Snowe Rejects Public Option as Senate Democrats Weigh Measure
“A public option at the forefront really does put the government in a disproportionate position with respect to the industry,” Snowe, the only Republican to vote for a health plan so far, said in an interview with Bloomberg Televisions “Political Capital With Al Hunt,” airing this weekend.
Snowes stance is crucial because Democrats such as Nebraska Senator Ben Nelson say a bill has to have Republican support to win his vote. She might also bring along more Republicans, such as fellow Maine Senator Susan Collins.
While the establishment of a so-called public option to compete with private insurers is opposed by all Republicans and has divided Democrats, the idea is getting fresh attention from Senate Democratic leaders, lawmakers say. It was the main topic of discussion all day on Capitol Hill and was brought up at a meeting that Majority Leader Harry Reid and other lawmakers had later with President Barack Obama at the White House.
Senator Kent Conrad, a North Dakota Democrat whos played a leading role in seeking a bipartisan compromise, said Reid and Obama administration officials are tilting in favor of including a version in a Senate bill.
States would be free to opt out of the insurance program and the plan would pay health-care providers at higher rates than does the Medicare insurance system for the elderly, Conrad, a member of the finance committee, told reporters.
“What Im hearing is this is the direction of the conversation,” he said, adding that no decision had been made.
Reids spokesman, Jim Manley, declined to comment.
60 Votes Needed
A Democratic aide familiar with the discussions said while a public option is being considered, it wont be included in legislation unless Reid can get 60 votes, the number needed to avoid Republican stalling tactics. Another possibility is Snowes plan to start a government plan only if there isnt enough competition for private insurers to keep rates low, said the aide, who requested anonymity.
Meanwhile, House Democratic leaders are trying to gain consensus among the partys rank and file for a public option that would peg doctor reimbursements to lower Medicare rates, which would present a stronger challenge to private insurers.
In the Senate, Democrats including Charles Schumer of New York and Jay Rockefeller of West Virginia say a public option is vital to bringing costs down. Snowe and some Democrats such as Nelson say theyre worried about undermining the market.
Biggest Changes
Lawmakers are considering the biggest health-care changes since the creation of Medicare in 1965. The legislation, Obamas top domestic priority, attempts to curb medical costs while covering tens of millions of uninsured Americans.
Obama has told Congress he wants to sign legislation this year, a goal that may slip, Snowe said.
“Christmas might be too soon,” she said in the Bloomberg interview. “We should give it the time it deserves.”
Reid is combining a measure passed by the Senate health committee in July with an $829 billion proposal approved by the Senate finance panel on Oct. 13 with Snowes vote. The Senate has to debate and vote on a plan before it can be merged with a bill from the House, which is going through the same process.
Legislative Timeline
House Speaker Nancy Pelosi said Democrats hope to introduce their combined legislation next week. Senate Finance Committee Chairman Max Baucus said he doesnt expect a Senate bill to be ready for floor debate in his chamber.
Ny Officials Rescind Mandatory H1n1 Flu Shot Order
New York will be getting only about 23 percent of its anticipated supply of the vaccine for the swine flu virus - also called H1N1 - by the end of the month, and that should be reserved for those most at risk for serious illness and death, according to Gov. David Patersons office.
“New evidence is showing that H1N1 can be especially virulent to pregnant women and young people - so they should get vaccinated first,” said Dr. Richard Daines, the state health commissioner.
Workers had protested Daines earlier order that health care workers receive the vaccine, arguing it was unfair to force them to put a substance into their body. Unions and health workers sued the state, and a judge issued a temporary restraining order last week.
“This is welcome news,” said Carl Korn, a spokesman for the New York State United Teachers union. “This suit was never about the safety of the vaccine, or the merits of it. The suit was always about giving individuals the choice, as adults, as to whether or not they wanted to be vaccinated without the threat of termination.”
Its unclear what will happen with the lawsuits. Thursdays action was a suspension of the order, and the Health Department plans to pursue making the order permanent in 2010, as long as theres enough vaccine for that flu season, said Diane Mathis, an agency spokeswoman.
The Health Department initially had said the workers must be vaccinated by November 30. Institutions had to determine how to enforce the mandate, leaving some workers concerned about possible disciplinary action, including dismissal.
“This was the proper and appropriate action for the state to take,” said Kenneth Brynien, president of the Public Employees Federation, one of the unions that sued. “This was an extremely passionate issue for many of our members.”
PEF said it encourages members to get flu vaccinations, but opposes the emergency regulation requiring the vaccine as a condition of employment.
This week the Centers for Disease Control and Prevention allowed the state to order 146,300 doses of vaccine, but health care providers across the state have requested more than 1.4 million doses.
Fda Warns: Swine Flu Scams Lurk On The Internet
These and other products making bogus claims to prevent or treat swine flu are flooding the Internet as scam artists prey on the publics fears while the vaccine is delayed and real Tamiflu - made by Switzerlands Roche Group - is rationed.
Every problem, it would seem, is a sales opportunity. Some of the products appear to have been pitched for other emergencies, such as one called “Quake Kare” and masks and purifiers sold during the SARS scare.
Federal officials have sent warning letters to promoters of more than 140 swine flu-related products, including well-known alternative medicine advocate Dr. Andrew Weil for his “Immune Support Formula.”
Consumer Reports also has warned subscribers to be wary.
“Its harmful, disappointing, frustrating to see folks take advantage of the public like this,” said Dr. John Santa, who evaluates health claims for Consumer Reports.
Fraudulent products emerged shortly after swine flu did last spring - about 10 a day, said Alyson Saben, head of a swine flu consumer fraud team formed by the Food and Drug Administration. The pace slowed over the summer as the flu abated, but “its picked up” in recent weeks, she said. “We are seeing new sites pop up.”
Most worrisome: sites that claim to sell Tamiflu without a prescription. The FDA bought and tested five such products. One contained powdered talc and generic Tylenol - no Tamiflu. Several others contained some Tamiflu but were not approved for sale in the U.S.
“We have no idea of the conditions under which they were manufactured. They could contain contaminated, counterfeit, impure or subpotent or superpotent ingredients,” Saben said.
Tamiflu and GlaxoSmithKlines Relenza are the only drugs recommended for treating swine flu.
Rogue Web sites are not the only ones trying to cash in on flu fears. Makers of some well-established products are making claims that may be close to the line, the FDA says.
This week, the makers of Dial Soap, Kleenex, Clorox and other big brands launched a joint promotional campaign costing up to $1 million. The FDA is reviewing the campaign, which includes a video that says:
“Germs are tiny organisms that can cause disease. According to the CDC, up to 80 percent of infectious diseases, like the flu, are spread by your hands. Thats why frequent, proper handwashing is so important in preventing spread of the flu, other viruses and germs. An antibacterial soap like Dial Complete foaming hand wash kills 99.9 percent of germs.”
The campaign is “not being specific down to swine flu,” said Scott Moffitt, an official with Dial Corp.s parent company, Germany-based Henkel AG. He also contends the video is not misleading, even though the germ-killing claim follows a sentence about flu and other viruses.
One product that drew a warning letter from the FDA is the Photon Genie, a gadget that delivers “energy waves.” Its Web site claimed it “helps strengthen the immune system, and a strong immune system is KEY to preventing swine flu symptoms and KEY to treating swine flu.”
The site has since removed the swine flu claim but “other claims remain,” Saben said.
The group behind the Web site, the Skilling Institute of Phoenix, “is not marketing, and will not market in the future, any product that is intended to diagnose, mitigate, prevent, treat or cure the H1N1 flu virus,” its director, Warren Starnes, wrote in an e-mail.
Some products the FDA warned about contain silver, such as “Swine Flu…Gone,” made by Secrets of Eden.
Sperm Donor Passed On Sudden Demise Heart Defect
Two children, both now teenagers, have developed symptoms and are at risk for sudden cardiac death, the report says. Its the second documented instance of a genetic condition being inherited through sperm donation.
The latest case highlights the importance of thoroughly screening sperm donors, according to the report and an editorial published with it in Wednesdays Journal of the American Medical Association.
The San Francisco sperm bank involved now gives all donors electrocardiogram tests to weed out men with genetic heart problems; the study authors recommend that other sperm banks follow suit.
Voluntary sperm bank guidelines say donors should be required to provide a complete medical history to rule out those with infectious diseases or a family history of inherited diseases. Many also do testing but for genetic diseases that are less common than the heart problem, according to co-author Dr. Barry Maron of the Minneapolis Heart Institute, a leading authority on the condition called hypertrophic cardiomyopathy.
Hypertrophic cardiomyopathy thickens the heart and makes it harder to pump blood. It affects about one in 500 people; many more likely have the genetic defect without symptoms, said study co-author Heidi Rehm of Harvard Medical School.
Symptoms can include an irregular heartbeat and shortness of breath but many cases go undetected until sudden death. The condition is often the culprit when young athletes collapse and die suddenly. Treatment includes medication and an implanted defibrillator to prevent sudden death.
Neither the sperm bank nor the donor were identified. The donor, now 42, had no symptoms of genetic heart disease and no obvious family history when he donated sperm in the early 1990s. His own condition wasnt diagnosed until after a child born through sperm donation was diagnosed. Maron declined to provide more details on the donors health, citing privacy concerns.
The children are now ages 7 to 16. Nine, including one born to the donors own wife, tested positive for the heart mutation. One born through sperm donation died; two others have developed symptoms, with one getting a defibrillator. The remaining children are at increased risk for problems, which often dont show up until adolescence, Maron said.
The only other documented case of a disease inherited through sperm donation involved a rare blood disease.
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On the Net:
JAMA: http://jama.ama-assn.org
Giving Kids Tylenol Makes Vaccines Less Effective, Study Finds
Babies who took paracetamol, also known as acetaminophen, right after a shot had less fever but also showed a lower immune response, possibly because the drug reduced the inflammation that may favor interactions between immune cells, according to research published in the medical journal The Lancet.
Using the painkiller, also sold under the brands Calpol in the U.K. and Anacin in the U.S., to prevent fever after vaccination “has become routine practice and is even recommended in some countries,” wrote the researchers, led by Roman Prymula of the University of Defence in Hradec Kralove, the Czech Republic.
Prymula and his colleagues studied 459 healthy babies divided in two groups. One group received three doses of paracetamol after vaccination and the other didnt. The researchers had two goals: to gauge how much fever the children had and how well immunized they were after the initial vaccine and the booster shot.
The children were vaccinated against diphtheria, tetanus, poliomyelitis, hepatitis B, whooping cough, diarrhea-causing rotaviruses and Haemophilus influenzae type B, a bacterium that can cause pneumonia and meningitis.
High Fever
Forty-two percent of the children who got paracetamol after the first shot had a fever of 38 degrees Celsius (100.4 degrees Fahrenheit) or above, compared with 66 percent of those who didnt, the study showed. High fever was rare in both groups. The immune response of the painkiller group, measured by the concentration of antibodies in their blood, was “significantly lower,” the researchers wrote.
“Vaccine policy makers must now assess the implications for vaccinations programs,” Robert Chen and Thomas Clark from the Centers for Disease Control and Prevention in Atlanta and Scott Halperin from Dalhousie University in Halifax, Canada, wrote in a comment published by The Lancet with the study. “Prymula and colleagues present a compelling case against routine use of paracetamol during pediatric immunizations.”
The vaccines used in the study were manufactured by London- based GlaxoSmithKline Plc, which funded the research.
Scientists Grow Mice Heart Muscle Strip That Beats
Lots of work remains before trying that dramatic an experiment in people. But regenerating damaged heart muscle is a holy grail in cardiac care.
Doctors today have lots of treatments to prevent a heart attack. But once one strikes, theres no way to restore the heart muscle it kills. Gradually the weakened heart quits pumping properly, leading to deadly heart failure.
Hence the focus on embryonic stem cells, master cells that can give rise to any tissue in the body. Until now, scientists havent known how to coax those cells into producing pure cardiac muscle.
Instead, researchers have tried injecting heart attack survivors with mixes of different kinds of stem cells, next-generation types like those found in bone marrow. The idea: Perhaps once those cells were inside a damaged heart, ones capable of growing cardiac muscle would receive a “get to work” signal and take root. Theres been little success so far.
The new research, published in Fridays edition of the journal Science, promises a more targeted approach.
“Its not the home run,” cautioned Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute, which is spending millions on research nationwide into cardiac regeneration. “But its a major advance thats helping to move the field forward in a very significant way.”
Embryonic stem cells give rise to more specialized organ-producing stem cells. The team from the Harvard Stem Cell Institute and Mass General recently discovered a master heart stem cell present in both human and mouse embryos.
But could they control it enough to make just the kind of heart cell they wanted to grow? Theyd have to winnow out the daughter cell whose only job is to grow the muscle fibers of the ventricle, or pumping chamber.
Chien genetically engineered mice so that certain cells in the embryos developing hearts would light either fluorescent red or green. As he watched the embryos grow, where the colors overlapped signaled developing heart muscle. Sure enough, when the team plucked out those cells, they were pure ventricle generators.
Next Harvard engineers pitched in with a special scaffolding. The team “seeded” the scaffolding with these ventricle stem cells, and a thin strip of mouse heart muscle grew right in the laboratory.
Not only that, it spontaneously beat, the team reported in Science and at a National Institutes of Health meeting this week on the state of cardiac regeneration.
“This looks like the kind of work a normal heart tissue strip would do,” said Chien, director of Mass Generals Cardiovascular Research Center. “We went from embryonic stem cells to an organ.”
The NIHs Nabel said the experiment also offers a possible new opportunity for cell therapy - that perhaps injecting the precise muscle-generating cell directly into a damaged heart would have a better chance of sticking and working.
The Harvard team wants both methods tried.
“Were not saying this is going to happen tomorrow,” said Chien, who also is working on repeating the work with human cells. “I believe within five years,” it might be ready to try with people.
Fda to Study Negative Effects Of Lasik Eye Surgery
The FDA says it will work with the National Eye Institute and the Department of Defense to determine the percentage of patients who experience negative side effects following surgery.
The first phase of the project is already under way, with plans for an online questionnaire to help patients gauge their quality of life following surgery, according to an FDA statement.
The project will also include a clinical trial tracking patients who undergo the procedure, which is expected to conclude by 2012.
“This study will enhance our understanding of the risks of Lasik and could lead to a reduction in patients who experience adverse effects,” said Dr. Jeffrey Shuren, the acting head of FDAs medical device division.
An estimated 6 million Americans have undergone Lasik surgery, which permanently reshapes the cornea, a clear layer covering the eye. There are no guarantees of 20/20 vision and the long-term safety of the procedure is still unknown.
Ophthalmology societies report that about 95 percent of patients are satisfied with their new vision.
But a small number of patients have reported permanent damage to their eyes following the surgery, including double vision, dry eye and halos around objects at night.
The FDA agreed to look into the problems in 2008 after years of complaints. The agency said last summer it received 140 reports of Lasik-related problems between 1998 and 2006.
Lasik procedures have fallen off in the past year as consumers cut back on the pricey surgeries, which can cost between $1,500 and $5,000
Makers of Lasik lasers include Advanced Medical Optics Inc., Alcon Inc., and Bausch and Lomb.
Also on Thursday, the FDA announced warning letters sent to 17 Lasik surgery centers for inadequate adverse event reporting procedures. Regulators periodically send letters to facilities that dont follow federal guidelines for reporting patient complaints.
“The inspections did not identify problems with the use of the Lasik devices at these facilities,” the FDA stated.
More Mri Scanners Lead to Excess Back Surgeries, Research Finds
Those in regions with the highest concentration of MRI scanners were about 20 percent more likely to have back surgery than those who lived in an area with the lowest concentration, research online today in the journal Health Affairs showed. Back surgery isnt proven or recommended to help patients with nonspecific low back pain, the study authors said.
The number of MRI machines tripled in the U.S. to 26.6 machines per 1 million people in 2005 from 7.6 machines per million people in 2000, according to the article. Medicare, the U.S. government health program for the elderly, pays about $600 for a lower back scan, the researchers said. An increase in the number of scans and surgeries is raising the cost of treating lower back pain, according to the study authors.
“Patients for a long time in this country had engrained in them that getting more stuff is better for you,” said study author Laurence Baker, a professor of health research and policy at Stanford University near Palo Alto, California, in a telephone interview yesterday. “More scanning did not make it better, it might make you worse and get you surgery that doesnt really work. The system as a whole needs to come to terms with how we use things like MRIs and their benefits without bankrupting the system.”
Detailed Images
Makers of MRI scanners include General Electric Co. of Fairfield, Connecticut, Siemens AG of Munich and Amsterdam-based Royal Philips Electronics NV. MRIs use a magnetic field, radio frequency pulses and a computer to produce detailed images of the body.
The machines may pick up abnormalities that are unrelated to the back pain, which can lead to doctors performing surgery that may not benefit the patient, the authors said.
The researchers looked at data from a 20 percent sample of Medicare recipients who received care for low back pain from 1998 to 2005 in 318 metropolitan areas. They linked the patient data with the number of MRI machines in each area. Those in the highest availability areas had at least two times as many MRI machines per capita as those in the lowest availability areas, the authors said.
The study included 666,455 episodes of low back pain. Almost 16 percent of the episodes led to an MRI and 2.7 percent resulted in low back surgery within a year of first visiting the doctor.
Additional MRIs
The researchers found a “clear relationship” between the availability of MRIs and the use of the tests in low back pain patients. Each additional MRI machine added from 1999 to 2004 was associated with eight more low-back scans, the study showed. Expanding those numbers to the entire Medicare population implied about 40 additional procedures for each extra scanner.
The authors projected that in 2004, 5.4 percent fewer low back MRIs and 9 percent fewer back surgeries wouldve been done if all Medicare patients with low-back pain had lived in the areas of lowest MRI availability.
“We hope that this study will contribute to the debate over how to restrain the growth of health care spending without reducing access to high-quality care,” Baker wrote in the article with co-author Jacqueline Baras, a Stanford University medical student.
Low back pain is more common than severe headaches, neck pain and facial pain, according to a National Institutes of Health survey. Back pain can limit activity and lead to poor health and psychological distress, according to the American Pain Foundation Web site.
The study was funded by the California Healthcare Foundation and the Stanford Medical Scholars Research Program.
Democrats Move to Assure Doctors, Unions On Health-care Strategy
Senators said they plan to ease a proposed tax on high-end insurance plans after unions protested that it would hurt too many workers. Lawmakers may also shield doctors from the threat of cuts in payments from the Medicare program for the elderly.
Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi are both working to combine different versions of legislation designed to curb medical costs and increase insurance coverage. The criticism from unions, the Democrats biggest financial backers, has them worried.
“We have to be careful,” Richard Durbin of Illinois, the Senates No. 2 Democrat, told reporters yesterday. “We dont want to see our friends in labor not supporting it.”
Lawmakers are also wooing doctors, whose American Medical Association trade group has backed the overhaul so far.
Reid put legislation to avert a 21 percent drop in Medicare reimbursements of doctors in January on a fast track. The measure proposed by Michigan Democrat Debbie Stabenow would repeal the reimbursement system, which was designed to save money on Medicare by ratcheting down payments to doctors.
Reid, a Nevada Democrat, invoked rules to bypass committees and bring the measure right to the floor.
No Spending Increase
The so-called sustainable growth rate system sets yearly and cumulative spending targets. If spending exceeds that years target, reimbursement rates are to be reduced. For seven years, Congress has enacted temporary fixes putting off the cuts, Stabenows office said in a statement.
The doctor-fee measure wouldnt add to the cost of the health-care overhaul because “it does not increase spending,” Jim Manley, a Reid spokesman, said in an e-mail. The legislation “simply restores a more honest picture of what future physician spending will actually be.”
Physicians have complained that the Medicare repayment rate underpays them. As a result, many no longer see Medicare patients, leaving seniors in some areas struggling to find health-care providers. The $829 billion Senate Finance Committee plan had a one-year fix for the doctors.
Own Merit
“Health-care reform really needs to be considered on its own merit” as does legislation for changing the formula adjusting doctor payments, House Democratic Leader Steny Hoyer of Maryland told reporters yesterday.
The revamp of the health-care system gained momentum this week when Maine Senator Olympia Snowe became the first Republican to support a plan. She joined the finance panels 13 Democrats to approve legislation on Oct. 13, guaranteeing herself a place in further negotiations.
The vote “has brought energy to the process,” White House Chief of Staff Rahm Emanuel said yesterday as he left a meeting with Pelosi. Earlier, he and other White House officials met with Reid, Senate Finance Committee Chairman Max Baucus and Connecticut Senator Chris Dodd, the chief negotiator from the chambers health panel, to discuss melding the bills.
Manley said the conversations will continue next week.
Taxes vaulted to the top of the agenda yesterday after 27 unions announced their opposition to the finance panel measure in a full-page newspaper advertisement. The unions said they would urge their members to seek its defeat in the Senate unless “substantial changes” are made.
Cadillac Plans
The proposed 40 percent excise tax on so-called Cadillac insurance plans would begin in 2013 and affect insurers of employer-sponsored health plans with benefits exceeding $8,000 for individuals and $21,000 for families. Those thresholds would be $9,850 and $26,000 for retirees 55 and older and for employees in the coal mining and other union-heavy industries.
Studies: Some Nursing Home Elderly Get Futile Care
One found that putting nursing home residents with failing kidneys on dialysis didnt improve their quality of life and may even push them into further decline. The other showed many with advanced dementia will die within six months and perhaps should have hospice care instead of aggressive treatment.
Medical experts say the new research emphasizes the need for doctors, caregivers and families to consider making the feeble elderly who are near death comfortable rather than treating them as if a cure were possible - more like the palliative care given to terminally ill cancer patients.
“We probably need to be offering a palliative care option to many more patients to make the last days of their lives as comfortable as possible,” said Dr. Mark Zeidel of the Beth Israel Deaconess Medical Center in Boston, who was not involved in the studies.
Palliative care focuses on managing symptoms of a disease and a main goal is to relieve pain at the end of life.
End-of-life care became a divisive issue in the national health care reform debate this summer after one proposal included Medicare reimbursement for doctors who consult with patients on end-of-life counseling. Critics called the counseling “death panels” and a step toward euthanasia. The Obama administration denied those claims, yet has signaled the Medicare benefit will be dropped.
The new studies are published in Thursdays New England Journal of Medicine.
In one study, doctors looked at health records of 3,702 nursing home residents nationwide who started dialysis between 1998 and 2000. The average age was 73 and many had other health problems, including diabetes, heart disease and cancer.
Within the first year, 58 percent died and another 29 percent declined in their ability to do simple tasks such as walking, bathing and getting dressed.
Kidney dialysis helps remove waste from blood, and the vast majority of patients with kidney failure benefit. However, in the case of seniors with failing kidneys, it is less clear whether the benefit outweighs the burden.
The findings call into question the common practice of transporting dialysis patients near the end of life to dialysis centers several times a week and hooking them up to a machine for hours at a time.
“We may be overestimating the benefits of dialysis in some of these patients and downplaying the burdens,” said lead author Dr. Manjula Kurella Tamura, a Stanford University kidney specialist.
The study did not include a comparison group of patients who didnt get dialysis, so its unknown if more elderly are dying after starting dialysis than not. Kurella Tamura said theres no one-size-fits-all recommendation for which nursing home residents should go on dialysis, and she suggests patients talk with their doctors about realistic expectations.
One out of four died within six months and half died during the 18 months they were followed. Nursing home residents with advanced dementia were more likely to die of pneumonia, fever and eating problems related to their dementia than from strokes or heart attacks.
During their final three months, 41 percent received aggressive care including being hospitalized and tube feeding. However, if the person making their medical decisions was aware of their poor prognosis, they were less likely to receive aggressive care near the end of life, the research found.
“We often temporarily inflict discomfort or pain on patients. We try to minimize it, but we accept it because we think the trade-off is curing or healing,” said Dr. Greg Sachs of Indiana University School of Medicine.
In an accompanying editorial, Sachs recalled how his grandmother, who suffered from Alzheimers and lived in a nursing home, was aggressively treated with antibiotics for every infection in her final months and had to be restrained. He said that people with dementia could benefit from hospice care inside a nursing home or in the community.
Sachs cited research that found nursing home residents who had hospice care during the last month of their life were half as likely to be hospitalized. Whats keeping dementia nursing home patients from getting hospice care is that dementia is not widely recognized as a terminal illness. Its also harder to predict when a dementia patient has six months or less to live - a criteria for Medicare-paid hospice care.