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  1. 1. July 26, 2010 Senate panel advances healthcare overhaul President Obama's ambitious drive to overhaul the nation's $2.3 trillion healthcare system cleared a key Senate committee yesterday. But the administration was promptly buffeted by criticism from some of the industry players and moderate Democrats it has courted for months, calling into question the prospects for a bipartisan landmark bill. The Senate's health committee approved a bill that would vastly expand healthcare in America, the first time in 15 years a congressional panel has endorsed coverage for all. But the 13 to 10 party-line vote, after comments by the top Republican on the committee, underscored the mounting tensions in Congress and the country over the president's signature item. In the House, a mini-rebellion was erupting over cost controls in its $1.2 trillion bill, while several influential industry groups broke their polite silence and issued pointed attacks on core elements of the legislation. The president countered with a round of network television interviews and a new advertising campaign with the message: "It's Time." Four Democrats on the Senate Finance Committee, in especially sharp language, called for new fees on the insurance industry aimed at raising $100 billion over the next decade. Standing before a chart showing profits of the largest insurance companies soaring, the lawmakers challenged insurers to join hospitals and drugmakers in making financial concessions in return for legislation that could deliver up to 50 million new customers. The lobbying group America's Health Insurance Plans warned, however, that "a new tax on healthcare coverage is the wrong approach and will make coverage less affordable for families and small businesses." A spokesman for WellPoint, the nation's largest publicly-traded health benefits firm, voiced similar objections. In the House, members prepared to begin work today on their version of a comprehensive healthcare overhaul. Like the bill approved in the Senate Health, Education, Labor and Pensions Committee, it would for the first time require both businesses and individuals to contribute to the cost of health insurance. Credits would be provided to some small businesses and families earning less than $88,000 a year. (Washington Post) Secretary Sebelius releases inaugural healthcare "Success Story" report HHS Secretary Kathleen Sebelius released the first in a series of healthcare "success story" reports that document innovative programs and initiatives that can serve as models for a reformed American healthcare system. The inaugural report highlights the Michigan Keystone ICU Project. A joint partnership between the Michigan Health & Hospital Association and the Johns Hopkins University, the Michigan Keystone ICU Project helped dramatically reduce the number of healthcare associated infections in Michigan, saving over 1,500 lives and $200 million. Medical errors, including healthcare associated infections, claim the lives of nearly 100,000 patients in America every year and patient safety measures have worsened by nearly 1 percent each year for the past decade. The Michigan Keystone ICU Project worked to make patient care safer in over 100 ICUs in the state of Michigan. The project targeted a specific type of infection that ICU patients can get while in the hospital: catheter-related bloodstream infections. To help reduce these infections, the project worked to ensure clinicians used a simple checklist when inserting catheters into ICU patients. Following the checklist was associated with a 66 percent reduction in these infections throughout the state of Michigan, saving over 1,500 lives and $200 million in the first 18 months alone. This project was funded by a grant from the Agency for Healthcare Research and Quality, and for every dollar invested, approximately $200 was saved. The Obama Administration has already begun work to reduce healthcare associated infections. The American Recovery and Reinvestment Act (ARRA) included $50 million in grants available for states to help fight healthcare associated infections across the country. Secretary Sebelius has also called on hospitals across America to commit to reduce Central Line Associated Blood Stream Infections in Intensive Care Units by 75 percent over the next three years by using the same checklist that has shown such success in Michigan. For more information see
  2. 2. Alzheimer's risk: Would you want to know? When people learn they are predisposed to Alzheimer's disease, any depression or anxiety is not long lasting, a new study indicates. These findings help address a longstanding debate about whether learning such information might cause lasting psychological harm, at least among those with a family history of Alzheimer's disease, says Scott Roberts, a University of Michigan researcher at the School of Public Health and co-author of the study findings, which appear today in the New England Journal of Medicine. Roberts and colleagues at Boston University, Case Western Reserve University, and Cornell Medical College tested 162 people with a parent with Alzheimer's, which means their risk for developing the disease by age 85 is about 30-35 percent, compared with the general population risk of about 10-15 percent. People with a family history are already at higher risk, which is further increased if they also carry a certain version of the gene called Apolipoprotein E (APOE). After an educational session about Alzheimer's and genetic testing, researchers tested people for their APOE genotype to learn if they carried the genetic variant. The presence of the gene increases the risk for those with a family history of Alzheimer's to more than 50 percent. For subjects who did agree to the test, specially trained genetic counselors then disclosed results and researchers followed participants over one year to determine the impact of risk information. The researchers measured anxiety, depression and test-related distress after six weeks, six months, and one year. Test-related distress did increase slightly at six weeks for people with the risk-increasing form of the gene, but not at 6 months or one year, Roberts said. Anxiety and depression levels remained stable. The APOE link to Alzheimer's was identified in the 1990s, and traditionally, the medical community doesn't favor disclosure of the APOE genotype---or other genetic markers---unless telling patients directly impacts clinical treatment, Roberts says. However, now that private companies offer genetic testing for a variety of conditions, the debate over clinical utility versus personal utility is growing. For more information see A new understanding of glaucoma For years, glaucoma was defined as elevated pressure within the eye that leads to vision loss. And for years experts knew there were glaring gaps in that definition. Many people with abnormally high intraocular pressure never develop glaucoma. As many as one in three people who do get the disease have normal or even low pressure. As researchers have tried to resolve those contradictions, a new paradigm for understanding glaucoma has emerged. Glaucoma isn’t simply an eye disease, experts now say, but rather a degenerative nerve disorder, not unlike Alzheimer’s or Parkinson’s disease. “All three of these diseases affect aging populations and involve selective loss of certain populations of neurons,” said Dr. Neeru Gupta, a professor of ophthalmology and director of the glaucoma unit at the University of Toronto. “Parkinson’s affects motor control. Alzheimer’s affects cognition. Glaucoma disrupts vision. But the closer we look, the more they seem to have in common.” Even the official definition of glaucoma, a disease that accounts for more than eight million cases of blindness worldwide, has changed. Today, diagnosis is based on just two features: visible damage to the optic nerve, which leads from the retina at the back of the eye to the brain, and loss of peripheral vision, which can be measured by a simple test in an eye doctor’s office. Researchers still recognize high pressure within the eye as a leading risk factor for glaucoma. And ophthalmologists still use the screening test that shoots a puff of air at the front of the eye to measure pressure and screen for the disease. But since about 30 percent of people with the disease have normal or low pressure, there’s obviously something else at work. What’s clear is that glaucoma begins with injury to the optic nerve as it exits the back of the eye. The damage then spreads, moving from one nerve cell to adjoining nerve cells. “In glaucoma, we’ve shown that when your retinal ganglion cells are sick, the long axons that project from the eye into the brain are also affected, resulting in changes that we can detect in the vision center of the brain,” Dr. Gupta said. The phenomenon, called transynaptic damage, occurs in Alzheimer’s and Parkinson’s disease as well. Experts are still deciphering what causes initial injury to the optic nerve. Although elevated intraocular pressure clearly increases the danger, some researchers suspect that steep fluctuations in pressure may be even more damaging. Another culprit may be perfusion pressure, or the difference between pressure within the eye and overall blood pressure. Low perfusion pressure occurs when pressure within the eye is high and systemic blood pressure is low. “When perfusion pressure drops, there’s not enough
  3. 3. blood flow getting to the optic nerve and the retina,” Dr. Varma said. Lack of adequate blood flow may damage not only the optic nerve but also supporting tissues around it. That possibility has led to a search for drugs to protect susceptible nerves from injury. Several promising candidates are under investigation, including a drug called memantine (Namenda), which is now approved to treat Alzheimer’s, and riluzole (Rilutek), used to treat Lou Gehrig’s disease. There is growing optimism that what works for one neurodegenerative disease, as these examples suggest, may be helpful for others. For researchers trying to understand the details of what goes wrong in such disorders, glaucoma may offer an easier model to study than a brain disease like Alzheimer’s. The optic nerve is the only nerve that can be examined visually, by peering through the pupil. And the visual system is a relatively compact structure that researchers already understand in great detail. (NY Times) Bariatric ambulances and services are more popular, but some patients pay the bill When paramedics come to the rescue, they typically look for vital signs first -- breathing, a pulse. But in more communities each year, paramedics might also be sizing up the patient to see if a bariatric ambulance specially designed to carry severly obese people needs to be called. Topeka, Kansas, is one of at least 30 communities across the United States that has commissioned ambulances with a specialized cot, ramp and winch to lift patients who weigh more than 350 pounds, according to ABC News affiliate KTKA in Topeka. Patients who need the special ambulances in Topeka will be charged more money for the service -- $1,172 rather than $629, plus $16 per mile rather than $11. After a decade of spiraling weight problems in America, hospitals across the country are responding with bariatric specialized care -- from floor- mounted toilets to specialized prenatal clinics for obese women. "We really think this helps provide dignity to a patient," said Douglas Moore, public relations manager for American Medical Response (AMR), a private ambulance service that operates in 43 states and is the developer of the "bariatric" ambulance used in Topeka's Shawnee County. The company's first bariatric ambulance debuted in 2002, and they have spread across the country ever since. Obesity activists reacted with disdain to the practice of charging more for use of the new bariatric equipment, especially in a service funded by taxpayers. AMR markets the higher charge as a solution to cities, counties and towns that respond frequently to such patients at an extra cost to ... someone. "We don't advertise this as a bariatric ambulance. ... You wouldn't know that it was a different ambulance on the outside," said Moore. "We do advertise it to the hospital." Many ambulance services and hospitals do not charge the patient directly for the specialized services. But it will cost something to continually serve such patients or keep up with the obesity rates. In 1999, 32 states had an obesity rate below 20 percent. Today, only one state has an obesity rate below 20 percent. "We look at it as an investment in service and quality versus an additional cost that we have to pass off on somebody," said Steve Lawler, president of Pitt County Memorial Hospital in Greenville, NC. Similar to a sub-specialty in geriatrics, Lawler said Pitt County Memorial Hospital has worked with the American Nurses Association to develop an accreditation for bariatric nursing. The hospital also has invested in lifts and special beds to accommodate bariatric patients in or outside of the bariatric surgery center. Perhaps spurred either by the idea of changing the focus of hospitals and healthcare, or by sheer logistics, hospitals in many areas are implementing similar renovations. When Baptist Hospital East in Louisville, KY, opened a 144-private-room tower, the administrators kept weight in mind. "Each nursing unit [floor] includes two bariatric rooms equipped with an overhead lift to assist the patient from the bed, or even all the way to the handicapped accessible bathroom," wrote Kit Fullenlove, public relations manager for Baptist Hospital East, in an e-mail to Such lifts are intended for 440 to 660-pound patients, and the renovations have extended to older areas of the hospital. The hospital is adding to the number of bariatric wheelchairs, blood pressure cuffs and gowns it already had. "None of these costs have been passed on to the patients," Fullenlove said. Alongside the movement to revamp equipment is a move into specialized treatment for bariatric patients in other specialties. Both the University of Michigan Hospital and St. Louis University Hospital developed special units for obstetric care for obese mothers. Activists have felt that while additional charges might be considered discriminatory, specialized bariatric care, in general, might be supportive. (ABC News)
  4. 4. Wastewater used to map illicit drug use A team of researchers has mapped patterns of illicit drug use across the state of Oregon using a method of sampling municipal wastewater before it is treated. Their findings provide a one-day snapshot of drug excretion that can be used to better understand patterns of drug use in multiple municipalities over time. Municipal water treatment facilities across Oregon volunteered for the study to help further the development of this methodology as a proactive tool for health officials. Applying analytical methods advanced at Oregon State University, researchers from the University of Washington, McGill University and OSU collected single-day samples from 96 municipalities across Oregon and tested the samples for evidence of methamphetamine, cocaine, and "ecstasy" or MDMA. The study is published this week in the journal Addiction. Using water samples from 96 municipalities, representing 65 percent of Oregon's population, the researchers calculated the presence, measured as index loads, of three stimulant drugs: methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA, or ecstasy), and benzoylecgonine (BZE, a cocaine metabolite). They found that the index loads of BZE were significantly higher in urban areas and below the level of detection in some rural areas. Methamphetamine was present in all municipalities, rural and urban. MDMA was at quantifiable levels in less than half of the communities, with a significant trend toward higher index loads in more urban areas. Researchers said the study validates wastewater drug testing methodology that could serve as a tool for public health officials. Officials could, for example, use the methodology to identify patterns of drug abuse and distribution across multiple municipalities over time. FDA issues draft guidance for industry on drug anticounterfeiting focus on physical chemical identifiers The U.S. Food and Drug Administration issued a draft guidance on the use of inks, pigments, flavors, and other physical-chemical identifiers (PCIDs) by manufacturers to make drug products more difficult to duplicate by counterfeiters, and to make it easier to identify the genuine version of the drug. The guidance is an important step in working with manufacturers to make drug products more difficult to duplicate by counterfeiters. The agency invites comments on the draft guidance, available online and titled “Draft Guidance for Industry: Incorporation of Physical-Chemical Identifiers into Solid Oral Dosage Form Drug Products for Anticounterfeiting.” See “Drug counterfeiting is a serious public health concern,” said Commissioner of Food and Drugs Margaret A. Hamburg, M.D. “We look forward to working with industry to help ensure that consumers are not exposed to products containing unknown, ineffective, or harmful ingredients.” The document is intended to provide guidance to industry regarding the use of PCIDs in solid oral dosage forms, which include pills and capsules, for anticounterfeiting purposes. A PCID is a substance or combination of substances possessing a unique physical or chemical property used to identify and authenticate a drug product or dosage. In addition to inks, pigments, and flavors, specific chemicals may be used as molecular tags in a PCID. In some cases, the PCID may be easily detected by wholesalers or pharmacists to determine if they have authentic products. In other cases, special analytical instruments may be necessary to identify whether the PCID is present. New data say uninsured account for nearly one-fifth of emergency room visits HHS Secretary Kathleen Sebelius released new data from the Nationwide Emergency Department Sample -- the largest, all-payer emergency department database in the United States. The Nationwide Emergency Department Sample is designed to help public health experts, policymakers, healthcare administrators, researchers, journalists and others find the data they need to answer questions about care that occurs in U.S. hospital emergency departments. These data indicate that uninsured persons accounted for nearly one-fifth of the 120 million hospital-based emergency department visits in 2006. “Our healthcare system has forced too many uninsured Americans to depend on the emergency room for the care they need,” said Secretary Sebelius. “We cannot wait for reform that gives all Americans the high-quality, affordable care they need and helps prevent illnesses from turning into emergencies.” The database is managed by HHS’ Agency for Healthcare Research and Quality (AHRQ) and generates national estimates on the number of emergency department visits in all community hospitals, by region, urban/rural location, teaching status, ownership and trauma designation. It also provides in-depth information on acute management of patients for all visits, including why patients were seen in the emergency department, the treatments they received, what happened to them at the end of the visit (admitted to the hospital, discharged home,
  5. 5. transferred to another hospital, died in the emergency room or left against medical advice), the charge for their care and who was billed. For more information see