The Agonist - Health Issues

Researcher's labour of love leads to breakthrough in treating MS

Sat, 21 Nov 2009 11:03:32 -0800

André Picard and Avis Favaro | November 21

Globe & Mail - New way of thinking about debilitating disease has yielded stunning new treatments – but MS societies urge sufferers to be cautious before experimenting

Elena Ravalli was a seemingly healthy 37-year-old when she began to experience strange attacks of vertigo, numbness, temporary vision loss and crushing fatigue. They were classic signs of multiple sclerosis, a potentially debilitating neurological disease.

It was 1995 and her husband, Paolo Zamboni, a professor of medicine at the University of Ferrara in Italy, set out to help. He was determined to solve the mystery of MS – an illness that strikes people in the prime of their lives but whose causes are unknown and whose effective treatments are few.

What he learned in his medical detective work, scouring dusty old books and using ultra-modern imaging techniques, could well turn what we know about MS on its head: Dr. Zamboni's research suggests that MS is not, as widely believed, an autoimmune condition, but a vascular disease. More at the link.

Tamiflu-resistant strain of swine flu spreading

Sat, 21 Nov 2009 00:01:59 -0800

Owen Bowcott | Nov 21

The Guardian - Doctors in Wales have discovered a Tamiflu-resistant strain of swine flu that has been spreading from patient to patient in a Cardiff hospital.

The emergence of an easily transmissible, resistant strain is a worrying development for health officials and appears to be the first documented case in Europe.

Five patients at University Hospital Wales, in Cardiff, were infected and isolated for treatment. All had severe underlying conditions that left them with weakened immune systems. At least three had acquired the infection in hospital.

Dr Roland Salmon, the director of the communicable disease surveillance centre in Wales, said: "The emergence of [H1N1] viruses that are resistant to Tamiflu is not unexpected in patients with serious underlying conditions and suppressed immune systems, who still test positive for the virus despite treatment.

"In this case, the resistant strain of swine flu does not appear to be any more severe than the swine flu virus that has been circulating since April."

Philip Morris ordered to pay $300 million to smoker

Fri, 20 Nov 2009 12:05:33 -0800

Gina Keating & Carol Bishopric | Los Angeles | November 20

Reuters - A Florida jury on Thursday ordered cigarette maker Philip Morris USA to pay $300 million in damages to a 61-year-old ex-smoker named Cindy Naugle who is wheelchair-bound by emphysema.

The Broward Circuit Court jury assessed $56.6 million in past and future medical expenses against the company, part of Altria Group Inc, as well as $244 million in punitive damages.

The verdict is the largest of the so-called Engle progeny cases that have been tried so far, both sides said.

Philip Morris will seek further review of the verdict because of "numerous erroneous rulings by the trial judge," Philip Morris spokesman Murray Garnick said in a statement.

"We believe that the punitive damages award is grossly excessive and a clear violation of constitutional and state law," Garnick said.

Stem cells: the first human trial

Thu, 19 Nov 2009 18:20:51 -0800

Steve Connor | Nov 20

The Independent -

Revolutionary treatment using human embryos for patients with incurable blindness

People suffering from a form of incurable blindness could soon become the first patients in the world to benefit from a new and controversial transplant operation using stem cells derived from spare human embryos left over from IVF treatment.

Scientists working for an American biotechnology company yesterday applied for a licence to carry out a clinical trial on patients in the US suffering from a type of macular degeneration, which causes gradual loss of vision. They expect the transplant operations to begin early in the new year.

The development is highly controversial because many "pro-life" groups are opposed to using human embryos in any kind of medical research but scientists believe that the benefits could revolutionise the treatment of many incurable disorders ranging from Parkinson's to heart disease.

The company has applied for a licence from the US Food and Drug Administration (FDA) and is confident of its application being granted.

Senate Democrats introduce $849 billion healthcare reform bill

Thu, 19 Nov 2009 06:11:56 -0800

Brad Knickerbocker | Washington | November 18

CSM - Though the congressional debate and legislative sausage-making are far from over, the Senate took a major step Wednesday in putting forth a $849 billion healthcare reform bill.

The bill, launched by Senate majority leader Harry Reid – and vigorously opposed by Republicans – aims to provide health insurance for 94 percent of all Americans, including 31 million people now uninsured.

The measure reportedly would require most Americans to carry health insurance, require large companies to provide coverage for their employees, and prohibit insurance companies from denying coverage because of preexisting medical conditions.

A senior Democratic leadership aide told the Associated Press that Congressional Budget Office analysis showed the bill would reduce federal deficits by a total of $127 billion over 10 years.

[...]

A key subject of debate – in addition to a public option and the impact on the federal deficit – is abortion. The House-passed bill includes the so-called “Stupak amendment” offered by Rep. Bart Stupak (D) of Michigan, which tightens current restrictions on the use of federal funds for abortion services.

Newsweek reports that abortion language in the Reid bill is less restrictive than Stupak. But it could well reappear as House-Senate negotiators try to work out their differences in conference committee.

[...]

Reuters reports that the debate is expected to begin on Nov. 30, after the Thanksgiving holiday next week, and last for at least three weeks.

HHS Task Force Mammogram Recs Slammed

Thu, 19 Nov 2009 04:53:20 -0800

"The (task force) recommends against routine screening mammography in women aged 40 to 49 years." U.S. Preventative Services Task Force, Nov. 17, 2009

"My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years - talk to your doctor about your individual history, ask questions, and make the decision that is right for you." Kathleen Sebelius, Health and Human Services Secretary, Nov. 18.

Talk about a short news cycle. A Department of Health and Human Services (HHS) appointed "best practices" task force dismissed the value of "routine" mammograms as a cancer prevention technique for women 40 to 49 years on Tuesday, November 17.

More after the jump.

A day later, Wednesday, Nov. 18, HHS Secretary Kathleen Sebelius issued a statement dismissing the committee recommendations.

'The U.S. Preventive Task Force is an outside independent panel of doctors and scientists who make recommendations.

"They do not set federal policy and they don't determine what services are covered by the federal government." Kathleen Sebelius, Nov. 18.

The committee is made up of independent practitioners but operates under the sponsorship of the Agency for Healthcare Research and Quality, HHS. The agency states that their task force "recommendations have formed the basis of the clinical standards for many professional societies, health organizations, and medical quality review groups."

Sebelius didn't care. Amidst Republican outcries that this was the way Democratic sponsored health reform would operate, she issued her terse statement dismissing the dismissal of mammography for women 40 to 49.

The DC flap started when had task force member Dr. Diane Pettiti, MD on her show yesterday, Nov. 18. She asked the doctor for the name of one cancer specialist on the task force. Petitti was unable to answer (video 1:53). The doctor also told Rehm that "Cost effectiveness was not a part of the discussion. Cost was not uttered in the room."

Dr. Rebecca Zurrbier, MD, Chief of Breast Imaging at Sibley Memorial Hospital in Washington, DC was listening to the Rehm show and became incensed. She pointed out that no one on the committee had either a clinical specialty or indicated any direct experience in treating cancer in a WUSA, Channel 9 special news feature (video). Zurrbier's WUSA critique was a devastating counterpoint to Rehm's skilful questioning on her radio show earlier in the day.

The HHS sponsored task force had 16 members. These members issued a statement on cancer treatment. There is not one oncologist on the panel nor is there a radiologist. The specialties of task force physicians consist of: Family Medcine (4 members); Pediatrics (2); Obstetrics and Gynecology (2); Internal Medicine (2); Geriatrics (1); Epidemiology (1); Primary Care (1). The non MD's had these specialties: Nurse Practitioner - Psychiatry (1); Nurse Practitioner - Family Medicine (1); and, PhD researcher (1).

If you were seeking treatment for cancer or consultation on current treatment, would you consult anyone with the specialties listed? Not if you're concerned about your health. Cancer is not what these doctors treat. Dr. Zurrbier's point was so obvious, she seemed amazed that this kind of finding could even occur. So should we.

WUSA's did an on-the-spot review of task force member affiliations. They came up with three members tied to HMO's or health insurance companies. Dr. George Isham, MD is the Chief Health Officer for a major health care provider, Health Partners. Dr. David Grossman, MD, is an investigator a research division of the Group Health Cooperative health care network in the Seattle area. Dr. J. Sanford Schwartz, MD, is the past executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania. He's also on the Blue Shield Medical Advisory Panel.

There are three other affiliations that deserve note.

Task force Chairman, Bruce Nedrow Calonge, MD, is a Colorado physician who is the Chairman of the Colorado Foundation for Medical Care, a major advisor on "quality improvement" in care for the state and other health care organizations. Dr. Pettiti, who said the recommendations would have no influence on insurance coverage, is a health policy and medical advisor for Kaiser Permanente of Southern California. Joy Melnikow, MD is the associate medical advisers for Healthwise, a medical knowledgebase company serving health providers, insurance companies, and government entities. The firm also provides software for patient information.

Thanks to the incisive questioning of NPR syndicated radio host Diane Rehm and the quick and clear response of cancer specialist, Dr. Zurrbier on WUSA, the issue hit the public airwaves and was quickly resolved with the rapid response of HHS Secretary Sebelius.

Now it's time to find out how this HHS research organization could impanel a group of experts to recommend cancer treatment protocols when none of the physicians on the panel were oncologists and none had any identified clinical experience treating cancer. It's also a good time for those on the task force to examine why they chose to issue this guideline without cancer researchers and clinicians on the committee?

Why were the deficiencies in this process, so obvious to us, too difficult for the HHS administrators to grasp?

END

This article may be reproduced in whole or in part with attribution of authorship and a link to this article.

Now you can have what she’s having...

Tue, 17 Nov 2009 04:43:45 -0800

Jeremy Laurance | Lyon, France | November 16

The Independent - As the old joke has it, men can be turned on with a simple flick of a switch while women require attention to a battery of dials and buttons. Today the debate over how to stimulate female sexual desire is set to be reopened with the discovery of a drug described as “Viagra for women”.

Doctors testing a new anti-depressant found it was useless as a mood brightener - but was unexpectedly effective at boosting the female libido.

Now three clinical trials have shown that the drug fibanserin significantly improved sexual desire and satisfaction in women.

The accidental discovery mirrors that of Viagra, which was being tested as a heart medicine in the 1990s when the male subjects prescribed it discovered it had a pleasing side effect.

In Reversal, Panel Urges Mammograms at 50, Not 40

Tue, 17 Nov 2009 03:12:38 -0800

Gina Kolata | Nov 17

NYT - Most women should start regular breast cancer screening at age 50, not 40, according to new guidelines released Monday by an influential group that provides guidance to doctors, insurance companies and policy makers.

The new recommendations, which do not apply to a small group of women with unusual risk factors for breast cancer, reverse longstanding guidelines and are aimed at reducing harm from overtreatment, the group says. It also says women age 50 to 74 should have mammograms less frequently — every two years, rather than every year. And it said doctors should stop teaching women to examine their breasts on a regular basis.

Just seven years ago, the same group, the United States Preventive Services Task Force, with different members, recommended that women have mammograms every one to two years starting at age 40. It found too little evidence to take a stand on breast self-examinations.

The task force is an independent panel of experts in prevention and primary care appointed by the federal Department of Health and Human Services.

Its new guidelines, which are different from those of some professional and advocacy organizations, are published online in The Annals of Internal Medicine They are likely to touch off yet another round of controversy over the benefits of screening for breast cancer.

Catholic Bishops' leader defends role in health debate, (& swipes at New York Times)

Mon, 16 Nov 2009 15:35:03 -0800

Julia Duin | Baltimore | Nov 16

Washington Times - Cardinal Francis George, president of the U.S. Conference of Catholic Bishops, defended the bishops' involvement in national health care legislation Monday, saying the church must be "leaven" in the debate.

Speaking at the opening of the bishops' annual business meeting, "to limit our teaching or governing to what the state is not interested in would be to betray both the constitution of our country and, much more importantly, the Lord himself," he said.

Not only did USCCB staff and individual bishops play a vital role in getting abortion restrictions into the recently passed House version of the health care overhaul bill, they served notice Monday they will influence the bill's future.

"We will work to persuade the Senate to follow the example of the House and include these critical safeguards in their version of health care reform legislation," Cardinal George said.

Other prelates expressed jubilation at how the USCCB's lobbying proved crucial to the House bill's passage earlier this month as well as anger at some of their critics.

"This is a principled position, not a political position," Bishop William Murphy of Rockville Centre said.

In a reference to the New York Times, "The grey lady of New York has continued to misrepresent this as a fundamental change to the availability of abortion in this country being curtailed because of the nefarious bishops," he added. "That is not the case."

Sex infections still growing in U.S., says CDC

Mon, 16 Nov 2009 05:18:21 -0800

Maggie Fox | Washington | November 16

Reuters - American squeamishness about talking about sex has helped keep common sexually transmitted infections far too common, especially among vulnerable teens, U.S. researchers reported Monday.

Latest statistics on chlamydia, gonorrhea and syphilis show the three highly treatable infections continue to spread in the United States.

"Chlamydia and gonorrhea are stable at unacceptably high levels and syphilis is resurgent after almost being eliminated," said John Douglas, director of the division of sexually transmitted diseases at the U.S. Centers for Disease Control and Prevention.

"We have among the highest rates of STDs of any developed country in the world," Douglas added in a telephone interview.

[...]

Overall, CDC estimates that 19 million new sexually transmitted infections occur each year, almost half among 15- to 24-year-olds.

You can cut back on alcohol

Mon, 16 Nov 2009 04:08:35 -0800

Shari Roan | Washington | November 16

LAT - Seventy years ago, Bill Wilson -- the co-founder of Alcoholics Anonymous -- declared his powerlessness over alcohol in a book by the same name. The failed businessman contended that, as an alcoholic, he had to "hit bottom" before changing his life and that sobriety could only be achieved through complete abstention.

For generations, Americans took these tenets to be true for everyone. Top addiction experts are no longer sure.

They now say that many drinkers can evaluate their habits and -- using new knowledge about genetic and behavioral risks of addiction -- change those habits if necessary. Even some people who have what are now termed alcohol-use disorders, they add, can cut back on consumption before it disrupts education, ruins careers and damages health.

In short, say some of the nation's leading scientists studying substance abuse, humans travel a long road before they become powerless over alcohol -- and most never reach that point.

"We're on the cusp of some major advances in how we conceptualize alcoholism," says Dr. Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism. The institute is the nation's leading authority on alcoholism and the major provider of funds for alcohol research. "The focus now is on the large group of people who are not yet dependent. But they are at risk for developing dependence."

Ukraine has a problem, Part 2

Sun, 15 Nov 2009 13:32:36 -0800

Local H1N1 doesn't kill everybody but looks very bad:

'We have carried out post mortems on two victims and found their lungs are as black as charcoal. They look like they have been burned. It's terrifying.'

Finally a bipartisan issue

Wed, 11 Nov 2009 14:44:02 -0800

High BPA levels linked to male sexual problems

How long before congress gets involved? ;)

A Dream Interpretation: Tuneups for the Brain

Tue, 10 Nov 2009 19:30:26 -0800

New York Times, By Benedict Carey, November 9

It’s snowing heavily, and everyone in the backyard is in a swimsuit, at some kind of party: Mom, Dad, the high school principal, there’s even an ex-girlfriend. And is that Elvis, over by the piñata?

Uh-oh.

Dreams are so rich and have such an authentic feeling that scientists have long assumed they must have a crucial psychological purpose. To Freud, dreaming provided a playground for the unconscious mind; to Jung, it was a stage where the psyche’s archetypes acted out primal themes. Newer theories hold that dreams help the brain to consolidate emotional memories or to work though current problems, like divorce and work frustrations.

Yet what if the primary purpose of dreaming isn’t psychological at all?

[...]

Drawing on work of his own and others, Dr. Hobson argues that dreaming is a parallel state of consciousness that is continually running but normally suppressed during waking. The idea is a prominent example of how neuroscience is altering assumptions about everyday (or every-night) brain functions.

[Another Scientist opines...]

“I argue that dreaming is not a parallel state but that it is consciousness itself, in the absence of input from the senses,” said Dr. Llinás, who makes the case in the book “I of the Vortex: From Neurons to Self” (M.I.T., 2001). Once people are awake, he argued, their brain essentially revises its dream images to match what it sees, hears and feels — the dreams are “corrected” by the senses.

More detail on the HR3962

Mon, 09 Nov 2009 19:24:30 -0800

I've written this in reference to Michael Collins's diary post One More Reason to Kill this Bill and some of the confusion over sections and what is in the bill as far as coverage requirements and penalties.

I'm looking here (.pdf file) for the new Health bill and somewhere around here for the IRS Tax Code. Will post more precise links (possibly to other sources) as needed.

1) HR3962 Sec. 501 (p. 297) If you fail to purchase insurance you will pay 2.5% of (modified adjusted gross income - gross income) but, if that value is higher than the “average premium for self-only coverage under a basic plan which is offered in a Health Insurance Exchange…” you will pay that average premium instead. So, there is a cap on the 2.5%, set at the average premium of a plan on the exchange. Not sure how high that average will be. HR3962 Sec. 501 (p.298) This amount is pro-rated based upon the fraction of the year that you go without coverage.

Note that a “basic plan” is outlined in HR3962 Section 303(c) on page 168.

Modified Adjusted Gross Income is defined as adjusted gross income increased by (A) any amount excluded from gross income under section 911 of IRS Code (see the link below) and (B) any amount of interest received or accrued by the taxpayer during the taxable year which is exempt from tax.

2) HR3962 Sec 501 (p.299). For Americans living overseas, you are exempt from paying this tax if you have been living abroad and are a resident of a foreign country for at least one taxable year. Relevant IRS code is here (scroll down a bit to sec. 911(d)(1)). I assume the prorating would apply if you’ve only been living overseas for less than a year.

3) You can apparently file an exemption from the requirement to purchase insurance based upon religious beliefs, though you must document your adherence to a faith that would want this. There’s a bit more in there, starting on HR3962 Sec. 501, pages 299-300.

4) HR3962 Sec 501, p. 304. Seems to state that small lapses in coverage are not going to result in taxes. I would assume this means a few days, but I don’t see any specific numbers. The bill just calls them “de minimis lapses of acceptable coverage.”

Now, if you don’t pay the tax in point (1) above then you will be subject to normal IRS rules and regulations. I would assume this is where IRS Code sections 7201 and 7203(see links below) come in. They feature up to $25,000 in fines and no more than 1 or 5 years in jail (depending on which is applicable). I’m not sure how these are applied in practice.

So, it looks like no specific penalties are outlined in the bill, but the 2.5% is designed as a tax and so would fall under IRS rules for non-compliance.

IRS Code Section 7201
IRS Code Section 7203