HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Saturday, April 4, 2009

Man's Best Friend

Technology Review provides an update on genetic research involving Duchenne Muscular Dystrophy in dogs that provides hope for humans as well.  Courtney Humphries writes about the new gene research and states,  

An international team of researchers has successfully treated dogs with the canine form of Duchenne muscular dystrophy (DMD), a rapidly progressing and ultimately fatal muscle disease that afflicts one out of every 3,600 boys. The researchers used a novel technique called exon skipping to restore partial function to the gene involved in Duchenne. The study, published in Annals of Neurology, gives hope that a similar approach could work in humans.

DMD is caused by an aberration in the gene that encodes dystrophin, an important structural protein in muscle cells. Patients with DMD are unable to produce functional dystrophin, which leads to holes in the outer membranes of their muscle cells. Eventually, their muscles degenerate faster than they can be rebuilt, and few patients survive beyond their early 30s.

Unlike traditional gene therapy, which attempts to replace a mutated gene with a functional copy, exon skipping relies on a variation of a technique called antisense, in which short synthetic DNA or RNA molecules are designed to bind to a region of DNA or RNA and block its function. Companies are developing antisense therapies for cancer, diabetes, heart disease, and autoimmune diseases, among others. . . .

Eric Hoffman, a lead author of the study at Children's National Medical Center, in Washington, DC, says that scientists realized they might help DMD patients by creating a "patch" that blocks transcription of a portion of the gene in a way that puts the remaining code back into sequence--essentially recreating the milder Becker muscular dystrophy. . . .

April 4, 2009 | Permalink | Comments (0) | TrackBack (0)

Friday, April 3, 2009

Natalie Cole, Organ Donors and Cash Payments

Natalie Cole went on Larry King Live Wednesday night and discussed her need for a kidney.  Many individuals watching the show have volunteered to provide her with a kidney. Cord Jefferson writing at the Daily Beast thinks that this rather uncomfortable public plea for help leads him to believe that Ms. Cole should be permitted to buy a kidney.  He argues,

On Wednesday night, Natalie Cole announced on Larry King Live that both of her kidneys were failing following a decades-long battle with Hepatitis C; without a kidney transplant, she lamented, she'd be looking at a life of dialysis.  Within minutes of her sharing her illness with the world, dozens of Cole's fans had emailed the show with offers of their organs. . . .    It's a heartwarming story, but it also underscores a major problem in America: the giant gulf between those in need of an organ and those willing to donate one. When patients waiting in an endless line for a kidney transplant are relegated to making on-air pleas for help, something’s seriously wrong with the system.

As Americans everywhere wait to see how Barack Obama will handle medical care, allow me to suggest to the new president a solution: an open, regulated, and legal cash-for-kidneys market in the United States.

It's a subject very near to my abdomen. Last summer, I traveled to Riyadh, Saudi Arabia, to donate a kidney to my ailing father, who lives and works there. By the time I arrived, his kidneys were functioning at 5 percent of their capacity and he was going to four hours of dialysis, three times a week. After the sessions, I would watch him struggle up the stairs, his weary body shaking, belying my childhood memories of riding on his broad, solid shoulders. Giving him my left kidney was an honor, and I'd do it again—even if there weren't thousands of dollars in it for me the next time.

See, like many in the creative underclass of New York, I was gainfully employed, yet still without health insurance. When my father's illness got gradually worse, I eagerly volunteered to donate. But because kidney donation in America is a nonprofit enterprise, the myriad expenses associated with the operation and the years of aftercare fell beyond my ability to pay. Before I could even broach this dilemma with my dad, he wired me thousands of dollars to pay for insurance and initial testing. Would I have gone through with the donation without the money? Probably—only because he was my father. The point is that the offer of money made me absolutely certain I wanted to donate. . . .

The chief argument against a cash-for-kidneys system is that it will summon an outright organ market, one in which the rich procure second chances at life from the poor. Nancy Scheper-Hughes, a professor of anthropology at Berkeley and one of America's most vocal critics of the organ trade, criticizes kidney sales for two main reasons. What she most takes issue with is that organ sellers are often impoverished laborers who return from their surgeries unable to work and without the proper aftercare. Soon, their fee is spent on things other than their health, and they're drinking unclean water and eating bad food, neglecting a body that needs time to recover. The professor's second point is less tangible: She believes it's dangerous to commodify the human body. "It's the sense that body and soul are connected," she once told the Christian Science Monitor, "and selling your body is chipping away at what gives you existence." . . .

I think it’s similar to America's failure to consider legalizing marijuana. Both are supported by many medical professionals, but the political will to change the law exists for neither. Yet every day, 17 Americans die while waiting for a kidney. It’s an organ most of us could give to them easily, if only there were a system in place to compensate us for our trouble. My father was lucky to have my support and the resources to go elsewhere if he didn't. But with such a definite source of life constantly operating just out of the reach, it's a shame that luck comes into the equation at all.

April 3, 2009 | Permalink | Comments (0) | TrackBack (0)

The Cost of Health Insurance for Women

NPR's Morning Edition yesterday had a brief story by Sarah Varney on her experience with health insurance after a job loss.  She writes,

During the last economic bust, I got laid off and couldn't afford the monthly COBRA payments for my health insurance. I applied for an individual plan through Blue Cross.I was 28 at the time and had no health problems. . . .  I got a letter from Blue Cross saying I was denied. They told me it was because my medical records showed I'd gone to the doctor complaining of stomach pain. The pain had long since gone away, but Blue Cross said if I wanted insurance, my doctor would need to fax a note guaranteeing I didn't have stomach cancer. He faxed the letter, and eventually I got a plan.  It makes you wonder, though, if Blue Cross didn't want to insure me — a healthy 20-something — how on earth do actuaries determine who's a good risk and who's not?

"It's very scientific and fact-based," says Jeff Fluke a senior underwriter with the risk management company Ingenix in Minneapolis. Fluke says actuaries first calculate average health costs over a broad population like 28-year-old women or 50-year-old men. Then the underwriter adjusts those averages based on your medical history and health status — your height and weight, and whether you have high blood pressure, asthma or hay fever.. . .

These complex algorithms boil down to: Will you cost the insurance company more money than the insurer can make off your premium? And if by insuring you — a potentially high-cost customer — does it drive up rates and thus drive other, healthier customers away? . . .

The companies also want to avoid paying for predictable high-cost events like childbirth. And that, says Miller, makes the individual market a punishing place for young to middle-aged women. Childbirth, he says, is really a family cost. . . .

Women are also more likely than men to get annual exams and see the doctor when they're ill. And in most states, they pay a price for it. For example, in California, women pay up to 39 percent more than men for similar individual policies, even when maternity benefits are excluded.

California and several other states are considering legislation to ban the use of gender for individual policies. Ten states — Maine, Massachusetts, Minnesota, Montana, New Hampshire, New Jersey, New York, North Dakota, Oregon and Washington — already have a ban in place. Insurers stopped using race as a basis for coverage decades ago.

"Now what people are asking is where can you draw the boundary and say it's OK to discriminate based on this trait, but not others," says David Magnus, who directs Stanford University's Center for Biomedical Ethics.

"One view is you shouldn't discriminate based on characteristics over which you don't have control," he says. "That doesn't really work or apply in this particular market since the No. 1 factor that is taken into account for health insurance is one over which people don't have control, and that's age." . . .

April 3, 2009 | Permalink | Comments (0) | TrackBack (0)

Thursday, April 2, 2009

Health Care By the Numbers

Christy Hardin Smith at Firedoglake makes the case for comprehensive health reform.  She provides some updated numbers and writes,

From the Frontline documentary "Sick Around America:

According to a study by the National Academy of Sciences, around 20,000 Americans die each year because they can't get the healthcare they need.

You cannot reform medical care and coverage without (a) covering everyone and (b) controlling costs. But how you get from here to there? That's the bazillion dollar question. . . .

-- Small businesses are fed up with rapidly rising costs and want changes.

-- Health insurers may finally be seeing the handwriting on the wall and have begun to offer some concessions.

-- Numbers of uninsured Americans are swelling rapidly:

From 1994 to 2007, the number of Americans without health insurance increased by almost 9 million....

-- How do we even define health care and its related needs? That's a subject of considerable debate.

-- But public support is rising for a total overhaul of the healthcare system. With one in five Americans lacking health insurance, the need is growing:

"The case for reform couldn't be clearer," Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said in a news release from the organization, which focuses on health and health-care issues. "Further inaction means that costs rise, businesses struggle and workers go without. As high as the numbers of uninsured people seem to be, they don't even reflect the current crisis, with millions of Americans losing their jobs, which puts their insurance status in jeopardy. And the more people who become uninsured, the harder it is on our health-care system."

So, how do we answer all the remaining questions and resolve the myriad of enormous problems? That's the next step. . . .

April 2, 2009 | Permalink | Comments (0) | TrackBack (0)

Fresh Air and End of Life Care

Today, NPR's Fresh Air has an interview with Dr. Robert Marensen, author of A Life Worth Living.  He provides some interesting insights into the problems with our current health system and our focus on longevity over quality of life.  Here is the brief blurb from the show:

Over the course of his career, author, doctor and bioethicist Robert Martensen has treated an estimated 75,000 patients in the emergency room and the ICU.

In his new book, A Life Worth Living Martensen presents case studies that illustrate the problems and complexities of American health care system, and argues that safeguarding the quality of a patient's life sometimes trumps the urge to sustain life at all cost.

Martensen has held positions teaching bioethics and medical history at Harvard Medical School and Tulane University in New Orleans. He currently directs office of history at the National Institutes of Health n Bethesda, Maryland.

April 2, 2009 | Permalink | Comments (0) | TrackBack (0)

Wednesday, April 1, 2009

Food Safety - Still Questionable

The LA Times reports on the latest food recall - pistachios and has a brief article about the need for reform of our food safety laws.  Mary MacVean writes,

Consumers could be forgiven for feeling a little weary about this week's recall of pistachios that might be contaminated with salmonella.  It comes just weeks after thousands of products containing peanuts were voluntarily recalled in a salmonella outbreak that sickened about 700 people, and follows highly publicized food-borne disease outbreaks connected to peppers and spinach.  As consumers, we all have that reaction, 'Here we go again,' " said Jeff Levi, executive director of the Trust for America's Health, a Washington-based nonprofit organization that works to reform the food safety system.  

But the string of alerts keeps food safety on the minds of Americans and could lead to legislative changes in California and the rest of the country. . . .

Among the changes under consideration in legislation before Congress are giving the FDA mandatory authority to recall products; requirements for food safety systems at companies to minimize the chance of contamination during production; increased inspections; more funding; and a better way to track products around the country.

"The reality of the basic system at FDA is that there is no requirement for companies to have in place modern preventive controls," said Mike Taylor, a professor at the George Washington University School of Public Health and Health Services and a former FDA official. "A lot of companies do it, and Kraft is one of the leaders. They're doing the kinds of things you'd like the whole system to do."

There also are calls to split up the FDA and establish a Food Safety Administration. That may be premature, Kathleen Sebelius, the nominee for Health and Human Services secretary, said at her confirmation hearing Wednesday. First, she said, the FDA should be restored "as a world-class regulatory agency." . . .

In addition, a California bill by two Los Angeles Democrats, Assemblyman Mike Feuer and Assembly Speaker Karen Bass, would require food processors in the state to have plans in place to prevent contamination and to respond quickly if it occurred.  The legislation would require periodic testing and that any positive result for a dangerous contaminant be reported within 24 hours.  Feuer said he was not aware, and expected most consumers did not know, that testing and reporting results were not mandatory. . . .

April 1, 2009 | Permalink | Comments (0) | TrackBack (0)

Tax Problems Again for HHS Nominee

The Wall Street Journal's Health Blog reports that Kathleen Sebelius has a small tax problem that has been corrected.  Sarah Rubenstein writes,

Sebelius, who testified yesterday before the Committee on Health, Education, Labor and Pensions, amended three years of tax returns to correct “unintentional errors,” paying back taxes and interest totaling just under $8,000, the WSJ reports. Those numbers are far below the $140,000 or so of back taxes and interest that were a big reason for Tom Daschle’s withdrawal from the HHS nomination. . .  .

Max Baucus, who chairs the Senate Finance Committee and is a big player involved with health reform, put out a statement supporting Sebelius. “Congress is going to need a strong partner at the Department of Health and Human Services to achieve comprehensive health reform this year, and we have that partner in Governor Sebelius,” said Baucus, as quoted by Politico. . . .

April 1, 2009 | Permalink | Comments (0) | TrackBack (0)

Tuesday, March 31, 2009

Interesting New Study - HOT Tea Drinkers Beware

The LATimes reports on a new study in the British Medical Journal concerning the link between hot tea and cancer (who knew).  According to the study,hot tea (and they mean hot) is not so great for you.  Karen Kaplan writes,

Residents of Golestan province in northern Iran have one of the highest rates of esophageal squamous cell carcinoma in the world. They don't drink alcohol or smoke -- the two primary risk factors for the disease in the West -- but they do consume tea. Lots of it. Nearly 1.2 liters per day, on average. So local researchers set out looking for a connection. . . .

Teaming up with investigators from the U.S., England, France and Sweden, the researchers calculated that people who said they drank "hot" tea (149 to 156 degrees Fahrenheit) were more than twice as likely to develop esophageal cancer as people who said they drank the beverage "warm" or "lukewarm" (less than 140 degrees). Those who said they took their tea "very hot" (at least 158 degrees) were more than eight times as likely to get esophageal cancer, according to the study, published online Thursday in BMJ, formerly the British Medical Journal.

The researchers also asked people how long they waited to drink their tea after pouring it. Those who said they waited two to three minutes were nearly 2.5 times more likely to develop the cancer compared with people who said they waited at least four minutes. Impatient tea drinkers who waited less than two minutes were 5.4 times as likely to be diagnosed with esophageal cancer, the study found.

The study didn't assess the mechanism linking hot tea to esophageal cancer, but the researchers said the temperature of the liquid was almost certainly to blame rather than the compounds in the tea itself. . . .

March 31, 2009 | Permalink | Comments (0) | TrackBack (0)

Cigarette Tax Increase

The Associated Press provides details on the cigarette tax increase that takes place today.  The AP reports,

Tobacco companies and public health advocates, longtime foes in the nicotine battles, are trying to turn the situation to their advantage. The major cigarette makers raised prices a couple of weeks ago, partly to offset any drop in profits once the per-pack tax climbs from 39 cents to $1.01. Medical groups see a tax increase right in the middle of a recession as a great incentive to help persuade smokers to quit.

Tobacco taxes are soaring to finance a major expansion of health insurance for children. President Barack Obama signed that health initiative soon after taking office.  Other tobacco products, from cigars to pipes and smokeless, will see similarly large tax increases, too. For example, the tax on chewing tobacco will go up from 19.5 cents per pound to 50 cents. The total expected to be raised over the 4 1/2 year-long health insurance expansion is nearly $33 billion. . . .

The tax increase is only the first move in a recharged anti-smoking campaign. Congress also is considering legislation to empower the Food and Drug Administration to regulate tobacco. That could lead to reformulated cigarettes. Obama, who has agonized over his own cigarette habit, said he would sign such a bill. . . .

About one in five adults in the United States smokes cigarettes. That's a gradually dwindling share, though it isn't shrinking fast enough for public health advocates. The Centers for Disease Control and Prevention says cigarette smoking results in an estimated 443,000 premature deaths each year, and costs the economy $193 billion in health care expenses and lost time from work. Smoking is a major contributor to heart disease, cancer and lung disease. . . . .

Philip Morris USA, the largest tobacco company and maker of Marlboro, is forecasting a drop, but spokesman Bill Phelps said he cannot predict how big. Philip Morris raised Marlboro prices by 71 cents a pack early this month, and prices on smaller brands by 81 cents a pack. Other major companies followed suit.  The pricing moves raised eyebrows. "That's nothing more than greed," said Kevin Altman, an industry consultant who advises small tobacco companies. "They weren't required to charge that until April 1. They are just putting that into their pockets."  Responded Phelps: "We raised our prices in direct response to the federal excise tax increase, and people who are upset about that should find out how their member of Congress voted, and contact him or her."

Some policy analysts have questioned the wisdom of boosting tobacco taxes to finance health care for children. They argue that the fate of such a broad program should not depend on revenues derived from a minority of the adult population, many of whom have low incomes and are hooked on a habit. The tobacco industry is also warning that the steep increase will lead to tax evasion through old-fashioned smuggling or by Internet purchase from abroad. . . .

March 31, 2009 | Permalink | Comments (0) | TrackBack (0)

Frontline: Sick Around America

PBS's Frontline will be airing Sick Around America on March 31, 2009.  I really enjoy most Frontline episodes and have used some excerpts from those relating to health issues in my health law classes  The PBS website generally has useful information on the guests who appear in the program and additional readings that may be of interest. Here is a brief overview:

As the worsening economy leads to massive job losses—potentially increasing the ranks of the tens of millions of Americans without health insurance—FRONTLINE travels the country examining the nation’s broken health care system and exploring the need for a fundamental overhaul. The scale of the problem now facing the Obama administration, FRONTLINE finds, is staggering, as lay-offs, major illness and other unexpected life changes leave more and more Americans uninsured, underinsured or uninsurable. FRONTLINE also goes inside insurance companies to question executives on their policies, programs and priorities and examines the problems in one state’s attempts at health care reform.

March 31, 2009 | Permalink | Comments (0) | TrackBack (0)

Monday, March 30, 2009

Splitting the FDA provides information on the recent talk about splitting the FDA into two separate agencies with one focusing on food and another focusing on medical products.  The site reports,

Some drug industry executives think a split FDA might result in faster product approvals because the agency would not "be distracted by high-profile food-safety breakdowns," according to the AP/Chronicle. FDA this year will spend 73 cents on food safety for each dollar that it will spend on medical product regulation, according to the Institute of Medicine. . . .

Rep. Rosa DeLauro (D-Conn.) has introduced legislation (HR 875) to move FDA's food safety responsibilities to a separate entity that would have additional responsibilities to order product recalls and increase food inspections. DeLauro said that she supports a newly created federal food safety task force, but added that the task force must not be "merely a cosmetic bureaucratic endeavor" and should "produce definitive recommendations that result in the modernization of our food safety regulatory structure." . .

Peter Pitts, a former FDA associate commissioner for external affairs and co-founder of the Center for Medicine in the Public Interest, said that President Obama's recent nomination of two public health specialists for the top FDA slots indicates that the president favors splitting up the agency. Pitts said, "[Commissioner-nominee Margaret] Hamburg is a safety and security expert, and it seems pretty clear she would become administrator of the food agency," while "[Deputy Commissioner-nominee] Josh Sharfstein would then slide over" to lead the drug agency. . .

March 30, 2009 | Permalink | Comments (0) | TrackBack (0)

Sunday, March 29, 2009

Caregivers and Alzheimer's Disease - Talk of the Nation

National Public Radio's Talk of the Nation had an interesting and informative discussion with Former Supreme Court Justice Sandra Day O'Connor, former Speaker of the House Newt Gingrich and former Surgeon General David Satcher concerning new ways to address Alzheimer's disease.  All three serve on a task force that discusses new medicines and new ways to treat Alzheimer's disease and help caregivers. 

March 29, 2009 | Permalink | Comments (0) | TrackBack (0)