HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

A Member of the Law Professor Blogs Network

Saturday, November 22, 2008

Rats and TB Detection

Images 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.

November 22, 2008 | Permalink | Comments (0) | TrackBack (0)

Friday, November 21, 2008

Professor Jay Katz

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

Katz190 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.

November 21, 2008 | Permalink | Comments (0) | TrackBack (2)

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.

November 21, 2008 | Permalink | Comments (0) | TrackBack (1)

Thursday, November 20, 2008

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,

Tomdaschletwn 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.

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

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. . . .

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

Wednesday, November 19, 2008

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,

Gavel3Ruling 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.

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

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,

Stethescope3Lawmakers 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."

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

Tuesday, November 18, 2008

Medicare Prescriptions and the Doughnut Hole

The Washington Post provides facts about Medicare Part D:

Stethescope5Facts 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.

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

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,

Stethescope4When 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.

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

Monday, November 17, 2008

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,

Wwwwashingtonpostcom_nati_harnik_neWhen 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.

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November 17, 2008 | Permalink | Comments (1) | TrackBack (0)

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,

Gavel4The 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."

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

Sunday, November 16, 2008

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,

Stethescope6It’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.

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

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,

Red_ribbonWhile 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.

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