HealthLawProf Blog

Sports in Your Genes

The New York Times has a story about children being tested for which sport they will perform best in due to their genetic make-up.  It is rather sad that parents decide to test their children - whatever happened to fun rather than winning. . .  The Times reports,

When Donna Campiglia learned recently that a genetic test might be able to determine which sports suit the talents of her 2 ½-year-old son, Noah, she instantly said, Where can I get it and how much does it cost? 

“I could see how some people might think the test would pigeonhole your child into doing fewer sports or being exposed to fewer things, but I still think it’s good to match them with the right activity,” Ms. Campiglia, 36, said as she watched a toddler class at Boulder Indoor Soccer in which Noah struggled to take direction from the coach between juice and potty breaks. “I think it would prevent a lot of parental frustration,” she said.

In health-conscious, sports-oriented Boulder, Atlas Sports Genetics is playing into the obsessions of parents by offering a $149 test that aims to predict a child’s natural athletic strengths. The process is simple. Swab inside the child’s cheek and along the gums to collect DNA and return it to a lab for analysis of ACTN3, one gene among more than 20,000 in the human genome.  The test’s goal is to determine whether a person would be best at speed and power sports like sprinting or football, or endurance sports like distance running, or a combination of the two. A 2003 study discovered the link between ACTN3 and those athletic abilities.

In this era of genetic testing, DNA is being analyzed to determine predispositions to disease, but experts raise serious questions about marketing it as a first step in finding a child’s sports niche, which some parents consider the road to a college scholarship or a career as a professional athlete.

Atlas executives acknowledge that their test has limitations but say that it could provide guidelines for placing youngsters in sports. The company is focused on testing children from infancy to about 8 years old because physical tests to gauge future sports performance at that age are, at best, unreliable.  Some experts say ACTN3 testing is in its infancy and virtually useless. Dr. Theodore Friedmann, the director of the University of California-San Diego Medical Center’s interdepartmental gene therapy program, called it “an opportunity to sell new versions of snake oil.” “This may or may not be quite that venal, but I would like to see a lot more research done before it is offered to the general public,” he said. “I don’t deny that these genes have a role in athletic success, but it’s not that black and white.”

Dr. Stephen M. Roth, director of the functional genomics laboratory at the University of Maryland’s School of Public Health who has studied ACTN3, said he thought the test would become popular. But he had reservations. “The idea that it will be one or two genes that are contributing to the Michael Phelpses or the Usain Bolts of the world I think is shortsighted because it’s much more complex than that,” he said, adding that athletic performance has been found to be affected by at least 200 genes. . . .

That is my little runner in the picture - I think that he is having a great time and that is all I really care about right now. 

 

Karl Rove on Obama's Health Reform

Thinkprogress provides an overview of Karl Rove's op-ed in the Wall Street Journal on President-elect Obama's new economic team and his plans for reforming health care.   Fortunately ThinkProgress points out some problems with his analysis.  Here is a brief excerpt:

. . . . But while issuing compliments of most of Obama’s nominees, Rove issued this back-handed swipe at Melody Barnes, who ThinkProgress first reported would be chosen to lead the White House Domestic Policy Council:

The only troubling personnel note was Melody Barnes as Domestic Policy Council director. Putting a former aide to Ted Kennedy in charge of health policy after tapping universal health-care advocate Tom Daschle to be Health and Human Services secretary sends a clear signal that Mr. Obama didn’t mean it when his campaign ads said he wouldn’t run to the “extremes” with government-run health care.

During the campaign, Barnes helped inform Obama’s health care approach — the same approach he is now promising to pursue in office. Obama pledged to bring together “doctors and patients, unions and businesses, Democrats and Republicans” together to build on the existing system and “reduce the cost of health care to ensure affordable, accessible coverage for all Americans.”

Taking a look at the health care stats in the Bush/Rove era, it’s clear that most Americans have seen a decline in their health care at the same time that health insurance companies have reaped tremendous gains:

– Since 2000, the ranks of the uninsured have grown by 7.2 million.

– Health care premiums have doubled under Bush. Employer-sponsored health insurance premiums have risen from $5,791 in 1999 to $12,680 in 2008.

– The fastest growing component of health care is health insurers’ administrative costs.

– Enrollment in Medicare private plans doubled. Through such plans, insurers “have increased the cost and complexity of the program without any evidence of improving care.”

–The combined profits of the nation’s largest insurance companies and their subsidiaries increased by over 170 percent between 2003 and 2007.

Obama is putting together a team, starting with Melody Barnes and Tom Daschle, who will be committed to ending the unfairness and inequity of the current health care system. Meanwhile, Karl Rove is committed to defending the health insurance industry and preventing any change to the status quo. Fortunately, the American people are proclaiming that they are ready for the change that Obama is promising.

Bitter Lawyer

Enjoying a day off work - perhaps you would like to experience the lovely law firm day even though you aren't there.  Bitter Lawyer is a rather interesting look a law firm life (in some ways accurate) and quite funny.  You can watch at your computer here.

Obama's Health Site

The Huffingtonpost reports on President-elect Obama's interactive health website.  It is quite fun but unfortunately the interactivity will not help you work off your Thanksgiving meal.

Organ Distribution Changes

The Boston Globe reports on the Journal of American Medical Association's recent article concerning a  change to the method of distributing organ donations - provide the donations to the sickest individuals.  Turns out that this change in method helps eliminate some of the racial differences in survival rates.

Blacks waiting for a liver transplant used to be more likely to die compared to whites. Now they have the same chance of getting a life-saving organ under a nationwide system that puts the sickest patients first, a new study found.  Racial differences disappeared when the old system was scrapped in 2002, according to the federally funded study, the first assessment of how blacks fared after the change.

 

"By design, we tried to make it race blind. It looks like we did," said Dr. Richard Freeman, a transplant surgeon at Tufts University School of Medicine in Boston, who helped create the new system and was not involved in the study.  But the research, in Wednesday's Journal of the American Medical Association, suggests the system may favor men over women. Dr. Cynthia Moylan, the study's lead author and a transplant fellow at Duke University Medical Center in Durham, N.C., called for more research on gender differences. . . .

Under the old system, which relied heavily on how long a patient spent on an official waiting list, sicker patients were passed over in favor of those waiting longer.  The system favored whites because blacks join waiting lists when they are sicker. Why isn't clear, but blacks may get treatment later or have poor access to liver specialists. . . .

The new system is based on three lab tests. Results are combined as a score that predicts a patient's risk of death within three months. Livers are allocated based on scores. The change was made after the government ordered the United Network for Organ Sharing, which runs the transplant network, to make liver allocation less arbitrary.  Prior research has also found racial disparities in the allocation of kidneys. UNOS is currently evaluating its system for kidneys, which is now based on waiting time, blood type and tissue type. . . .

For women, MELD wasn't an improvement. The study found women had a 30 percent greater chance of dying or becoming too sick for transplant with the new scoring system. The gender difference wasn't significant before. One of the lab tests in the score may underestimate the severity of illness in women because of their smaller average size, said Dr. David Axelrod of Dartmouth-Hitchcock Medical Center in Lebanon, N.H., who was not involved in the study, but wrote an accompanying editorial.  "With a relatively minimal change we can deal with that," Axelrod said, suggesting a different weight-adjusted measurement. . . .

Regional differences in waiting list times are still a big problem, said Dr. J. Michael Millis, head of transplantation at University of Chicago Medical Center. Donated organs are generally offered to local patients first. Some states with greater demand for organs have longer wait times. "In Wisconsin, waiting time is approximately half that in Chicago 90 miles away," Millis said. "There's no rational way to justify that."

Happy Thanksgiving

Happy Thanksgiving - I hope it is happy and healthy for all of you!  If you find that you have some extra food - now is the time that many people could use a little hand.  Feeding America is a helpful place to start if you would like to express your thanks for all you have. 

Step Away from the Computer and Call Me in the AM

The New York Times reports on a new ailment plaguing many Americans, Cyberchondria.   Here are the symptoms:

On Monday, Microsoft researchers published the results of a study of health-related Web searches on popular search engines as well as a survey of the company’s employees.The study suggests that self-diagnosis by search engine frequently leads Web searchers to conclude the worst about what ails them. The researchers said they had undertaken the study as part of an effort to add features to Microsoft’s search service that could make it more of an adviser and less of a blind information retrieval tool.

Although the term “cyberchondria” emerged in 2000 to refer to the practice of leaping to dire conclusions while researching health matters online, the Microsoft study is the first systematic look at the anxieties of people doing searches related to health care, Eric Horvitz said.  Mr. Horvitz, an artificial intelligence researcher at Microsoft Research, said many people treated search engines as if they could answer questions like a human expert.  “People tend to look at just the first couple results,” Mr. Horvitz said.  “If they find ‘brain tumor’ or ‘A.L.S.,’ that’s their launching point.” . . . .

They found that Web searches for things like headache and chest pain were just as likely or more likely to lead people to pages describing serious conditions as benign ones, even though the serious illnesses are much more rare.  For example, there were just as many results that linked headaches with brain tumors as with caffeine withdrawal, although the chance of having a brain tumor is infinitesimally small.

The researchers said they had not intended their work to send the message that people should ignore symptoms. But their examination of search records indicated that researching particular symptoms often led quickly to anxiousness.They found that roughly 2 percent of all Web queries were health-related, and about 250,000 users, or about a quarter of the sample, engaged in a least one medical search during the study.   About a third of the subjects “escalated” their follow-up searches to explore serious illnesses, the researchers said. . . . .

Cancer Deaths Decline

The LA Times reports on a recent cancer study demonstrating a decline in deaths from different cancers. 

For the first time since the government began compiling records, the rate of cancer has begun to decline, marking a tipping point in the fight against the second-leading cause of death among Americans. 

Researchers already knew that the number of cancer deaths was declining as the result of better treatment, but the drop in incidence indicates that major progress is also being made in prevention. 

"The drop in incidence ... is something we have been waiting to see for a long time," said Dr. Otis W. Brawley, chief medical officer of the American Cancer Society. And "the continuing drop in mortality is evidence once again of real progress made against cancer, reflecting real gains in prevention, early detection and treatment."  But the declines may be temporary, said Dr. Robert Figlin of the City of Hope Comprehensive Cancer Center in Duarte. "Baby boomers are reaching the age at which they develop cancer ... so we should not be surprised if it changes direction again."   Researchers also fear that the economic meltdown may trigger a new increase in incidence as fewer people feel comfortable paying for screening tests and increased stress leads some people to resume smoking.

Incidence rates for all cancers combined and for men and women combined dropped by 0.8% per year from 1999 through 2005, with the rates for men dropping at about three times the rate for women. The only ethnic groups for which rates did not decline were American Indians and Alaskan natives.  The overall death rate declined by an average of 1.8% per year over the same period.

Newshour on Health Care Reform

The Newshour had an excellent discussion last week on the road to health care reform for President-elect Obama and some of the new obstacles that may exist because of the weak economy.  Here is a link to the transcript. 

On a related topic of health news generally, the Wall Street Journal's health blog reports today on the Kaiser Family Foundation's study with the Pew Research Center's Project for Excellence in Journalism concerning the reporting on health news - health news made up only 3.6% of all the news content.  The WSJ breaks out the study results and reports,

Here’s how the study broke down the type of health coverage that was out there:

42% of stories were about specific diseases or conditions. Cancer got the most attention, at 10% of all health coverage.

31% focused on public health issues, including potential epidemics and contamination of food and drugs.

27% focused on health policy or the health-care system. . . .

Kaiser is taking direct action to improve coverage of health policy. The New York Times reports on the group’s plan to start publishing health stories early next year. Our former colleague Laurie McGinley and ex-Congressional Quarterly editor Peggy Girshman are running the service, called Kaiser Health News.

Flu Vaccine for All

Sydney Spiesel at Slate.com writes about the wonders of the flu vaccine and argues that a new study from Canada demonstrates that everyone should receive the wonderful shot each year.  He writes,

If we're going to give annual flu shots to children from 6 months to 19 years old, the parents of babies, pregnant women, people 50 years and older, and everyone else with a chronic disease, maybe everybody should just get it. Starting in 2000, the Canadian province of Ontario offered free flu shots to everyone older than 6 months. Fortunately for science, though perhaps not for public health, the other Canadian provinces continued to offer the flu vaccine just as we do in the United States—targeted to specific populations, like the very old, the young, and people with chronic disease. This "experiment in nature" gave Canadian public-health researchers a unique opportunity to compare the benefits of universal influenza immunization with targeted policies.

Results: It's slightly dicey business to compare data from Ontario with those of the provinces that didn't enact a universal-immunization policy. Researchers can't be sure that the differences in the rate of immunization actually caused the differences in influenza diagnoses, hospitalization rates, or excess deaths. In fact, during the seven-year period under study, there was improvement in flu-vaccination rates in all the provinces. As a result, influenza statistics everywhere in Canada improved—but they improved a lot more in Ontario than in the rest of Canada. Influenza-associated deaths dropped by 57 percent in the rest of Canada, but they fell by 74 percent in Ontario. Every other statistic about influenza in Canada—flu-related cases seen in emergency rooms, doctors' offices, or hospital admissions—showed exactly the same pattern: Things are significantly better in Ontario. We do need to be a bit skeptical—that difference might, indeed, be due to some other environmental, economic, or educational difference between Ontario and the rest of Canada. But this evidence is the best we have today, and it's probably good enough to serve as a basis for changes in public-health policy. The only Ontario patients who didn't get significant benefit from flu shots were the elderly. As other studies have also shown, it seems as if it's simply harder to give the elderly good protection against flu using our standard methods of immunization, and there is active ongoing research to develop new, more potent vaccines. Meanwhile, we keep giving older people the present vaccine, hoping that at least some will benefit.

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Medical Students and Abortion

Yesterday, the Washington Post ran a lengthy article entitled, "A Hard Choice," discussing a pro-choice medical student and her struggle with decisions concerning her future medical practice and abortion particularly.  The article provides a look into the decision of a young female medical student as she considers whether she will perform abortions as part of her medical practice.  It reviews the danger that some of the doctors who do provide these services experience as well as some of the conflicting viewpoints individuals hold about the abortion procedure.  The article spotlights some of the ethical dilemmas that doctors face in their practice,

You think you are pro-choice, Carole Meyers was saying. But, really, "how pro-choice are you? What does it mean for you? What's your limit? Will you do an abortion on a woman who is 12 weeks pregnant? Twenty-four weeks pregnant?"  What's your limit with birth defects? she asked. "Would you do an abortion at 28 weeks if the baby had a club foot? How about hemophilia?" 

Meyers, a 51-year-old obstetrician and genetics expert, has performed hundreds of abortions over the course of her career and, until earlier this year, served as the medical director of Planned Parenthood of Maryland. She loves her work -- it's very rewarding, she said, and women always thank her -- but she doesn't shrink from examining abortion's ethical dilemmas or from setting her own limits. The truth, she told Lesley and the other medical students, is that abortion is not a black-and-white issue, not for patients and not for doctors.

"If you are going to perform abortions, how is your family going to think about it?" she asked. "How will you tell your kids? What are you going to do if your church doesn't want you to come anymore?" . . .

How medical students choose to become abortion providers is in some ways no different from how they choose to become cardiac surgeons or pediatric neurologists. They explore the specialty and test themselves in it, finding some connection to a patient or a mentor that ignites their passion. Except for one difference: Medical students must explore abortion largely on their own.

Today, the Washington Post has a forum for those who wish to discuss the article with the featured medical student Lesley Wojcik and the article's author freelance writer Patricia Meisol.  They will be online Monday, November 24 at 12 noon ET.

Malcolm Gladwell's Outliers

Well, with the holiday season approaching, many new books appear that might be worth a read.  The Washington Post provides a quick review of Malcolm Gladwell's lastest work, Outliers.  I have enjoyed his earlier works, Tipping Point and Blink because of his interesting use of social science research to describe various aspects of our society.  The Post is not as enthusiastic about this work but it does have some appeal for those who are interested in the nature/nurture debates and what makes some people more successful than others.  Here is an excerpt from the Post's review,

With his knack for spotting curious findings in the social sciences, his vivid writing about phenomena that he has named (The Tipping Point, Blink), his signature Afro and his star quality in public appearances, Malcolm Gladwell stands out among contemporary writers: In his own terms, he is one of the outliers -- "men and women who do things that are out of the ordinary."

As an outlier, Gladwell turns conventional wisdom on its head. In much of the world, particularly in the United States today, we attribute success to the attributes of the individual. In other regions, and in other eras, great achievements are attributed to luck or fate. But the pendulum of explanation swings. Following a period in which it was politically incorrect to invoke nature, we now find ourselves in an era in which biological causes are all too readily cited.

By reconceptualizing the relationship between nature and nurture, Gladwell performs a valuable service. He assembles a powerful brief in favor of the argument that the time, place and resources available to individuals and groups are decisive factors in their eventual success or failure. In vintage Gladwellian fashion, he applies this lens to a fascinating array of cases, many of them unfamiliar, and culminates with an account of one outlier to whom he has special access: himself. . . .

Five Health Law Myths Exposed

The New America Foundation's Shannon Brownlee and Ezekiel Emanuel have a terrific article in the Washington Post concerning the myths surrounding our health care system and discussing the need for reform.  They write,

With Congress ready to spend $700 billion to prop up the U.S. economy, enacting health-care reform may seem about as likely as the Dow hitting 10,000 again before the end of the year. But it may be more doable than you think, provided we dispel a few myths about how health care works and how much reform Americans are willing to stomach.

1. America has the best health care in the world. . . . .

 

2. Somebody else is paying for your health insurance. . . .

 

3. We would save a lot if we could cut the administrative waste of private insurance. . . .

 

4. Health-care reform is going to cost a bundle. . . . .

 

5. Americans aren't ready for a major overhaul of the health-care system. . . . .

 

The article makes many interesting points and is well worth a quick read.  Thanks to Ezra Klein's blog for the link.

Rats and TB Detection

The Boston Globe's  Colin Dickerson reports on a new use for rats - its turns out that they can help solve some fairly major public health problems.  I know most people probably think of rats as a public health problem but according to this article they have been put to use detecting landmines and TB.  The article is quite interesting and states,

Meanwhile, in a conceptual leap, Weetjens decided to turn the rats' sharp olfactory sense to disease detection, starting with tuberculosis. "The medical applications, I believe, will eventually prove even more important than the hunt for land mines," he predicted.

In the pilot project in the Tanzanian capital of Dar es Salaam and the nearby city of Morogoro, Apopo-trained rats evaluate saliva samples at a rate of 40 every 10 minutes; that's equal to what a skilled lab technician, using a microscope, can effectively complete in a day.

A TB rat signals with unmistakable paw motions when it detects sputum infected by Mycobacterium tuberculosis, the infectious bug responsible for 1.7 million deaths and 9.2 million new TB cases each year, mainly in poor countries, according to the World Health Organization. Scientists at Germany's Max Planck Institute are now trying to determine whether the rats are detecting the scent of the actual TB bacteria or some metabolic reaction produced by the infection.

For both TB and land mines, the rats are trained to respond to the sound of a clicker; when the rat makes the scratching motion that means it has detected an explosive or the odor of disease, the handler or trainer responds by snapping the clicker, which means a nut or fruit is on the way.

So why don't the animals just scratch every few minutes to win a treat? "That would be human behavior," said Weetjens. "Rats are more honest."

I think I will have to re-think my view of rodents.

Professor Jay Katz

The LA Times provides a moving tribute to the life and work of Professor Jay Katz.  It provides,

Dr. Jay Katz, a psychoanalyst and Yale Law School professor whose analysis of the conflicting interests and motivations of doctors and patients made him a leading authority on medical ethics, died of heart failure Monday in New Haven, Conn. He was 86.  Katz was best known for his 1984 book "The Silent World of Doctor and Patient," which examined the complex factors that shape the physician-patient relationship and hinder the medical decision-making process.  . . .

Katz was a forceful advocate for patients involved in medical research.   In the early 1970s, he was a member of a national panel that investigated the Tuskegee syphilis experiment, in which researchers from the U.S. Public Health Service withheld treatment from 400 rural Alabama black men in order to observe the progress of the disease. Some men were allowed to die during the 40-year study, which ended in 1972 at the urging of the panel.   

Katz said the Tuskegee subjects had been "exploited, manipulated and deceived. They were treated not as human subjects but as objects of research."  . . . .

In 1993, he was named to a presidential commission that documented the exploitation of research subjects in post-World War II studies on the effects of radiation.   "There is persistent confusion between research and [clinical] practice and the obfuscation of the two," Katz told The Times in 1994. "You cannot use people -- or you should not use people -- as means for others' ends and for ends that might ultimately even be good."

He urged doctors and patients to share the responsibility of making medical decisions by talking honestly to each other about the uncertainties of treatment, their expectations and the role each party must play, a radical idea given the long tradition of physician paternalism and patient passivity.

"As a doctor steeped in the law, Jay Katz illuminated better than anyone has before or since, the complex of medical, legal and ethical choices that haunt the silent world of doctor and patient," Harold Hongju Koh, the dean of Yale Law School, said in a statement last week.

Katz, who was the school's first professor of law, science and medicine, made major contributions in a number of areas, including family law and reproductive technology.  He spoke sternly against a change in federal regulations in 1996 that allowed investigators in some medical studies to enroll patients who are unable to give their consent because of a head injury or other life-threatening condition. Katz said the change violated the Nuremberg Code, developed after the Nuremberg trials of Nazi doctors after World War II, which said that nothing should be done to a human being without his or her approval.  He also was a vocal opponent of scientists' use of data from experiments that Nazi doctors conducted on concentration camp prisoners during Hitler's reign.

These issues resonated particularly profoundly for Katz, who was born Oct. 20, 1922, in Zwickau, Germany, and witnessed Hitler's rise to power. He endured intense harassment by teachers and classmates as the only Jewish student in a school for the gifted. His father, a prominent businessman, was arrested by the Gestapo. . . .   One by one, Katz's family, including his father, escaped Germany. In 1940, he arrived in the U.S., soon to be joined by the rest of his family. He graduated from the University of Vermont in 1944 and became a U.S. citizen in 1945. He earned his medical degree at Harvard University in 1949. . . .   
At his retirement in 1993, he was the Elizabeth K. Dollard professor of law, medicine and psychiatry.

Pardoning Turkeys - Thanksgiving Week Approaching

Ok, it is Friday and when I saw this video of Governor Sarah Palin last night pardoning a turkey while other turkeys met a less pleasant fate immediately behind her - well, it seemed like something to share.  Really, it helped remind me of all that I am thankful for now that the Presidential election is over.  On a separate note,I think with more such press conferences Governor Palin could do wonders for increasing the numbers of vegetarians in the world. 

Here is the much more pleasant video from WKRP in Cincinnati (the famous frozen turkey drop) along with some fun commentary from those witty people at Firedoglake.com.

Daschle to HHS

News sources are reporting that former Senate Majority Leader Tom Daschle has been tapped as the next Secretary of Health and Human Services. ThinkProgress reports that this is a good sign for those interested in dramatic health reform. They state,

Earlier this year, during an address at the Families USA Action Conference, Daschle concurred with the need to ‘think big’ on reform:

Incremental change in our system is no longer a viable option. Instead we need comprehensive reform. In growing numbers the American people are demanding that we do something. Our goal should be to build what current and retired members of Congress have today, and make that available for all Americans.

Daschle is a Senior Distinguished Fellow at the Center for American Progress and is the author of Critical: What We Can Do About the American Health-Care Crisis. . . . .

Here are Ezra Klein's thoughts about this appointment.  He concurs that this appointment shows President-elect Obama's determination to reform our health care system.

Health Insurance Companies See Writing on Wall

Robert Pear of The New York Times continues a story demonstrating health insurance companies apparerent new acceptance of future health care reform.  He writes,

The health insurance industry said Wednesday that it would support a health care overhaul requiring insurers to accept all customers, regardless of illness or disability. But in return, the industry said, Congress should require all Americans to have coverage.

The proposals, put forward by the insurers’ two main trade associations, have the potential to reshape and advance the debate over universal health insurance just as President-elect Barack Obama prepares to take office.  In separate actions, the two trade groups, America’s Health Insurance Plans and the Blue Cross and Blue Shield Association, announced their support for guaranteed coverage for people with pre-existing medical conditions, in conjunction with an enforceable mandate for individual coverage.  In the absence of such a mandate, insurers said, many people will wait until they become sick before they buy insurance. . .

The new position taken by the insurance industry — the industry that helped sink President Bill Clinton’s plan for universal health coverage in 1994 — could ease the way for passage of such legislation.  But the industry’s position differs from that of Mr. Obama in one significant respect. Insurers want the government to require everyone to have and maintain insurance. By contrast, Mr. Obama would, at least initially, apply the requirement only to children.  . . . 

Asked on Wednesday for reaction to the insurance industry’s proposals, Tommy Vietor, a spokesman for the Obama transition team, said, “We are declining comment.” Mr. Vietor cited Mr. Obama’s view that “we have only one president at a time.” . . .

Donald G. Hamm Jr., president of Assurant Health, explained why the industry thought an individual mandate must be coupled with any ban on such underwriting practices.  “In the individual market, people can choose whether or not to apply for coverage,” Mr. Hamm said in an interview. “If they know they can obtain coverage at any time, many will wait until they get sick to apply for it. That increases the price for everyone.”  Insurers say that is just what happened in several states that prohibited insurers from turning down applicants on the basis of their health status. . . .

Federal Court Upholds Drug Privacy Law

The New York Times reports that a federal appeals court in Boston on Tuesday dealt a setback to the pharmaceutical industry and companies that collect prescription data for use in drug marketing.  Stephanie Saul writes,

Ruling in support of a New Hampshire law, the court upheld the right of states to prohibit the sale of doctor-specific prescription drug data that is widely used in pharmaceutical marketing.

The case is a defeat for two large data-mining companies, IMS Health and Verispan. They sued in 2006 to block implementation of the New Hampshire law, which prohibited the sale of computerized data showing which doctors were prescribing what drugs.

The law was intended to cut down on state health care costs by eliminating the tool used by drug sales representatives in promoting brand name drugs. By purchasing the data describing which doctors prescribe what drugs, pharmaceutical sales forces are better able to identify which doctors might use their products and be receptive to their sales pitches. They can also focus on persuading doctors who do not write many prescriptions for their products to change their minds.

The sale of prescription data, in which individual patients’ identities have been removed, has become a lucrative industry. The information is purchased from pharmacy chains and the companies that manage drug benefits for employers.

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Insurers Make Pitch for Health Coverage Mandate

The Washington Post reports that the health insurance industry said Wednesday it will support a national health care overhaul that requires them to accept all customers, regardless of pre-existing medical conditions, but in return it wants lawmakers to mandate that everyone buy coverage.  Kevin Freking writes,

Lawmakers have signaled their intent to craft health care legislation early next year, and the insurance industry's support would make passage easier. That legislation is expected to closely track the proposals of president-elect Barack Obama. However, Obama separated himself from his Democratic challengers by opposing an individual mandate for adults to buy health insurance.

More lawmakers may agree to a mandate if it means the insurance industry will back those efforts. They'll remember it was the industry's opposition 15 years ago that helped scuttle former President Clinton's health plan.

The board of directors for America's Health Insurance Plans agreed to the trade-off Monday night. The board endorsed the proposal after a series of hearings in various states.

"We hope this will be a contribution to help members of Congress fashion their proposal," said Karen Ignagni, president and chief executive officer of the trade group. "We're going to provide all the technical background that we have assembled, all the experience we've assembled at the state level, and we're going to work very hard with members of Congress on both sides of the aisle. We want to make sure that whatever reforms are advanced, no one falls through the cracks."

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