HealthLawProf Blog

Allen Brain Atlas

WOW!  The NewsHour has a terrific segment last night on the Allen Brain Atlas, a new tool for medical research, that "provides a three-dimensional catalog of all the genes active in the brain and has revealed clues to diseases such as Alzheimer's, Parkinson's and Lou Gehrig's, as well as conditions such as autism."  You can access the information at AllenBrainAtlas.org.  Here is a brief excerpt from last night's show discussing how the Allen Brain Atlas was created.

SUSAN DENTZER: The ideal would be to have an atlas of genes expressed throughout the entire human brain, but that would require dissecting a live brain, an ethical and physical impossibility.

So scientists at the Allen Institute settled for the next best thing: an atlas of the brains of special laboratory-bred, genetically identical mice. It may be surprising, but 90 percent of a mouse's genes are identical to a human's. Assembling the Atlas required the work of nearly 100 scientists, engineers, mathematicians and information experts.

ALLAN JONES: We've got individual microscope slides. Each one of them is bar-coded so we can track all of the information. And there, as you can see here, there are very thin slices of mouse brain on each of these slides.

SUSAN DENTZER: They began by literally slicing apart the brains of several thousand mice. Each slice, just 25 microns thick, or about one-sixth of a human hair, was subjected to special chemical probes to detect the presence of specific genes.

Under sophisticated microscopes, the mouse brain cells with specific genes switched on look like this. Special cameras captured thousands of these images.

ALLAN JONES: We've generated over 600 terabytes of raw data, raw picture data. To put that in context, that would fill over 20,000 iPods.

SUSAN DENTZER: The digital images of the mouse brain cells with genes switched on were assembled into a giant database.

ALLAN JONES: We've assembled a large cluster of computers, which simply grind away and process this information and put it into this three-dimensional framework.

SUSAN DENTZER: The end product is this 3-D catalog. It's freely accessible to all on the Web site AllenBrainAtlas.org. Users can easily click on a brain section and see which genes are active there.

DR. SUSAN SWEDO, National Institute of Mental Health: It is exactly like having a Google for the mouse brain now.

SUSAN DENTZER: One researcher who's used the Allen Brain Atlas is Dr. Susan Swedo. She oversees autism research at the National Institute of Mental Health.

DR. SUSAN SWEDO: To be able to go online and just map various areas of the brain and what genes are being expressed in that area is phenomenal. I, in five minutes, was able to do what used to take a graduate student four years for one tiny, little nerve cell connection, and now they have it for the entire brain.

Family Planning Secretary (Con't)

The fantastic Professor Ross D. Silverman, Associate Professor and Director Program in Law & Health Policy Department of Medical Humanities, SIU School of Medicine provides a link to some additional information on the President's new appointment to the assistant secretary of population affairs within the Department of Health and Human Services, Dr. Eric Keroack.  The article states,

On Monday, (Nov. 20th) the federal office that oversees the nation's family-planning program got a new boss who doesn't believe in birth control. Eric Keroack is a Massachusetts obstetrician-gynecologist who argues that abstinence until marriage is the only healthy choice for women. Until recently, he served as medical director of a pregnancy-counseling organization that runs down contraception and gives out scientifically false health information—for instance, that condoms "offer virtually no protection" against herpes or HPV. Keroack also promotes a wacky piece of pseudoscience: the claim that premarital sex disrupts brain chemistry so as to create a physiological barrier to happy marriage.

I cannot wait to see how he plans to implement policies to prevent the disruption of brain chemistry from premarital sex . . . .  if this wasn't an important position, it might be funny.

Fixing Medicare Part D

Kevin Drum at Washington Monthly.com has a great round-up of recent articles concerning how the new Congress may attempt to reform Medicare Part D.  He advocates that new the Congress require that pharmaceutical companies provide Medicare beneficiaries with their lowest prices.  He states,

An MFP (most favorable pricing) clause with appropriate exceptions takes care of this, and it's something the federal government already knows how to do since Medicaid currently operates this way. It's not price control, since pharmaceutical companies wouldn't be required to supply drugs at any particular price, but if they did supply them at a price to anyone else — or any other country — then they'd also be required to offer the same deal to Uncle Sam. This is pretty standard practice when you're the biggest buyer in an industry. Just ask Wal-Mart.

And if it turns out that giving Americans the Canadian/French/German/whatever price prevents pharmaceutical companies from making money, then they'll have to raise prices in other countries. But that's OK. There's no reason American taxpayers should be subsidizing healthcare for the rest of the world, after all.

Health Care for Young People

Ezra Klein posts about an interesting idea raised by Andy Stern, President of the Service Employees International Union (SEIU).  Mr. Stern advocates:

We’re thinking of creating a new organization called My Life that would be mainly focused on 18 to 34 year olds. It would be web-based, and what it would allow people to do is purchase on a national level health care that you can move from job to job. You’d also be able to do things like tweak your resume on file permanently in your personal account. You could access debit cards potentially and start doing some of the new financial transactions like putting money on your cell phone. It would have opportunities for people to network with other people who are doing similar jobs or somewhat of a Craigslist-type function. It would be in some ways what AARP is for seniors: a place that advocates on their behalf. But clearly it’s a different form of organization; whether you call that a union, or an internet community, or an association, I’m not sure. But it has that kind of potential.

Here from Atrios at Eschaton is an initial on-line responses to the idea. 

Responding to various commenters and emailers, as a means of fixing the horrible health care system in this country it is true that a group plan for young people is probably a terrible idea, except to the extent that it could blossom into something for everyone. But as a means of fixing the problem that younger people don't have portable health insurance it's possibly an excellent idea. Lots of 20somethings either don't have jobs with health insurance or have to make life decisions based on having to find a job which will give them health insurance.

You have to scroll down a bit to find the posts (there are two of them "My Life" and "Health Care for the Young Ones" -- I apologize that I could not find a way to link to them directly but some of the comments are interesting).

Worlds AIDS Day Approaching

Here is a request that I recently received:

Hi friends:

My friend Nancy Bryant sent this email to me. Please pass it on. And apologies for multiple postings.

As World AIDS Day approaches (Dec. 1), we are reminded that millions of people need our help with the AIDS pandemic, but we often think, "What can I do?"

Here is one simple way you can help, and it costs you nothing but a moment and a mouse click.

Bristol Myers Squibb will donate $1 for every person who goes to their web site and lights a candle to fight AIDS, up to a max of $100,000 (chump change for them, but every little bit helps). We need many more candles lit. Thanks for your help.

Please go to this link to light a candle... and help spread the light.

https://www.lighttounite.org/

You may have to copy the link to your browser.

With best wishes, Nancy Bryant

PS I work at CDC in the National Center for HIV/AIDS... Please do this, and pass the email along to your lists. It is important. Thank you.

Unsafe Abortions

The Lancet released a new research study that examines the death rate and hospitalizations resulting from unsafe abortions in developing countries.   

The researchers spoke with the BBC News about their study and its findings:

Lead researcher Dr Susheela Singh said: "The evidence shows that the health burden of unsafe abortion is large.

"The most effective way of eliminating this highly preventable cause of maternal illness and death, would be to make safe and legal abortion services available and accessible.  A second, more immediately achievable, goal is to prevent unintended pregnancies in the first place through improved contraception use."

Also writing in The Lancet, Marge Berer, editor of the journal Reproductive Health Matters, said the study painted a grim picture.  "The burden of injury and hospital admission are all the worse for being almost always avoidable.  When legal restrictions on abortion are reduced, the rate of deaths and morbidity decreases greatly." . . .

Paul Tully, general secretary of the Society for the Protection of Unborn Children, said Dr Singh's findings were guesses based on estimates.  "The burden of the study is clearly to promote the killing of more unborn babies in poorer countries, regardless of the fact that women do not want abortions," he said.

He also took issue with the notion liberalisation of abortion laws led to a cut in death and disability among pregnant women.

"This is contradicted by hard data from Poland, which imposed new legal restrictions on abortion in the mid 1990s and consequently showed improved maternal and infant health."

Exciting Health Law Faculty Opportunity

Professor Seth Chandler, Foundation Professor of Law and co-director of the Health Law and Policy Institute at the University of Houston Law Center, has sent along news of an ope Research Faculty Position.   Applicants are encouraged to submit applications ASAP.  Here is a link to the full job description:    http://www.uh.edu/provost/fac_openings/l_law_health04.html   

Here is an overview:  Health Law & Policy Institute - Research Faculty Position -
Non-Tenure Track

Description:

The University of Houston Law Center's Health Law & Policy Institute
invites applications for a research faculty position for January 1,
2007 - August 31, 2007.

Applicants should hold the J.D. degree, have an excellent academic
record, and have educational or practical experience with health law
and policy. An additional advanced degree, such as an M.P.H. or
Ph.D., in a health policy-related field or economics is preferred but
not required.  Previous experience with grant writing and/or
empirical research methodology is preferred but not required.

Rank and Salary:

The faculty rank (assistant, associate or full professor) will depend
on the applicant's experience and publication record. The salary will
depend on qualifications of up to $41,250 for this time period
(50,000 - 55,000 annually).

Research faculty members work on externally-funded research projects
under the supervision of the Institute Director. Research faculty
positions are not tenure track positions and time in rank does not
apply toward tenure. Reappointment is contingent on performance and
the continued availability of external funding. Research faculty have
no regular teaching responsibilities in the law school but may apply
to teach one course per academic year.

The Health Law & Policy Institute:

The Law Center's Health Law & Policy Institute is recognized as one
of the leading health law programs in the United States. The program
offers over twenty health law courses per year to J.D. and LL.M.
students; students also may participate in interdisciplinary studies
with local universities leading to the M.P.H., M.D., or Ph.D.
(Medical Humanities). Courses are taught by five tenure track faculty
members, one distinguished visiting faculty member, and adjunct
faculty drawn from one of the most sophisticated health law bars in
the United States. The health law program engages in a significant
program of externally sponsored research and currently includes three
research faculty. Houston offers many opportunities for the
successful candidate to engage in interdisciplinary projects. The
Texas Medical Center is the largest medical center in the United
States, with over forty different member institutions. For more
information about the Law Center's health law program, see: http://
www.law.uh.edu/healthlaw/.

The University of Houston and The Law Center:

The University of Houston is a comprehensive research and doctoral
granting public institution, situated on a beautiful 550-acre campus.
The university's diverse student population exceeds 32,500 with over
900 ranked faculty. For more information about the University, see:
http://www.uh.edu/.

The University of Houston Law Center has 52 full-time faculty and
enrolls over 1000 J.D. and over 100 LL.M. students. It is ranked
among the top seventy law schools in the country.  For more
information about the Law Center, see: http://www.law.uh.edu/.

Houston:

Houston is the fourth largest city in the United States with a
vibrant, diverse and growing economy. With an outstanding art museum,
natural history museum, children's museum, health museum, zoo,
professional opera, symphony, and theater, and two major universities
(not to mention at least five professional major league sports
teams), cultural attractions abound. Its ethnic diversity, including
growing Hispanic, and Asian communities, contributes to a
cosmopolitan and international economy, as well as to culinary and
cultural opportunity.  The climate during most of the academic year
is sunny and mild. The cost of living is still relatively low, and
attractive housing is available within a short commute. Best Places
to Live places Houston in its top ten.

Application Procedures:

Interested applicants should submit a current CV and cover letter to:

Nadia Mosqueda, Secretary
Health Law & Policy Institute
University of Houston Law Center
100 Law Center
Houston, TX 77204-6060

Phone: (713) 743-2101.
Fax (713) 743-2117.
[email protected]

Equal Opportunity / Affirmative Action:

The University of Houston is an Equal Opportunity/Affirmative Action
employer. Minorities, women, veterans, and persons with disabilities
are encouraged to apply.

                        

National Health Law Professor Conference

PLEASE SAVE THE DATE:  On May 31 - June 2,  2007, The National Health Law Professors Conference will return to Boston University Law School.  (Yes, the conference name is slightly different – but since we teach primarily graduate students rather than undergrads, the annual gathering sponsored by the American Society of Law, Medicine & Ethics will henceforth be known as the Health Law Professors - rather than Teachers - Conference.)

If you would be interested in presenting your work at the conference, in either a regular or a poster session (pls specify which one), please e-mail Fran Miller at [email protected] with your title and a 2 or 3 sentence description of your project as soon as possible.  We would like to get to work on figuring out how to structure the concurrent panels and plenary sessions by the beginning of December, if possible.

Diane Hoffmann, Dean Karen Rothenberg, and all their wonderful colleagues at the University of Maryland School of Law did a terrific job hosting the conference in Baltimore this past year, and Diane’s post-conference session on “ideas for next time” came up with some interesting new directions and subjects people would like to explore, and we plan to follow up on many of them.   We also have several innovations planned, including a session on “News You Can Use” (with suggestions for supporting materials) to provoke classroom discussion (The Polyheme study of blood substitutes on unconscious accident victims, or Senator Grassley's request for a complete FDA/HHS review/investigation might be examples, but if you have other topics to suggest we’d love to hear them).

We’ve booked 100 rooms for attendees at the 4-star Hotel Commonwealth in Kenmore Square, plus another 30 rooms at the Hyatt across the Charles River from the law school, both at very attractive rates for Boston, so you may want to reserve a room early when the official conference brochure comes out.

Best regards, and we look forward to hearing from you all soon.

Fran Miller, George Annas and Wendy Mariner,

Boston University Schools of Law & Public Health

 

Health Spending: An Easy to Follow Graph

Ezra Klein has a helpful graph demonstrating the problem with health spending that he found at the Kaiser website.  Kaiser posted more information on who spends how much on their health care.  There is quite a large diffential between consumers.  As Mr. Klein notes, to lower health care costs, those individuals who spend so much on health care should be targeted for assistance - assistance that probably won't come in the form of Health Savings Accounts.

Decline in Employer Sponsored Health Care

The Kaiser Family Foundation released last month several reports that examine the rising number of uninsured.  One of these reports addresses, in part, the decline of employer sponsored health care.   The report summary states,

This paper examines the underlying reasons behind the decline in employer coverage among employees from 2001 to 2005. The paper finds that almost half of the decline in employer-sponsored coverage was due to a loss of employer sponsorship. Another quarter of the decline was due to lost eligibility for benefits or losing access as a dependent of another employee. The remaining quarter of the decline was due to employees not participating in the offer of coverage.

Employers and Employee Mental Illness

Law.com has an interesting article with advice to employers on ways to comply with the Americans with Disabilities Act when responding to employees who have a mental illness.   The author, Jonathan O. Hafen states, 

As the stigma of mental illness lessens, employers are handling more frequent requests for accommodation under the Americans with Disabilities Act. Because serious physical impairments are often easier to identify and accommodate, learning to handle the gray areas of mental disorders as they relate to the ADA can be a challenge for employers.

As defined by the ADA, a qualifying disability is "a physical or mental impairment that substantially limits one or more of the major life activities of such individual." 42 U.S.C. 12102(2)(B), (C). The ADA regulations define disabilities broadly, including a specific reference to "neurological systems, mental or psychological disorders." (29 C.F.R §1630.2 (h).)

Because the ADA only provides such general guidance, litigation continues to arise as parties try to refine the concepts presented in the Act, such as whether a mental disorder is a qualifying impairment, whether an employee with a qualifying mental illness can perform essential job functions, and how the limitation of a major life activity caused by a qualifying mental illness can be reasonably accommodated in the workplace. As the contours of these issues sharpen, the employer's pathway to compliance, without "overcomplying," is becoming more clear.

The article provides a quick overview of some of the issues employers face when an employee with a mental illness.

Happy Thanksgiving

I hope that everyone is enjoying a happy and healthy Thanksgiving with family and friends and also hope that this past year has brought you much to be thankful for in your lives!   Here is a fun story about the importance of all your senses to the enjoyment of your Thanksgiving meal.  Apparently those taste buds just aren't all we might think  -- our brains are more amazing than we know.    

Taxes and Universal Health Care

Ezra Klein breaks down the tax problem for providing universal health care coverage.  He compares approaches in several states.  It is an interesting an informative read and we hopefully will have some more discussion in this new Congress on how to solve our health care access and cost issues.

Too Thin

Shakespeare's Sister has a piece on a recent death of a Brazilian model who had a body mass index of 13.4.   The blogger says that articles like this are "why I sometimes write about eating disorders and their relationship to the images of extreme female thinness that our print and electronic media fire at young people all day long."   The news article states, 

A 21-year-old anorexic model who weighed only 88 pounds has died of generalized infection, a hospital said. Ana Carolina Reston, who had worked in China, Turkey, Mexico and Japan for several modeling agencies, died Tuesday, according to Sao Paulo's Servidor Publico Hospital.

The hospital said the infection that killed the 5-foot-8-inch model was caused by anorexia nervosa, a disorder characterized by an abnormal fear of becoming obese, an aversion to food and severe weight loss.

Ezra Klein on Value of Stents

Ezra Klein has an interesting response to recent news about the use and value of stints and angioplasties.  He writes:

Just to freak folks out a bit, angioplasties and stents -- two canonical treatments for blocked arteries -- are rapidly being proven worthless. Not totally worthless in every case, but given their frequency, pretty damn worthless. A similar thing, incidentally, is happening to bypass surgeries, which don't exhibit anything near an efficacy justifying their ubiquity.

Libertarian response: If consumers had more "skin in the game" (and by skin we don't mean actual skin, which is already "in the game," but more financial vulnerability), they'd demand more comparative studies and begin weeding out such ineffective treatments.

Paternalistic liberal response: It's been so hard to conduct studies on these treatments precisely because desperate patients adore their promise and doctors know they'd be considered monsters if they put unsuspecting individuals in a "control group" that was denied a treatment that soon proved effective. Patients are terrible at evaluating care -- look at the holistic health industry, and the limitless range of unproven supplements and treatments -- and skin in the game will always be overwhelmed by lives-on-the-line. On the other hand, if doctors lacked their current incentives for providing such intensive medical procedures, we could begin to make a dent.

Bipartisan response: In 100 years, a good half of our medical treatments will look to our descendants like leeches look to us.

Update response: And yes, leeches are back in use in very limited contexts. Much as the research shows angioplasties should be.

Anti-Depressants for the Non-Depressed?

CNN.Com reports on individuals who take anti-depressants who do not appear to need them.

Troy Dayton pops a little white pill every morning. He's one of the 10 million Americans taking a daily antidepressant. But in his case, he says he was never depressed in the first place.  This 29-year-old political lobbyist is one of the happiest people you'll ever meet. He's constantly smiling, and says he wakes up belly-laughing two or three times a week. Dayton says he's an optimist by nature, and that his daily dose of Wellbutrin makes him feel even better.

"Wellbutrin makes me feel great," Dayton told CNN. "Wellbutrin made me feel clear-headed, much more able to focus. I don't think it means that I don't ever experience any sadness, but I think it makes me experience sadness in a very healthy way." . . .

Psychiatrists tell CNN that Dayton's use of Wellbutrin as a lifestyle drug is potentially dangerous, although little is known about the long-term effects.  "These medicines are not harmless," said Dr. Peter Kramer, author of "Listening to Prozac." Kramer said some doctors think that if you stay on antidepressants long enough, you'll come to rely on them. Other doctors believe they might trigger manic-depressive illness in susceptible people, he said. . . .

Chemically, there's little difference between good feelings induced by medication and those occurring naturally. But the use of antidepressants by those who don't need them raises, for many, not just medical concerns but ethical flags as well. The concerns grow larger when the subject turns to illegal drugs. Millions of Americans take them, but few are willing to admit it. Once again, Troy Dayton is a rare exception. He told CNN he takes Ecstasy, also known as MDMA, about once a year. . . .

Dr. Julie Holland, a psychiatrist at New York University, says MDMA holds promise as an aid to psychotherapy for some patients, if taken under the guidance of a trained therapist under tightly controlled conditions. The federal government has approved early human trials.  "Our understanding of the brain is still in its infancy," says Holland. "The SSRIs that I like to prescribe take really about two or three weeks before people start to feel them. The full effects won't kick in until about four to six weeks, or six to eight weeks."  By contrast, illicit drugs kick in almost immediately. Dr. Nora Volkow, director of the National Institute on Drug Abuse, says they produce pleasure - and often lead to addiction - using the same neural pathways that light up when people have sex or enjoy a good meal. She says these pathways also guide primal emotions like the satisfaction a mother gets from nurturing her infant.

"It's not that drugs create a new landscape in our brains," Volkow said. "Drugs hijack those landscapes that are there [already], that are extraordinarily important to motivate our behaviors."  Volkow says Ecstasy users are risking serious physical harm, including damaged neurons and deep depression. Government statistics show Ecstasy is linked to about 8,000 emergency room visits every year, mostly for overheating and dehydration.

Dayton is unrepentant about his drug use. "If we have the ability to have something better, then why not?" he asks. "However someone can sustain a certain level of happiness without hurting someone else, should be celebrated and not questioned."  Where antidepressants are concerned, Holland agrees. "I think it's sort of this puritanical mind set. You're supposed to sort of go it alone, and you don't need crutches unless your leg is broken," she said.

"[But] short of doing very advanced PET scans, where you're looking at receptors and neurotransmitters and things like this, it's hard to say who really deserves to take antidepressants and for whom it's a luxury. Having a private practice in New York City, I have a lot of luxury-minded patients who just know if they take something they'll feel a little bit better. And I'm okay with that."

New Employee Benefits Blog

Precept has a new employee benefits blog - you can never have too much help on these issues!

http://www.preceptgroup.com/blog/

Former HHS Secretary Exploring Presidential Bid

Last week, the Associated Press reported that Former Health and Human Services Secretary Tommy Thompson intends to form a committee to explore a possible run for the White House in 2008. 

Thompson, who will turn 65 on Sunday, spent nearly four decades in politics and government, including 14 years as governor. He resigned as HHS secretary in December 2004 shortly after Bush won a second term. His tenure at HHS was marked by anthrax attacks, a flu vaccine shortage and passage of the Medicare prescription law.   

"We touched the third rail of politics and delivered on our promise to modernize Medicare with prescription drug coverage," Thompson said.   During his stop in Iowa, Thompson argued that his background as a Midwest governor and HHS secretary would appeal to voters.   "The three big issues in 2008 are going to be health, energy independence and the war in Iraq," he said.   

Prescription Drug Reform?

Kevin Drum at the Washington Monthly discusses the future effort of the new Congress to permit the government to negotiate prescription drug prices with the pharmaceutical companies who provides drugs under the new Medicare drug benefit.  He cites to a recent Jonathon Cohn article in the New Republic and discusses his belief that such negotiations and resulting lower prices will not doom the industry.

But wait. If the feds negotiate prices, then prices will go down. And if prices go down, pharmaceutical companies might make less money. And if pharmaceutical companies make less money, they'll do less basic research and churn out fewer lifesaving drugs. As Jonathan Cohn says in The New Republic, this is "a potent argument." It's also probably wrong:

The most important basic medical and scientific research that leads to major medical breakthroughs usually takes place under government auspices — typically, through grants from the National Institutes of Health. In other words, taxpayers — not drug companies — are the ones financing the most important drug research today. So, even if the pharmaceutical industry did reduce its research and development investment because of declining revenues, what we'd lose probably wouldn't be the next cure for cancer — it would be the next treatment for seasonal allergies, and likely no better than the ones we have already.

New Chief of Family Planning

The Washington Post reports that President Bush has announced his new chief of Family Planning, Eric Keroack, medical director for A Woman's Concern, a nonprofit group based in Massachuestts., will become deputy assistant secretary for population affairs.  This announcement has met with some controversy.  The Post reports:

The Keroack appointment angered many family-planning advocates, who noted that A Woman's Concern supports sexual abstinence until marriage, opposes contraception and does not distribute information promoting birth control at its six centers in eastern Massachusetts.

"A Woman's Concern is persuaded that the crass commercialization and distribution of birth control is demeaning to women, degrading of human sexuality and adverse to human health and happiness," the group's Web site says.

Keroack was traveling and could not be reached for comment. John O. Agwunobi, assistant secretary for health, said Keroack "is highly qualified and a well-respected physician . . . working primarily with women and girls in crisis."

Perhaps it is only me but I don't think appointing someone who opposes birth control and finds its marketing and availability "demeaning" to women is the best choice for a family planning director but I know I still have lots to learn . . .