February 7, 2009
Have a cup of coffee - for your health
Drinking coffee may do more than just keep you awake. A new study suggests an intriguing potential link to mental health later in life, as well. A team of Swedish and Danish researchers tracked coffee consumption in a group of 1,409 middle-age men and women for an average of 21 years. During that time, 61 participants developed dementia, 48 with Alzheimer’s disease.
After controlling for numerous socioeconomic and health factors, including high cholesterol and high blood pressure, the scientists found that the subjects who had reported drinking three to five cups of coffee daily were 65 percent less likely to have developed dementia, compared with those who drank two cups or less. People who drank more than five cups a day also were at reduced risk of dementia, the researchers said, but there were not enough people in this group to draw statistically significant conclusions. . .
Dr. Kivipelto and her colleagues suggest several possibilities for why coffee might reduce the risk of dementia later in life. First, earlier studies have linked coffee consumption with a decreased risk of type 2 diabetes, which in turn has been associated with a greater risk of dementia. In animal studies, caffeine has been shown to reduce the formation of amyloid plaques in the brain, one of the hallmarks of Alzheimer’s disease. Finally, coffee may have an antioxidant effect in the bloodstream, reducing vascular risk factors for dementia.Dr. Kivipelto and her colleagues suggest several possibilities for why coffee might reduce the risk of dementia later in life. First, earlier studies have linked coffee consumption with a decreased risk of type 2 diabetes, which in turn has been associated with a greater risk of dementia. In animal studies, caffeine has been shown to reduce the formation of amyloid plaques in the brain, one of the hallmarks of Alzheimer’s disease. Finally, coffee may have an antioxidant effect in the bloodstream, reducing vascular risk factors for dementia.
February 6, 2009
FDA Review by Obama
Yahoo News reports on President Obama's recent discussion about the FDA and a need to improve food safety. The article provides,
President Barack Obama, speaking as the nation's chief executive and a father, promised a comprehensive review of the Food and Drug Administration amid a salmonella outbreak linked to a Georgia peanut processor.
More than 500 people have been sickened and at least eight may have died. Authorities fault Peanut Corp. of America. Officials said the company shipped products that initially tested positive for salmonella after retesting and getting a negative result. The outbreak has led to a massive recall of products ranging from ice cream to cookies and prompted consumer groups to urge Congress to require annual inspections of food processing plants.
"I think that the FDA has not been able to catch some of these things as quickly as I expect them to catch," Obama said in an interview aired Monday on NBC's "Today" show. "And so we're going to be doing a complete review of FDA operations." . . .
The FDA has asked the Justice Department to launch a criminal investigation into Virginia-based Peanut Corp. of America. Documents showed that until shortly before the salmonella outbreak, federal food safety inspectors had not been to the plant since 2001. . . . Federal officials say the Peanut Corp. plant in Georgia had a salmonella problem dating back at least to June 2007 but had not disclosed it to the FDA. The salmonella outbreak has prompted voluntary recalls by makers of more than 800 products. The recall reaches into Canada and Europe. National brands of jarred peanut butter sold directly to consumers, as well as the perennial must-have Girl Scout Cookies, have been unaffected by the recalls. . . .
The government has warned consumers to check foods containing peanuts and peanut products against a list of recalled products, available at http://www.fda.gov.
Kansas Governor for HHS?
McClatchy News reports that Governor Kathleen Sibelius is a leading contender for Secretary of HHS. Steve Kraste writes,
Kansas Gov. Kathleen Sebelius emerged Wednesday as a leading candidate for the Cabinet post of secretary of Health and Human Services."I've got to believe she's on the short, short, short list," said Ron Pollack of the health advocacy group Families USA in Washington. "I think the likelihood is enormous."
Sebelius' rapid elevation as a potential successor to nominee Daschle came after the former senator from South Dakota withdrew Tuesday following a controversy over unpaid taxes. And it came a day after Sebelius' office declined to end speculation that she might be interested in the job. On Wednesday, her office declined to respond to a request for comment. "We don't have anything new today," spokesman Beth Martino said. . . .
But none of that is expected to undermine the job's importance. Sebelius, 60 and a former state lawmaker, also served two terms as the Kansas insurance commissioner before becoming governor in 2003. She advocated increases in the cigarette tax as a way to expand health coverage during her first term as governor. . . .
But Pollack said Sebelius stood out from the pack. "Governor Sebelius is probably the most knowledgeable governor in the country about health care," he said. "She served as insurance commissioner. She was president of the National Association of Insurance Commissioners. She was appointed by President Clinton...to a commission that crafted the patients' bill of rights. "And she obviously has a very close relationship with the president. It seems to me there would be every reason to think she is a leading candidate."
But leaving her post as governor would be tricky, coming as it would less than two months after she withdrew from consideration for Obama's Cabinet on Dec. 6. At the time, she said she wanted to focus on state spending "given the extraordinary budget challenges facing our state." While joining the Obama team would be exciting, she said at the time that "my service to the citizens who elected me is my top priority in these difficult times." Finessing an about-face would be awkward, but manageable, said Joe Aistrup a Kansas State University political scientist. . .
February 5, 2009
Judges Order Health Benefits for Same-Sex Spouses
The ABA Law Journal provides a brief description of the judicial orders of payment of health insurance benefits to same-sex spouses of employees of the U.S. government. Debra Weiss states,
Judge Stephen Reinhardt and Chief Judge Alex Kozinski issued the orders as hearing officers for circuit employee disputes, the Daily Journal reports (sub. req.). Reinhardt’s order declared the federal Defense of Marriage Act is unconstitutional, while Kozinski’s order didn’t reach the “hard question” of the statute’s constitutionality. Instead, he said ambiguous language in a federal health benefits act allowed him to order benefits, the story says.
The cases were brought by Deputy Federal Public Defender Brad Levenson of Los Angeles and 9th Circuit staff lawyer Karen Golinski, according to the story. Lawyers from Morrison & Foerster represented Golinski on a pro bono basis. Jennifer Pizer, senior counsel and director of the national marriage project at Lambda Legal in Los Angeles, acknowledged that the orders do not create direct precedent. But she told the Daily Journal that “they will become part of our national conversation about fairness and equality for same-sex couples."
Public Health and the Stimulus
Harold Pollack public health policy researcher and faculty member at the University of Chicago's School of Social Service Administration, writes in the New Republic's Treatment Blog about his displeasure over the removal of certain public health measures from the stimulus bills in Congress, and explains why these provisions were seemingly so easy to remove. He states,
What is remarkable and galling is the way Senate critics focus like a laser beam on the smallest, most defensible, glatt kosher items.
This in today’s Washington Post: The most ambitious effort to cut the bill is being led by Sens. Ben Nelson (D-Neb.) and Susan Collins (R-Maine), moderates in their parties who share a dislike of the current version. Collins is scheduled to visit Obama at the White House this afternoon. "I'm going to go to him with a list" of suggested deletions, she said….Among the items that the Collins-Nelson initiative is targeting: $1.1 billion for comparative medical research, $350 million for Agriculture Department computers, $75 million to discourage smoking, $20 million in Interior Department funding, $400 million for HIV screening and $650 million for wildlife management.
I don’t know about the Agricultural and Interior Departments or managing wildlife. I do know about the health stuff. These provisions don’t belong on anyone’s list to cut.
Comparative medical research is a high priority by any conceivable measure. Candidate Obama and Candidate McCain both advocated major investments here to improve the quality and cost-effectiveness of care, and they were right. An astonishing proportion of American medical care has never been rigorously evaluated, or outright fails to meet reasonable thresholds of quality and cost-effectiveness. As Ezekiel Emanuel put it in his book Healthcare, Guaranteed: “The United States spends over $2 trillion on healthcare, about $200 billion on prescription drugs, and nearly $100 billion on medical research and development, but only a paltry $1 billion to evaluate the comparative costs and effectiveness of medical interventions and their influence on health outcomes.” . . . .
Washington conventional wisdom has fastened on HIV/STI/TB prevention and related services as tangential and unworthy stimulus items. (I won’t even discuss family planning, which was dropped with predicable but depressing alacrity.) In policy terms, these efforts are unobjectionable. Inflation-adjusted federal expenditures on HIV prevention have markedly declined since 2002, despite rising numbers of new infections. Our society faces other serious challenge from other sexually-transmitted infections, and from tuberculosis, too. A large body of evidence-based interventions could attack these problems with monies appropriated in the House stimulus bill.
Perversely, the obvious social value of public health investments has become a mark against them in the current stimulus debate. Critics worry that someone might support these policies because they are sensible and humane, not merely because they shovel some quick money into the economy. I guess the charge rings true. Yet as a mechanism of economic stimulus, hiring nurses and counselors to prevent unintended pregnancies or HIV infection is no less worthy than hiring burly construction workers to build a road. Public health measures are a lot cheaper. They are a hell of a lot less likely to stiff taxpayers for an environmentally dicey boondoggle. . . .
As my colleague Jens Ludwig points out, public health measures are vulnerable because they are not porky enough. They do not slide neatly into the grooves of American interest-group politics. Public health policies have an unfortunate tendency to improve health among diffuse, disorganized, or politically marginal constituencies. These policies provide too little gravy to organized and powerful constituencies. Although many interest groups and many politicians claim to support public health and prevention, few care quite enough to support these values once the shoving starts.
It’s time to shove back.
February 4, 2009
Who will be Secretary of HHS?
The Wall Street Journal's Health blog provides a helpful list of those individuals who may be considered as contenders for Secretary of Health and Human Services. Sarah Rubenstein writes,
It appears a number of governors are in the mix, since governors have oversight of state Medicaid programs and therefore have health-care experience. Gov. Kathleen Sebelius of Kansas is one possibility, NYT says. Others are Govs. Ed Rendell of Pennsylvania and Jennifer Granholm of Michigan and former Gov. John Kitzhaber of Oregon, the paper reports. . . .
It also appears that whoever is the next HHS secretary won’t lead the new health-reform office that Daschle was also slated to oversee. Jeanne Lambrew, who co-authored Daschle’s book on health reform and was slated to be the office’s deputy director, might get the nod for the job. The New Republic’s Jonathan Cohn writes that from what he’s heard Lambrew has been doing much of the job anyway.
Don’t count out Howard Dean, another former governor who was one of three names for HHS we heard about back in November before Daschle got tapped. As governor of Vermont, Dean, an MD, took a crack at health reform too.
Economy Hits Health Care Workers/Hospitals
The Minnesota Star Tribune reports on how the economy has had a dramatic impact on local hospitals and health care workers. Chen May Yee writes,
For three decades, health care has been Minnesota's economic juggernaut, generating thousands of high-wage jobs, supporting a prestigious academic research community and spinning off a thriving medical technology industry. Today, one of every seven employed Minnesotans works in health care.
But an industry that sailed through the last two recessions is hitting the shoals this time. Local hospitals have shed more than 1,000 workers since last year and postponed big construction projects. The University of Minnesota Medical School is "looking under every stone'' for savings. State nursing homes are bracing for millions of dollars in cuts proposed by Gov. Tim Pawlenty. . . .
February 3, 2009
Daschle Withdraws Name from HHS Consideration
ThinkProgress reports on Senator Daschle's decision to withdraw his name as HHS Secretary. The story provides his statement,
Daschle’s full statement below:
I have just informed the president that I am withdrawing my name from consideration for secretary of health and human services.
To be chosen by President Obama to run the Department of Health and Human Services and to lead the reform of America’s health care system is one of the signal honors of an improbable career.
But if 30 years of exposure to the challenges inherent in our system has taught me anything, it has taught me that this work will require a leader who can operate with the full faith of Congress and the American people, and without distraction.
Right now, I am not that leader, and will not be a distraction. The focus of Congress should be on the urgent business of moving the president’s economic agenda forward, including affordable health care for every American.
We need the best care in America to be av ailable to all Americans. We need this effort to succeed. Lives and livelihoods are at stake.
I will not be the architect of America’s health system reform, but I remain one of its most fervent supports. Thank you.
Stimulate the Economy with HIPAA Actions?
The National Law Journal reports on one of the little-noticed provisions in the proposed stimulus bills - providing state attorneys general with new enforcement power for HIPAA violations, including civil damages and injunctions in federal courts. Marcia Coyle writes,
Both the House-passed economic stimulus bill and the proposed Senate version would give state attorneys general new enforcement authority to file civil actions for damages or injunctions in federal courts for violations of the federal Health Insurance Portability and Accountability Act (HIPAA).
The U.S. Chamber of Commerce's Institute for Legal Reform recently attacked the provisions in a letter to House and Senate leadership urging that the provisions be removed from both proposals.
"While the emergency economic stimulus package is aimed at turning our economy around and getting Americans back to work, the provision slipped into the House version and included in the Senate proposal is nothing more than a gift to the plaintiffs' lawyers," said ILR President Lisa A. Rickard. . . . But a spokesman for the trial lawyers' organization, the American Association for Justice, said, "AAJ did not lobby on this provision" and indicated it was a surprise to the organization.
HIPAA was adopted in 1996 to ensure health insurance coverage after leaving an employer and also to provide standards for facilitating health-care-related electronic transactions. It included provisions that required the federal government to adopt national standards for electronic health care transactions. At the same time, Congress recognized that advances in electronic technology could erode the privacy of health information and so Congress incorporated into HIPAA provisions that mandated adoption of federal privacy protections for certain individually identifiable health information.
The federal law does not pre-empt state laws in this area, and a number of states have enacted state HIPAAs with stronger privacy protections than the federal law. The economic stimulus bill would strengthen enforcement of the federal HIPAA in those states without state HIPAA laws.
Besides damages and injunctions, state attorneys generals also could seek attorney fees and costs associated with pursuing federal civil actions.
New Single Payer Organization: What will they accept if single payer isn't on the table?
Ezra Klein points out the new health reform coalition named, "The Leadership Conference for Guaranteed Health Care." He describes the new group as follows:
Another week, another health care coalition. But this one isn't like most of the others. It's not a Washington project. It's not playing an inside game. Rather, The Leadership Conference for Guaranteed Health Care advocates for a "single payer national health program [that] would eliminate the wasteful role played by private health insurance companies." The coalition includes the National Nurses Organizing Committee/ California Nurses Association, Healthcare NOW!, Physicians for a National Health Care Program, Progressive Democrats of America, All Unions Committee for Single Payer H.R. 676, and the California School Employees Association. . . .
My sense of the single payer movement, having watched and interacted with them for some time, is that they think, not necessarily wrongly, that their enemies are on the left. Their targets tend not to be those blocking reform, but those promoting the wrong type of reform. . . . . It's a sincere disagreement, and there's a compelling strategy to the approach: Single payer can't become the consensus choice for the country if it doesn't first become the consensus on the left.
But what if it doesn't? At the end of the day, some form of incrementalism is likely to advance in Congress. Does the Conference then campaign against the bill the Administration eventually champions? . . . Or is there a set of policies that single-payer advocates want to see inserted into hybrid legislation and could stomach supporting even if the final legislation stops short of full single-payer?
February 2, 2009
Mail Order Drugs: Do they save money and are they safe?
The Boston Globe has an article on the incredible cost-savings found in mail-order drug delivery but also some of the questions about the lack of regulations over their operations. The article reports,
. . . . Mail-service pharmacies pitched themselves to Barack Obama's team as one tool for beating back rising health costs and improving healthcare quality. In a country that spends a larger share of its economy on healthcare than any other in dustrialized nation, and where the chronically ill account for 75 percent of all health spending, owners of mail-service pharmacies say Medicare could save billions if more people bought their regular medications from mail-service pharmacies, exploiting their scale, efficiency, and specialized expertise. "Chronic and complex disease is where you need to focus for meaningful health reform, and that's who we serve in mail," said Dave Snow, Medco's chief executive officer.
But like many issues in healthcare, drug delivery is more complicated than it seems. Community pharmacies see mail orders as shady operators that threaten neighborhood pharmacists, a crucial source for drugs needed right away. They also challenge the potential savings. And they say customers, particularly the chronically sick and elderly, crave a personal relationship with the person who gives them their medicine. "When people call the 800 number at the mail-order pharmacy, how do they know if they're talking to a pharmacist?" said Reginia Benjamin, senior director of public policy for the National Community Pharmacists Association, the lobbying group for independent pharmacies.
Mail-order pharmacies are essentially middlemen in the prescription drug supply chain. Pharmaceutical benefit management companies - PBMs, which manage drug benefits for most Americans, and which own most of the mail-order pharmacies - buy discounted drugs from manufacturers in exchange for supplying drug makers with millions of customers. . . .
Mail-service pharmacies say that increasingly, they also save money by helping patients manage chronic disease. Medco says its specialized pharmacists develop expertise on side effects, drug interactions and dosages in a particular set of drugs relevant to a particular disease that a neighborhood pharmacist cannot match. That, they argue, means fewer mistakes and complications, which adds to the long-term cost savings. Pharmacists are typically available 24 hours a day.
There is a misconception that a PBM is just "a big benefits administrator," said Dave Snow, chief executive officer of Medco, which has teams of specialist pharmacists for more than a dozen common diseases. "The real truth is, we're an intensive clinical company with thousands of pharmacists who take care of patients each and every day in a very advanced way."
Right now, Medicare recipients order only 10 percent of their chronic care drugs by mail - far less than retirees with drug benefits through their former employers, who get 40 percent of drugs that way, according to the Pharmaceutical Care Management Association, which lobbies for the PBMs.
One reason for the low rate is that when Congress created the Medicare drug benefit in 2003, drugstore lobbyists won provisions that prohibit mail-service pharmacies from offering large incentives to switch to mail order. The PBMs want Medicare rules changed to make it easier for them to drive customers to mail-order, and they say consumers need to be educated about the benefits of switching. They have told the Obama administration that Medicare could save $1 billion over 10 years for every 1 percent of recipients who switch to mail-service for their chronic care medications, or $40 billion over a decade if everyone with Medicare drug benefits were automatically enrolled in mail-service for chronic care.
They also say there are few independent studies documenting mail orders' savings, noting mail-orders have paid multimillion dollar settlements for things like giving patients more expensive drugs instead of cheaper ones in an effort to maximize their profits. They question whether mail-order pharmacies have sufficient oversight to ensure that real pharmacists are answering the phones and filling the prescriptions. (Medco and Express Scripts say they adhere strictly to state laws governing pharmacists and undergo regular auditing.) "Overall, I believe that mail-order facilities need more regulation and accountability," said Benjamin, the lobbyist for the independents. . . .
Payment for an "Episode of Care"
The Wall Street Journal's Health Blog posts an interesting blurb on a new idea of how to pay for health care. Jacob Goldstein reports on the episodic care payment and writes,
When you pay doctors for every procedure they do, there’s an incentive for unnecessary treatments. There’s a financial reward for fixing problems that better care might have prevented. And there’s no incentive for doctors to prevent complications. On the other hand, few people want to go back to capitation — paying a single, annual fee for all of a patient’s care. That’s been criticized for leading to undertreatment.
So a lot of powerful people are looking toward a middle road: Paying a single, bundled fee for an “episode of care” such as a hip implant or a few months of treatment for cancer or a chronic disease. As a story in this morning’s WSJ notes, Tom Daschle, the man Obama’s picked to lead the health reform push, is a backer of episode-based payments. Max Baucus, a key senator in the health reform puzzle, likes them as well.
Medicare’s piloting a program that pays a lump-sum to be split by the hospital and physicians for acute-care procedures like coronary bypass. Of course, the prospect of the hospital handling a lump-sum payment makes a lot of docs nervous. And poorly designed bundles could encourage cherry-picking healthy patients or denying needed care.
But beyond Medicare, several experiments are looking at different ways of bundling payments. Later this year, UnitedHealth plans to test bundled payments for oncologists. Under the current system, many cancer docs make much of their income from buying and selling the drugs they administer to patients. UnitedHealth wants to pay a single, bundled fee for a few months of cancer treatment. The fee would be worth about what docs make now from fees and from profit on the drugs. “What you used to be making on drugs now becomes a patient-care fee that can be redistributed in whatever way you think is right,” Lee Newcomer, the oncologist-turned-UnitedHealth exec, told us .. . .
February 1, 2009
SuperBowl - Try Some Red Wine to Celebrate
More news that red wine is good for you. Newsweek reports on some new studies that red wine has powerful effects beyond just being an intoxicant. Tina Peng writes,
It's common knowledge that a glass or two of red wine a night will do more than enhance a great meal or put you to sleep: it can reduce production of "bad" cholesterol, boost "good" cholesterol and reduce blood clotting, all of which will help reduce the risk of heart disease. But recent studies are showing that wine aficionados may also reap even more benefits, from inhibiting tumor development to helping form nerve cells. Here's a roundup of four recent studies that might encourage you to uncork that bottle of merlot:
1. It Can Help Keep You Fit: For senior citizens who are already in shape, moderate alcohol intake can help prevent the development of physical disabilities, according to a new UCLA study in the American Journal of Epidemiology. . . . But don't take that as a cue to rest easy: the benefits only applied to seniors who were already in good health. Seniors in poor health may already be too close to developing disabilities for the wine to be of much use, researchers said.
2. It May Help Fight Alzheimer's. In animal trials, UCLA researchers found that compounds known as polyphenols, which naturally occur in red wine, can inhibit the development of proteins that deposit in the brain and form the plaques associated with Alzheimer's disease. . . .
3. It Boosts Heart-Healthy Omega 3 Levels. Moderate alcohol consumption helps boost the body's omega-3 levels, European researchers report in the January issue of the American Journal of Clinical Nutrition. . . .
4. It May Lower Lung Cancer Risk. Moderate consumption of red wine may decrease the risk of lung cancer in men, researchers reported in the October issue of Cancer Epidemiology, Biomarkers and Prevention. . . . .