Wednesday, May 31, 2006
Your sexual desire or lack thereof could be in your genes, scientists announced today. The discovery might change how psychologists view sexuality.
The researchers found that individual differences in human sexual desire can be attributed to genetic variations. The study is the first to provide data to show that common variations in the sequence of DNA impact on sexual desire, arousal and function, the researchers said.
The scientists, at the Hebrew University of Jerusalem, examined the DNA of 148 healthy male and female university students and compared the results with questionnaires asking for the students' self-descriptions of their sexual desire, arousal and sexual function. They found a correlation between variants in a gene called the D4 receptor and the students' self-reports on sexuality. . . .
The research was led by Richard Ebstein and was published in the online version of the journal Molecular Psychiatry.
I am not quite sure what to make of this . . . . [bm]
PBS's Frontline had a great episode last night that addressed the AIDS epidemic. The program is entitled, "The Age of AIDS," and will continue tonight. It provides a detailed overview of the AIDS virus and the manner in which physicians and others have responded to it. The introduction states,
On the 25th anniversary of the first diagnosed cases of AIDS, FRONTLINE examines one of the worst pandemics the world has ever known in "The Age of AIDS." After a quarter century of political denial and social stigma, of stunning scientific breakthroughs, bitter policy battles and inadequate prevention campaigns, HIV/AIDS continues to spread rapidly throughout much of the world, particularly in developing nations. To date, some 30 million people worldwide have already died of AIDS.
"It's a very human virus, a very human epidemic. It touches right to the heart of our existence," says Dr. Peter Piot, executive director of UNAIDS. "When you think of it, that in let's say 25 years, about 70 million people have become infected with this virus, probably coming from one [transmission] ... it's mind blowing."
The Frontline website provides additional materials and information. I have ordered Frontline tapes to use in my class and have found them to be extremely informative. The additional materials that can be found on the website add to the class and help provoke wonderful class discussions. [bm]
From a e-blast couresy of the Regulation, Accreditation, and Payment Practice Group of the American Health Lawyers Association:
The Centers for Medicare and Medicaid Services today announced "a final rule setting forth new quality measures and data reporting requirements that organ procurement organizations (OPOs) must meet to have their services covered by Medicare and Medicaid."
"The final rule contains three new outcome measures similar to measures recommended by many commenters, requirements for reporting of OPO performance data, and new and more objective criteria for selecting the winner of a competition for an open donation service area. There is also a new appeals process for OPOs that includes an OPO's right to request reconsideration from CMS. CMS received many comments on a proposed rule that was published on Feb. 4, 2005, resulting in substantial changes in this final rule."
CMS has not posted a pre-publication copy of the final rule, but the rule will be published in the May 31, 2006 edition of the Federal Register.
Tuesday, May 30, 2006
High praise from the AJOB blog for a recent publication:
I'm forever finding jewels that Rosamond Rhodes strings together in her various projects, from the APA philosophy of medicine newsletter to more complex collections like this special issue of the Mount Sinai Journal of Medicine on ethics in pediatrics, which contains at least four (that's as far as I've gotten) of the best articles on ethical issues in pediatrics I've read in years.
Kurt Hirschhorn, Ian R. Holzman, Daniel A. Moros, and Rosamond Rhodes
- Understanding, Avoiding, and Resolving End-of-Life Conflicts in the NICU
Arthur E. Kopelman
- When Parents Request Seemingly Futile Treatment for Their Children
- When Staff and Parents Disagree: Decision Making for a Baby with Trisomy 13
Linda B. Siegel
- An Exploration of the Ethical, Legal and Developmental Issues in the Care of an Adolescent Patient
Daniel Summers, Ivanya Alpert, Thaina Rousseau-Pierre, Mara Minguez, Simone Manigault, Sharon Edwards, Anne Nucci, and Angela Diaz
- Children as Research Subjects: Moral Disputes, Regulatory Guidance, and Recent Court Decisions
Loretta M. Kopelman
- Genetic Testing of Children for Adult-Onset Diseases: Is Testing in the Child’s Best Interests?
Mary Kay Pelias
- Why Test Children for Adult-Onset Genetic Diseases?
Monday, May 29, 2006
For allegedly billing cardiac rehab services with the CPT code for cardiac stress tests -- which, if true, would be a clear example of upcoding -- a Cape Cod cardiologist who was medical director of the cardiact center settled fraud charges with a $1.9 million payment to the government, according to the May 29 issue of AISHealth.com's newsletter. And no, not that CIA: the doc got saddled with a Corporate Integrity Agreement. The U.S. Attorney's office in Boston has a press release on the settlement. [tm]
Friday, May 26, 2006
Thanks to Paul Caron's TaxProf Blog for this item:
The IRS has launched an initiative to determine whether tax-exempt hospitals are adhering to the community benefit standard set forth in Rev. Rul. 69-545 by sending Form 13790, Compliance Check Questionnaire, to 600 hospitals across the country. The initiative follows the Senate Finance Committe hearings last year on tax-exempt hospitals. (Hat Tip: McDermott, Will & Emery.)
Wednesday, May 24, 2006
BBC reports that an article in the journal NeuroRehabilitation (abstract) claims three PVS patients woke up and talked to people around them 20 minutes after taking Zolpidem. The effects allegedly wore off after four hours. If this study holds up (i.e., if the three patients were correctly diagnosed with PVS, the researchers accurately reported what occurred, and the study can be reproduced by others), this could change everything. [tm]
Monday, May 22, 2006
For those of you working on your summer writing, please consider the St. Thomas Law Review and its upcoming symposium issue on Employer-Sponsored Health Care. Here is the information from Professor Pendo:
St. Thomas Law Review Symposium Issue: Employer-Sponsored Health Care
I have been asked by the St. Thomas Law Review to invite contributors to their symposium issue on challenges, choices and alternatives facing employer-sponsored health care plans. This could include (but is not limited to) topics such as state law initiatives regarding heath care coverage and delivery, developments in ERISA litigation, labor and employment law issues, retiree health plans, the impact of Medicare Part D, HSAs and high deductible health plans, COBRA and HIPAA issues, or issues raised by disability plans or other welfare benefit plans.
They are flexible on length, and would like a complete draft of the articles by the end of August. Please contact me if you are interested or have questions, and I can put you in touch with the Law Review.
Contact: Elizabeth A. Pendo
Professor of Law
St. Thomas University School of Law
16401 NW 37th Ave.
Miami Gardens, FL 33054
Wednesday, May 17, 2006
What's cooking on other blogs of note:
New lethal injection challenge
A Tennessee death row inmate, Sedley Alley, on Tuesday asked the Supreme Court to block his scheduled execution for 1 a.m. Wednesday, as he raised a challenge to the chemical protocol used in Tennessee for executions. The case of Alley v. Little (05-10959) [link] thus becomes the second of two cases from Tennessee on that issue. The other case, Abdur'Rahman v. Bredesen (05-1036) [link] is scheduled for consideration by the Court at its private Conference on Thursday, according to the Court's electronic docket. The two cases illustrate anew the increasingly complex puzzle the Court faces amid the increasing number of challenges to lethal injection execution methods, and a rising number of cases over the procedural issue of how inmates may pursue such challenges.
These cases are undoubtedly of greater interest to the criminal defense bar than the health care bar, but I can't help but believe that their resolution will involve much medical testimony based upon medical scholarship, and if the Court eventually holds that lethal injections as currently practiced violate the 8th Amendment, doctors will become much more involved in the design and possibly the implementation of whatever system is adopted by the states, no matter what the AMA says.
- From the AJOB blog, news of a conference on vaccine distribution and pediatric ethics:
The brand new Treuman Katz Center for Pediatric Bioethics, soon to be directed by Benjamin Wilfond, who is certain to rise to that occasion and create an entirely new kind of research and service institution, is holding a great conference on vaccines and kids, with a broad focus on all of the questions related to the ethics of the use and distribution and scarcity and side effects of vaccines. This is the program and the cost isn't awful, though good luck with cheap airfare to Seattle in July.
- Another post from the AJOB blog originally misreported the gist of an editorial from the NY Post, which we can read for ourselves: NY is decades behind the rest of the country in providing legal authorization for family members to make end-of-life decisions for incompetent patients (as has been noted here before), and now the liberals (pro-choice and gay rights groups) are lining up to torpedo the bill:
ALBANY - In a classic case of Albany gridlock, lawmakers fixated on abortion and gay rights are blocking a bill that would rescue thousands of elderly and disabled New Yorkers from legal limbo. Legislation first proposed 13 years ago would give family members and close friends the right to make medical decisions for patients who are too sick to speak for themselves. Today, in many cases, family members have no such control, leaving the fate of their loved ones in the hands of strangers with medical degrees. Fixing this glitch should be a no-brainer. Forty-eight other states managed to do it with little fuss.
But Albany is where no-brainers go to die, because lawmakers here are all too willing to put their narrow agendas ahead of the greater good. In this case, a measure that's vitally important to patients and families across the state is being held hostage by pro-choice and gay rights purists in the Assembly.
The bill says nothing about abortion or gay relationships. But it includes a line saying family members of an incapacitated pregnant woman should, in thinking about her best interests, "consider the impact of treatment decisions on the fetus." And - unpardonable sin No. 2 - it fails to specify that same-sex partners should have the same rights as husbands and wives.
Sunday, May 14, 2006
A bunch of new articles (including one by our own Betsy Malloy), courtesy of the Marian Gould Gallagher Library at the University of Washington law school, which provided the links to Lexis [L] and WestLaw [W]:
Doherty, Joan M. Comment. Form over substance: the inadequacy of informed consent and ethical review for Thai injection drug users enrolled in HIV vaccine trials. 15 Pac. Rim L. & Pol'y J. 101-135 (2006). [L][W]
Fisher, Lauren E. Comment. The use of tandem mass spectrometry in newborn screening: Australia's experience and its implications for United States policy. 15 Pac. Rim L. & Pol'y J. 137-167 (2006). [L][W]
Symposium: Can the Seamless Garment Be Sewn? The Future of Pro-Life Progressivism. Foreword by Thomas C. Berg; keynote address by Rev. Jim Wallis; articles by John L. Carr, Sidney Callahan, Susan Frelich Appleton, Kevin E. Schmieing, Helen M. Alvare, John P. O'Callaghan, Kevin Doyle, Mark A. Sargent and Ted G. Jelen; closing address by James L. Oberstar. 2 U. St. Thomas L.J. 235-424 (2005). [L][W]
Therapeutic Approaches to Conflict Resolution in Health Care Settings. Foreword by Charity Scott; articles by Coby J. Anderson, Linda L. D'Antonio, Ansley Boyd Barton, Debra Gerardi, R.N., Dale C. Hetzler, Marc R. Lebed, M.D., John J. McCauley, Virginia L. Morrison, Linda Morton, Ellwood F. Oakley, III, Jennifer K. Robbennolt and Edwart A. Dauer. 21 Ga. St. U. L. Rev. 797-1054 (2005). [L][W]
Krier, Cameron. Comment. One step forward, two steps back: the impact of Aetna Health Inc. v. Davila on ERISA and patients' rights. (Aetna Health Inc. v. Davila, 124 S. Ct. 2488, 2004.) 38 Tex. Tech L. Rev. 127-158 (2005). [L][W]
2004 John Marshall International Moot Court Competition in Information Technology and Privacy Law. Bench Memorandum by Patricia Gerdes, Tim Scahill, Otto Shragal, Richard C. Balough, Leslie Ann Reis, Brief for Petitioner by Ryan Dry, Angela Hamilton, Jason Newman; and Brief for the Respondent by Ashley S. Kamphaus, Michelle M. Prince and Jon Paul Carroll. 23 J. Marshall J. Computer & Info. L. 563-658 (2005). [L][W]
I'll try to keep closer watch on these articles, and list them more frequently, in the future. [tm]
Saturday, May 13, 2006
The Times published an interesting piece this week about an article that recently appeared in the Annals of Surgery and the Journal of The American College of Surgeons. Here's the gist of it:
The researchers surveyed more than 2,100 surgeons, anesthesiologists and nurses about operating room communications. Their views — and the divergence among them — may shed light on how some surgical mistakes happen.
When the participants were asked to "describe the quality of communication and collaboration you have experienced" with other members of operating teams, surgeons were given the lowest rating for teamwork. Their worst assessment was from nurses, the group that got the highest rating. . . .
Many operating room mistakes, like sponges left in patients or the wrong body part being operated on, could be avoided through better communication, the researchers said. But this can mean getting over barriers of class, race, gender and even general outlook.
Afterward, the researchers spoke with participants and found that "nurses often describe good collaboration as having their input respected, and physicians often describe good collaboration as having nurses who anticipate their needs and follow instructions."
Friday, May 12, 2006
The avian flu virus hasn't yet managed to mutate into a form that can be efficiently transmitted from person to person, and we don't yet have a vaccine (since we don't know the precise form of virus we will be dealing with), but the experts all say that preparedness is the key to survival, and that includes getting straight on the ethical dimensions of preparedness. So along come Ezekial Emanuel and his co-author, Alan Wertheimer -- both of the Department of Clinical Bioethics, The Clinical Center (NIH) -- with a provocative suggestion for allocating inevitably scarce vaccine:
Science 12 May 2006: Vol. 312. no. 5775, pp. 854 - 855
Policy Forum, PUBLIC HEALTH: Who Should Get Influenza Vaccine When Not All Can?
The potential threat of pandemic influenza is staggering: 1.9 million deaths, 90 million people sick, and nearly 10 million people hospitalized, with almost 1.5 million requiring intensive-care units (ICUs) in the United States. The National Vaccine Advisory Committee (NVAC) and the Advisory Committee on Immunization Policy (ACIP) have jointly recommended a prioritization scheme that places vaccine workers, health-care providers, and the ill elderly at the top, and healthy people aged 2 to 64 at the very bottom, even under embalmers. The primary goal informing the recommendation was to "decrease health impacts including severe morbidity and death"; a secondary goal was minimizing societal and economic impacts. As the NVAC and ACIP acknowledge, such important policy decisions require broad national discussion. In this spirit, we believe an alternative ethical framework should be considered.
The alternative ethical framework: After front-line healthcare workers and vaccine production and distribution workers, preference goes generally to younger people over older, with a slight additional preference for key government leaders; public health, military, police, and fire workers; utility and transportation workers; telecommunications and IT workers; and funeral directors. Their rationale is complex and subtle and well worth reading. For those without access to Science, the Chicago Sun-Times has a pretty good article on this, as does Ceci Connelly at the Washington Post. [tm]
Thursday, May 11, 2006
As reported by AP/Yahoo, the New England Journal of Medicine today published an article by researchers at the Harvard Public Health School that concludes that 40% of med mal cases are meritless: either there was no injury or there was no evidence of negligence. Here's the abstract:
Background In the current debate over tort reform, critics of the medical malpractice system charge that frivolous litigation — claims that lack evidence of injury, substandard care, or both — is common and costly.
Methods Trained physicians reviewed a random sample of 1452 closed malpractice claims from five liability insurers to determine whether a medical injury had occurred and, if so, whether it was due to medical error. We analyzed the prevalence, characteristics, litigation outcomes, and costs of claims that lacked evidence of error.
Results For 3 percent of the claims, there were no verifiable medical injuries, and 37 percent did not involve errors. Most of the claims that were not associated with errors (370 of 515 [72 percent]) or injuries (31 of 37 [84 percent]) did not result in compensation; most that involved injuries due to error did (653 of 889 [73 percent]). Payment of claims not involving errors occurred less frequently than did the converse form of inaccuracy — nonpayment of claims associated with errors. When claims not involving errors were compensated, payments were significantly lower on average than were payments for claims involving errors ($313,205 vs. $521,560, P=0.004). Overall, claims not involving errors accounted for 13 to 16 percent of the system's total monetary costs. For every dollar spent on compensation, 54 cents went to administrative expenses (including those involving lawyers, experts, and courts). Claims involving errors accounted for 78 percent of total administrative costs.
Conclusions Claims that lack evidence of error are not uncommon, but most are denied compensation. The vast majority of expenditures go toward litigation over errors and payment of them. The overhead costs of malpractice litigation are exorbitant.
How do these data fit into the larger debate about whether there is a malpractice crisis, or whether federal tort reform is needed to stem the tide of frivolous lawsuits that are bleeding the system dry? The answer depends on which side of the fence you're on. Here (from the AP story) are some reactions:
- "[T]he American Medical Association, which favors caps on malpractice awards, called the study proof that a substantial number of meritless claims continue to slip through the cracks, 'clogging the courts' and forcing doctors to waste time defending them, association board member Dr. Cecil Wilson said in a statement."
- "Chris Mather, a spokeswoman for the Association of Trial Lawyers for America, said the study was biased because data was taken from insurers, which sometimes are the defendants in malpractice suits."
- "George Annas, a Boston University bioethicist who had no role in the study, said he was not surprised by the findings. Many personal injury attorneys receive a contingency fee — meaning they get paid only if they win — and will not go to court with a baseless lawsuit, Annas said. 'There's really no motivation to bring a frivolous lawsuit,' he said. 'It's not worth their time and effort.'"
Forty percent sounds like a ridiculously high percentage of meritless cases, now matter what Prof. Annas says. And although the system seems to be doing a pretty good job of weeding these bad cases out without payment, the cost of defending the suits to the point of dismissal or defendant's judgment needs to be reckoned (which the article does), as well as the emotional cost to the individual defendants. Worth reading . . . [tm]
Tuesday, May 9, 2006
The Archives of Internal Medicine has an interesting study of off-label prescribing practices (abstract) this week, and Monday's "All Things Considered" on NPR had a good story on the study. [tm]
Monday, May 8, 2006
According to news reports (AP/MyWay), the CDC is poised to recommend that HIV testing be automatically included in standard blood workups for all patient between the ages of 13 and 64 years. The Center's recommendations include eliminating pre-test counseling and offering post-test counseling only in the event the patient tests positive. [tm]
Sunday, May 7, 2006
The Medicare Hospital Insurance Trust Fund will become insolvent in 2018, based on current cost and population trends, two years earlier than predicted last year, according to the Social Security and Medicare trustees annual report. Inside the Beltway, the response to this news seems to split along (gasp!) party lines, with Republicans calling for cuts in benefits and Democratic party leaders speculating whether the report is a GOP scare tactic designed to drum up support for the President's going-nowhere-fast program to reform Social Security. Joseph Antos at the American Enterprise Institute has a very helpful analysis of the concept of "insolvency" as it applies to the two Medicare trust funds, in the course of which he basically says we should ignore the trustee's estimate of the year the Medicare HI Trust Fund won't be able to meet its obligations.
Friday, May 5, 2006
The Washington Post reports that:
Based on nationwide data collected by the National Center for Health Statistics and other sources, the researchers found that from 1994 through 2001, the rate of unplanned pregnancies increased by almost 30 percent for women below the federal poverty line -- now defined as $16,000 annually for a family of three. For women in families comfortably above poverty, the rate of unplanned pregnancies fell by 20 percent during the same period.
The abortion rate also rose among poor women while declining among the more affluent.
"Clearly, something is changing, and it doesn't bode well in terms of unplanned pregnancies and abortions for poor women, in particular," said Heather Boonstra, one of the authors of the report.
Asked what was driving the trends, the authors noted that some state and federal reproductive health programs have been cut or made more restrictive in recent years. State and federal programs have increasingly focused on abstinence rather than contraception, and some analysts have argued that the shift is leading to less use of contraceptives and more unintended pregnancies.
Perhaps now would be the time to realize that the abstinence only programs do not seem to be working too well. [bm]
Kate Steadman from Healthy Policy will be leaving blogging (hopefully for only a little bit) but with her departure provides us with a helpful primer on the uninsured as well as a follow-up Insured Primer. Here are some of the interesting and rather discouraging facts that she reports in her Insured Primer:
• The average annual cost for insurance in 2004 was $3,695 for individuals and $9,950 for families.
• Employer-sponsored premiums are growing at an immense rate: 8.2% in 2000, 10.9% in 2001, 12.9% in 2002, 13.9% in 2003.
• The number of employers providing health insurance has dropped 9% in five years; from 69% in 2000 to 60% in 2005.
• The dollar amount of co-pays is increasing as well; for HMO participants the number paying at least $20 for office visits has increased from 1% in 1998 to 22% in 2004.
• The major problem with affordable health insurance right now is the total health spending increase, which is making premiums cost more and more every year. And as health expenditures are estimated to be $2.16 trillion in 2006, and are projected to rise to over $4 trillion in 2015, it's showing no signs of slowing. Per person health spending is $7,110 this year and is projected to increase to $12,320 by 2015. And unless you predict your wages will double during that time, be prepared to shell out more and more.
• Although many policy analysts encourage greater cost sharing in the form of higher deductibles and copays, the average insured person already pays 34% of their health costs out of pocket. Don't count on greater cost sharing to reign in the expected increase to solve our spending crisis. Americans can only afford so much more out of pocket without forgoing care altogether, which creates crises in worker productivity and absenteeism.
From in the Uninsured Primer:
• 41% of the uninsured adults reported skipping medical care because of cost last year. This number doesn't include the 20% of children who lack health insurance.
• 23% of uninsured adults report their health as "fair" or "poor," compared with 12% of insured adults.
That percentage will tick higher and higher while we distract ourselves from solving this problem with brave new explorations into the world of Health Savings Accounts. As health costs continue to outpace inflation markedly and wages remain stagnant, fewer and fewer of the uninsured will be able to afford any medical care. State and hospital funds that currently act as reimbursement for the cost of acute treatment will cover less and less.
Thursday, May 4, 2006
The New York Times reports on our government's latest avian flu program. It states,
The 227-page plan estimates that a third of the population could become infected, two million people could die, 40 percent of employees might be absent from work during the height of the outbreak, and $600 billion in income could be lost nationwide.
If rioting broke out and overwhelmed the National Guard, the plan says, the president could call out the Army to establish order.
Dr. Josh Sharfstein, commissioner of the Baltimore Health Department, said the plan was welcome but offered "new expectations without new resources."
The plan asks local governments to deal with a flood of hospital patients, care for more patients at home and spend millions of dollars on antiviral drugs, Dr. Sharfstein said.
Congress has appropriated $3.8 billion to pay for preparations like drug and vaccine purchases. The Bush administration has spent $1.8 billion of that appropriation, although Ms. Townsend said that all the money would be spent by October.
Senator Tom Harkin, Democrat of Iowa, who advocated preparations for a pandemic, said the administration had been slow in implementing plans and spending money already appropriated.
A bill to provide another $2.3 billion for flu preparations is moving through Congress, and Ms. Townsend said the administration expected to ask for an additional $1 billion in 2008. . . .
Divided into nine chapters, the plan provides a list of actions federal departments must complete as a pandemic spread. . . .
Mary Selecky, secretary of health for Washington, said the administration plan would help her state align its efforts with those of the federal government. . . . .Like her counterparts in other states, she complained that the administration was not helping states to finance flu preparations. "They gave us a list of work that they expect us to do," Ms. Selecky said, "but they've only given us a little bit of one-time money. We need a sustained effort."
Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University, echoed the state officials' complaints, saying: "There's a disconnect between the rhetoric about what's needed and the resources on the table. This is the mother of all unfunded mandates."
The American Cancer Society website has a call to action against proposed Senate Bill 1955 (Health Insurance Marketplace Modernization and Affordability Act of 2005) which would, among other things, extend ERISA's broad preemption to the small group insurance market, currently regulated at the state level. Many of these state insurance laws provide a significant source of patient protection by providing access to such items as mammograms and other essential diagnostic tools.
For more information about this bill, see the text here and some commentary on its impact on diabetes coverage here and here. Many health care providers and state attorneys generals oppose this legislation.
This doesn't look like a very good idea to me. Having these tests covered by insurance would seem to lead to a healthier citizenry, which would save money in the long run. I am not sure how much they cost, but it doesn't seem that coverage for these tests would force the insurance companies into bankrupty. Thanks to firedoglake for the heads up on this legislation. [bm]