HealthLawProf Blog

Rats and TB Detection

The Boston Globe's  Colin Dickerson reports on a new use for rats - its turns out that they can help solve some fairly major public health problems.  I know most people probably think of rats as a public health problem but according to this article they have been put to use detecting landmines and TB.  The article is quite interesting and states,

Meanwhile, in a conceptual leap, Weetjens decided to turn the rats' sharp olfactory sense to disease detection, starting with tuberculosis. "The medical applications, I believe, will eventually prove even more important than the hunt for land mines," he predicted.

In the pilot project in the Tanzanian capital of Dar es Salaam and the nearby city of Morogoro, Apopo-trained rats evaluate saliva samples at a rate of 40 every 10 minutes; that's equal to what a skilled lab technician, using a microscope, can effectively complete in a day.

A TB rat signals with unmistakable paw motions when it detects sputum infected by Mycobacterium tuberculosis, the infectious bug responsible for 1.7 million deaths and 9.2 million new TB cases each year, mainly in poor countries, according to the World Health Organization. Scientists at Germany's Max Planck Institute are now trying to determine whether the rats are detecting the scent of the actual TB bacteria or some metabolic reaction produced by the infection.

For both TB and land mines, the rats are trained to respond to the sound of a clicker; when the rat makes the scratching motion that means it has detected an explosive or the odor of disease, the handler or trainer responds by snapping the clicker, which means a nut or fruit is on the way.

So why don't the animals just scratch every few minutes to win a treat? "That would be human behavior," said Weetjens. "Rats are more honest."

I think I will have to re-think my view of rodents.

Professor Jay Katz

The LA Times provides a moving tribute to the life and work of Professor Jay Katz.  It provides,

Dr. Jay Katz, a psychoanalyst and Yale Law School professor whose analysis of the conflicting interests and motivations of doctors and patients made him a leading authority on medical ethics, died of heart failure Monday in New Haven, Conn. He was 86.  Katz was best known for his 1984 book "The Silent World of Doctor and Patient," which examined the complex factors that shape the physician-patient relationship and hinder the medical decision-making process.  . . .

Katz was a forceful advocate for patients involved in medical research.   In the early 1970s, he was a member of a national panel that investigated the Tuskegee syphilis experiment, in which researchers from the U.S. Public Health Service withheld treatment from 400 rural Alabama black men in order to observe the progress of the disease. Some men were allowed to die during the 40-year study, which ended in 1972 at the urging of the panel.   

Katz said the Tuskegee subjects had been "exploited, manipulated and deceived. They were treated not as human subjects but as objects of research."  . . . .

In 1993, he was named to a presidential commission that documented the exploitation of research subjects in post-World War II studies on the effects of radiation.   "There is persistent confusion between research and [clinical] practice and the obfuscation of the two," Katz told The Times in 1994. "You cannot use people -- or you should not use people -- as means for others' ends and for ends that might ultimately even be good."

He urged doctors and patients to share the responsibility of making medical decisions by talking honestly to each other about the uncertainties of treatment, their expectations and the role each party must play, a radical idea given the long tradition of physician paternalism and patient passivity.

"As a doctor steeped in the law, Jay Katz illuminated better than anyone has before or since, the complex of medical, legal and ethical choices that haunt the silent world of doctor and patient," Harold Hongju Koh, the dean of Yale Law School, said in a statement last week.

Katz, who was the school's first professor of law, science and medicine, made major contributions in a number of areas, including family law and reproductive technology.  He spoke sternly against a change in federal regulations in 1996 that allowed investigators in some medical studies to enroll patients who are unable to give their consent because of a head injury or other life-threatening condition. Katz said the change violated the Nuremberg Code, developed after the Nuremberg trials of Nazi doctors after World War II, which said that nothing should be done to a human being without his or her approval.  He also was a vocal opponent of scientists' use of data from experiments that Nazi doctors conducted on concentration camp prisoners during Hitler's reign.

These issues resonated particularly profoundly for Katz, who was born Oct. 20, 1922, in Zwickau, Germany, and witnessed Hitler's rise to power. He endured intense harassment by teachers and classmates as the only Jewish student in a school for the gifted. His father, a prominent businessman, was arrested by the Gestapo. . . .   One by one, Katz's family, including his father, escaped Germany. In 1940, he arrived in the U.S., soon to be joined by the rest of his family. He graduated from the University of Vermont in 1944 and became a U.S. citizen in 1945. He earned his medical degree at Harvard University in 1949. . . .   
At his retirement in 1993, he was the Elizabeth K. Dollard professor of law, medicine and psychiatry.

Pardoning Turkeys - Thanksgiving Week Approaching

Ok, it is Friday and when I saw this video of Governor Sarah Palin last night pardoning a turkey while other turkeys met a less pleasant fate immediately behind her - well, it seemed like something to share.  Really, it helped remind me of all that I am thankful for now that the Presidential election is over.  On a separate note,I think with more such press conferences Governor Palin could do wonders for increasing the numbers of vegetarians in the world. 

Here is the much more pleasant video from WKRP in Cincinnati (the famous frozen turkey drop) along with some fun commentary from those witty people at Firedoglake.com.

Daschle to HHS

News sources are reporting that former Senate Majority Leader Tom Daschle has been tapped as the next Secretary of Health and Human Services. ThinkProgress reports that this is a good sign for those interested in dramatic health reform. They state,

Earlier this year, during an address at the Families USA Action Conference, Daschle concurred with the need to ‘think big’ on reform:

Incremental change in our system is no longer a viable option. Instead we need comprehensive reform. In growing numbers the American people are demanding that we do something. Our goal should be to build what current and retired members of Congress have today, and make that available for all Americans.

Daschle is a Senior Distinguished Fellow at the Center for American Progress and is the author of Critical: What We Can Do About the American Health-Care Crisis. . . . .

Here are Ezra Klein's thoughts about this appointment.  He concurs that this appointment shows President-elect Obama's determination to reform our health care system.

Health Insurance Companies See Writing on Wall

Robert Pear of The New York Times continues a story demonstrating health insurance companies apparerent new acceptance of future health care reform.  He writes,

The health insurance industry said Wednesday that it would support a health care overhaul requiring insurers to accept all customers, regardless of illness or disability. But in return, the industry said, Congress should require all Americans to have coverage.

The proposals, put forward by the insurers’ two main trade associations, have the potential to reshape and advance the debate over universal health insurance just as President-elect Barack Obama prepares to take office.  In separate actions, the two trade groups, America’s Health Insurance Plans and the Blue Cross and Blue Shield Association, announced their support for guaranteed coverage for people with pre-existing medical conditions, in conjunction with an enforceable mandate for individual coverage.  In the absence of such a mandate, insurers said, many people will wait until they become sick before they buy insurance. . .

The new position taken by the insurance industry — the industry that helped sink President Bill Clinton’s plan for universal health coverage in 1994 — could ease the way for passage of such legislation.  But the industry’s position differs from that of Mr. Obama in one significant respect. Insurers want the government to require everyone to have and maintain insurance. By contrast, Mr. Obama would, at least initially, apply the requirement only to children.  . . . 

Asked on Wednesday for reaction to the insurance industry’s proposals, Tommy Vietor, a spokesman for the Obama transition team, said, “We are declining comment.” Mr. Vietor cited Mr. Obama’s view that “we have only one president at a time.” . . .

Donald G. Hamm Jr., president of Assurant Health, explained why the industry thought an individual mandate must be coupled with any ban on such underwriting practices.  “In the individual market, people can choose whether or not to apply for coverage,” Mr. Hamm said in an interview. “If they know they can obtain coverage at any time, many will wait until they get sick to apply for it. That increases the price for everyone.”  Insurers say that is just what happened in several states that prohibited insurers from turning down applicants on the basis of their health status. . . .

Federal Court Upholds Drug Privacy Law

The New York Times reports that a federal appeals court in Boston on Tuesday dealt a setback to the pharmaceutical industry and companies that collect prescription data for use in drug marketing.  Stephanie Saul writes,

Ruling in support of a New Hampshire law, the court upheld the right of states to prohibit the sale of doctor-specific prescription drug data that is widely used in pharmaceutical marketing.

The case is a defeat for two large data-mining companies, IMS Health and Verispan. They sued in 2006 to block implementation of the New Hampshire law, which prohibited the sale of computerized data showing which doctors were prescribing what drugs.

The law was intended to cut down on state health care costs by eliminating the tool used by drug sales representatives in promoting brand name drugs. By purchasing the data describing which doctors prescribe what drugs, pharmaceutical sales forces are better able to identify which doctors might use their products and be receptive to their sales pitches. They can also focus on persuading doctors who do not write many prescriptions for their products to change their minds.

The sale of prescription data, in which individual patients’ identities have been removed, has become a lucrative industry. The information is purchased from pharmacy chains and the companies that manage drug benefits for employers.

Sales representatives — known as detailers in industry argot — often visit doctors’ offices carrying laptop computers with detailed reports on each doctor’s prescription-writing habits.

Saying in Tuesday’s opinion that the enterprise of buying and reselling prescription information was “mind-boggling” in its scope, United States Court of Appeals Judge Bruce Marshall Selya wrote, “The record contains substantial evidence that, in several instances, detailers armed with prescribing histories encourage the overzealous prescription of more costly brand-name drugs regardless of both the public health consequences and the probable outcome of a sensible cost/benefit analysis.”

The three-judge panel concluded that “the state adequately demonstrated that the Prescription Information Law is reasonably calculated to advance its substantial interest in reducing overall health care costs within New Hampshire.”

The appeals court ruling overturned a decision last year by United States District Judge Paul Barbadoro of Concord, N.H., that stuck down the New Hampshire law on First Amendment grounds.

In a statement, IMS, based in Norwalk, Conn., said it was disappointed with the decision and was evaluating its potential next steps. Shares in IMS fell 12 cents, or 1 percent, to $11.75 on the New York Stock Exchange.

Along with Verispan, which is located in Yardley, Pa., IMS had argued that the purchase and collection of prescription data were valuable for public health reasons and, also, that the law infringed on commercial free speech.

The New Hampshire law, which was to take effect in July 2006 before it was challenged, was the first state law to specifically prohibit the sale or transfer of information identifying doctors for commercial purposes.

Tuesday’s decision could also have implications in other states that have either adopted or are considering similar legislation, particularly Maine, which is in the same appellate district as New Hampshire and where a similar law was also struck down by a district court this year. Vermont has also enacted a similar law that is to take effect next year but is also facing a court challenge.

Such legislation has been urged by doctors who object to the disclosure of their prescribing patterns.

The American College of Physicians asked the larger American Medical Association to prohibit the release or sale of doctors’ prescribing information. In 2006, the A.M.A. established a registry of doctors who could “opt out” of having their prescription data shared with sales representatives. That was part of a voluntary arrangement the A.M.A. reached with the data companies.

In sponsoring the New Hampshire legislation in 2006, Representative Cindy Rosenwald of Nashua, said she was motivated partly by high state Medicaid drug costs, which she said had been driven up by pharmaceutical marketing.

Besides her state, Maine and Vermont, Ms. Rosenwald predicted Tuesday that other states would now take a more serious look at enacting such laws.

“A lot of states have been looking at this and have come very close to enacting it,” she said, “and then they’ve basically said while this is still on appeal, we should just wait.”

Insurers Make Pitch for Health Coverage Mandate

The Washington Post reports that the health insurance industry said Wednesday it will support a national health care overhaul that requires them to accept all customers, regardless of pre-existing medical conditions, but in return it wants lawmakers to mandate that everyone buy coverage.  Kevin Freking writes,

Lawmakers have signaled their intent to craft health care legislation early next year, and the insurance industry's support would make passage easier. That legislation is expected to closely track the proposals of president-elect Barack Obama. However, Obama separated himself from his Democratic challengers by opposing an individual mandate for adults to buy health insurance.

More lawmakers may agree to a mandate if it means the insurance industry will back those efforts. They'll remember it was the industry's opposition 15 years ago that helped scuttle former President Clinton's health plan.

The board of directors for America's Health Insurance Plans agreed to the trade-off Monday night. The board endorsed the proposal after a series of hearings in various states.

"We hope this will be a contribution to help members of Congress fashion their proposal," said Karen Ignagni, president and chief executive officer of the trade group. "We're going to provide all the technical background that we have assembled, all the experience we've assembled at the state level, and we're going to work very hard with members of Congress on both sides of the aisle. We want to make sure that whatever reforms are advanced, no one falls through the cracks."

Obama's health plan calls for a health insurance exchange, a sort of government-run shopping center where customers could go to select from private plans or a plan administered by the federal government. Any insurer that wants to participate in that exchange must accept all customers regardless of pre-existing health conditions, such as diabetes or heart disease.

Insurers will want to participate in the exchange because government subsidies will make it easier for millions of people to buy coverage from them. But the insurers say that experience in the states shows the coverage guarantee often made it harder for people to find coverage. That's because insurers raised premiums to meet the expense of covering all applicants with chronic health conditions.

"They ended up making the problem much worse," Ignagni said of the state efforts. "The data is clear about the need to have everyone part of the system."

Analysts say Massachusetts is an example where the coverage guarantee has worked well, but it's also a state that requires everyone to buy health coverage or suffer a tax penalty.

Some key Democratic lawmakers have already expressed support for an individual mandate. The concept was a centerpiece of Sen. Hillary Rodham Clinton's health care plan. It was also part of the blueprint offered last week by Sen. Max Baucus, chairman of the Senate Finance Committee.

Medicare Prescriptions and the Doughnut Hole

The Washington Post provides facts about Medicare Part D:

Facts about Medicare Part D prescription coverage:

- Under Medicare Part D, elderly and disabled Medicare benficiaries can enroll in a private drug plan that is largely subsidized by the federal government. Before the benefit began in 2006, that drug coverage was available only though private supplemental plans.

- Medicare Part D contains a gap in coverage often described as "the doughnut hole." Patients in the coverage gap have to pay full cost out of pocket for their drugs,

- Under 2008 Medicare rules, once the cost of a patient's prescriptions reaches $2,510, including the amount the patient pays and the amount his or her insurer pays, the patient is in the coverage gap and must cover the next $3,850 in spending on his or her own. After that point, Medicare coverage resumes.

-  In 2009, the coverage gap begins at $2,700 in spending. The gap ends after the member has spent $4,350.

- Health insurers that do significant amounts of Medicare Part D business include Cigna Corp., WellPoint Inc., Universal American Corp., WellCare Health Plans Inc. and Health Net Inc. Insurers compete for Medicare business in a bidding system, with those who offer prices below a government standard being chosen.

- Humana Inc. will no longer participate in Part D coverage after Jan. 1, 2009.

Political Temperature may be Just Right for Healthcare Overhaul

The Los Angeles Times reports that experts say the nation's hard times may paradoxically quicken a sweeping reform of the healthcare system.  Noam N. Levey and Lisa Girion write,

When Barack Obama steps into the Oval Office in January, healthcare reform will join a list of priorities crowded with two wars, a ballooning budget deficit and an economy mired in one of the worst slowdowns since the Great Depression.

But the bleak environment may paradoxically spur the kind of costly, sweeping overhaul of the nation's healthcare system that has eluded policymakers in Washington for decades, many political strategists, industry leaders and economists say.

Hospitals and physicians are increasingly worried about the escalating burden of newly unemployed workers being thrown onto the rolls of the uninsured.

Liberal advocacy groups see the Treasury Department's $700-billion commitment to banks and other financial institutions bolstering the case for a similar investment to help sick Americans get medical care.

And businesses see new urgency in addressing the nation's healthcare crisis as they struggle to pay costs for medical benefits while sales plummet and profit margins shrivel.

When Senate Finance Committee Chairman Max Baucus (D-Mont.) last week announced an outline for universal health coverage, he was applauded by dozens of interest groups across the ideological spectrum.

"Healthcare reform is very much linked to the broader economic issues that the country is facing," said Todd Stottlemyer, president of the National Federation of Independent Business. "Our view is that there is the energy now to make this a top priority."

Fifteen years ago, the federation, which represents about 300,000 small businesses, helped fight the Clinton administration's proposed healthcare overhaul. Today, it is one of the leading champions of broad-based reform.

"I have never seen an effort like this," said Ron Pollack, who heads Families USA, a nonprofit consumer group promoting a healthcare overhaul.

Even the most sanguine observers concede it will be immensely difficult to reshape a healthcare sector that makes up 16% of the nation's economy and move tens of millions of uninsured Americans into the system.

Democrats generally agree on an approach that would allow most Americans to keep their current coverage while creating an exchange so people and businesses without coverage could link up with insurers.

Obama proposed such a plan on the campaign trail, and Baucus offered his own version last week.

Still unresolved are important details about the cost of a new system, provisions for increasing quality and a mechanism for compelling businesses and people to participate.

"People are unhappy with today's healthcare system," said Karen Davenport, director of health policy at the Center for American Progress, a liberal think tank with close ties to Obama. "But they are also nervous about letting go of what they have now."

Most observers expect conflicts between interest groups and policymakers as the debate heats up on Capitol Hill. Last week, the powerful Pharmaceutical Research and Manufacturers of America fired an early warning shot: an ad campaign opposing Obama's proposal to allow the federal government to negotiate lower Medicare drug prices.

Republican lawmakers are already expressing concerns about proposals that would drive the federal budget deeper into the red. By some estimates, extending coverage to the nation's uninsured could cost more than $100 billion a year.

"We have a huge financial problem in this country," said Joe Antos, a healthcare scholar at the conservative American Enterprise Institute, who called the idea that bold action would save money on healthcare "completely ludicrous."

"You have everybody gearing up and trying to make noise and saying, 'Don't forget us.' And health is right there with everybody else," he said. "They are trying to create political space next year for their issue, when there is going to be precious little political space to be had."

Obama has not indicated whether he will champion major healthcare legislation right away or if he will pursue a more incremental approach, as some lawmakers and analysts have counseled.

The president-elect and his Democratic allies on Capitol Hill have said immediate federal action to prop up the sagging economy will be their top priority.

Continue reading "Political Temperature may be Just Right for Healthcare Overhaul"

Nebraska to Alter Safe-Haven Law

The Washington Post reports that Nebraska intends to alter its safe-haven law to set an upper age limit of days or weeks for parents to deliver babies to the state without repercussions, an attempt to still care for abandoned children without becoming a dumping ground.  Peter Slevin writes,

When social worker Courtney Anderson got the urgent call, she knew another child was being abandoned to the state. She spotted a boy, 12 years old, sobbing in a chair at the emergency room registration desk.

Standing behind him was a woman, also crying.

"I'm sorry, I'm sorry," the woman told the boy over and over.

"Please don't leave me," he begged.

Anderson introduced herself and began asking the woman the boy's name, his address and school, but the woman said she was in a hurry. She got ready to leave and hugged the boy, who asked through his tears, "Will you come see me?"

"I will if I can," the woman said and ran out the door.

When Nebraska legislators passed a bill creating a safe haven to help overwhelmed parents and guardians, they were thinking of babies and toddlers who had been abandoned by young mothers. Instead, 35 children -- typically adolescents -- have been dropped at the hospital door, most recently a 5-year-old boy on Thursday night.

The legislature opened a special session on Friday to fix the law. Discussion is expected to begin Monday to set an upper age limit of days or weeks for parents to deliver babies to the state without repercussions.

By next weekend, the old law probably will be history, but the unexpected images of adults from half a dozen states dumping their kids in Nebraska has revealed a largely hidden crisis across the country.

"They'll close the books, but they'll still be dealing with the same issues," said Tom Rawlings, the state children's advocate in Georgia, home of Tysheema Brown, who drove 15 hours to drop her 12-year-old in Lincoln. She later told the Atlanta Journal-Constitution: "I ran out of fight. I ran out of hope. I never ran out of love for my child."

"Looking back, a number of us would have voted differently," Sen. Mike Flood (R), the speaker of the Nebraska legislature. "But it has uncovered a bigger issue. It demonstrates a need for families in crisis."

In Nebraska, the adults who dropped children on the doorsteps of hospitals and police stations typically told social workers they were at wit's end. In some cases, they blamed stress in their own lives. In other cases, they said the child had become depressed or uncontrollable.

Continue reading "Nebraska to Alter Safe-Haven Law"

N.Y. Boy On Life Support in D.C. Dies

The Washington Post reports that the battle over whether to keep a 12-year-old New York boy on life support has ended, as the boy passed away early Saturday.  While doctors declared the boy legally dead after his brain activity ceased, his parents sought an order from the D.C. Superior Court to keep him on life-sustaining equipment at Children's National Medical Center.  N.C. Aizenman and Michael Alison Chandler write,

The emotional legal battle over whether to keep a 12-year-old New York boy on life support at Children's National Medical Center ended early Saturday after the boy's heart stopped beating, an attorney for the boy's family said yesterday.

Motl Brody, who had been at the hospital in Northwest Washington with brain cancer since June 1, was buried near his home in Brooklyn yesterday after a funeral, said the family's attorney, Jeffrey I. Zuckerman.

Doctors had declared the boy legally dead Nov. 4 after his brain activity had ceased. But his parents, who are Orthodox Jews, said their faith does not define death on that basis and had sought an order from D.C. Superior Court to keep him on life-sustaining equipment.

Although the boy was kept on a ventilator to maintain breathing and was given intravenous drugs to keep up his blood pressure, pending a court decision, neither measure proved enough to sustain his heart.

Early Saturday, Motl's "heart stopped beating," Zuckerman said as he rode a train to Washington from the funeral. "In the end, nature took its course before the judicial system ran its course."

Motl, the third-eldest of seven siblings, had spoken of becoming a rabbi like his father, Eluzer Brody, and often wrote Hebrew poems that he sang at family functions in his soprano voice. He was diagnosed with an aggressive brain tumor six months ago and underwent surgery and other treatments.

Zuckerman said thousands of people from the close-knit Hasidic community attended the service, held outside the school the boy had attended in Brooklyn.

A court hearing scheduled for last week was postponed at the hospital's and family's request because Motl's condition had been worsening. "By Tuesday, we all knew it was a matter of hours or days," Zuckerman said.

Paula Darte, director of public relations for the hospital, declined to comment yesterday.

Motl Brody's uncle Yitzchak Halberstam said: "We are very grateful he was able to stay on life support until he died. We hope the case will sensitize the medical establishment to the importance of respecting any patient's religious beliefs regarding life and death."

The hospital received nearly 200 e-mails and phone calls on the case, mostly from New York residents urging the hospital not to give up on Motl. The public outpouring echoed debates over life support for Terri Schiavo and Karen Ann Quinlan.

However, despite having profound brain damage, Schiavo and Quinlan maintained some brain function. Schiavo, who died in 2005 after being comatose for 15 years, occasionally appeared to follow movement with her eyes and smile and laugh. She and Quinlan, who died in 1985 after 10 years in a coma, were able to control breathing and maintain blood pressure and blood volume. Such actions are governed by the unconscious parts of the brain.

Motl was unable to control those passive functions.

According to experts in Jewish law, there is no consensus within the faith on the medical definition of death. Some Orthodox Jews base it on the absence of brain activity; others focus on whether the heart is beating.

Employers Offer Workers Fewer Health Care Plans

The New York Times reports that many workers are finding fewer options being offered for health care as many companies only offer high-deductible plans to employees.  Milt Freudenheim writes,

It’s the annual “open enrollment” season in corporate America, when employees choose their medical plans for the coming year. But this time, even if they are fortunate enough to have a job at a company that still offers health benefits, many workers are finding that the buffet of options has been trimmed to a very short menu.

And typically the offerings now include a health plan with a financially daunting feature: a high annual deductible that is likely to be $1,100 or more for an individual, and much higher for family coverage. Under conventional insurance, the annual deductible — the amount an employee is obliged to spend on medical care before the insurance begins — may be only about one-third as high.

Employers generally try to offset the high deductible with a somewhat lower monthly premium than workers pay with conventional insurance. Another deal sweetener is the opportunity for the worker to put money in a tax-sheltered health savings account whose balance can grow year after year. Many employers also make contributions to those worker accounts.

Despite such lures, high-deductible plans have received only tepid acceptance from employees since they were introduced in 2002. But this year, at more than 100 large companies and hundreds of smaller ones, the high-deductible plans are the employee’s single take-it-or-leave-it option.

One of those companies is the automaker Nissan, which is offering only high-deductible plans to its 15,000 United States employees for the coming year. Another is Delta Airlines.

Most large companies still do offer a choice between high-deductible plans and more conventional insurance, which means workers must try to decide which approach is best for them.

Typically, if consumers run the numbers, they will find the high-deductible plans are most attractive to healthy single workers who do not expect many medical costs — or to families who know their medical costs will quickly exceed the annual out-of-pocket maximum, after which their medical care is covered 100 percent. But even for those people, the lower premium does not compensate for the much greater out-of-pocket payments they will make before reaching that high deductible.

Such plans “put a lot of financial burden on employees in a way they haven’t felt in the past,” said Peter V. Lee, executive director for health policy at the Pacific Business Group on Health, a West Coast employers’ group. “If you are a heavy user of health care,” he said, “health maintenance organizations have more generous coverage.”

In one variation of the Nissan plan, the deductibles for a family are $2,500 for each person, with a $7,500 maximum for the family. Monthly premiums are about $100 for a family — or $35 for a single worker.

As an enticement, the company will deposit up to $1,600 in a family’s health savings account. And annual physical checkups, well-child care and immunizations, as well as flu shots and cancer screenings, are covered 100 percent even before the deductible has been reached — a feature similar to many traditional health plans.

Marlin Chapman, the benefits director at Nissan, says the high-deductible plans are “aimed at getting people to focus on their health.”

“When you are spending your own money,” Mr. Chapman said, “you are more careful in the way you spend it.”

Betsy Talton, a Delta Airlines spokeswoman, offered this reason, in part, for her company’s making high-deductible plans the employees’ only choice: “We felt it was important to offer a plan that encourages participants to manage their health care and maintain their health and enables them to get the most out of their health care dollar. We find that when people get engaged in their health care they generally get healthier.”

As a cost-saving measure for employers, the high deductibles are meant to make workers think hard before spending out-of-pocket cash on doctors, emergency room visits and expensive diagnostic tests. President Bush has advocated the plans as a “consumer-directed” way to rein in health care spending.

Continue reading "Employers Offer Workers Fewer Health Care Plans"

Rare Treatment Is Reported to Cure AIDS Patient

The Washington Post reports that doctors say an American man who suffered from AIDS appears to have been cured of the disease 20 months after receiving a targeted bone marrow transplant normally used to fight leukemia.  However, researchers and doctors caution that this might just be a coincidence.  Patrick McGroarty writes,

While researchers, and the doctors themselves, caution that the case might be no more than a fluke, others say it may inspire a greater interest in gene therapy to fight the disease that claims 2 million lives each year. The virus has infected 33 million people worldwide.

Dr. Gero Huetter said Wedneday his 42-year-old patient, an American living in Berlin who was not identified, had been infected with the AIDS virus for more than a decade. But 20 months after undergoing a transplant of genetically selected bone marrow, he no longer shows signs of carrying the virus.

"We waited every day for a bad reading," Huetter said.

It has not come. Researchers at Berlin's Charite hospital and medical school say tests on his bone marrow, blood and other organ tissues have all been clean.

However, Dr. Andrew Badley, director of the HIV and immunology research lab at the Mayo Clinic in Rochester, Minn., said those tests have probably not been extensive enough.

"A lot more scrutiny from a lot of different biological samples would be required to say it's not present," Badley said.

This isn't the first time marrow transplants have been attempted for treating AIDS or HIV infection. In 1999, an article in the journal Medical Hypotheses reviewed the results of 32 attempts reported between 1982 and 1996. In two cases, HIV was apparently eradicated, the review reported.

Huetter's patient was under treatment at Charite for both AIDS and leukemia, which developed unrelated to HIV.

As Huetter _ who is a hematologist, not an HIV specialist _ prepared to treat the patient's leukemia with a bone marrow transplant, he recalled that some people carry a genetic mutation that seems to make them resistant to HIV infection. If the mutation, called Delta 32, is inherited from both parents, it prevents HIV from attaching itself to cells by blocking CCR5, a receptor that acts as a kind of gateway.

"I read it in 1996, coincidentally," Huetter told reporters at the medical school. "I remembered it and thought it might work."

Roughly one in 1,000 Europeans and Americans have inherited the mutation from both parents, and Huetter set out to find one such person among donors that matched the patient's marrow type. Out of a pool of 80 suitable donors, the 61st person tested carried the proper mutation.

Continue reading "Rare Treatment Is Reported to Cure AIDS Patient"