HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Saturday, November 15, 2008

Confronting the Racial Barriers Between Doctors and Patients

The New York Times reports that the election of the nation’s first African-American president raises questions about racial disparities in health care.  Pauline W. Chen, M.D. provides an account of her experiences,

Stethescope4Last Tuesday, like most of the country, I stayed up too late watching the election results come in and then became emotional when it was clear that Barack Obama, an African-American, was going to be our next president. Wednesday morning’s New York Times captured the most salient part of the moment for me in its headlines: “Racial Barrier Falls in Decisive Victory.”

But a few days later, as I thought more about racial barriers, I started to question my election euphoria. In politics, the racial barriers might have fallen, I thought, but what about in health care?

There is no question that racial barriers still exist in many parts of this society. The first time I remember having a frank conversation about racial barriers in medicine was during my residency.

Of all the surgical residents I trained with, “Eric” was easily one of the smartest. He possessed a great bedside manner, brilliant clinical skills and plenty of that Obama cool. Eric was African-American, and one night, when we were both on call together, he told me something I have never forgotten.

“You know, Pauline,” he said, “there are a lot of times when I go to a patient’s room for the first time and they ask me, 'Are you transport? Are you here to wheel me to radiology?’” I can remember Eric shaking his head as he spoke. “They never assume I’m one of the doctors.”

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

Rule Allows More Time Off For Families of Injured Troops

The Washington Post reports that the Labor Department released a new regulation yesterday allowing workers to take up to 26 weeks off each year to care for family members seriously injured in the military.  Michael A. Fletcher writes,

CalendarThe new rule grew out of a recommendation by the President's Commission on Care for America's Returning Wounded Warriors that was incorporated into legislation signed into law in January. The change will also allow relatives of active-duty National Guard members and military reservists to take off for up to 12 weeks to look after their affairs.

"We made sure we were as generous as we could be on this leave," said Victoria Lipnic, an assistant secretary of labor.

While they generally applauded the new leave provisions for military families, labor and family advocates were critical of other changes to the law, including rules on how employees must notify their bosses that they are taking leave.

The liberalized military leave entitlements are part of a series of modifications to the 15-year-old Family and Medical Leave Act that have been finalized by the Labor Department. The changes come after a nearly two-year review in which the department received more than 20,000 comments from worker advocates and employers. The rules will go into effect 60 days after their official publication on Monday.

"Everybody knew this was coming," said David W. James, a Labor Department spokesman. "There is no way it can be confabulated into being a last-minute regulatory change" by the outgoing Bush administration.

The changes also include a new requirement that workers notify employers before they miss work to care for family members or tend to their own health concerns. Currently, department officials say, the act is interpreted to allow people to take off and inform their employers as many as two days after the fact -- a provision that was protested by business owners.

"Lack of advance notice for unscheduled absences is one of the biggest disruptions employers point to as an unintended consequence of the current regulations," the department said in a fact sheet.

Also under the new rules, a worker with a chronic health condition is required to certify doctor visits at least twice a year for that condition.

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

Friday, November 14, 2008

FDA Blocks Chinese Milk Products

The Washington Post reports on the largest effort to date to keep products tainted with the industrial chemical melamine from reaching U.S. consumers.  Annys Shin writes,

Fda2Federal food safety officials yesterday began holding up shipments of food from China that contain milk or milk-derived ingredients in the largest effort to date to keep products tainted with the industrial chemical melamine from reaching U.S. consumers.

The Food and Drug Administration is requiring importers of the halted shipments to test for the chemical, which is used to make plastic and fertilizer but has been added to human and animal food to boost protein readings. The types of products likely to be waylaid are cookies, candies, and other goods made with milk or milk powder.

If an importer can prove his product is not tainted, FDA will release it, said Steve Solomon, the agency's deputy associate commissioner for compliance and policy. The agency also will step up its testing of products already on the market.

FDA Commissioner Andrew von Eschenbach and Health and Human Services Secretary Mike Leavitt are scheduled to travel to China next week to meet with food safety officials there about melamine and other issues, and to open FDA offices in three Chinese cities.

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

Obama Urged to Overhaul Healthcare, Stat

The Los Angeles Times reports that four leading adovcacy groups representing business, labor, and reitrees retirees are calling for comprehensive healthcare reform in the new administration's first 100 days.  Noam N. Levey writes,

Stethescope5Reporting from Washington -- Four leading advocacy groups representing business, labor and retirees are starting a campaign today to press Barack Obama to enact comprehensive healthcare reform, upping the pressure on the president-elect to tackle the issue quickly after he takes office.

In a letter to Obama, the Business Roundtable, the National Federation of Independent Businesses, AARP and the Service Employees International Union urge that a healthcare overhaul be a priority in the administration's first 100 days.
The groups plan to spend nearly $1 million to publicize their cause in newspaper and television advertising in coming weeks.

"What we are doing is reminding not just the president but the Congress as well that . . . this remains one of the most important issues facing the country," said Business Roundtable President John Castellani. "We need to now follow through."

In their letter, the groups link healthcare reform with the nation's bleak economic conditions.
"Addressing skyrocketing healthcare costs is a critical component of stabilizing household, national and global economies," the letter said. "Inaction undermines the economic security of our families; limits the productivity of our workforce; stagnates job creation and wage growth; and threatens to crowd out investments in energy, education and infrastructure."

Obama made healthcare reform a central plank of his presidential campaign, pledging a sweeping effort to expand coverage and lower costs.

But since his victory, he has not indicated how he plans to proceed with an overhaul that could cost hundreds of billions of dollars and spark an intense political battle.

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

Thursday, November 13, 2008

Subsidized Insurance Backed

The Washington Post reports that Maryland health advocates unveiled a $15.5 billion proposal yesterday for universal health care that would subsidize insurance coverage for low-income residents with a payroll tax and increases to cigarette and alcohol taxes.  Lisa Rein writes,

Stethescope3The Maryland Citizens Health Initiative also calls for mandated coverage for those who do not get it through their employer. The group pledged that the policies would be more affordable than they are now.

The coalition of labor groups, churches, businesses and community organizations consulted with health policy experts from the University of Maryland, Johns Hopkins University and the Robert Wood Johnson Foundation.

The plan aims to build on two programs the General Assembly passed last year, an expansion of the federal-state Medicaid program for the poor and subsidies to some small businesses to help them afford insurance.

But lawmakers and even the advocates acknowledged that the plan has no chance for passage soon.

"We don't expect it to pass in 2009," said Vincent DeMarco, president of the nonprofit Baltimore-based group. "This is the beginning of a campaign."

DeMarco called the plan a way to "make quality health care affordable to all, especially small businesses" and said his group will focus in coming months on building public support for it.

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

More Countries Make Spreading HIV a Crime

The Washington Post reports that an increasing number of countries worldwide are making spreading HIV a crime, according to a new report from the International Planned Parenthood Federation.  Thirty-two states in the US have alerady criminalized HIV transmission.  Maria Cheng writes,

Wwwwashingtonpostcom_hiv_laws_2Health officials fear the trend could undermine gains made in fighting the AIDS pandemic and provoke a surge in cases. Globally, about 33 million people are thought to have HIV and nearly 3 million people are newly infected every year.

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"If the law is applied badly, this could set us back and do incredible damage," said Paul de Lay, an AIDS expert at UNAIDS, who was not involved in the report.

De Lay said the laws could result in forced testing and drive the epidemic underground as people hide their HIV status, allowing the virus to spread unnoticed.

According to Planned Parenthood, 58 countries worldwide have laws that criminalize HIV or use existing laws to prosecute people for transmitting the virus. Another 33 countries are considering similar legislation.

Since 2005, seven countries in West Africa have passed HIV laws. In Benin, simply exposing others to HIV is a crime, even if transmission doesn't occur. And in Tanzania, intentional transmission of the virus can lead to life imprisonment.

Many of the laws in Africa were passed after a meeting in Chad in 2004 sponsored by the U.S. Agency for International Development, the world's biggest funder of AIDS programs, and attended by U.N. officials.

"The U.N. was definitely remiss to allow this to happen," said Kevin Osborne, a senior HIV adviser at IPPF and one of the report's authors.

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

Wednesday, November 12, 2008

Senators Hurry to Keep Health Care in Forefront

The Washington Post reports on Senator Max Baucus and Senator Edward Kennedy's different plans of reforming American health care.  Ceci Connolly writes,

Gavel4Two of the Senate's most influential leaders are working separately behind the scenes on legislation that would dramatically alter the way Americans get health care, hoping their early efforts -- including the release today of a position paper -- will push President-elect Barack Obama to move rapidly on the issue and spare the incoming administration some of the missteps that killed Bill Clinton's health reform initiative in 1994.

Senate Finance Committee Chairman Max Baucus (D-Mont.) is unveiling a 104-page blueprint today that serves as the opening move in a fierce competition in the Senate to frame the debate. Sen. Edward M. Kennedy (D-Mass.), who is battling a life-threatening brain cancer, has directed aides over the past several months to convene negotiating sessions with a diverse group of stakeholders, including physicians, patient advocates, small-business owners and insurers. He intends to have legislation drafted by Inauguration Day.

The first promise Obama made as a presidential candidate was to enact a universal health-care plan by the end of his first term, but since his victory a week ago, he has focused on repairing the economy. Health reform advocates fear that just as Clinton was sidetracked in early 1993 by debates over the North American Free Trade Agreement and gays in the military, Obama's urgency about taking on health care may wane.

"President Clinton came in determined to do something significant on health-care reform" but did not submit a bill until 10 months after taking office, noted Ron Pollack, executive director of the pro-consumer health group Families USA. "A president's leadership is most effective before he expends much of his political capital."

The Senate maneuvering, combined with an unprecedented level of post-election lobbying by outside interest groups, is intended to hold Obama to his pledge.

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

Senator Takes Initiative on Health Care

The New York Times reports more on Senator Max Baucus' plan to guarantee health insurance for all Americans by facilitating sales of private insurance, expanding Medicais and Medicare, and requiring most employers to provide or pay for health benefits.  Robert Pear writes,

Stethescope3Without waiting for President-elect Barack Obama, Senator Max Baucus, the chairman of the Finance Committee, will unveil a detailed blueprint on Wednesday to guarantee health insurance for all Americans by facilitating sales of private insurance, expanding Medicaid and Medicare, and requiring most employers to provide or pay for health benefits.

Aides to Mr. Obama said they welcomed the Congressional efforts, had encouraged Congress to take the lead and still considered health care a top priority, despite the urgent need to address huge problems afflicting the economy.

The plan proposed by Mr. Baucus, Democrat of Montana, would eventually require everyone to have health insurance coverage, with federal subsidies for those who could not otherwise afford it.

Other Democrats with deep experience in health care are also drafting proposals to expand coverage and slow the growth of health costs. These lawmakers include Senator Edward M. Kennedy of Massachusetts and Representatives John D. Dingell of Michigan and Pete Stark of California.

The proposals are all broadly compatible with Mr. Obama’s campaign promises. But Mr. Baucus’s 35,000-word plan would go further than Mr. Obama’s in one respect, eventually requiring all people — not just children — to have coverage.

“Every American has a right to affordable, high-quality health care,” Mr. Baucus said. “Americans cannot wait any longer.” Far from being a distraction from efforts to revive the economy, he said, “health reform is an essential part of restoring America’s economy and maintaining our competitiveness.”

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

Tuesday, November 11, 2008

The Promise and Power of RNA

The New York Times reports that RNA interference, discovered only about 10 years ago, is attracting huge interest for its seeming ability to knock out disease-causing genes.  Andrew Pollack writes,

Wwwhealthusnewscom_dnaPeople whose bodies make an unusually active form of a certain protein tend to have dangerously high levels of cholesterol. Those with an inactive form of the protein have low cholesterol and a low risk of heart attacks.

Needless to say, pharmaceutical companies would love to find a drug that can attach itself to the protein and block its activity. That might be difficult for this protein, which is called PCSK9.

But a powerful new approach, called RNA interference, may surmount that obstacle. Instead of mopping up a protein after it has been produced, as a conventional drug would do, RNA interference turns off the faucet, halting production of a protein by silencing the gene that contains its recipe.

In monkeys, a single injection of a drug to induce RNA interference against PCSK9 lowered levels of bad cholesterol by about 60 percent, an effect that lasted up to three weeks. Alnylam Pharmaceuticals, the biotechnology company that developed the drug, hopes to begin testing it in people next year.

The drug is a practical application of scientific discoveries that are showing that RNA, once considered a mere messenger boy for DNA, actually helps to run the show. The classic, protein-making genes are still there on the double helix, but RNA seems to play a powerful role in how genes function.

“This is potentially the biggest change in our understanding of biology since the discovery of the double helix,” said John S. Mattick, a professor of molecular biology at the University of Queensland in Australia.

And the practical impact may be enormous.

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

AMA Acts Against Trans Fats and Texting While Driving

The Washington Post reports that the American Medical Association on Monday took a stand against two unhealthy habits: eating foods made with artificial trans fats and text-messaging while driving.  The Washington Post writes,

Nutrition_factsAt its semiannual policy meeting, the nation's largest physicians' group agreed to support any state and federal efforts to ban the use of artificial trans fats in U.S. restaurants and bakeries. And it agreed to lobby for more state legislation banning text-messaging while driving or operating machinery.

Several cities and fast-food chains already have shunned trans fats, which can increase artery-clogging of "bad" cholesterol, and decrease levels of "good" cholesterol.

Numerous bans on texting while driving also are in effect.

Delegates at the meeting in Orlando, Fla., also rejected establishing ethical guidelines for hospitals and doctors offices that use "secret shopper" patients. Many hospitals, clinics and doctors' offices hire these fake patients to evaluate things like waiting times, staff behavior and even doctors' bedside manner.

Opponents called the practice devious and unethical.

The measure was first proposed at an AMA meeting in Chicago in June but was referred for a vote at the Orlando meeting.

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

Monday, November 10, 2008

Obama Weighs Quick Undoing of Bush Policy

The New York Times reports that President-elect Barack Obama is poised to move swiftly to reverse actions that President Bush took using executive authority, and his transition team is reviewing limits on stem cell research and the expansion of oil and gas drilling, among other issues, members of the team said Sunday.  Jeff Zeleny writes,

Barack_obama_2As Mr. Obama prepared to make his first post-election visit to the White House on Monday, his advisers were compiling a list of policies that could be reversed by the executive powers of the new president. The assessment is under way, aides said, but a full list of policies to be overturned will not be announced by Mr. Obama until he confers with new members of his cabinet.

“There’s a lot that the president can do using his executive authority without waiting for Congressional action, and I think we’ll see the president do that,” John D. Podesta, a top transition leader, said Sunday. “He feels like he has a real mandate for change. We need to get off the course that the Bush administration has set.”

Throughout his presidency, Mr. Bush has made liberal use of his executive authority, using it to put his stamp on a range of hot-button policy issues.

In January 2001, on his first full day in office, Mr. Bush reinstated the so-called global gag rule, initiated during the Reagan administration and overturned by President Bill Clinton, which prohibited taxpayer dollars from being given to international family planning groups that perform abortions and provide abortion counseling. After Mr. Obama’s victory last week, the Center for Reproductive Rights delivered a 23-page memorandum to his transition team, calling for “bold policy change,” including a repeal of the gag rule.

On Sunday, in a sign that the presidential campaign had definitively ended and that the fast-forming administration had become the focal point, the faces of Mr. Obama’s new team appeared across the spectrum of Sunday talk shows, a changing of the guard more than two months before he officially assumes power.

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

African Researchers Plan Malaria Vaccine Trial

The Washington Post reports on a medical trial hoping to develop the first malaria vaccine.  Donna Bryson writes,

Mosquito_wwwuhhhawaiieduA medical trial involving 16,000 children across Africa will be a challenge to human, scientific and communications resources on the world's poorest continent, three researchers hoping to develop the first malaria vaccine said Monday.

Joe Cohen and Drs. Christian Loucq and Eusebio Macete said in an interview in Johannesburg that much of the groundwork already has been laid in preliminary trials involving 4,000 children since 2003. They said that even if their vaccine does not succeed, Africa will be left with better communications, research and other infrastructure that could be used in the search for vaccines against AIDS and other diseases.

Malaria, caused by parasites and spread by mosquitoes, kills nearly 1 million people every year, most of them children in Africa. The massive trial of a vaccine that could cut those numbers may start as early as next month, and should be well under way by January, said Cohen, a top vaccine researcher for the international pharmaceutical giant GSK.

GSK is working with the PATH Malaria Vaccine Initiative, which is an anti-malaria charity funded by the Bill & Melinda Gates Foundation, and clinics and research centers in Africa. While the researchers were optimistic, it will be several years before they know whether their vaccine candidate is safe and effective enough for wide use.

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

Sunday, November 9, 2008

Seven Things Obama's Win Could Mean for Women's Health

US News reports on some of the policies put in place by Bush that women's health activists are hoping Obama will reverse.  Deborah Kotz writes,

Barack_obama_2Women's health activists are fist-bumping each other over Obama's slam-dunk win, and they're hoping that he'll reverse some of the policies put in place by Bush. Yesterday, I had a chance to catch up with Planned Parenthood President Cecile Richards in between her strategy meetings and blogging for the Huffington Post. She predicted seven things that would change in the new administration.

1. No more federal funds for abstinence-only education. Two years ago Obama told a conservative Christianaudience that abstinence-only education was not enough to prevent teen pregnancy and that he "respectfully but unequivocally" disagrees with those who oppose condom distribution to prevent HIV transmission, according to the reproductive health blog Reality Check. He's also an original co-sponsor of the Prevention First Act, which mandates that all federal sex-education programs be medically accurate and include information about contraception. That legislation could be resurrected in the new Congress.

2. No more global gag rule. On Bush's first day in office in 2001, he reinstituted the "global gag rule" that restricted federally funded health clinics in foreign countries from performing abortions or even providing referrals or medical counseling on abortion. "We think there's going to be a change in that approach and that these clinics will be allowed once again to offer a full range of family planning services," Richards says.

3. Better coverage for contraception and pregnancy. While Richards says women's health activists had to "battle the current administration to get emergency contraception approved over the counter," they're now hoping that Obama's proposed health plan will make contraception more affordable to women. It could force drug plans to cover birth control pills as they would any other drug. (Many still do not.) And it could include more comprehensive prenatal coverage; some women shell out $5,000 or more to have a baby. I'm also curious to see whether Obama reverses a Medicaid rule that last year stopped allowing discounted birth control pills to be dispensed on college campuses.

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November 9, 2008 | Permalink | Comments (2) | TrackBack (0)

Vitamin Pills Don't Prevent Heart Disease, Study Says

Contrary to what most would think, the Washington Post reports that a study funded by the National Institutes of Health and several vitamin makers suggests that Vitamins C and E do nothing to prevent heart disease in men, and instead may aid cancer and raise the risk of bleeding strokes.  Marilynn Marchione writes,

Pills14Vitamins C and E, pills taken by millions of Americans, do nothing to prevent heart disease in men, one of the largest and longest studies of these supplements has found.

Vitamin E even appeared to raise the risk of bleeding strokes, a danger seen in at least one earlier study.

Besides questioning whether vitamins help, "we have to worry about potential harm," said Barbara Howard, a nutrition scientist at MedStar Research Institute of Hyattsville, Md.

She has no role in the research but reviewed and discussed it Sunday at an American Heart Association conference. Results also were published online by the Journal of the American Medical Association.

About 12 percent of Americans take supplements of C and E despite growing evidence that these antioxidants do not prevent heart disease and may even be harmful.

Male smokers taking vitamin E had a higher rate of bleeding strokes in a previous study, and several others found no benefit for heart health.

As for vitamin C, some research suggests it may aid cancer, not fight it. A previous study in women at high risk of heart problems found it did not prevent heart attacks.

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November 9, 2008 | Permalink | Comments (0) | TrackBack (0)