HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

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Wednesday, May 27, 2009

Ezra Klein on the Senate Finance Committee

Ezra Klein, now writing at the Washington Post, has a brief post on the Senate Finance Committee and its importance to health care reform legislation.  He writes,

You hear a lot about the "how" of health care reform. You hear a fair amount about the "who" of it. You even get some "when." But you don't hear that much about the "where." But the "where" matters. And the where, somewhat confusingly, is primarily the Senate Finance Committee -- the same committee chaired by Baucus.

There are two reasons for this. The first is that pushing health care reform through the United States Senate is harder than pushing it through the House of Representatives. The reason is simple enough: The filibuster. If House Speaker Nancy Pelosi could handle health reform on her own, the bill would be signed by lunchtime Wednesday.

The second has to do with the confusing composition of the Senate's committee. There is, after all, a more obvious committee where health reform could dock: The Health, Education, Labor, and Pensions Committee. "Health," after all, isn't even that committee's middle name. It's its first name.

The catch, however, comes in rule XXV of the Senate, which contains the Senate Finance Committee's charter. Among its areas of jurisdiction: "Health programs under the Social Security Act and health programs financed by a specific tax or trust fund." Health programs, in other words, that will cost money. And health reform will cost money. If this were just a matter of insurance market reform -- or simple regulations, in other words -- the HELP committee could bear the burden on its own. But since reform requires money, they're the junior partner to the Finance Committee. . . .

May 27, 2009 | Permalink | Comments (0) | TrackBack (0)

Health Care, Increased Costs and Decreased Quality

This week's New Yorker contains yet another great article by Atul Gawande on the costs of health care.  He writes,

McAllen [Texas] as another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns. . . .

Yet public-health statistics show that cardiovascular-disease rates in the county are actually lower than average, probably because its smoking rates are quite low.  . . .   An unhealthy population couldn’t possibly be the reason that McAllen’s health-care costs are so high. (Or the reason that America’s are. We may be more obese than any other industrialized nation, but we have among the lowest rates of smoking and alcoholism, and we are in the middle of the range for cardiovascular disease and diabetes.). . . .

And yet there’s no evidence that the treatments and technologies available at McAllen are better than those found elsewhere in the country. The annual reports that hospitals file with Medicare show that those in McAllen and El Paso offer comparable technologies—neonatal intensive-care units, advanced cardiac services, PET scans, and so on. Public statistics show no difference in the supply of doctors. Hidalgo County actually has fewer specialists than the national average.  . .  .

“Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.  The surgeon came to McAllen in the mid-nineties, and since then, he said, “the way to practice medicine has changed completely. Before, it was about how to do a good job. Now it is about ‘How much will you benefit?’ ” . . .  

This is a disturbing and perhaps surprising diagnosis. Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care. . . . 

May 27, 2009 | Permalink | Comments (0) | TrackBack (0)

Tuesday, May 26, 2009

Judge Sonia Sotomayor Nominated

The New York Times reports that President Obama has nominated Judge Sonia Sotomayor to the Unisted States Supreme Court.  Peter Baker and Jeff Zeleny write,

President Obama has decided to nominate the federal appeals judge Sonia Sotomayor to the Supreme Court, choosing a daughter of Puerto Rican parents raised in Bronx public housing projects to become the nation’s first Hispanic justice, officials said Tuesday. . . .

Judge Sotomayor, 54, who has served for more than a decade on the 2nd Circuit Court of Appeals based in New York City, would become the nation’s 111th justice, replacing David H. Souter, who is retiring after 19 years on the bench. Although Justice Souter was appointed by the first President George Bush, he became a mainstay of the liberal faction on the court and so his replacement by Judge Sotomayor likely would not shift the overall balance of power.

But her appointment would add a second woman to the nine-member court and give Hispanics their first seat. Her life story, mirroring in some ways Mr. Obama’s own, would add a different complexion to the panel, fulfilling the president’s stated desire to add diversity of background to the nation’s highest tribunal.

Judge Sotomayor’s father died when she was 9 years old and she was raised by her mother, who worked six-day weeks to earn enough money to send her and a brother to Catholic school. She got into Princeton University, where she once said she felt like “a visitor landing in an alien country,” but graduated summa cum laude.

After Yale Law School, where she was editor of the Yale Law Journal, she worked for Robert M. Morgenthau in the district attorney’s office in New York and later was in private practice. The first President Bush nominated her in 1991 to the federal district court on the recommendation of Senator Daniel Patrick Moynihan, Democrat of New York, and she was confirmed a year later. President Bill Clinton decided to elevate her to the appeals court in 1997 and she was confirmed a year later.

Judge Sotomayor has said her ethnicity and gender are important factors in serving on the bench, a point that could generate debate. “I would hope that a wise Latina woman with the richness of her experiences would more often than not reach a better conclusion than a white male who hasn’t lived that life,” she said in a 2002 lecture. . . .

On the appeals court, Judge Sotomayor has not been involved in many hotly disputed decisions, but one that she participated in is before the Supreme Court right now. As part of a panel, she voted to uphold New Haven’s decision to throw out a set of fire department promotion tests because no minority candidates made the top of the list. White firefighters who scored high but were denied promotion are appealing that ruling.   As a district judge, she briefly earned fame in 1995 by ending a Major League Baseball strike, ruling in favor of players and against the owners, who she said were trying to subvert the labor system. . . .

More background on Judge Soto myere can be found here and here.

May 26, 2009 | Permalink | Comments (0) | TrackBack (0)

Regulating Tobacco

The Hill reports that tobacco and tobacco products will soon fall under some government agency's   jurisdiction.  J. Taylor Rushing writes,

The congressional drive to bring tobacco under Food & Drug Administration control -- given new life in the Senate last week --  is poised to approach the finish line in the Senate in June, but not without a bipartisan fight from North Carolina's two senators.

Sens. Kay Hagan (D) and Richard Burr (R) plan to push a substitute bill that would put the controversial drug under the control of a newly created entity of the U.S. Department of Health and Human Services instead of the FDA. The substitute bill by Burr and Hagan has been criticized by critics who say taking control outside the FDA would short-circuit attempts at worthwhile regulation, while Burr and Hagen say HHS is better equipped to regulate the drug. . . .

The Family Smoking Prevention and Tobacco Control Act passed the House by a vote of 298-112 on April 2 -- a vote opposed by most House Republicans. Jim Manley, a spokesman for Senate Majority Leader Harry Reid (D-Nev.), said last week that Senate Democrats plan to move forward on their side sometime in June.  The Senate's Health, Education, Labor and Pensions Committee passed the bill on a 15-8 vote last Wednesday. . . .

The bill -- primarily pushed by HELP Committee Chairman Edward Kennedy (D-Mass.) would set new FDA regulations on nicotine. Federal officials would gain new power to regulate the ingredients, marketing and disclosure requirements of cigarettes, for example, including the power to ban advertising that seeks to downplay the drug's effect, such as companies that advertise cigarettes as "low-tar," or "mild."  The bill is also an attempt to circumvent a March 2000 Supreme Court ruling that struck down a Clinton administration attempt to regulate tobacco. On a 5-4 vote, justices at the time said the FDA was "overreaching" in attempting to regulate tobacco without congressional approval. . . .

But the bill won't go down without a fight. Democrats say they have the necessary 60 votes to pass the bill, but Burr said he will lead opposition.  "FDA's core mission is to prove the safety of every product that they regulate -- except for tobacco, which we know is dangerous and kills people," said Burr. "So what do you do, ask FDA to ignore their core mission when it comes to tobacco but apply it on everything else?"  Burr said he and Hagan do not disagree with the need for increased regulation.  ,But where you put it is important," Burr said.

May 26, 2009 | Permalink | Comments (0) | TrackBack (0)

Monday, May 25, 2009

Summer Pool Tip from CDC

As if one needed to be reminded:  Headline of the Day from CNN.com -  Please don't pee in the pool.  The rest of the story goes into more detail as to why: 

Although urine in the water probably will not cause swimmers to go to the emergency room, it causes "more of a respiratory, ocular irritation: the red puffy eyes or a cough, an itchy throat," said Michele Hlavsa, an epidemiologist in the division of parasitic diseases at the Centers for Disease Control and Prevention."A big health message is not to urinate or pee in the water."

And it happens far more frequently than water-lovers would like to think. In a survey of 1,000 U.S. adults conducted in April and May, 17 percent admitted relieving themselves in a swimming pool. Even the Olympics' most decorated swimmer, Michael Phelps, confessed to urinating in the water to TV host Jimmy Kimmel. In a 2008 interview, Kimmel asked the 14-gold medal winner, "You pee in the pool, true?" "Yeah," Phelps replied. "Which nationality pees in the pool the most?" Kimmel asked. "Probably Americans," Phelps said. "Oh, so we're number one in that too," Kimmel quipped.

May 25, 2009 | Permalink | Comments (0) | TrackBack (0)

Saturday, May 23, 2009

Book Review: Bodies: Big Ideas/Small Books

Susan G, writing at DailyKos, provides a great review of Bodies:  Big Ideas/Small Books by Susie Orbach.  Susan writes,

For psychoanalyst Susie Orbach, the human body in the 21st century has become--. . . . --a burden. "Our bodies," she writes, "no longer make things." They "are and have become a form of work. The body is turning from being the means of production to the production itself."

The new idea that our bodies are and should be an individual creation rather than the simple outcome of biology means that the body takes up enormous amounts of energy and becomes a source of considerable difficulty for many, many people today.

Worse, she claims, "Our body is judged as our individual production." This assignment of body as our "production" means we are responsible for it, in all its manifest messiness and inescapable breakdown. No matter how healthy our diets, how rigorous our workout routines, how dedicated our appearance regimens, we're going to age, wither, wrinkle and ultimately, decay. Failure of our physical body is, obviously, inevitable; previous generations often wore theirs out with hard brutal use. Today, we witness our own often more genteel declines and despair. . . .


May 23, 2009 | Permalink | Comments (0) | TrackBack (0)

Friday, May 22, 2009

Schools and Obesity

The Robert Wood Johnson Foundation and the National Association of State Boards of Education have released a new report to help schools combat obesity in children.  It states,

Schools have many powerful tools at their disposal to serve as one of the primary agents to address the obesity crisis (e.g., access to children for significant amounts of time in their daily lives, mechanisms for education and reinforcement of healthy behaviors, and are portals to accessing the community at large). (footnote deleted)  This policy guide is based on the National Association of
State Boards of Education’s Fit, Healthy, and Ready to Learn: A School Health Policy Guide, a comprehensive document developed in cooperation with the Division of Adolescent and School Health of the U.S. Centers for Disease and Control and Prevention (CDC) divided into several chapters addressing various student health needs and the school’s role in addressing those needs.

May 22, 2009 | Permalink | Comments (0) | TrackBack (0)

Lessons from State Health Reform Efforts

HGM MA writing at the DailyKos website has some thoughts about what Massachusetts and its health care public option might teach America as the public option is debated.  The author writes,

 I am surprised to see the abundance of support in this community for a specific Public Option when the debate should be focused in a much larger context within Health Care reform. The tremendous opportunity at hand presents long time universal access advocates with an opening to engrave into the debate once and for all that health care is a human right and not a privilege for only those who are working and not only for those who are citizens. Also to focus energy on a public option within a paradigm where the profit motive still dictates the delivery of health care services does nothing to forward the goal to universal access.  In my view supporting a public option as merely a mode of paying for private services is akin to being satisfied with table scraps.  We must expand the debate to include the complete trifecta of a not only a public payer, but public points of access and a stringent public regulatory framework that ensures patients are treated fairly. . . .

May 22, 2009 | Permalink | Comments (0) | TrackBack (0)

Thursday, May 21, 2009

The Daily Dose

Ezra Klein, who now blogs at the Washington Post, points to another helpful Washington Post health resource, The Daily Dose.  Some recent stories include: 

Experts Offer CBO New Formula for Determining Cost of Reform

By Lori Montgomery As key lawmakers begin drafting health reform legislation, health advocates are nervously wondering whether the numbers will add up in the eyes of the Congressional Budget Office, the official arbiter of legislative costs and savings. Today, a...

By Paul Volpe | May 21, 2009; 03:05 PM ET | Comments (0)

Liberal Group Offers Porposal to Fund Health Reform Plan

By Lori Montgomery With lawmakers struggling to find ways to pay for an overhaul of the nation's health care system, the liberal Citizens for Tax Justice today offered its own modest proposal: A plan to raise $1 trillion over the...

By Paul Volpe | May 21, 2009; 02:59 PM ET | Comments (0)

Baucus: Senate Health-Care Plan Unlikely to Cover All Americans

By Lori Montgomery Health care legislation being drafted in the Senate is unlikely to meet the ambitious goal of covering all Americans, and will specifically exclude undocumented workers from receiving benefits, the chairman of the Senate Finance Committee said today....

By Sarah Lovenheim | May 21, 2009; 01:25 PM ET | Comments (6)

May 21, 2009 | Permalink | Comments (0) | TrackBack (0)

Swine Flu Continues to Spread

Although it no longer tops the news, swine flu has not gone away.  MSNBC reports that it has now spread to Japan and that the US death rate is now in the double digits.  The story provides,


. . . . Swine flu has sickened more than 11,000 people in 41 countries and killed 85, according to the World Health Organization, whose figures often trail those of individual countries. Mexico has reported 75 deaths, the U.S. 10, and one in both Canada and Costa Rica. . . .

In Japan, two high school girls who recently visited New York for a Model United Nations Conference became Tokyo's first confirmed cases. Japan had 280 total confirmed cases as of Thursday afternoon, making it the world's fourth-most infected country, behind Mexico, the U.S. and Canada.

While Japan's Health and Welfare Minister Yoichi Masuzoe urged citizens to remain calm, Egypt's health minister warned that Egyptians who perform the annual Muslim pilgrimage to Mecca risk being quarantined upon their return.

"It is my job to warn," Hatem el-Gabali said. "I can also open the quarantine and say no one will return to their homes after arriving from Saudi Arabia."

Egyptian officials already have ordered that the country's roughly 300,000 pigs be killed as a preventive measure and have finished off about a third of the job in a couple of weeks.

Other diseases neglected?
In Geneva, health campaigners and officials from some poorer nations complained this year's World Health Assembly was neglecting diseases killing millions of people all over the world because of swine flu fears.

"Malaria, drug-resistant tuberculosis — they are killing people every day," said Dr. Sam Zaramba, Uganda's chief medical officer. "If all the emphasis that has been put on swine flu had been put on malaria and TB, we would have made a bigger impact on health."

Discussions were postponed on fighting Chagas disease, a scourge in Latin American countries, and the first-ever WHO resolution addressing hepatitis was dropped from the meeting's agenda.

But WHO spokesman Thomas Abraham said the assembly was still taking on a "broad agenda" that went far beyond swine flu to deal with improving basic health care and tackling global killers like TB.

May 21, 2009 | Permalink | Comments (0) | TrackBack (0)

Wednesday, May 20, 2009

Missing Link or Not - Pretty Exciting Find

Scientists have been all abuzz about the find of a new fossil named Ida - a small female primate estimated to be around 47 million years old.  How significant is the find - well, that is debatable but most agree that it is a big deal.  PZ Myers at Pharynagula writes about the discovery and Ida's importance not just for humans but for all,

250px-Darwinius_masillae Phylogeny. A cladistic analysis of the fossil revealed another interesting point. There are two broad groups of primates: the strepsirrhines, which includes the lemurs and lorises, and the haplorhines, which includes monkeys and apes…and us, of course. Ida's anatomy places her in the haplorhines with us, but at the same time she's primitive. This is an animal caught shortly after a major branch point in primate evolutionary history.

She's beautiful and interesting and important, but I do have to take exception to the surprisingly frantic news coverage I'm seeing. She's being called the "missing link in human evolution", which is annoying. The whole "missing link" category is a bit of journalistic trumpery: almost every fossil could be called a link, and it feeds the simplistic notion that there could be a single definitive bridge between ancient and modern species. There isn't: there is the slow shift of whole populations which can branch and diverge. It's also inappropriate to tag this discovery to human evolution. She's 47 million years old; she's also a missing link in chimp evolution, or rhesus monkey evolution. She's got wider significance than just her relationship to our narrow line. . . .

May 20, 2009 | Permalink | Comments (0) | TrackBack (0)

Professor Gostin on Preemption and Drug Regulation

This week's Journal of the American Medical Association has an interesting article by Professor Gostin on the regulation of pharmaceuticals which touches on the FDA, tort law, and the preemption doctrine.  He writes,

The responsibilities of the FDA are vast, accounting for approximately 25% of all consumer spending, including food, drugs, vaccines, and medical devices. However, it lacks adequate staffing and resources, even as public safety concerns have increased.(cites omitted) At the same time, the agency often does not have the information needed for effective oversight. It is reliant on the manufacturer to find and disclose hazards at the time of approval and postmarketing. Approval decisions, moreover, often consider relatively small numbers in clinical trials, almost ensuring that the full safety and effectiveness profile will emerge only after the drug is marketed to a large population. (cite omitted) Tort litigants, unlike the FDA, have subpoena power and discovery can be a potent way to inform the agency and public of undisclosed risks.

The civil justice system also can compensate patients who are wrongly harmed by drugs and medical devices. Absent tort litigation, patients who sustain grievous injuries would have no recourse.

The "preemption wars" between consumers and industry raise a vital public health question—should FDA approval set a regulatory ceiling for product safety or can states enforce higher safety standards? (cite omitted)  Wyeth will not be the death knell of the preemption doctrine. The Supreme Court strongly hinted that it would preempt tort litigation if the FDA takes an active role and pays close attention to a particular safety risk, and the manufacturer fully discloses all the pertinent facts. If, however, as too often appears to be the case, industry conceals relevant information and the FDA lacks the capacity to do anything about it, the tort system becomes a failsafe, facilitating effective agency oversight and offering a remedy for patients who are wrongly harmed.

May 20, 2009 | Permalink | Comments (0) | TrackBack (0)

Tuesday, May 19, 2009

Making Medical Decisions for Children

The Associated Press reports on the on-going conflict between doctors and family members in a case involving a child with cancer who does not wish to continue with chemotherapy.  Amy Forliti writes,

A judge issued an arrest warrant Tuesday for the mother of a 13-year-old boy resisting chemotherapy after the pair missed a court hearing on his welfare. Brown County District Judge John Rodenberg also ordered that Daniel Hauser be placed in protective custody so he can get proper medical treatment for Hodgkin's lymphoma.

The cancer is considered highly curable with proper treatment, but Daniel quit chemo after a single treatment and with his parents opted instead for "alternative medicines," citing religious beliefs. That led authorities to seek custody. Rodenberg last week ruled that Daniel's parents, Colleen and Anthony Hauser, were medically neglecting their son. . . .

In his ruling last week, Rodenberg wrote that he would not order chemotherapy if Daniel's prognosis was poor. But if the outlook was good, it appeared chemotherapy and possibly radiation was in the boy's best interest, he wrote. Daniel's lymphoma was diagnosed in January, and six rounds of chemotherapy were recommended. Daniel underwent one round in February but stopped after that single treatment. He and his parents sought other opinions, but the doctors agreed with the initial assessment.  Colleen Hauser testified at the earlier hearing that her son "is not in any medical danger." She said she had been treating his cancer with herbal supplements, vitamins, ionized water and other natural alternatives.

Rodenberg wrote that state statutes require parents to provide necessary medical care for a child. The statutes say alternative and complementary health care methods aren't enough. He also wrote that Daniel, who cannot read, did not understand the risks and benefits of chemotherapy and didn't believe he was ill. Daniel testified that he believed the chemo would kill him and told the judge in private testimony unsealed later that if anyone tried to force him to take it, "I'd fight it. I'd punch them and I'd kick them." . . . .


May 19, 2009 | Permalink | Comments (0) | TrackBack (0)

Wyeth in trouble . . .

The Associated Press reports on some potentially big trouble for Wyeth pharmaceuticals.  The story states,


The Justice Department on Monday accused Wyeth, one of the nation's biggest drugmakers, of cheating Medicaid programs out of hundreds of millions of dollars by overcharging for a stomach acid drug.  The Justice Department and more than a dozen states have joined in two whistleblower lawsuits against the Madison, N.J.-based drug company filed in federal court in Massachusetts.

The government is seeking financial penalties against the company of up to three times the amount lost by Medicaid. And if a settlement is reached, the two whistleblowers who filed the original suits likely would be entitled to some share of the sum.  The court papers claim that between 2000 and 2006, Wyeth offered steep discounts to thousands of hospitals for two versions of Protonix, a drug that suppresses stomach acid.  By law, manufacturers of brand-name drugs are required to offer the same rebates to state Medicaid programs that they provide to other customers.  . . .

Wyeth defended its pricing plan. "The company believes that its pricing calculations were correct and intends to defend itself vigorously in these actions," said Doug Petkus, a Wyeth spokesman. . . .

The Wall Street Journal's Health Blog has more here.

May 19, 2009 | Permalink | Comments (0) | TrackBack (0)

Monday, May 18, 2009

Dr. Margaret Hamburg Confirmed as FDA Commissioner

The Associated Press reports that the Senate confirmed Dr. Margaret Hamburg to be the new Food and Drug Administration commissioner and states, . 

Images The Senate on Monday confirmed President Barack Obama's pick to oversee food and drug safety, two areas that are vital to consumers and widely seen as in critical need of improvement.  Dr. Margaret Hamburg, a bioterrorism expert, will be sworn in as the 21st commissioner of the Food and Drug Administration and only the second woman to hold the post in 100 years of agency history. The Senate confirmed her nomination by voice vote. Her first priority will be to help direct development of a vaccine for the new swine flu. She says she also wants to revamp food safety. . . .

Hamburg, 53, told senators at her confirmation hearing that she wants to restore public confidence in the agency by putting science first and running an open and accountable operation.  As an assistant health secretary under President Bill Clinton, Hamburg helped lay the groundwork for the government's bioterrorism and flu pandemic preparations. Before that, she ran the New York City health department. Her tenure saw improvement in childhood vaccinations, a reduction in the number of new HIV cases, and praise for the way the agency helped contain an epidemic of drug-resistant tuberculosis.  On food safety, Hamburg says she wants to shift from chasing outbreaks after they have broken out to preventing them in the first place. But that will require sustained effort, more money and stronger laws. . . .

DailyKos has a great overview of both Dr. Hamburg and the FDA here.

May 18, 2009 | Permalink | Comments (0) | TrackBack (0)

Single Payer Discussion on Diane Rehm

The Diane Rehm Show has an interesting and informative discussion on single payer health care plan.

10:00 Single Payer Health Care:    Proponents of a single-payer plan argue it is the best solution for the nation’s health-care system. But chances of such a program making it into law appear remote. How a single-payer plan might work and why it faces an uphill battle in Congress.

Guests

Roger Hickey, Co-director of the Campaign for America's Future

Dr. David Himmelstein, primary care doctor; co-founder, Physicians for a National Health Program; associate professor of medicine at Harvard University

Bernie Sanders, was elected to the U.S. Senate in 2006 after serving 16 years in the House of Representatives. He is the longest serving independent member of Congress in American history.

Susan Dentzer, Editor-in-Chief of Health Affairs, and an on-air analyst on health issues with The NewsHour with Jim Lehrer on the Public Broadcasting Service (PBS)

May 18, 2009 | Permalink | Comments (0) | TrackBack (0)

Sunday, May 17, 2009

Menu Education and Labeling Act

Ezra Klein now has a blog at the Washington Post and one of his first posts concerns the new focus on menu labeling among some in the public health field.  He writes,

Sen.Tom Harkin (D-Iowa) and Rep. Rosa DeLauro(D-Conn.) are reintroducing the aptly-named MEAL Act. "MEAL" stands -- somewhat awkwardly -- for Menu Education And Labeling. That is to say, it stands for calorie counts. Right there on the menu. Next to your food. So you know. Harkin and DeLauro want to see restaurants with more than 20 locations displaying the total calories, sodium, saturated and trans fats, and carbohydrates of each dish right next to its name on the menu. Or, as the case may be, the menu board. . . .

The theory here is simple. Ignorance, as my Libertarian friends claim, might be bliss. But it also makes you fat. It's not simply that consumers don't know how many calories are in restaurant meals. It's that repeated studies show they systematically underestimate how many calories are in restaurant meals. . . .   Studies show that even nutritionists tend to lowball their estimates at fast food restaurants, coming in 200 to 600 calories below the mark. . . .

Hence: Menu labeling. The key insight here is that small changes in behavior can have large impacts on outcomes. A Health Impact Assessment (pdf) prepared for the city of Los Angeles estimated that if calorie labeling convinced a mere 10 percent of large-chain patrons to order meals that were merely 100 calories lighter, then menu labeling "would avert 38.9% of the 6.75 million pound average annual weight gain in the county population aged 5 years and older." Get 20 percent to reduce their meals by 75 calories? You've knocked out 58.3 percent of the projected 6.75 million pounds. That's huge. . . .

May 17, 2009 | Permalink | Comments (0) | TrackBack (0)

Saturday, May 16, 2009

Dr. Thomas Frieden: New Head of Centers for Disease Control and Prevention

The Associated Press reports on President Obama's selection for head of the Centers for Disease Control and Prevention - Dr. Thomas Frieden, currently New York's Health Commissioner.  The AP's story provides,

For seven years, Dr. Thomas Frieden has been the nagging conscience of the nation's biggest city, the man who made sure New Yorkers couldn't smoke in bars or eat french fries cooked in artery-clogging trans fats. Now, the city's health commissioner will be taking his crusade against unhealthy living national as the head of the U.S. Centers for Disease Control and Prevention.

President Barack Obama announced Friday that he has picked the 48-year-old Frieden to lead the public health agency, where he will be faced with some immediate decisions on how to deal with the swine flu outbreak, including whether to produce a vaccine. Frieden also may play a role in health care reform. The selection reunites Frieden with an agency where he worked as an infectious-disease detective at the beginning of his career. . . .

In a 2004 editorial in the American Journal of Public Health, he chided most public health agencies for being "asleep at the switch" on chronic disease. "Local health departments generally do a good job of monitoring and controlling conditions that killed people in the United States 100 years ago," while doing little about modern-day threats like diabetes, he wrote.

It is unclear how Frieden's approach will play in the rest of America. His support of needle exchange programs and condom distribution to help prevent the spread of AIDS (he distributed tens of millions of free condoms, proudly stamped with the city's NYC logo and the slogan "Get Some!") may not sit well with conservatives.  Civil libertarians have chafed at his attempts to force changes in our diets, including, most recently, a push to get restaurants to use less salt. New York magazine's Web site greeted the news of Frieden's appointment with the headline, "Health Commissioner Thomas Frieden to Take Fun-Hating National." . . . .

He will begin at the CDC in June. His appointment does not require Senate confirmation.

May 16, 2009 | Permalink | Comments (0) | TrackBack (0)

Friday, May 15, 2009

Free Drugs - Is this for real?

I am sure that most of you have heard that Pfizer has decided to offer free drugs to individuals who lose their jobs.  Here is a great take with some further information on the Maintain program from Doc Gurley writing at SFGate.com:

Okay, just the threat of healthcare reform has industry promising to stop excluding the sick, to stop discriminating against women, and to hand over 2 trillion dollars to Obama. What else can they offer us, a kidney?  Um, try a little further south. Today Pfizer offered America Viagra. Free! For a year!

If, that is, you can prove a) that you've been on it for three months, and b) you have lost your job. Clearly there's no longer any reason to feel unmanned by a lay-off. You can still hold your head high.

The PR for this move is phenomenal - tales of weeping reps, company meetings spent wondering how to help all the diabetics who can't afford their medicines. The Pfizer answer, obviously, was free Viagra. Or Lyrica. Or Lipitor. Or Celebrex, which, BTW, very few people should be taking any more...

If you're noticing a theme with that list of drugs, you're not alone. Rumor is, these particular drugs may have been picked as freebies because there are way cheaper (and equally effective) generics out there. . . .   By offering these drugs free, in addition to lots of great PR, Pfizer can build brand loyalty and keep patients from switching to generics.

As a doctor, I wanted to find out what other free drugs are available. . . .    I called the 1-866-706-2400 Pfizer information number, sat on hold, punched the "doctor" number and then got transferred to the free-drug program line. I spoke to an informed, competent actual human being (named Jennifer). The way the program will work is that you must apply, showing both that you were employed (then laid off - keep that severance letter!), that you were on one of these drugs for three months, and that you were/are not eligible for pharmacy benefits. To get the pills, a doctor would then re-write a prescription, and a 90-day supply of the drugs will be mailed directly to you on an on-going basis, free-of-charge, for one year, or until you're re-insured. Basically Pfizer will function as a direct-to-you pharmacy benefits service. I went down a list of their products and asked about a Pfizer brand drug in several categories to see if it was covered. Jennifer kindly looked them up one by one to see if they would be free.

Check it out:

  • A seizure drug, Dilantin - free
  • Injected once-a-month birth control, Depo-Provera - free
  • A diabetes pill, Glucotrol - free
  • An anti-psychotic, Geodon - free
  • A sleeping pill, Halcion - free
  • An antibiotic, Zithromax - free
  • Jennifer and I could only find one, rarely used inhaler, Spirivia - free
  • An antidepressant, Zoloft - free

Pfizer Score: A

I'm serious - and this from little ole cynical moi. The only reason Pfizer didn't get an A+ is because they don't have an actual list to share yet - with doctors or the public. I also asked a clinical question, which was: How can an antibiotic be on the list - almost no one should be taking one for three months continuously. Jennifer admitted that could be an issue, but didn't have an answer.

Bottom line:

The Pfizer free drug giveaway program, called Maintain, is better than I expected. If you've been (and stay) a loyal Pfizer customer, you could be unemployed and get many of your pills through the mail - at least that's the promise for now.. . .

May 15, 2009 | Permalink | Comments (0) | TrackBack (0)

Are Cheerios drugs?

The FDA has sent General Mills, the manufacturer of Cheerios, a warning letter.  It seems that General Mills went a little far in its advertising claims about the health benefits of eating the cereal.  The AP reports,

Federal regulators are scolding the maker of Cheerios, saying it made inappropriate claims about the popular cereal's ability to lower cholesterol and treat heart disease.

The Food and Drug Administration says in a warning letter to General Mills that language on the Cheerios box suggests the cereal is designed to prevent or treat heart disease. Regulators say that only FDA-approved drugs are allowed to make such claims.  Among other claims, the labeling states: "you can lower your cholesterol 4 percent in six weeks."

General Mills said the health claims on Cheerios have been approved for 12 years and the FDA's complaints deal with how the language appears on the box. The company said in a statement that the science was not in question.

May 15, 2009 | Permalink | Comments (0) | TrackBack (0)