Obama Executive Orders Review Health And Other Strategies
Obama plans to review orders by the previous executive involving a broad range of subjects including health research. “Theres a lot that the president can do using his executive authority without waiting for congressional action, and I think well see the president do that,” Podesta said. “I think that he feels like he has a real mandate for change. We need to get off the course that the Bush administration has set.”
Podesta also said Obama is working to build a diverse Cabinet. That includes reaching out to Republicans and independents - part of the broad coalition that supported Obama during the race against Republican John McCain. Defense Secretary Robert Gates has been mentioned as a possible holdover.
“Hes not even a Republican,” Senate Majority Leader Harry Reid of Nevada said. “Why wouldnt we want to keep him? Hes never been a registered Republican.”
Obama was elected on a promise of change, but the nature of the job makes it difficult for presidents to do much that has an immediate impact on the lives of average people. Congress plans to take up a second economic aid plan before years end - an effort Obama supports. But it could be months or longer before taxpayers see the effect.
Obama could use his executive powers to at least signal that Washington is changing.
“Obamas advantage of course is hell have the House and the Senate working with him, and that makes it easier,” said Carl Tobias, a law professor at the University of Richmond. “But even then, having an immediate impact is very difficult to do because the machinery of government doesnt move that quickly.”
Presidents long have used executive orders to impose policy and set priorities. One of Bushs first acts was to reinstate full abortion restrictions on U.S. overseas aid. The restrictions were first ordered by President Reagan and the first President Bush followed suit. President Clinton lifted them soon after he occupied the Oval Office and it wouldnt be surprising if Obama did the same.
Executive orders “have the power of law and they can cover just about anything,” Tobias said in a telephone interview.
Bush used his executive power to limit federal spending on embryonic stem cell research, a position championed by opponents of abortion rights who argue that destroying embryos is akin to killing a fetus. Obama has supported the research in an effort to find cures for diseases such as Alzheimers. Many moderate Republicans also support the research, giving it the stamp of bipartisanship.
On drilling, the federal Bureau of Land Management is opening about 360,000 acres of public land in Utah to oil and gas drilling. Bush administration officials argue that the drilling will not harm sensitive areas; environmentalists oppose it.
“They want to have oil and gas drilling in some of the most sensitive, fragile lands in Utah,” Podesta said. “I think thats a mistake.”
“Its going to be a cheerful opposition,” said Rep. Mike Pence, R-Ind. “Were going to carry those timeless principles of limited government, a strong defense, traditional values, to the American people.”
Pence, of Indiana, is expected to take over the No. 3 leadership post among House Republicans.
In other transition matters, Obamas new chief of staff, Rahm Emanuel, would not say whether Obama would return to the Senate for votes during the postelection session this month. Obamas presence would be extraordinary, given his position as president-elect, especially if Congress takes up a much-anticipated economic stimulus plan.
“I think that the basic approach has been hes going to be here in Chicago, setting up his economic, not only his economic team, but the policies he wants to outline for the country as soon as he gets sworn in, so we hit the ground running,” Emanuel said.
Also, Emanuel would not commit to a Democratic proposal to help the auto industry with some of the $700 billion approved by Congress to for the financial bailout.
Source: txbea
Stem Cell Opponents Continue The Fight Against New Treatments
“We may lose it, but were going to continually fight it and offer the ethical alternative,” said Rep. Joe Pitts, R-Pa. “I dont know what the votes will be in the new Congress … but its very possible we could lose this thing.”
Stem cells are the building blocks that turn into different kinds of tissue. Embryonic stem cells,e unlike more mature versions, are blank slates. If scientists could control them, they could direct regenerative therapy, perhaps allowing a diabetics pancreas to begin produce insulin, for example.
Harvesting stem cells from four- or five-day-old embryos kills the embryo, which outrages opponents of this type of research. But supporters say hundreds of thousands of embryos stored in fertility clinics eventually will be destroyed anyway and that people should be allowed to donate them for research that could help others.
“I believe that it is ethical to use these extra embryos for research that could save lives when they are freely donated for that express purpose,” Obama wrote during the campaign in response to 14 questions from scientists, doctors and engineers.
Under President George W. Bush, federal money for research on human embryonic stems cells was limited to those stem cell lines, or families of constantly dividing cells, that were created before Aug. 9, 2001. No federal dollars could be used on research with cell lines from embryos destroyed from that point forward. Federal regulations do not restrict embryonic stem cell research using state or private funds.
John Podesta, head of Obamas transition team, strongly hinted that the president-elect would deal with stem cell research soon after taking office Jan. 20. “As you know, he has said something specific about stem cell research, so I think you can expect that what he said in the campaign will be fulfilled once in office,” Podesta said.
Obama made it clear during the campaign he would overturn Bushs directive.
“As president, I will lift the current administrations ban on federal funding of research on embryonic stem cell lines created after August 9, 2001, through executive order, and I will ensure that all research on stem cells is conducted ethically and with rigorous oversight,” he said.
Opponents of such research say they will press their case on several fronts.
The main argument is that life begins at conception - that once fertilization occurred in the lab, so did a human being.
Secondly, they will argue that scientists are having success using other methods - adult stem cells that form specific tissues, or reprogramming skin cells to act like stem cells - so money should be directed where the biggest scientific breakthroughs have occurred. For example, this past week, doctors gave a woman a new windpipe with tissue grown from her own stem cells, eliminating the need for anti-rejection drugs.
Added Wendy Wright, president of Concerned Women for America: “Theres a lot thats happened over the seven years that includes some remarkable scientific discoveries, which really should have made the issue of federal funding of embryonic stem cell research moot.”
But Sean Tipton, director of public affairs at the American Society for Reproductive Medicine, took aim at those arguments.
“Its a little disingenuous for opponents who have effectively blocked federal funding of the work to then cite a lack of progress,” Tipton said. “You hold someone at the starting line then you criticize them for not getting very far.”
Dr. Chi Dang, professor of medicine at the Johns Hopkins University School of Medicine, agreed there have been tremendous advances with adult stem cells. But he said it is not yet clear that they have enough flexibility to be used in all the ways that an embryonic stem cell could be.
“From a scientific viewpoint, we would be cornering ourselves into generalizing things that may not be true,” Dang said.
Source: msjad
Napping, Good Sleep Thought To Boost Memory
Good sleep is a casualty of our 24/7 world. Surveys suggest few adults attain the recommended seven to eight hours a night.
Way too little clearly is dangerous: Sleep deprivation causes not just car crashes but all sorts of other accidents. Over time, a chronic lack of sleep can erode the body in ways that leave us more vulnerable to heart disease, diabetes and other illnesses.
But perhaps more common than insomnia is fragmented sleep - the easy awakening that comes with aging, or, worse, the sleep apnea that afflicts millions, who quit breathing for 30 seconds or so over and over throughout the night.
Indeed, scientists increasingly are focusing less on sleep duration and more on the quality of sleep, whats called sleep intensity, in studying how sleep helps the brain process memories so they stick. Particularly important is “slow-wave sleep,” a period of very deep sleep that comes earlier than better-known REM sleep, or dreaming time.
Fishbein suspected a more active role for the slow-wave sleep that can emerge even in a power nap. Maybe our brains keep working during that time to solve problems and come up with new ideas. So he and graduate student Hiuyan Lau devised a simple test: documenting relational memory, where the brain puts together separately learned facts in new ways.
First, they taught 20 English-speaking college students lists of Chinese words spelled with two characters - such as sister, mother, maid. Then half the students took a nap, being monitored to be sure they didnt move from slow-wave sleep into the REM stage.
Upon awakening, they took a multiple-choice test of Chinese words theyd never seen before. The nappers did much better at automatically learning that the first of the two-pair characters in the words theyd memorized earlier always meant the same thing - female, for example. So they also were more likely than non-nappers to choose that a new word containing that character meant “princess” and not “ape.”
“The nap group has essentially teased out whats going on,” Fishbein concludes.
These students took a 90-minute nap, quite a luxury for most adults. But even a 12-minute nap can boost some forms of memory, adds Dr. Robert Stickgold of Harvard Medical School.
Conversely, Wisconsin researchers briefly interrupted nighttime slow-wave sleep by playing a beep - just loudly enough to disturb sleep but not awaken - and found those people couldnt remember a task theyd learned the day before as well as people whose slow-wave sleep wasnt disrupted.
That brings us back to fragmented sleep, whether from aging or apnea. It can suppress the birth of new brain cells in the hippocampus, where memory-making begins - enough to hinder learning weeks after sleep returns to normal, warns Dr. Dennis McGinty of the University of California, Los Angeles.
The catch-up sleep didnt help: Rested rats used room cues to quickly learn the escape hole in a maze. Those with fragmented sleep two weeks earlier couldnt, only randomly stumbling upon the escape.
None of the new work is enough, yet, to pinpoint the minimum sleep needed for optimal memory. Whats needed may vary considerably from person to person.
“A short sleeper may have a very efficient deep sleep even if they sleep only four hours,” notes Dr. Chiara Cirellia of the University of Wisconsin, Madison.
But altogether, the findings do suggest some practical advice: Get apnea treated. Avoid what Harvards Stickgold calls “sleep bulimia,” super-late nights followed by sleep-in weekends. And dont feel guilty for napping.
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Source: ctnhr
Tobacco Product “Snus” Targets Youth, Easy To Hide And Use At School
Snus - Swedish for tobacco, rhymes with “noose” - is a tiny, tea bag-like pouch of steam-pasteurized, smokeless tobacco to tuck between the cheek and gum. Aromatic to the user and undetectable to anyone else, it promises a hit of nicotine without the messy spitting associated with chewing tobacco. Just swallow the juice.
“I think Id rather throw up in my mouth,” says Flint, an 18-year-old West Virginia University student, emerging from a convenience store with a pack of Winstons and a coupon for free Camel Snus. “Id rather not swallow anything like that.”
Reynolds America Inc., the nations No. 2 tobacco company, can also expect resistance from the public health community. Experts wonder whether snus will help wean people off cigarettes and snuff, or just foster a second addiction. While snus has been around, it hasnt been prominent in this country.
“I think were all holding our breath in terms of whats going to be coming down the pike,” says Dorothy Hatsukami, director of the Tobacco Use Research Center at the University of Minnesota. “Theres not much known about these products - whats in these products, how theyre going to be used, whos going to be using them and what the effects of that use will be. … Will it create more harm or less harm?”
Reynolds is confident its new product will find a following. It launched Camel Snus in Austin, Texas, and Portland, Ore., in 2006, and has since expanded to test markets nationwide, with customers in nearly every state. Early next year, its taking snus national with a marketing blitz that spokesman David Howard says will include direct mail, print and Web advertising, and point-of-sale promotions.
Popular for decades in Sweden, where it was invented, snus has been banned in every other European Union nation since 2004 over concerns about carcinogens.
But smokeless tobacco is legal in the U.S., where there are two schools of thought: Some researchers suggest the lower risk of lung cancer makes snus an attractive alternative to smoking, while others fear an increase in problems including mouth lesions or pancreatic cancer.
The American Cancer Society supports any tool that helps smokers quit. “But we dont have any good scientific evidence that snus is one of those tools,” said Tom Glynn, director of cancer science and trends.
“If all smokers switched to snus tomorrow, in a few years wed certainly see less heart disease, less lung disease and fewer cancers,” he said. “But theres no evidence that smokers can switch and stay switched.”
Prevention officials already have their work cut out for them in West Virginia, which has the third-highest adult smoking rate in the U.S. at nearly 27 percent and the highest rate of “spit” or chewing tobacco use at 16 percent.
“The industry is brilliant, and whatever they want to outspend us by - $1 million, $10 million, $100 million - they can do it,” said Bruce Adkins of the state Division of Tobacco Prevention.
U.S. tobacco companies developed snus in response to both declining cigarette sales and consumer demand. With more public bans on puffing, they say smokers need socially acceptable alternatives.
Danny Wolfe, a 38-year-old computer draftsman, gave up regular spit tobacco and has been using Copenhagen tobacco pouches for several years. He spits out the juice; it gives him heartburn.
“Its the same product, just packaged differently. It doesnt get in your teeth. It doesnt have the mess,” says Wolfe, who was sick of smoking outside his Morgantown office. “Youre not quitting anything. Youre replacing.”
Snus is also popular with hunters, who try to avoid scent detection by their prey, and with coal miners, who work in underground mines where the smallest spark can trigger an explosion.
“I find that more rednecks use it,” Wolfe says. “I wont lie to you about that.”
Source: ctnhr
Anti-Smoking Laws Drop Cancer Rates By Half In Some US States
Also, the cancer death rate among men and women continued to drop, by an average of 1.8 percent a year through 2005, said the report published in the Journal of the National Cancer Institute.
The improvements are due to gains against some leading cancers - prostate, colorectal, breast and, for men, lung cancer. But numerous other types still are on the rise, including melanoma and kidney cancer.
Also, Tuesdays report highlights a disappointing missed opportunity: Huge state-by-state variations in anti-smoking policies that translate into big differences in lung cancer. Men in Kentucky die from lung cancer at twice the rate of men in California, for example. California, through higher cigarette taxes and other steps, has logged a 2.8 percent a year decline in that death rate, compared with less than a percent a year for Kentucky.
Nor is it clear that the drop in new cases represents a true decrease in cancer, or if some may be due to people skipping screenings that would have caught brewing disease, cautioned American Cancer Society epidemiologist Ahmedin Jemal, who led the report along with government scientists.
But NCI Director Dr. John Niederhuber said the decline seems steady enough to be real, a feat considering that cancer risk jumps with age and the U.S. is rapidly graying.
“This really is quite significant,” Niederhuber said. “Some of the things were doing, were doing right.”
Still, experts questioned if the good trends can survive the bad economy. Consider: The report credits a drop in colorectal cancer to a big increase in colonoscopies between 2000 and 2005. That screening can detect precancerous growths in time to remove them and avoid cancer - if people have insurance that pays.
Already the NCI has had a below-inflation budget for several years, cutting investment in research to prevent and treat cancer.
“Ive had to find about $175 million to take out of our budget, just take it out,” said Niederhuber. “Its hard to keep momentum. … Were chipping away at the bone.”
More recent rises in unemployment and poverty add to the concern, warned Dr. Louis Weiner, director of Georgetown Universitys Lombardi Comprehensive Cancer Center.
“Weve had some hard-won gains,” Weiner said. “To slow down progress when were so close to a fundamental understanding of cancer biology that we need to really made advances is really tragic.”
-New cases of lung cancer dropped about 1.8 percent a year among men but kept rising among women, about half a percent a year. Thats because smoking rates fell for men before they did for women, so men reaped the benefits sooner. It remains the top cancer killer, but the death rate dropped 1.9 percent a year for men and 0.9 percent among women.
-The rate of new breast cancer dropped about 2.2 percent a year, due largely to millions of women abandoning hormone replacement therapy starting around 2002. The death rate dropped 1.8 percent a year.
-For colorectal cancer, the incidence rate dropped 2.8 percent a year among men and 2.2 percent among women, largely due to screening. Early detection and improved care also fueled a 4.3 percent a year drop in the death rate for both sexes.
-Prostate cancer turned a corner, with the incidence rate dropping 4.4 percent a year between 2001 and 2005 after rising in previous years. The change probably reflects a leveling of prostate screening that had surged in the late 1990s.
-Melanoma, the deadliest skin cancer, jumped 7.7 percent a year among men and by nearly 3 percent a year among women.
Source: midtn
Anemic Children In Louisiana, Fatigue And Learning Problems
Iron deficiency anemia can cause fatigue and learning problems. Severe deficiency in young children can delay growth and development and even cause heart murmurs.
The national rate for children that young is below 10 percent. Louisiana has one of the nations highest anemia rates, with about 24 percent of all children below the age of 5 affected, according to the 2007 Pediatric Nutrition Surveillance survey.
Dr. Irwin Redlener, president of the Childrens Health Fund and director of Columbia Universitys National Center for Disaster Preparedness, said the Renaissance Village rate was double the rate for homeless children the same age in New York City shelters.
The study used records for all 261 babies and children who lived in New Orleans until Katrina and were treated last year at CHFs mobile clinics at the trailer park and Baton Rouge schools, said Roy Grant, the organizations director of applied research and policy analysis.
While most of the affected children were storm evacuees, it was possible that a few were natives of Baton Rouge.
But studying the problem further and providing follow-up care for the children is difficult because the state closed the parks in May.
“Now its more difficult, because theyre no longer in the trailer area. Theyre dispersed around the state. So its a little harder to get follow-up,” said Dr. Jimmy Guidry, Louisianas health officer.
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On the Net:
http://www.cdc.gov/nccdphp/dnpa/nutrition/nutrition-for-everyone/iron-defici ency/index.htm
Source: ctnhr
AIDS Drugs, Sex Education Effective In South Africa And Malawi
“Its quite a startling result,” said Charlie Gilks, an AIDS treatment expert at the World Health Organization and one of the papers authors. “In a relatively short amount of time, we could potentially knock the epidemic on its head.”
Gilks and colleagues used data from South Africa and Malawi. In their model, people were voluntarily tested each year and immediately given drugs if they tested positive for HIV, regardless of whether they were sick.
Within 10 years, HIV infections dropped by 95 percent. Other initiatives like safe sex education and male circumcision were also used.
The strategy would cut the estimated number of AIDS deaths between 2008 and 2050 by about half, from about 8.7 million to 3.9 million, leaving only sporadic HIV cases.
Experts think the strategys cost would peak at about $3.4 billion a year, though expenses would fall after an initial investment.
“This is certainly beyond the bounds of the current infrastructure for many countries, but that is not a reason not to think big,” said Myron Cohen, of the University of North Carolina, who has done similar research. He was not involved in the WHO study.
Only 3 million people are currently on AIDS drugs. Nearly 7 million people are still awaiting treatment, and about 3 million more people were infected last year. Worldwide, WHO guesses that about 33 million people have HIV.
Increasing access to testing and drugs would stretch already weak health systems in Africa, which has most of the worlds HIV cases.
“This is not like giving someone a Tylenol,” said Jennifer Kates, director of HIV policy for the Kaiser Family Foundation in Washington, DC. Once people start AIDS drugs, they must continue indefinitely. “The idea should be explored, but its a huge leap,” Kates said.
Handing out AIDS drugs to everyone who tests positive could also worsen drug resistance.
In addition, doctors dont know if its safe to take AIDS drugs for decades; the oldest drug combinations have only been around for about a dozen years.
That would benefit the community, but not necessarily the patients themselves. AIDS drugs come with side effects including vomiting, liver failure, and heart attacks.
WHO emphasized that the study findings do not signal a policy change. “This is only a theoretical exercise,” said Dr. Kevin De Cock, director of WHOs HIV/AIDS department. He said WHO would hold a meeting next year to study the idea more closely.
On the Net:
http://www.lancet.com
http://www.who.int
Source: midtn
Medicaid Paid For Unapproved Drugs To Fight Common Colds And Pain, US
United States medicaid paid nearly $198 million from 2004 to 2007 for more than 100 unapproved drugs, mostly for common conditions such as colds and pain. Data for 2008 were not available but unapproved drugs still are being sold. The AP checked the medications against FDA databases, using agency guidelines to determine if they were unapproved. The FDA says there may be thousands of such drugs on the market.
The medications date back decades, before the Food and Drug Administration tightened its review of drugs in the early 1960s. The FDA says it is trying to squeeze them from the market, but conflicting federal laws allow the Medicaid health program for low-income people to pay for them.
Medicaid officials acknowledge the problem, but say they need help from Congress to fix it. The FDA and Medicaid are part of the Health and Human Services Department, but the FDA has yet to compile a master list of unapproved drugs, and Medicaid - which may be the biggest purchaser - keeps paying.
“I think this is something we ought to look at very hard, and we ought to fix it,” said Medicaid chief Herb Kuhn. “It raises a whole set of questions, not only in terms of safety, but in the efficiency of the program - to make sure we are getting the right set of services for beneficiaries.”
At a time when families, businesses and government are struggling with health care costs and 46 million people are uninsured, payments for questionable medications amount to an unplugged leak in the system.
Sen. Charles Grassley, R-Iowa, has asked the HHS inspector general to investigate.
That unapproved prescription drugs can be sold in the United States surprises even doctors and pharmacists. But the FDA estimates they account for 2 percent of all prescriptions filled by U.S. pharmacies, about 72 million scripts a year. Private insurance plans also cover them.
The roots of the problem go back in time, tangled in layers of legalese.
It wasnt until 1962 that Congress ordered the FDA to review all new medications for effectiveness. Thousands of drugs already on the market were also supposed to be evaluated. But some manufacturers claimed their medications were grandfathered under earlier laws, and even under the 1962 bill.
Then, in the early 1980s, a safety scandal erupted over one of those medications. E-Ferol, a high potency vitamin E injection, was linked to serious reactions in some 100 premature babies, 40 of whom died.
In response, the FDA started a program to weed out drugs it had never reviewed scientifically. Yet some medications continued to escape scrutiny.
Critics say the FDAs case-by-case enforcement approach is not working.
“The FDA does not appear to have a systematic mechanism to report these drugs out,” said Jon Glaudemans, senior vice president of Avalere Health, a health care industry information company, “and there doesnt seem to be a systematic process by which health insurance programs can validate their status. And everyone is pointing the finger at someone else as to why we cant get there.”
In most cases, doctors, pharmacists and patients are not aware the drugs are unapproved.
“Over the years, they have become fully entrenched in the system,” said Patti Manolakis, a Charlotte, N.C., pharmacist who has studied the issue. Only a few unapproved drugs are truly essential and should remain on the market, she added.
Tackling the problem is made harder by confusing - and sometimes conflicting - laws, regulations and responsibilities that pertain to different government agencies.
Source: msjad
Bacteria Found To Congregate On Chicken Trucks
Even so, its not clear that germy debris will make you sick. None of the scientists who studied this problem got sick. And the disease-causing bacteria in question are normally spread by food or water, not air.
Rule and her colleagues at the Bloomberg School of Public Health focused on the so-called Delmarva Peninsula, a coastal area that includes parts of Delaware, Maryland and Virginia. The region is a chicken mecca, with one of the highest concentrations of broiler chickens per acre in the nation.
The researchers chose a 17-mile stretch of highway connecting chicken farms in Maryland to a processing plant to the south in Accomac, Va. They rode in four-door cars with all the windows down and the air conditioning off.
They checked the cars for bacteria after driving when there were no chicken trucks around. And they checked for bacteria after 10 trips behind flatbed trucks carrying crates of broiler chickens.
They collected bacteria from air samples, door handles and soda cans inside the car.
In all the truck chases, they found high levels of certain bacteria, including some that are resistant to antibiotics.
The study, released this week, is being published in the first issue of the Journal of Infection and Public Health, and its billed as the first to look at whether poultry trucking exposes people to antibiotic-resistant bacteria.
It was a casual conversation that inspired the effort.
“Somebody said, I went to the beach the other day and I got stuck behind a chicken truck, and boy, is that nasty,” Rule said.
She said studies to determine if chicken trucks can make you sick are somewhere down the road.
Dr. Keith Klugman, an Emory University epidemiologist who was not involved in the research, said getting sick that way is unlikely. Most healthy people dont suffer serious illness from these bacteria even when exposed in more conventional ways.
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On the Net:
Journal of Infection and Public Health: http://www.elsevier.com/locate/jiph
Source: midtn
Changes: Replacement Livers Distributed Based Upon Need Instead Of Waiting List
“By design, we tried to make it race blind. It looks like we did,” said Dr. Richard Freeman, a transplant surgeon at Tufts University School of Medicine in Boston, who helped create the new system and was not involved in the study.
But the research, in Wednesdays Journal of the American Medical Association, suggests the system may favor men over women. Dr. Cynthia Moylan, the studys lead author and a transplant fellow at Duke University Medical Center in Durham, N.C., called for more research on gender differences.
The nation faces a serious shortage of livers from deceased donors, with nearly 16,000 people now waiting. About 6,500 liver transplants were performed last year, but 1,602 people died waiting for a new one.
Under the old system, which relied heavily on how long a patient spent on an official waiting list, sicker patients were passed over in favor of those waiting longer.
The system favored whites because blacks join waiting lists when they are sicker. Why isnt clear, but blacks may get treatment later or have poor access to liver specialists.
Compared to whites, blacks on the waiting list had a 50 percent greater chance of dying or becoming too sick for transplant within three years, according to an analysis of five years of transplant records before the change. After the new system, called Model for End-Stage Liver Disease, or MELD, that difference disappeared.
The new system is based on three lab tests. Results are combined as a score that predicts a patients risk of death within three months. Livers are allocated based on scores.
The change was made after the government ordered the United Network for Organ Sharing, which runs the transplant network, to make liver allocation less arbitrary.
Prior research has also found racial disparities in the allocation of kidneys. UNOS is currently evaluating its system for kidneys, which is now based on waiting time, blood type and tissue type.
North Carolina resident Sharon Dickens, 40, who is black, received a new liver in 2004 after five years on the waiting list. She suffered from a rare disease that blocks the bile ducts; transplant is the only cure.
Dickens wonders whether her transplant might have come sooner if the new system were in place in 1999 when she joined the waiting list. If so, she would have spent less time at home sick in bed.
The research compared adults on the waiting list during two periods: nearly 22,000 patients before the new system and nearly 24,000 patients after the scores were used. They took into account other risk factors for dying while on the waiting list.
Before the change, 810 blacks, or 49 percent of those on the waiting list, got transplants. Meanwhile, 10,202 whites, or 52 percent of those on the list, got transplants.
In the years after the change, 849 blacks, or 47 percent, got transplants compared to 8,492 whites, or 42 percent.
For women, MELD wasnt an improvement. The study found women had a 30 percent greater chance of dying or becoming too sick for transplant with the new scoring system. The gender difference wasnt significant before.
One of the lab tests in the score may underestimate the severity of illness in women because of their smaller average size, said Dr. David Axelrod of Dartmouth-Hitchcock Medical Center in Lebanon, N.H., who was not involved in the study, but wrote an accompanying editorial.
Source: midtn