HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

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.


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)