HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

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Friday, October 17, 2008

As Budgets Tighten, More People Decide Medical Care Can Wait

The Washington Post reports that the global economic crunch is forcing a growing number of Americans to scale back on medical care as they push off seemingly less urgent services in the hope their financial health will improve.  Ceci Connolly and Kendra Marr write,

Medicare_3To monitor the multiple sclerosis attacking Ann Pietrangelo's central nervous system, her doctor recommends an annual MRI. Last year, the 49-year-old Winchester, Va., woman had to pay a $3,000 co-payment to get the imaging done.

This year, she's skipping the test. Even with insurance, it's more than her budget can tolerate, especially with the roller coaster on Wall Street devouring her retirement savings.

"I'm doing everything I can to avoid going to the doctor," she said.

From Park Avenue dental offices to the Arlington Free Clinic, the global economic crunch is forcing a growing number of Americans to scale back on medical care. Consumers are attempting their own form of triage, pushing off seemingly less-urgent services in the hope that their financial health will improve. But the danger, say physicians, is that the short-term savings may translate into more severe long-term health implications.

At the extreme are cases such as the Texas woman who went to the hospital complaining of back pain. Physician Doug Curran immediately spotted cancer on the X-ray.

"She'd had a lump in her breast for a while, but things were tight and she said she couldn't get it looked at," he recalled. "We're going to see more of that."

Nationwide, the number of consumers who went without a prescription, tapped into retirement savings to pay for health care or skipped a doctor visit for themselves or a child has risen since last year, according to a survey released this summer by the Rockefeller Foundation and Time magazine. One-quarter of the 2,000 respondents, for example, said they had decided not to see a doctor because of cost in 2008, up from 18 percent the year before. Ten percent said they did not take a child to the doctor for the same reason.

"When the economy is in the situation we have today, people make tough choices," said Kansas Insurance Commissioner Sandy Praeger, who is head of the National Association of Insurance Commissioners. "Things are just not going to get done."

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

States Ask Baby Product Companies to Avoid BPA

The Washington Post reports that attorneys general from Connecticut, New Jersey and Delaware sent letters Friday to eleven companies that make baby bottles and baby formula containers, asking that they no longer use the chemical bisphenol A (BPA) in their manufacturing despite the FDA's tentative conclusion that BPA is safe.  Larry Smith writes,

Baby_bottleThe Food & Drug Administration has tentatively concluded that BPA is safe based on a review of research, and some manufacturers have already said they would make BPA-free baby bottles.

But Connecticut Attorney General Richard Blumenthal criticized the FDA for declining to take action after a preliminary study last month drew a possible connection to BPA and risks of heart disease and diabetes.

"Unfortunately the federal agency, the Federal Food and Drug Administration, has been asleep at the switch, in fact resistant to respecting the scientific evidence that grave harm can result in use of this product," Blumenthal said.

Scientists are at odds about the risks of BPA. A preliminary study released last month by the Journal of the American Medical Association suggested that adults exposed to higher amounts of the chemical were more likely to report having heart disease and diabetes. The study doesn't provide proof, although its authors said the results deserve scientific follow-up.

Michael Herndon, an FDA spokesman, said Monday that the agency is continuing to evaluate its risk assessment.

More than 90 percent of Americans have traces of BPA in their bodies, but the FDA says the levels of exposure are too low to pose a health risk, even for infants and children. Other scientists, however, say BPA has been shown to affect the human body even at low levels.

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

Thursday, October 16, 2008

Infant Deaths Drop in U.S., but Rate Is Still High

The New York Times reports that according to government researchers, infant deaths in the United States declined 2 percent in 2006, but the rate still remains well above that of most other industrialized countries and is one of many indicators suggesting that Americans pay more but get less from their health care system.  Gardiner Harris writes,

Infant_mortality_wwwnytimescom

Infant mortality has long been considered one of the most important indicators of the health of a nation and the quality of its medical system. In 1960, the United States ranked 12th lowest in the world, but by 2004, the latest year for which comparisons were issued by the Centers for Disease Control and Prevention, that ranking had dropped to 29th lowest.

This international gap has widened even though the United States devotes a far greater share of its national wealth to health care than other countries. In 2006, Americans spent $6,714 per capita on health — more than twice the average of other industrialized countries.

Some blame cultural issues like obesity and drug use. Others say that the nation’s decentralized health care system is failing, and some researchers point to troubling trends in preterm births and Caesarean deliveries.

Many agree, however, that the data are a major national concern. More than 28,000 infants under the age of 1 die each year in the United States.

“Infant mortality and our comparison with the rest of the world continue to be an embarrassment to the United States,” said Grace-Marie Turner, president of the Galen Institute, a conservative research organization. “How can we get better outcomes?”

The data, collected by the Centers for Disease Control and Prevention, indicate that the nation’s infant mortality rate has been static for years despite enormous advances in the care given to preterm infants. Two-thirds of the infant deaths are in preterm babies.

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October 16, 2008 | Permalink | Comments (1) | TrackBack (0)

Hospitals Protest New California Rules on Patient Billing

The Los Angeles Times reports that hospitals are protesting in court new rules that will bar hospitals and physicians from billing patients for the balance of emergency care not covered by insurers.  Lisa Girion writes,

Stethescope6Emergency room patients can no longer be stuck with the bill when hospitals or physicians disagree with insurance companies on their fees.

Under new state rules that take effect today, hospitals and physicians are barred from billing patients for the balance of emergency care not covered by insurers.
But the relief for patients may not last long. Hospitals and physicians are protesting the rules in court. Meanwhile, the state Supreme Court is set to hear another "balance billing" challenge next month.

And another court test may come sooner in a challenge by hospital chain Prime Healthcare Services Inc. of Victorville.

In that case, set for hearing this month, the state Department of Managed Health Care sued Prime. The state is seeking to bar Prime from billing insured patients for unpaid medical bills that the hospital chain contends it is owed from insurers and is seeking from patients as a last resort.
Department director Cindy Ehnes said she was moving forward with the ban on emergency room balance billing in spite of the legal disputes because of the hardship the practice creates for patients.

She called Prime Healthcare a "serial balance biller whose actions have unjustly threatened the credit rating of thousands of Californians." Ehnes said she wanted to take patients out of the middle of billing disputes between insurers, hospitals and physicians.

"No longer will Californians face the possibility that if they have to use an emergency room, they may be stuck with a bill, asking them to pay a second time for emergency care, which they already purchased with their [insurance] policy," she said.

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October 16, 2008 | Permalink | Comments (0) | TrackBack (0)

Wednesday, October 15, 2008

Researchers Decode the Genome of Two More Malaria Parasites

The New York Times reports that scientists have now sequenced the genome of two more malaria parasites, Plasmodium vivax and Plasmodium knowlesi.  Donald G. McNeil Jr. writes,

ScientistSix years after the genome of the most deadly malaria parasite was decoded, scientists have now sequenced two others, opening the way for research into new drugs and vaccines.

Plasmodium falciparum, which is most common in Africa and is responsible for most malaria deaths, was sequenced in 2002; now a team of 40 scientists from around the world, led by a New York University researcher, has untangled Plasmodium vivax, the most common malaria in Asia and Latin America.

While vivax is rarely fatal, it can cause debilitating fevers and shakes for many days and lifelong brain damage. It also has a dormant stage that hides in the liver, causing recurrences months or years later, sometimes long after the victim has left the malarial area.

The parasite seems to have several ways to attack a red blood cell, but it does not cause the cells to twist into clumps, clogging tiny vessels in the brain, as falciparum does.

It has taken longer to sequence vivax because of greater interest in falciparum malaria and because the vivax parasite cannot be kept alive in the laboratory.

A second team sequenced the genome of Plasmodium knowlesi, which is most common in monkeys. It had not been known to infect humans, but scientists suspect that it is the killer in some deaths attributed to other parasites. Both studies were published last week in the journal Nature.

October 15, 2008 | Permalink | Comments (0) | TrackBack (0)

No Carrots for Federal Workers

The Washington Post reports that while health insurance premiums are slated to rise 8 percent on average for federal employees next year, those enrolled in the most popular federal plan, Blue Cross Blue Shield Standard Option, face a 13 percent rate hike.  Christopher J. Gearson writes,

Health_careFederal workers and families, meanwhile, will not be offered the financial incentives that the private sector is increasingly using to promote wellness and disease management, said Nancy Kichak, associate director of the Office of Personnel Management.

The federal government has a long history of offering health services on-site through the Federal Occupational Health program, said Bill Hall, a spokesman for the Department of Health and Human Services. In the Washington area, 82 occupational health centers and 19 wellness centers offer immunizations, allergy shots and various preventive and work-related physical exams to federal employees.

October 15, 2008 | Permalink | Comments (0) | TrackBack (0)

Tuesday, October 14, 2008

Appeals Court Considers Overturning Tobacco Case

The Washington Post reports that a federal appeals court appeared skeptical Tuesday that a landmark tobacco judgment could be supported under racketeering laws, questioning whether cigarette makers had conspired to hide the dangers of smoking and would continue deceiving the public.  Hope Yen writes,

Gavel4During the three-hour oral argument, all three judges on the appeals panel queried whether the 2006 ruling by U.S. District Judge Gladys Kessler had fully laid out the evidence showing a group conspiracy as required under RICO, a law designed to combat mobsters and other organized criminals.

On several occasions, government attorneys seeking to convince the Court of Appeals for the D.C. Circuit to sign off on billions in financial penalties against the industry allowed that Kessler's 1,653-page ruling might not have spelled out the racketeering violations, or the remedies, as clearly as it should.

"We're asking the judge's order be enforced based on what the court meant," Justice Department lawyer Mark Stern said at one point. He spoke after attorneys for the tobacco industry criticized Kessler's ruling as "cobbling" together statements by cigarette makers that failed to "connect the dots" showing fraud.

"So you want us to enforce the decree not based on what it says but what it 'meant,'" responded a bemused Judge David S. Tatel, a Clinton appointee who has sided with the government in tobacco cases.

Chief Judge David B. Sentelle, a Reagan appointee, was critical of Kessler's finding that the tobacco industry had committed fraud by describing cigarettes as "light," "mild," or "low tar" and by suggesting they were safer than regular cigarettes.

Studies show such cigarettes are not safer because smokers tend to puff harder. Still, cigarette makers were simply following a Federal Trade Commission rule that allowed them to make factual statements about tar and nicotine content based on a specialized test, he said.

"They are basically making factually correct statements," Sentelle said.

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

Lack of Compensation Can Tempt Doctors to Tailor Their Care to a Patient's Coverage

The Washington Post reports that it's not uncommon for patients with no insurance or poor insurance to receive different treatment. A study shows that in nearly one in four encounters, physicians reported adjusting their clinical management based on a patient's insurance status; nearly 90 percent of physicians admitted to making such adjustments.  Manoj Jain writes,

Health_care_2When I walked into the hospital room of a 19-year-old woman, a foul smell all but overwhelmed me. I called a nurse to assist me and saw her, too, catch her breath.

When we examined the young woman we found a chronic infection of her pelvis so painful that she resisted our slightest touch.

How long had she been living like this, I wanted to know. Through tears, my patient hesitantly began an explanation that told me as much about our diseased medical system as about her illness: She'd had diabetes since she was a child, she said. On her 18th birthday, she lost her insurance and had been able to afford insulin only occasionally. She worked two jobs, she said, but neither offered insurance. Uncontrolled, her diabetes had let the infection develop and fester.

As I left her room, I realized I'd already grown accustomed to the rank odor. That, I think, is what happens when we learn that 47 million people in the United States are uninsured. At first, we find it shocking. But over time, most of us learn to ignore it.

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October 14, 2008 | Permalink | Comments (1) | TrackBack (0)

Monday, October 13, 2008

AIDS Vaccine Focus Shifts After Disappointments

The Washington Post reports that a global AIDS vaccine conference this week will seek fresh strategies against the HIV virus, with experts weighing the value of basic laboratory research against large-scale human clinical trials after a string of disappointments.  Andrew Quinn writes,

Red_ribbonApproaches focusing on "neutralizing antibodies" that would allow the human immune system to block infection completely, are likely to take precedence over existing models that seek to manage infection after it occurs, experts said.

"There's a real redirection and rethinking," said Lynn Morris, co-chair of a world AIDS vaccine conference that starts in Cape Town, South Africa, on Monday.

"Fundamentally we don't understand enough about the human immune system and we don't know how the immune system deals with HIV."

The conference -- a gathering of many of the top names in HIV research -- follows a year that saw scientists drop plans for widespread human testing of the two most promising vaccine prototypes due to safety concerns.

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October 13, 2008 | Permalink | Comments (0) | TrackBack (0)

Pediatricians Double Vitamin D Recommendations

The Washington Post reports that the nation's leading pediatricians group says children (from newborns to teens) should get double the usually recommended amount of vitamin D because of evidence that it may help prevent serious diseases.  Lindsey Tanner writes,

Pills8To meet the new recommendation of 400 units daily, millions of children will need to take daily vitamin D supplements, the American Academy of Pediatrics said. That includes breast-fed infants _ even those who get some formula, too, and many teens who drink little or no milk.

Baby formula contains vitamin D, so infants on formula only generally don't need supplements. However, the academy recommends breast-feeding for at least the first year of life and breast milk is sometimes deficient.

Most commercially available milk is fortified with vitamin D, but most children and teens don't drink enough of it _ four cups daily would be needed _ to meet the new requirement, said Dr. Frank Greer, the report's co-author.

The new advice is based on mounting research about potential benefits from vitamin D besides keeping bones strong, including suggestions that it might reduce risks for cancer, diabetes and heart disease. But the evidence isn't conclusive and there's no consensus on how much of the vitamin would be needed for disease prevention.

The new advice replaces a 2003 academy recommendation for 200 units daily.

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October 13, 2008 | Permalink | Comments (0) | TrackBack (0)

Sunday, October 12, 2008

Financial Crisis May Hit AIDS Funding

The Washington Post reports that the two French researchers who shared the Nobel Prize in medicine for discovering the AIDS virus are voicing fears that the world financial crisis will hurt funding to fight the disease.  The Washington Post writes,

Red_ribbonLuc Montagnier and Francoise Barre-Sinoussi say they told President Nicolas Sarkozy of their concerns that both research and international funding to fight AIDS could be cut in the crisis.

The two met with Sarkozy Wednesday. They told him that medication in Africa is often paid by a global fund for AIDS and distributed for free. Montagnier questioned whether that arrangement will continue.

Barre-Sinoussi and Montagnier discovered HIV in 1983.

They shared the award with Germany's Harald zur Hausen, who discovered viruses causing cervical cancer.

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

Cost Estimates Vary on Mental Health Parity Law

The Los Angeles Times reports that agencies predict that health insurance costs could increase from 0.2% to 5%, depending on the type of plan.  Tammy Worth writes,

Stethescope2Will the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 increase the cost of health insurance?

Most likely, but estimates vary. According to the Congressional Budget Office, the cost of the legislation could increase group healthcare premiums 0.2% to 0.4% on average.
The (which implemented mental health parity for federal employees' plans back in 2001) estimates the likely average increase as 1.64% for fee-for-service plans (where an insurance company pays the physician or patient directly for each service after a claim has been filed) and 0.3% for HMOs. It estimates that an individual would pay an extra 46 cents per biweekly paycheck and a family would pay $1.02.

Michael Carter, vice president of the benefits consulting firm the Hay Group, predicts increased costs of 2% to 3%, depending upon what type of plan is offered. A 1998 study released by the Substance Abuse and Mental Health Services Administration estimated full parity could increase premiums up to 3.6% and as high as 5% for fee-for-service plans.

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