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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Monday, February 06, 2006

    A Novel Treatment for Sleep Apnea: Playing the didgeridoo. What's a didgeridoo? Find out all about it here.

    The full text of the study is here, though it didn't seem to make much difference in the quality of sleep and life.

    posted by Sydney on 2/06/2006 08:26:00 AM 1 comments

    The Invader: The "superbug", methicillin-resistant staph aureus, or MRSA, an antibiotic resistant scourge of modern hospitals, is most often brought into the hospital by patients:

    AT LEAST 100,000 people admitted to hospital each year are unknowing carriers of the MRSA superbug, putting other patients with open wounds at risk of potentially fatal bloodstream infections, research suggests.

    ...A study by a Swiss research team, published today in Critical Care, suggests that more comprehensive screening of hospital admissions for MRSA could be greatly enhanced with a molecular test that shortens the time taken to identify carriers by two-thirds to less than a day. The test looks for traces of the bacteria's DNA, rather than spotting evidence of the bugs.

    If the NHS data available were extrapolated for all 174 acute trusts, they would suggest that nearly 100,000 carriers of MRSA are entering hospital each year. A comprehensive screening strategy would probably push the figure even higher.

    We know this bacteria is in the community. It would make sense to test for it on admission and to take proper precautions. Of course, hospital personnel should be taking proper precautions anyway to avoid infections with common, sensitive bacteria as well.
    posted by Sydney on 2/06/2006 08:16:00 AM 1 comments

    Garbage In = Garbage Out: Orac at Respectful Insolence notes that our national databse of adverse vaccine reactions has been skewed by litigators:

    Not only an anyone access it and enter reports without verification, but there is no denominator, which means testing for causality is not even possible with VAERS [the acronym for the database - ed.] Worse, as the authors point out, the rate of reporting of autism as a complication of vaccines is easily influenced by numerous external factors. For example, the authors pointed out that 75% of the autism reports in VAERS between 1990 and 2001 were received not long after the publication of the now utterly and completely discredited Wakefield study that claimed to find a link between the MMR vaccine and autism and that 2/3 were received after the American Academy of Pediatrics recommendation that thimerosal be removed from vaccines.

    The original paper he refers to is here ( or at least its abstract is.) Sounds like the reporting system needs to be tightened up a bit. Especially if someone can enter that their flu vaccine changed them into the Incredible Hulk.
    posted by Sydney on 2/06/2006 08:03:00 AM 0 comments

    Sunday, February 05, 2006

    Misguided Intentions: Some public health programs give clean needles to addicts to minimize infections caused by a self-destructive behavior, so why not clean knives for body-cutters?

    Nurses want patients who are intent on harming themselves to be provided with clean blades so that they can cut themselves more safely.

    They say people determined to harm themselves should be helped to minimise the risk of infection from dirty blades, in the same way as drug addicts are issued with clean needles.

    This could include giving the “self-harm” patients sterile blades and clean packets of bandages or ensuring that they keep their own blades clean. Nurses would also give patients advice about which parts of the body it is safer to cut.

    The proposal for “safe” self-harm — which is to be debated at the Royal College of Nursing (RCN) Congress in April — is likely to provoke controversy.

    If you can't cure them, enable them.

    posted by Sydney on 2/05/2006 01:49:00 PM 2 comments

    Oh, Well: Influenza experts say that the advances in the avian flu vaccine announced last week aren't all that spectacular:

    Two teams working on better vaccines for use against a potential bird flu pandemic have announced progress in the past week, but influenza experts are skeptical.

    The two labs both used a human cold virus, called an adenovirus, to carry pieces of DNA from H5N1 flu in a vaccine. Both labs -- one at the U.S. Centers for Disease Control and Prevention and one at the University of Pittsburgh Medical Center -- were able to protect mice against fatal H5N1 infections.

    But neither study was even mentioned at a meeting of top U.S. flu experts in Washington this week.

    "It's just not that new," Dr. John Treanor, a flu vaccine expert at the University of Rochester in New York, said in an interview. "There are a zillion vaccines that protect in mice. On the grand scale of things, it's nowhere near to being a vaccine you would see in humans."

    It's true, it will be years before any new vaccine will be ready to be used in people. Just think of all the testing for side effects that would need to be done.
    posted by Sydney on 2/05/2006 01:44:00 PM 0 comments

    Infectious Cancer: Tasmanian devils are in danger from an infectious form of cancer:

    This offers support for the idea that the disease apparently began with a single sick devil, probably in the mid-1990s, that directly spread the cancer cells by biting other animals. The authors propose that cancer cells are dislodged from one animal and essentially transplanted to another as a result of bites inflicted around the mouth.

    "Devils jaw wrestle and bite each other a lot, usually in the face and around the mouth, and bits of tumor break off one devil and stick in the wounds of another," said Ms Pearse.

    Seems a worse fate than any delivered by Bugs Bunny.
    posted by Sydney on 2/05/2006 01:30:00 PM 0 comments

    Bird Flu Update: Indonesia is the latest hot-spot:

    Indonesia's death toll from bird flu rose to 16 as the World Health Organization confirmed two more people had died from the H5N1 virus, an agency official said.

    ``The number of confirmed cases is now 23, which is an additional four cases, including the two fatalities,'' Sari Setiogi, WHO's spokeswoman in the country, said today in a telephone interview. ``That brings the death toll to 16.''
    posted by Sydney on 2/05/2006 11:14:00 AM 1 comments

    Shut Down: The New Jersey biotech company that collected cadaver tissue for transplant under dubious conditions - including the bones of Alistair Cooke - has been shut down:

    "FDA's investigation of BTS revealed serious and widespread deficiencies in their manufacturing practices that provide the agency reason to believe that allowing the firm to manufacture would present a danger to public health by increasing the risk of communicable disease transmission," FDA official Margaret Glavin said in a statement.

    In a letter to the company published on the FDA's Web site, the agency cited death certificates provided by BTS that changed the age and cause of death of at least eight donors when compared to their official death certificates.

    The company has not operated since October when the FDA announced it was under investigation, an FDA spokesman said.

    Published reports said the company sold bones from the late broadcaster Alistair Cooke, who died in March 2004, before he was cremated. His death at age 95 from cancer would have made his tissues off-limits for transplant.
    posted by Sydney on 2/05/2006 11:09:00 AM 0 comments

    Saturday, February 04, 2006

    Future of Medicine II: Dean Esmay wonders if artificial wombs will one day replace incubators.

    posted by Sydney on 2/04/2006 01:41:00 PM 2 comments

    How Do I Distrust Thee II: On a more personal level, here are some commonly used phrases that scream out to a doctor "I DON'T TRUST YOU.":

    My [husband, wife, daughter, son] thinks I should see a specialist.

    My [husband, wife, daughter, son, neighbor, friend, grocery clerk] says I should be on medication x, not medication y.

    If Dr. Specialist A isn't on my plan, then I'll see your friend, er, Dr. Specialist B.

    Do you mind if I tape our conversation?

    Well, you're the doctor.
    posted by Sydney on 2/04/2006 01:35:00 PM 9 comments

    How Do I Distrust Thee, Let Me Count the Ways: In a comment to the earlier future of medicine post, Boinky pointed to this article from The New York Times about the attraction of alternative medicine:

    This straying from conventional medicine is often rooted in a sense of disappointment, even betrayal, many patients and experts say. When patients see conventional medicine's inadequacies up close - a misdiagnosis, an intolerable drug, failed surgery, even a dismissive doctor - many find the experience profoundly disillusioning, or at least eye-opening.

    Haggles with insurance providers, conflicting findings from medical studies and news reports of drug makers' covering up product side effects all feed their disaffection, to the point where many people begin to question not only the health care system but also the science behind it. Soon, intuition and the personal experience of friends and family may seem as trustworthy as advice from a doctor in diagnosing an illness or judging a treatment.

    The most avid users of alternative medicine do seem to be those with the deepest distrust in modern medicine. They don't just distrust doctors, they distrust the entire system. But there's an even stronger reason that so many people find alternative medicine attractive - they feel that they're making the choice themselves, rather than having choices made for them. And that's why they're willing to spend so much money on unproven techniques, and why they're more forgiving when things don't go as expected:

    With help from friends, Ms. Paradise raised about $40,000 to pay for the Arizona clinic's treatment, plus living expenses while there.

    "I had absolutely no scientific reason for choosing this route, none," she said. "I just think there are times in our life when we are asked to make decisions based on our intuition, on our gut instinct, not based on evidence put in front of us, and for me this was one of those moments."

    ......But Ms. Paradise said that her relationship with the natural medicine specialist in Arizona had been collaborative and that she had felt "more empowered, more involved" in the treatment plan, which included large doses of vitamins, as well as changes in diet and sleep routines. After four months on the regimen, she said, she felt much better.

    But the cancer was not cured. It has resurfaced recently and spread, and this time Ms. Paradise has started an experimental treatment with an oncologist in New York.

    She is complementing this treatment, she said, with another course of alternative therapy in Arizona. She moved in with friends near Phoenix and started the alternative regime in January.

    One suspects she would not have been so forgiving of modern medicine if she had spent $40,000 on treatment that didn't work. But, having chosen to spend that money herself, against the advice of the very profession and professionals she dislikes, she has a vested interest in maintaining its legitimacy.

    There's a fortune to be made in exploiting the weaker points of our natures.
    posted by Sydney on 2/04/2006 12:53:00 PM 5 comments

    Friday, February 03, 2006

    Emotional Circuit: Today is an international day of anger. How about instead, we have an international day of love.

    posted by Sydney on 2/03/2006 08:07:00 AM 0 comments

    Thursday, February 02, 2006

    Forcing Hands: An abortion-rights group is backing a suit against Massachusetts WalMarts for failing to stock the morning after pill.

    The plaintiffs argued that state policy requires pharmacies to provide all "commonly prescribed medicines.

    Can the state really tell a store what products to stock? Seems unlikely, but it is Massachusetts, so who knows. More to the point, is the morning after pill really a "commonly prescribed" drug?

    Well, maybe it is, at least at Planned Parenthood:

    Internal e-mails exchanged between Planned Parenthood employees, and provided to the Globe by an attorney who filed a wrongful firing lawsuit on behalf of a former executive, indicate the drug's manufacturer sells Plan B kits -- with one or two pills in each -- to Planned Parenthood clinics at a ''special" price of $4.25 apiece. The kits are usually sold to consumers for about $30.

    The price per kit Planned Parenthood pays is 25 cents lower than the discount rate its maker, Barr Laboratories, offered public agencies.

    Planned Parenthood said its distribution of emergency contraception has grown by 4,484 percent since 1995. In 2003, the most recent year statistics are available, it distributed 774,482 emergency contraception kits. A spokeswoman, Elizabeth Toledo, said the agency distributes some kits for free or at sliding rate scales, though she declined to provide specifics.

    And at such a handsome profit!

    posted by Sydney on 2/02/2006 01:31:00 PM 5 comments

    Future of Medicine: Hippocrates at The Medical Blog Network, thinks perhaps the answer to retail clinics may be internet medicine:

    Aside from locating your office in a mall (bad joke huh?), support for telemedicine may be the answer. Consider the issues:

    * Costs: Online consults for routine matters could cost less than full office visits, but cannot compete with co-pays. Still the lower cost per incidence could actually net more per hour, because of less time and interruption required. 
    * Scope: No doubt, you cannot do everything without seeing patient face to face. Physical exam is still required by law to diagnose and prescribe in many jurisdictions. Getting to know your patients personally has no substitute too.
    * Availability: Telemedicine does not have to be real-time. A busy professional can submit a request before or after work hours and the doctor can answer... whenever he or she feels like, perhaps within a certain time window.
    * Location: Flexibility can be increased not only for time but place of care. Travel is a big issue for many people, especially in rural areas. For physicians this could mean being able to increase the "service radius" and attract more patients.
    * Reimbursement: In most places, telemedicine still means "cash-only-please". But some health plans (e.g. in California) are starting to catch up and include coverage. Yet, it still may be too early to count on this in your planning.

    Maybe in another generation, telemedicine will be the answer, but I don't expect it to be widely adopted any time soon. For one thing, the majority of the population still is not internet connected. It might seem that way for those of us who spend most of our time on the internet, but that's only from within the bubble. Most baby boomers do not use the internet regularly. Many of them assign the internet tasks for their jobs to someone else - a secretary to print out the email for them, a grown child to buy their airline tickets for them.

    Two years ago, the American Board of Family Medicine decided to create an internet-based ongoing certification program for family physicians. Once a year, doctors are expected to complete an exam on their website. If any group would be expected to have a high internet use rate, you think it would be physicians, but the outcry was great. In fact, the second year they modified it so the test could be printed out and taken on paper, then later entered into the website. (A task that could conceivably be delegated to a trusted internet-savvy employee or spouse or child.) I suspect the under-35 population (or maybe even under 40) are much more intensive users of internet services, and when they need more medical care, perhaps telemedicine will fly.

    The other problem is technological. There is no substitute for experiencing something in person in 3-D with the added senses of touch and smell. It might be possible to send a photograph or digital video of a patient, or to even use a realtime webcam to view needed parts of the physical, but it's still inferior to being there. Anyone who's ever taken a written medical test with photographs of rashs knows what I mean. And never underestimate the importance of smell:

    Still, I have come to appreciate one part of the physical exam that cannot be replaced by blood draws and x-rays, a part in which I have actually improved since first donning a long white coat. This part often doesn't make it into my official histories or daily progress notes, but its prognostic implications can be as important as those of the white-cell count or costophrenic angles. I am referring to a patient's smell.

    In a closed hospital room, odors are often much easier to appreciate than carotid bruits. I have been greeted by enough stenches on removing dressings from the feet of diabetic patients to know whether someone is going to need intravenous or oral antibiotics. I have sniffed sufficient foul-scented tracheostomy sites that I'm no longer surprised when sputum cultures grow out a mixture of oral flora. I have done morning rounds for so many patients who are being prepped for colonoscopy that I now know who has and who has not received a full dose of GoLytely. When a nephrologist asked whether my new patient's confusion was due to her age or her renal function, I felt confident choosing uremia on the basis of her fetid breath.

    Smells also indicate in which direction a patient is headed. A patient who has showered and brushed his teeth before 6:30 a.m. is obviously getting ready to go home, no matter what his laboratory values might say. More than once, just a few sniffs have let me know that I can advance a patient's diet without embarrassing her by asking whether she's been passing gas. When I admit a new patient from the emergency room who reeks of cigarette smoke, I make a mental note to watch his oxygen requirements closely and to keep cancer in my differential diagnosis no matter what the reason for his presentation.

    I'm not convinced that telemedicine will ever be as good as real time medicine.
    posted by Sydney on 2/02/2006 09:22:00 AM 10 comments

    Not-So-Blue Flu: Researchers at the CDC may be a step closer to developing an avian flu vaccine:

    Researchers at the U.S. Centers for Disease Control have created a prototype of an avian flu vaccine that could hold significant promise for use in an influenza pandemic.

    The vaccine — made by engineering a human cold virus to produce a protein made by the H5N1 flu virus — would likely be quicker to make than standard flu vaccine, induce a better immune response and could be made without reliance on eggs, the researchers said in a study rushed to print by The Lancet, a prominent medical journal.

    Influenza vaccine experts unrelated to the work praised the study, but noted as yet the vaccine has only been tested in mice.

    Will they be able to use the technique to make a regular influenza vaccine, too? That would truly be a breakthrough.
    posted by Sydney on 2/02/2006 08:22:00 AM 0 comments

    Failing Grades: The American College of Emergency Physicians has issued a report card on the state of emergency care in the nation. It's not so good:

    The number of people coming to emergency departments continues to increase, with nearly 114 million patient visits in 2003, the highest number ever, according to the Centers for Disease Control and Prevention (CDC). At the same time, the overall capacity of the nation?s emergency systems has decreased, with hundreds of emergency departments closing in the past 10 years. The number of emergency departments has decreased by 14 percent since 1993, according to the CDC, and hospitals are operating far fewer inpatient beds than they did a decade ago. During the 1990s, hospitals lost 103,000 staffed inpatient medical-surgical beds and 7,800 intensive care unit beds nationwide.

    Most of the problem is budgetary. Due to declining reimbursement, hospitals have had to cut back on staffing and thus on beds. The fewer beds, the more likely a back up is to occur in the emergency room as people wait to be admitted to the hospital. And part of the problem is malpractice fears. Many doctors in high-risk specialties refuse to participate in emergency care - the riskiest care there is. If a hospital can't get any neurosurgeons or trauma surgeons to be on call, then they can't have trauma beds. Even worse, some hospitals have had to close their emegency rooms completely because they couldn't get doctors to staff them. Remember that the next time you hear someone say the medical malpractice crisis is "just made up" and a "scare tactic."
    posted by Sydney on 2/02/2006 08:17:00 AM 1 comments

    Wednesday, February 01, 2006

    Flu Blues II: Sanofi-Pasteur has sold out of next year's flu vaccine already. From their vaccine ordering website:

    During the first 30 minutes of accepting prebooking requests, the company received over 40,000 phone calls and more than 200,000 calls came in during the first eight hours. As a result of the unprecedented demand, the company has committed all influenza vaccine doses planned for production for the next season except its no preservative Fluzone vaccine in pediatric doses. Sanofi pasteur anticipated a surge in demand for its influenza vaccine and doubled the capacity of its phone lines and on-line ordering systems. Under normal conditions, the company receives an average of 1,500 customer calls per day. During the eight-hour period from noon to 8 PM yesterday, the company received as many calls as it normally receives in a six-month period.

    The company plans to produce approximately 50 million doses of all Fluzone vaccine formulations for U.S. distribution by the end of October. Additional doses could be produced for delivery in November or December based on customer needs and production yields. To determine customer need, sanofi pasteur established a waiting list of customers who were unable to prebook and will contact those providers to offer the alternative of accepting later delivery. Customers willing to accept later delivery will have the option to cancel their request later in the year if they are able to obtain earlier delivery from another supplier. At this time, the company is no longer accepting additional customers on the waiting list.

    The company is currently unable to supply the entire U.S. influenza vaccine market. However, based on public statements made by other influenza vaccine manufacturers, the company anticipates that there will be an adequate supply of vaccine to meet the nation’s needs for the 2006-2007 season. Sanofi pasteur is sending apologies to its customers for the frustration they experienced in attempting to place their requests. Immunization providers who were unable to prebook their vaccine with sanofi pasteur will likely be able to look to other manufacturers to meet their vaccine needs.

    One of those other manufacturers would be Chiron, which had production problems for the past two years, and which this year, shipped their product to their big customers (chain stores, etc.) before they shipped it to their physician customers. (But whose distributors are still taking orders for next year's vaccine.) I know doctors who didn't recieve their order until the end of December. By that time, most of their patients had gotten the vaccine elsewhere. That left one group practice with a $20,000 loss. Would you want to order from that company again? Or even take a chance on purchasing the flu vaccine at all?

    One reason that Sanof-Pasteur had such a quick run is that they have been reliable about delivering the vaccine to all its customers regardless of size, and because they haven't had the history of production problems that Chiron has had.

    GlaxoSmithKline also has a flu vaccine, although it was approved under an accelerated FDA program, which leaves some physicians a little leary of it (including this one). Just how "accelerated" was the approval process and what steps got skipped?

    Accelerated approval allows products that treat serious or life-threatening illnesses to be approved based on successfully achieving an endpoint that is reasonably likely to predict ultimate clinical benefit, usually one that can be studied more rapidly than showing protection against disease. In this case, the manufacturer demonstrated that after vaccination with Fluarix adults made levels of protective antibodies in the blood that FDA believes are likely to be effective in preventing flu. GlaxoSmithKline, the manufacturer of Fluarix, will do further clinical studies as part of the accelerated approval process to verify the clinical benefit of the vaccine.

    A few too many "believe's" and "likely's" in their for my comfort.

    UPDATE: Here's more on the surge:

    A flurry of physicians attempting to order influenza vaccine for the 2006-07 flu season directly from manufacturer sanofi pasteur temporarily "maxed out" the Web servers supporting the company's VaccineShoppe.com site Jan. 31, according to John Zahradnik, M.D., sanofi pasteur's director of immunization policy.

    The ordering frenzy that followed sanofi pasteur's previously announced noon EST opening of physician prebooking for next season's flu vaccine also overloaded the company's toll-free ordering phone lines, despite the addition of extra staff to handle the anticipated greater volume.

    The result: Many would-be visitors to the Web site couldn't get through, especially early in the afternoon. Some switched to the phone lines and succeeded in their efforts to prebook vaccine; others still could not make those connections. Members of the Academy's Influenza Vaccine Task Force reported mixed results when they tried to order vaccine from sanofi pasteur that day. Those who eventually succeeded in prebooking vaccine using one or the other method typically did so only later that evening.

    The distribution system, obviously, continues to be imperfect:

    "It's an indication that this whole system of flu vaccine production, purchasing and distribution -- from egg to arm -- doesn't work. The entire ordering process needs to be examined, with preference given to those who serve high-risk patients -- physicians, hospitals and long-term care facilities.

    "This is just another example of the larger fact that this system isn't working. The manufacturers, distributors, CDC and organized medicine are going to have to work out a better system for getting influenza vaccine into the hands of physicians."

    I think we have to face it. We simply don't have the ability to make enough flu vaccine for everyone. Maybe we need to go back to just recommending it for those who are at true risk from influenza. And just missing a few days from work doesn't count as risk.

    posted by Sydney on 2/01/2006 10:14:00 PM 0 comments

    Life Worth Living: I haven't paid much attention to the story of the little girl in Massachusetts who got a last minute reprieve from death by dehydration, but if this portrayal is true, her story should be a lesson to all state-appointed guardians of the most vulnerable. Take the time to check things out for yourself before submitting to expert opinion. For those of you who, like me, haven't been following the story, the child was in a coma after suffering a beating, allegedly at the hands of her adoptive parents. After eight days, her doctors declared her "virtually brain dead" and her state-appointed guardian moved to have her removed from all life support, including feeding. Then he had second thoughts:

    ''It's her incredible will to live," said Harry Spence, commissioner of the state Department of Social Services, which has had custody of the 11-year-old girl since she was brought, badly beaten, to a hospital last September and lapsed into a coma.

    Spence, who has been criticized for seeking to remove her life support as soon as eight days after her hospitalization, said he visited Haleigh for the first time ''out of some sense of responsibility."

    He said he wanted to see the girl whose fate he will help determine. ''I needed to put myself in the place of a parent," he said.

    ...On Tuesday, Spence said, he went to Haleigh's room at Baystate and noticed a quiet brown-haired girl lying in bed. In front of her, he said, there were three objects: a yellow duck, a Curious George stuffed animal, and a yellow block. He said a DSS social worker accompanied him, and she said, ''Haleigh, this is Harry."

    ''Give him the yellow duck," the social worker said, according to Spence's recollection.

    Haleigh picked up the yellow duck, he said.

    ''Where's Curious George?" the social worker asked Haleigh.

    Haleigh then picked up the stuffed animal, Spence said.

    Thank goodness he wasn't too proud to have second thoughts - and to act on them. In the absence of brain death, eight days is an awfully short time to decide that someone is irreversibly damaged - especially a child:

    Children are more likely than adults to significantly recover from severe brain injuries, and some neurologists say they would want to wait at least a year before concluding that a child had stagnated in that state with no hope for a better life.

    ''I wouldn't give up before a year," said Dr. Douglas Katz, medical director of the traumatic brain injury program at Braintree Rehabilitation Hospital.

    Katz said many patients in a minimally conscious state can track movements with their eyes and even pick up objects. But only when they begin to pick up objects and use them appropriately are they believed to have gained a higher level of consciousness.

    At best, however, these patients generally stay ''extremely disabled," Katz said.

    And that's the real question here, isn't it; whether or not "extremely disabled" have as much right to live as the lightly disabled or not at all disabled.
    posted by Sydney on 2/01/2006 09:06:00 PM 0 comments

    Details, Details: Those little blurbs about healthcare insurance reform in the State of the Union address are fleshed out here. Some key points:

    The President proposed to build on this success and expand HSAs by:

    * Giving Individuals That Purchase HSAs On Their Own The Same Tax Advantages As Those With Employer-Sponsored Insurance. The President proposes making premiums for HSA-compatible insurance policies deductible from income taxes when purchased by individuals outside of work. In addition, an income tax credit would offset payroll taxes paid on premiums paid for their HSA policies. This will level the playing field for those who currently do not have access to employer health care plans, including the self-employed, unemployed, and workers for companies that don’t offer health insurance. For Americans who are not working, especially early retirees, premiums for the purchase of non-group HSA plans would now be allowed tax-free from an HSA account.

    * Eliminating All Taxes On Out-Of-Pocket Spending Through HSAs. The President proposed allowing Americans with HSAs and their employers to make annual contributions to their accounts to cover all out-of-pocket costs under their HSA policy, not just their deductible as provided under current law. This will allow patients to cover all their out-of-pocket expenses tax-free through their HSA. The new proposal would also provide a credit for payroll taxes paid on HSA contributions made by individuals. The President's HSA proposals are projected to increase the number of Americans with HSAs from the currently projected 14 million to 21 million by 2010, a 50-percent rise.

    Guess that last one means you could blow your entire HSA on breast implants and no one would stop you.

    There's more. How about health insurance that you can keep when you change jobs?

    * Enabling Portable HSA Insurance Policies. Employers would have the ability to offer workers a Portable HSA insurance policy that the employees would own, control, and be able to take wherever they went. Their premiums would be tax-free and would not increase based on their health status at the time that they changed jobs, left the labor force, or moved. Employers could contribute to new employees' Portable HSA insurance policies – no matter where the policy was originally purchased. Employers would have the ability to decide whether or how much to contribute to these plans, but whatever they contributed would be tax-free.

    * The President Supports Permitting The Purchase Of Health Insurance Across State Lines. This would allow Americans to buy the best health insurance, based on their own circumstances, instead of being limited to only the policies available in their state. Allowing Americans to purchase health insurance policies issued in other states will provide much-needed choice and competition, while retaining the consumer protections of enforcement and licensing states currently provide.

    And then, there's the demand for transparency:

    Americans Should Be Able To Easily Obtain Understandable Information About The Price And Quality Of Health Care. The President urges medical providers and insurance companies to make information about prices and quality readily available to all Americans prior to the time of service or treatment.

    I support that. And the first step toward achieving that sort of transparency is to do throw out our current coding/billing system. Right now, if you call a doctor's office and ask how much a visit will cost, they can only give you an estimate. The amount billed will depend on how many things the doctor has to address and how hard he has to think about it. Suppose, for example, you have an ear infection. Usually, that would be a 99213 - the billing code for an intermediate level office visit. In my neck of the woods that would run around $60-65 out of pocket. BUT, if, while you are in the office you mention casually that you've been having chest pain whenever you walk a little too fast, well, that changes things. The visit will probably go up to a 99214 code, a detailed office visit, that involves more thinking and more risk for the doctor and costs around $75 to $80 in my neighborhood.

    It would be far better for everyone if we just billed by time, like lawyers.

    And finally, there are these two very interesting proposals to help the less fortunate:

    The President Proposes Providing $500 Million Per Year To Encourage States To Test Innovative Methods For Covering Chronically Ill Residents. Americans who are chronically ill and are not part of an employer or public pool must pay the full burden of their care through high premiums or, in some cases, go without insurance at all. Some states have established high-risk pools to insure chronically ill patients otherwise denied coverage, but there are also other innovative approaches that could provide better coverage at lower costs. The President proposes grants, awarded by the HHS Secretary, that would help cover chronically ill patients by helping up to 10 states build on their existing high-risk pools or test other innovative approaches such as risk-adjusted subsidies or plans designed to manage chronic illnesses such as diabetes.

    ...The President Proposes Expanding AHPs To Allow Civic, Community, And Religious Groups To Purchase Health Coverage For Their Members. This gives individuals and their families, including the most vulnerable Americans, the ability to pool together to buy health insurance outside of their workplace. Giving people more choices to buy insurance at group rates from organizations they already know and trust will help many Americans purchase quality, affordable, and portable health insurance.

    That last proposal is, perhaps, the most exciting. Why shouldn't we be able to pool our resources in the community for healthcare insurance? We have Catholic credit unions. Why not a Catholic health union? They probably wouldn't cover abortions and birth control, but that specific group of insureds wouldn't care, would they? And why not an American Baptist health union? or a Kiwanis health? You know, it might even improve participation in community organizations, to know you could get health insurance by virtue of membership.

    UPDATE: The Wall Street Journal offers some advice on choosing HSA's.
    posted by Sydney on 2/01/2006 08:31:00 PM 3 comments

    Memento: What to do with chronic deja vu:?

    "The man who thinks he's been to Moulin's clinic even gave details of the visit that never occurred. He has deja vu so bad that he doesn't watch TV news because he feels like he's seen it all before, "Moulin said. Things get tricky when the man is asked to predict what's ahead, however.

    'When this particular patient's wife asked what was going to happen next on a TV program he'd claimed to have already seen, he said, 'How should I know? I have a memory problem!''

    ...."It suggests that the sensations associated with remembering are separate to the contents of memory, that there are two different systems in the brain at work."

    Memory is a tricky thing. No doubt.
    posted by Sydney on 2/01/2006 08:12:00 PM 0 comments

    Professor of Survivorship: The Susan G. Komen Breast Cancer Foundation is looking for nominees for its Professor of Survivorship Awards:

    The award, which was established by the Komen Foundation in 1999, is granted each year to two individuals who have distinguished themselves in research specific to long-term breast cancer survivor issues or in work with survivors that takes place in a clinical setting. Awardees are appointed Komen Professors of Survivorship for a one-year period, and each awardee receives a $20,000 honorarium to advance their work.

    Follow the link for details.
    posted by Sydney on 2/01/2006 07:37:00 PM 0 comments

    A Woman's Tender Heart: Heart disease may really be different in women:

    Even women whose coronary arteries are free of major blockages could be heading toward a heart attack, scientists cautioned Tuesday.

    Roughly 12 million U.S. women are thought to have heart disease, and as many as 3 million of them have a condition called coronary microvascular syndrome, the scientists write in a supplement to the Journal of the American College of Cardiology. In women with this condition, plaque has accumulated in the tiniest arteries of their heart, reducing oxygen flow.

    Standard X-rays of the coronary arteries, or angiography, miss the problem; only additional tests of coronary blood flow can tip doctors off.

    ....Men get coronary microvascular syndrome, too, but they represent only 20% of cases, says WISE chair C. Noel Bairey Merz, a cardiologist at Cedars-Sinai Medical Center in Los Angeles.

    So, let's see. In women, 25% of the cases are due to microvascular disease, compared to only 20% in men. Not such a striking difference after all. The lesson being that we should keep our eyes and minds open to the possibility in all of our patients whose symptoms are more suggestive of heart disease than their coronary angiogram would suggest. [as pointed out in the comments, it does appear that they mean 20% of the microvascular cases are men, not the otherway around. My mistake.-ed.]

    Unfortunately, disease of the very tiny vessels is not as amenable to an easy fix as disease of the large vessels. All you can do is reduce/eliminate as many risk factors as possible - stop smoking, watch the diet, control blood pressure - and take medication to try to keep the very little blood vessels as open as possible.
    posted by Sydney on 2/01/2006 08:35:00 AM 3 comments

    How Do You Spell Relief? The FDA has approved a new drug for constipation:

    The FDA approved the sale of Sucampo Pharmaceuticals Inc.'s lubiprostone capsules, which are marketed as Amitiza.

    Amitiza works by increasing the body's intestinal fluid secretion, which helps ease the passage of stools and alleviate symptoms associated with chronic constipation, the FDA said.

    ......Amitiza has been shown in two clinical studies to give 60 percent of patients a bowel movement within 24 hours of taking the medication.

    Common side effects reported in testing included headache, nausea, diarrhea, abdominal pain and swelling.

    The drug increases intestinal fluid by opening chloride channels in the cells of the gut lining and thus increasing fluid secretion. The result is wetter, better lubricated stools. Other laxatives either irritate the colon enough to make it contract, and then squeeze out the stool, or by pulling water in to the gut by osmosis to make the stool softer and easier to pass.

    Most of the older laxatives work their magic in the lumen of the gut without entering the body and causing multi-system side effects. The question for lubiprostone will be whether or not it acts on chloride channels in the rest of the body in addition to those in the gut. If it does, then expect the side effect profile to be worse than the older laxatives.
    posted by Sydney on 2/01/2006 08:25:00 AM 1 comments

    Taking No Chances: Hong Kong is taking a pro-active stance against Avian flu. They're isolating people who've been exposed:

    Three people have been admitted to hospital in Hong Kong after eating chicken believed to have been infected with the H5N1 strain of bird flu, officials said.

    The three, including a 79-year-old woman, were placed in an isolation ward after it was found a chicken they had eaten during a family feast had nested with an infected bird smuggled in from China, the health department said.
    posted by Sydney on 2/01/2006 08:02:00 AM 0 comments

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