Remove 12 Year Old Boy From Life Support

The Washington Post reports that the parents of a 12-year-old boy are trying to prevent a hospital from taking him off life support because they say their faith does not define death as cessation of brain function alone.  Del Quentin Wilber writes,

Gavel4The family of a 12-year-old New York boy is entangled in a legal fight with Children's National Medical Center over whether doctors can cease life support because they believe he is brain-dead.

The dispute involves Motl Brody of Brooklyn, who was diagnosed with a severe form of brain cancer. The boy has been under the care of the Northwest Washington hospital for about six months. His tumor grew progressively worse, and doctors there pronounced him dead Tuesday night after tests showed no signs of brain activity.

His parents, Eluzer and Miriam Brody, are trying to prevent the hospital from taking him off life support because they say their faith does not define death as cessation of brain function alone. The parents, Orthodox Jews, have retained a lawyer who says that the boy's circulatory and respiratory systems are functioning, although with mechanical and other assistance.

"Under Jewish law and their faith, there is no such thing as brain death," said the parents' attorney, Jeffrey Zuckerman. "Their religious beliefs are entitled to respect."

The hospital has taken the dispute to D.C. Superior Court. In filings, the hospital extended its sympathy to the family but said the boy should no longer be on its equipment, saying that "scarce resources are being used for the preservation of a deceased body."

Under D.C. law, doctors can declare patients dead if there is no brain activity. The hospital wants a court order, over the parents' objections, that affirms its plan to disconnect the boy from a ventilator and to discontinue intravenous medications that keep his heart beating.

But Zuckerman says that doing so would infringe upon religious freedom.

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

First-Ever Mapping of Cancer Patient's Genome

The Washington Post reports that researchers have decoded the complete DNA sequence of a person with leukemia and discovered earlier unknown mutations associated with the blood cell cancer.  Ed Edelson writes,

Dna2In a genetics first, researchers report that they have decoded the complete DNA sequence of a person with acute myelogenous leukemia.

There were some surprises -- eight previously unknown mutations, along with two already identified genetic alterations, were associated with the blood cell cancer.

But more importantly, it is now possible to detect individual genetic differences for each case of cancer, said study senior author Richard K. Wilson, director of the Washington University Genome Sequencing Center, in St. Louis.

"We found mutations in genes that make a lot of sense when normal cells become cancer cells," Wilson explained. "That they seem to be fairly unique to this particular patient says on the one hand that this is a complicated disease. But the complications validate our approach -- we have to look at a number of patients to see not only what is different but what they have in common."

The feat brings the routine use of genomic screens for cancer patients a little closer, one expert said.

"Technically, this is a great achievement," added Richard Gibbs, director of the Human Genome Sequencing Center at Baylor College of Medicine, in Houston. "This really is a new era, based on genome studies. There is real clinical applicability, and that is what's remarkable about it."

The findings were reported in the Nov. 6 issue of Nature.

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

Wednesday, November 5, 2008

Obama Makes History: "Yes, We Can"

The Washington Post reports on last night's election.  The U.S. decisively elects its first African American President and the democrats expand control of Congress.  Robert Barnes and Michael D. Shear write,

Barack_obama_4Sen. Barack Obama of Illinois was elected the nation's 44th president yesterday, riding a reformist message of change and an inspirational exhortation of hope to become the first African American to ascend to the White House.

Obama, 47, the son of a Kenyan father and a white mother from Kansas, led a tide of Democratic victories across the nation in defeating Republican Sen. John McCain of Arizona, a 26-year veteran of Washington who could not overcome his connections to President Bush's increasingly unpopular administration.

Standing before a crowd of more than 125,000 people who had waited for hours at Chicago's Grant Park, Obama acknowledged the accomplishment and the dreams of his supporters.

"If there is anyone out there who still doubts that America is a place where all things are possible, who still wonders if the dream of our founders is alive in our time, who still questions the power of our democracy, tonight is your answer," he said just before midnight Eastern time.

"The road ahead will be long. Our climb will be steep. We may not get there in one year or even one term, but America, I have never been more hopeful than I am tonight that we will get there. I promise you: We as a people will get there."

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November 5, 2008 | Permalink | Comments (1) | TrackBack (0)

Obama's Victory Speech

Barack_obama_2_3If you couldn't stay up late last night for Obama's victory speech or just want to hear or read it again, the New York Times has provided the clip and transcription.

Watch Obama's Victory Speech

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

Biden Sees Vice President's Role as 'Adviser in Chief,' Aides Say

The Washington Post reports on the new Vice President, Joseph Biden. Perry Bacon Jr. writes,

BidenVice President-elect Joseph R. Biden Jr. sees his role in Barack Obama's administration as "adviser in chief," using his decades of experience in the Senate to offer the president candid input on domestic and foreign policy issues, according to Biden aides.

But Biden, a twice-failed presidential candidate, will not use the post in a way many vice presidents have: to make a play for the Oval Office. He has said publicly that he does not intend to run for the presidency again.

Although Vice President Cheney has performed a similar role in the Bush administration, advising the president on key issues, meeting with congressional leaders and eschewing his own presidential run, Biden intends to operate differently. In the vice presidential debate last month, Biden called Cheney "the most dangerous vice president we've had probably in American history," and he has criticized Cheney for excessive secrecy and holding too much power in the Bush White House.

"There will be cc's and not bcc's," said Antony Blinken, a top Biden adviser, referring to the practice in the current administration in which Cheney aides receive e-mails on key matters, but without other recipients knowing the vice president's staff is involved. "There is not going to be a shadow operation."

Biden aides said the senator from Delaware does not intend to take on a defining issue, as Al Gore sought to do with his "reinventing government" initiative, which aimed to improve the efficiency of the federal bureaucracy. Biden's team says such a project distracts from a vice president's ability to serve as a general adviser to the president.

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

Tuesday, November 4, 2008

The Value of Voting, Beyond Politics

The New York Times discusses that although psychologists and neuroscientiests have tried to determine how people make voting decisions by taking brain scans and comparing how certain messages or images activate emotion centers, none of this has helped predict people's behavior in elections any more than a half-decent phone survey.  Benedict Carey writes,

Vote_5For those who love the civic cheer and lukewarm coffee of their local polling place, an absentee ballot has all the appeal of a tax form. The paperwork, the miniature type, the search (in some states) for a notary public: it’s a tedium bath, and Pam Fleischaker, a lifelong Democrat from Oklahoma City, had every reason to take a pass this year.

Ms. Fleischaker, 62, was in New York recovering from a heart transplant, for one. And in her home state, the Democratic candidate, Senator Barack Obama, was polling hopelessly behind his opponent, Senator John McCain. She mailed in her absentee packet anyway, and hounded her two children, also in New York, to do the same.

“That one vote isn’t going to be decisive makes no difference to me,” Ms. Fleischaker said in a telephone interview last week. “Your vote is your voice, and there’s more power in it than in most of the things we do. It’s a lost pleasure, the feeling of that power.”

In recent years psychologists and neuroscientists have tried to get a handle on how people make voting decisions. They have taken brain scans, to see how certain messages or images activate emotion centers. They have spun out theories of racial bias, based on people’s split-second reactions to white and black faces. They have dressed up partisan political stereotypes in scientific jargon, describing conservatives as “inordinately fearful and craving order,” and liberals as “open-minded and tolerant.”

None of which has helped predict people’s behavior in elections any more than a half-decent phone survey. The problem is not only sketchy science, some experts say; it’s that researchers don’t agree on the answer to a more fundamental question: Why do people vote at all?

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November 4, 2008 | Permalink | Comments (1) | TrackBack (0)

Court Blocks White House Push on Medicare Expenses

The New York Times reports that a federal court has blocked the Bush administration’s effort to save money on Medicare by paying for only the least expensive treatments for particular conditions.  Robert Pear writes,

The case, just now being scutinized by Medicare officials and consumer advocates, involved drugs used to treat chronic obstructive pulmonary disease.

Judge Henry H. Kennedy Jr. of Federal District Court here said the policy of paying for only “the least costly alternative” was not permitted under the Medicare law.

The administration’s position would give the health and human services secretary “enormous discretion” to determine the amount paid for every item and service covered by Medicare, without reference to the detailed formulas set by Congress, Judge Kennedy said. “This flies in the face of the detailed statutory provisions,” he added.

Over the years, Medicare officials have often tried to adopt regulations that allow them to consider cost in deciding whether the program should cover various goods and services. Health care providers, manufacturers and some patients’ advocates have resisted these efforts, saying that coverage decisions should be made based on clinical effectiveness and not cost.

“We are disappointed with the ruling and continue to believe that our policy is supported by the statute,” Peter L. Ashkenaz, a spokesman for the federal Centers for Medicare and Medicaid Services, said Monday. “We are still considering our options and next steps.”

Federal health officials said the decision would make it more difficult to rein in Medicare costs.

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November 4, 2008 | Permalink | Comments (1) | TrackBack (0)

Monday, November 3, 2008

Lean Economy, Fatty Diet

The Los Angeles Times reports that when money's tight, many people switch to cheap, unhealthful processed foods.  Karen Ravn writes,

String_beans Prices are way down on the stock market and way up at the grocery store. Just thinking about it could make you lose your appetite -- or, alternatively, give you a serious craving for some comfort food. Indeed, as the economy flags, sags and drags, there's talk that it could affect the way people eat, and even how much they weigh.

You might imagine that high food prices could put the nation on a diet as people, strapped for cash, tighten their belts and eat less. Forget that idea. Many nutrition experts fear that soaring food prices will have the opposite effect -- fatten up the nation.
They point to science showing that price changes can make people change what they buy as well as how much. As the price of one food goes up, people not only buy less of it, but they also sometimes buy other, cheaper food in its place. And cheaper foods tend to have more calories than those with a higher price tag. For instance, as the price of oranges goes up, people don't buy as many oranges. And some may decide to buy cookies instead. Today, "people are eating cheap, unhealthy food who never thought they would be," says Adam Drewnowski, director of the Center for Obesity Research at the University of Washington in Seattle.

It's no accident that high-calorie foods (chips, dips, cookies, candy) are generally cheaper than low-calorie foods (broccoli, asparagus, peaches, blueberries). Processed foods are cheaper to produce, ship and store. As researchers note, this is partly due to agricultural policies, which could be changed, and partly due to the nature of the foods themselves, which can't.

"You can see how this situation could fuel both under-nutrition and over-nutrition," says Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University in New Haven, Conn.
But despite the fact that a diet could easily get derailed during these lean economic times, it doesn't have to be that way. In a related story, we provide some simple tips to help you stay on track and eat cheaply -- and healthfully.

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November 3, 2008 | Permalink | Comments (0) | TrackBack (0)

12 Things You Should Know About Aspirin

US News offers twelve benefits and limitations of taking aspirin.  Sarah Baldauf writes,

AspirinAspirin, that old standard in everyone's medicine chest, can really pack a wallop. So much so that the American Heart Association has long recommended aspirin therapy for people who've had a heart attack, stroke caused by blood clot, unstable angina, or "ministrokes." The AHA also notes that even people who have not experienced such an event but who are at increased risk because of family history, say, may also stand to gain from aspirin therapy.

We're certainly familiar with our aspirin: About 60 percent of people ages 65 and older pop aspirin at least once a week. But this cheap, over-the-counter pill is not benign, and regular use should be discussed with a doctor. And beware marketing claims. Bayer was sent warning letters by the Food and Drug Administration today for touting two products—Bayer Women's Low Dose Aspirin + Calcium (Bayer Women's) and Bayer Aspirin with Heart Advantage (Bayer Heart Advantage)—for making unproved health claims.

Along with its benefits, aspirin has limitations, too. A roundup of recent research suggests taking aspirin regularly may do the following:

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November 3, 2008 | Permalink | Comments (1) | TrackBack (0)