HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Saturday, January 30, 2010

The Relationship Between Slum Tourism and Social Change

Slum tourism is increasing as more and more wealthy travelers are choosing to visit the poorest parts of the world. This new trend raises the following question: "Does slum tourism make us better people?" Fabian Frenzel, a researcher from the University of the West of England's Bristol Business School, is setting out to answer this question and others. According to a report in ScienceDaily, Fabian Frenzel explains that

[s]lumming is not a new phenomenon, rich people have been attracted by slums since they occurred as a result of the industrial revolution in the early 19th century. And there is evidence that the slum experience has perpetuated social motivation to do good and moreover has prompted political demands for greater social justice.

What interests me is the recent growth in organized tours to do slums or shanty towns with a variety of different kinds of tour operator. I am going to look at one 'social' not for profit enterprise and one profit oriented enterprise with a view to determining the moral dilemmas implicit in this kind of tourism. Critics argue that the dignity of slum dwellers is violated by the tourist gaze. But others say that exposure to the 'experience' can motivate people from more privileged backgrounds to 'do some good' as a result.

Many areas around the world that were once regarded as slums have become significantly gentrified and the conditions that people once lived in have led to the growing of unique cultural communities. Harlem in New York is a prime example, the area once associated with violent crime, drugs and sex trade has emancipated itself out of this as travelers have become attracted to the people, the music and the atmosphere of this multi dimensional neighborhood. Much that now makes Harlem attractive grew out of the experience of the people who lived there when times were much harder. Arguably visitors to the neighborhood have spread the word about the unique culture and this has helped to motivate the very gradual change. This has already been documented in historical books like "Slumming" by Seth Koven, looking particularly at Victorian slum-tourism in London or "Slumming in New York" by Robert M. Dowling.

January 30, 2010 | Permalink | Comments (0) | TrackBack (0)

Thursday, January 21, 2010

Cancer Therapy Costs Influence Treatment: A National Survey of Oncologists

A new article in Health Affairs reports on a national survey of the treatment recommendations of 1,379 oncologists. The survey indicates that rising drug costs are influencing practice, even though oncologists generally don’t communicate with patients about costs. Hat tip to Ed Silverman at Pharmalot who summarizes the findings:

84 percent of oncologists say patient out-of-pocket spending influences treatment recommendations and 56 percent strongly or somewhat agreed that costs influence their treatment decisions. Yet only 43 percent always or frequently discuss costs with patients. The survey notes prices rose 14 percent annually in recent years.

Meanwhile, 73 percent agreed with the statement that “over the next 5 years, costs of new cancer drugs will play a more significant role in my decisions regarding which cancer treatments to recommend for my patients.” The results also found 79 percent favor more comparative effectiveness research and 80 percent support more cost-effectiveness data, but only 42 percent feel well prepared to interpret it. And 58 percent believe patients should have access to effective cancer treatment only if the treatments are cost-effective or provide good value for money. What’s good value? The most popular response, or 49 percent, was $50,001 to $100,000 per life-year gained.

The results suggest docs support federally funded comparative effectiveness research but they wish to retain a central role in making decisions about how and when to use expensive cancer meds. “This finding has special relevance in light of the recent American Recovery and Reinvestment Act, which provides $1.1 billion to fund comparative effectiveness research, and in light of provisions of health reform legislation that would expand the research even further,” the authors conclude.

January 21, 2010 | Permalink | Comments (0) | TrackBack (0)

Wednesday, January 20, 2010

Scott Brown and the Health Care Debate

Will the health care bill still pass? According to the Wall Street Journal Blog, the key points from the Washington coverage found in the WSJ, Washington PostNew York Times and Politico are as follows:

Scott Brown’s win in Massachusetts means the Dems no longer have a filibuster-proof majority in the Senate. That means Republicans could (and almost certainly would) block any wholesale changes to the Senate health-care bill.

The House could pass the same version of the health-care bill that already passed the Senate, and send it to the President’s desk. Some further tweaks to the health-care overhaul could be made under a process known as reconciliation, which requires only a simple majority in the Senate.

Or House Dems could balk, both because they don’t like some of the provisions in the Senate bill, and because of popular opposition to the health-care overhaul. Rep. Anthony Weiner, a New York Dem who had earlier pushed for a single-payer system, seems to be in this camp. “I don’t think I can vote for the Senate bill, and I don’t think there are the votes in the House for the Senate bill,” he said, according to the WSJ.

January 20, 2010 | Permalink | Comments (0) | TrackBack (0)

Tuesday, January 19, 2010

California Caps Patient Wait Times for HMOs

California regulators are implementing new rules that limit the long waits that many people endure to see a doctor when they are members of health maintenance organizations. The LA Times reports that  

[t]he regulations by the California Department of Managed Health Care, in the works for much of the last decade, will require that patients be treated by HMO doctors within 10 business days of requesting an appointment, and by specialists within 15.

Patients seeking urgent care that does not require prior authorization must be seen within 48 hours. Telephone calls to doctors' offices will have to be returned within 30 minutes, and physicians or other health professionals will have to be available 24 hours a day.

California says it is the first state to set time standards for HMOs, which serve nearly 21 million of its residents. The managed healthcare department acted in response to a 2002 law that mandated more timely access to medical care. The law left it to state officials to work out the details, which became subject to protracted negotiations with HMOs, doctors, hospitals, consumer groups and other healthcare activists.

In all, it took seven years to finally reach agreement amid intensive talks, bureaucratic hurdles and a lengthy rule-writing process, participants said.

After the rules are unveiled Wednesday, HMOs will be given nine months to submit plans that meet the new guidelines, allowing for the fact that many HMOs will need to revise their contract agreements with physician networks and other groups.

HMOs will be given until January 2011 to comply; after that, the managed healthcare department will have the authority to penalize HMOs that fail to ensure timely care. People will be able to complain to the department about delays.

January 19, 2010 | Permalink | Comments (0) | TrackBack (0)

Monday, January 18, 2010

Will Democrats Attempt to Push the Health Care Bill Through the House?

According to the New York Times, "White House and Democratic Congressional leaders, scrambling for a backup plan to rescue their health care legislation if Republicans win the special election in Massachusetts on Tuesday, have begun laying the groundwork to ask House Democrats to approve the Senate version of the bill, which would send the measure directly to President Obama for his signature."

January 18, 2010 | Permalink | Comments (0) | TrackBack (0)

Thursday, January 14, 2010

Haiti Earthquake: How To Help

The Washington Post has created a fairly comprehensive list of the organizations involved in the Haiti relief effort. Here is the list:  

Oxfam has an emergency team in the capital, Port-au-Prince, responding with public health, water, and sanitation services. You can donate online through its Haiti Earthquake Response Fund or by calling 1-800-77-OXFAM.

Partners In Health is taking contributions for relief efforts in Haiti, including medical supplies. The organization has had a presence in Haiti for more than 20 years, working to address the health care needs of the country's poor.

You can donate to The Salvation Army's efforts in Haiti by calling 800-SAL-ARMY (725-2769) or visiting their Web site and designating that your donation is for the Haiti earthquake.

The UN World Food Programme is accepting donations. Head of the WFP Josette Sheeran said the agency is deploying its resources in Haiti, including 86 metric tons of food. You can donate here.

National Nurses United has issued a call for nurse volunteers to provide assistance to those affected by the earthquake in Haiti.

To donate to specific relief efforts in Haiti:
United Nations Central Emergency Response Fund (CERF)
Mercy Corps
Save the Children
International Red Cross
World Vision
Catholic Relief Services
International Medical Corps
Network for Good
Operation USA
Operation Blessing International
Convoy of Hope
The Global Syndicate
Beyond Borders
Community Coalition for Haiti
International Orthodox Christian Charities
Baptist World Aid
Doctors Without Borders
Habitat for Humanity
Action Against Hunger
Direct Relief International
B'nai B'rith International
Bright Hope
Hope for Haiti
American Jewish World Service
World Relief
American Friends Service Committee
Food for the Poor
CHF International
The Lambi Fund of Haiti
Islamic Relief USA
United Way Worldwide
International Organization for Migration
Food for the Hungry

The State Department has set up a hotline for Americans to inquire after family in Haiti: 888-407-4747.

There are several ways to donate via mobile device:

• Text the word "Yele" to 501501 to donate $5 on behalf of the Yele Haiti Foundation, founded by Haitian musician Wyclef Jean.

• Text the word "Haiti" to 85944 to donate $5 on behalf of the Rescue Union Mission and MedCorp International.

• Text the word "Haiti" to 25383 to donate $5 on behalf of the Internal Rescue Committee.

• Text the word "Haiti" to 864833 to donate $5 to United Way Worldwide's disaster fund.

• Text the word "Haiti" to 90999 to donate $10 on behalf of the American Red Cross.

• Text the word "Haiti" to 45678 (in Canada only) on behalf of the Salvation Army in Canada.

You can also find updated information and general ways to help during disasters at ReliefWeb, USAID and InterAction.

The FBI also warns donors to be alert to the potential for scams involving the earthquake. After a tsunami devastated Southeast Asia in 2004, many people lost money by donating to relief organizations that turned out to be fraudulent. The FBI offers several tips here.

January 14, 2010 | Permalink | Comments (0) | TrackBack (0)

More Evidence that Bisphenol A (BPA) is Linked to Cardiovascular Disease in Adults

A new study confirms previous findings that Bisphenol A (BPA, a chemical used in plastic containers) exposure is linked to cardiovascular disease. The study, Association of Urinary Bisphenol A Concentration with Heart Disease: Evidence from NHANES 2003/06, was performed by the same team that originally identified the link in 2008. As reported in ScienceDaily

In 2008 the team believed that higher urinary BPA concentrations might be associated with adverse health effects in adults, especially in relation to liver function, insulin, diabetes and obesity. By using data from the US government's National Health and Nutrition Examination Survey (NHANES) 2004-2004, which for the first time measured urinary BPA concentrations, the research team found that a quarter of the population with the highest levels of BPA were more than twice as likely to report having heart disease or diabetes, compared to the quarter with the lowest BPA levels. They also found that higher BPA levels were associated with clinically abnormal liver enzyme concentrations.

The new study uses data from NHANES 2006-2006 US population study... Professor David Melzer, Professor of Epidemiology and Public Health at the Peninsula Medical School (Exeter, UK), who led the team, commented: "This is only the second analysis of BPA in a large human population sample. It has allowed us to largely confirm our original analysis and exclude the possibility that our original findings were a statistical 'blip'"

BPA is a controversial chemical commonly used in food and drink containers. It has previously caused concerns over health risks to babies, as it is present in some baby's bottles. Several nations have moved to ban BPA from the manufacture of baby's bottles and other feeding equipment.

BPA is used in polycarbonate plastic products such as refillable drinks containers, some plastic eating utensils and many other products in everyday use. It is one of the world's highest production volume chemicals, with over 2.2 million tonnes (6.4 billion pounds) produced annually, and it is detectable in the bodies of more than 90% of the population.

January 14, 2010 | Permalink | Comments (0) | TrackBack (0)

Wednesday, January 13, 2010

Health Care Fraud Becomes the Newest Multi-Billion Dollar Industry

What is the newest multi-billion dollar industry? The answer is health care fraud with up to 100 billion dollars a year for scammers and organized crime gangs. CNNMoney reports that, in recent months, health care identity theft has topped the list of crimes. Identity theft in the health care context involves a con in which criminals tap real patient information to rack up fake charges.

The most common method of health care identity fraud occurs when someone with legitimate access, such as a hospital administrator or a doctor's assistant, sells patients' information to organized criminal groups according to Louis Saccoccio, executive director of the National Health Care Anti-Fraud Association (NHCAA). The NHCAA is an advocacy group whose members include insurers, law enforcement and regulatory agencies. 

Increasingly, criminal groups are hacking into digital medical records so that they can steal money from the $450 billion, 44-million-beneficiary Medicare system -- making the government, by far, the "single biggest victim" of health care fraud, according to Rob Montemorra, chief of the FBI's Health Care Fraud Unit.

All the stolen information includes medical insurance data and Social Security numbers, explained James Van Dyke, president of Javelin Strategy & Research, a research firm specializing in trends in security and fraud initiatives. Van Dyke said that, with the information, the fraudster falsely bills Medicare and private insurers for drugs, equipment or treatment that were never prescribed.

With medical equipment, for example, fraudsters might order a wheelchair for someone who doesn't need it and bill Medicare for two or three times the cost, pocketing the money. For home health care, criminals profit by the false billing of insurers for care of people who never asked for it.

On a smaller scale, criminals also sell medical information in some communities to uninsured people who are desperate to get medical care. To collect the money, the criminals set up shell billing companies that disappear as soon as there's any indication of an investigation, according to the FBI.

January 13, 2010 | Permalink | Comments (0) | TrackBack (0)

Tuesday, January 12, 2010

New Jersey Lawmakers Pass Medical Marijuana Bill

The New Jersey Legislature approved a measure on Monday that would make the state the first in the region and the 14th in the nation to legalize the use of marijuana for medical reasons according to the The New York Times.

The measure, passed on the final day of the legislative session, will allow patients diagnosed with severe illnesses like cancer, AIDS, muscular dystrophy and multiple sclerosis to have access to marijuana distributed through state-monitored dispensaries. Gov. Jon S. Corzine has said he would sign it into law before leaving office next Tuesday.

For those who want to do further reading, The New York Times has a web page devoted to stories about issues involving marijuana and medical marijuana as part of its Times Topics series. 

January 12, 2010 | Permalink | Comments (0) | TrackBack (0)

Monday, January 11, 2010

Call for Articles

The West Virginia Law Review announces a call for articles and invites scholars, practitioners and researchers to submit contributions for its upcoming issue focusing on health care. This issue will include articles from the Law Review’s Lecture Series, “Beyond Politics: A Discussion of Health Care in America,” a thoughtful discourse on the social disparities in access and outcomes engrained in our current health care system. For this issue, we are particularly interested in scholarship discussing the following topics:

• Health care reform;
• Health care access and outcome disparities, especially as they affect women and children, racial minorities, and the rural poor; and,
• Health care as a human right.

Articles will be selected by our Articles Selection Team and the Editor-in-Chief based on scholarly merit, originality, relevancy and writing style. Articles should be thoroughly researched and contain appropriate footnotes in bluebook format. Please submit articles electronically to by June 30, 2010. Any questions regarding the call for articles or article submissions generally should be sent to

January 11, 2010 | Permalink | Comments (0) | TrackBack (0)

Sunday, January 10, 2010

Access to Assisted Living Facilities Limited for Low Income, Minorities and People Living in Rural Communities

A new Harvard study shows that assisted living facilities are disproportionately located in areas where people have higher levels of income and education and where home values are higher. The first nationwide county-level analysis of supportive housing was published January 5 in the journal Health Affairs. According to this study, low-income people, minorities, and people living in rural areas have relatively little access to this housing and long-term care option.

January 10, 2010 | Permalink | Comments (0) | TrackBack (0)

Saturday, January 9, 2010

New Vidoes on the FDA YouTube Channel Provide Rare Insights Into FDA Perspectives

The FDA has posted a new set of interesting and informative videos on the FDA YouTube channel that present key experts within the agency talking on specific topics.  Hat tip to Mark Sinak of the Eye on FDA blog  who points out that the videos provide some rare insight into the FDA's thinking on a range of topics.

The series is called "FDA Basics" and the topics of the videos posted so far are:

January 9, 2010 | Permalink | Comments (0) | TrackBack (0)

Friday, January 8, 2010

New Study Discovers Serious Emotional Disturbances Among Children Post Katrina

Mental health professionals have shown that there are serious emotional disturbances (SED) among children as a result of Hurricane Katrina. The Category 3 storm ravaged the Gulf Coast in August 2005. Characteristics of SED include inappropriate behavior, depression, hyperactivity, eating disorders, fears and phobias, and learning difficulties.

According to Virginia Tech News 

A team made up of mental health professionals, emergency response experts, and researchers from several universities, including Virginia Tech, has published the results of a study that shows serious emotional disturbances among children who were affected by Hurricane Katrina. The Category 3 storm ravaged the Gulf Coast in August 2005.

The study, published in a recent issue of the Journal of the American Academy of Child and Adolescent Psychiatry, showed the estimated prevalence of serious emotional disturbances (SED) among residents of the affected areas was 14.9 percent. Of those, 9.3 percent of youths were believed to have SED that was directly attributable to Hurricane Katrina.

"Stress exposure was associated strongly with serious emotional disturbances," said Russell Jones, professor of psychology in the College of Science at Virginia Tech and member of the research team. "More than 20 percent of the youths with high stress exposure had hurricane-related SED."

The study found that youth who experienced death of loved one during the storm had the strongest association with SED. Exposure to physical adversity was the next strongest.

"The prevalence of SED among youths exposed to Hurricane Katrina remains high 18 to 27 months after the storm," Jones said. "This suggests a substantial need for mental health treatment resources in the hurricane-affected areas."

Katrina was the costliest hurricane in United States history as well as one of the five deadliest. Four years after the storm, nearly thousands of residents of Mississippi and Louisiana are still displaced from their homes.

January 8, 2010 | Permalink | Comments (0) | TrackBack (0)

Thursday, January 7, 2010

Drug Misuse and the Worldwide Impact of Drug Resistance

The worldwide misuse of drugs is contributing to drug resistant diseases according to a series of articles written by the Associated Press as a result of a six-month investigation. 

• The AP examines growing resistance to HIV drugs: "Ten years ago, between 1 percent and 5 percent of HIV patients worldwide had drug resistant strains. Now, between 5 percent and 30 percent of new patients are already resistant to the drugs. … The story of HIV mirrors the rise worldwide of new and more deadly forms of killer infections, such as tuberculosis and malaria." The article includes information about the rising rates of resistance in sub-Saharan Africa, and the challenges in treating drug resistance in developing countries. The news service adds, "The United Nations estimates $25 billion will be needed to fight AIDS worldwide in 2010, but probably only half that sum will be available. That estimate doesn't account for drug-resistant strains, which could cost $44 billion by 2010" (Mason/Mendoza, 12/29).

• In a second story, the AP examines growing concerns among public health experts over drug-resistant malaria on the Thai-Cambodian border. According to the AP, too little medicine, substandard medicine and counterfeit medicines lead patients to develop drug-resistant forms of the virus, which is then spread to others by mosquitoes. The article details the problems with counterfeit and outdated drugs in Asia and Africa, and the efforts of public health officials to contain the drug-resistant forms of the virus (Mason/Mendoza, 12/28).

• A third AP story examines how antibiotic use in animals is contributing to drug resistance. "Researchers say the overuse of antibiotics in humans and animals has led to a plague of drug-resistant infections that killed more than 65,000 people in the U.S. last year – more than prostate and breast cancer combined," according to the news service. "And in a nation that used about 35 million pounds of antibiotics last year, 70 percent of the drugs – 28 million pounds – went to pigs, chickens and cows. Worldwide, it's 50 percent." The article explores why farmers give antibiotics to their animals and growing pressure by some U.S. lawmakers to regulate such practices (Mason/Mendoza, 12/28).

• In a fourth story, the AP examines how the efforts by Norway's public health system to scale back prescriptions for antibiotics has helped decrease the number of drug-resistant staph infections in the country. The article details how increased access to antibiotics in developed countries over time led to the development of more resistant bacteria and why public health experts believe Norway's model can be replicated around the world (Mason/Mendoza, 12/23).

January 7, 2010 | Permalink | Comments (0) | TrackBack (0)