Because they Can…

June 24, 2009

Insurers Wrongfully Charged Consumers Billions

Health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released today by the staff of the Senate Commerce Committee.

The report is part of multi-pronged assault today on the trustworthiness of private insurers by Commerce Committee Chairman John D. Rockefeller IV (D-W.Va.). It comes at a time when the insurance industry is battling efforts to offer consumers a public alternative to private health plans.

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Music is Treatment for Almost Anything…

June 23, 2009

Music Keeps Rhythm for Heart and Lungs

Cardiovascular and breathing rates consistently fall into step with musical crescendos and rhythms, according to a controlled clinical trial that may give impetus to new musical therapies.

Contrary to the conventional view of music as an intensely personal medium, researchers found that the same piece of music had similar cardiovascular effects on all subjects.

Taking advantage of these interactions may open the way to standardized treatments for blood pressure control and rehabilitation, Luciano Bernardi, MD, of Pavia University in Pavia, Italy, and colleagues wrote in the June 30 issue of Circulation.

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Young v. Old Views of Medicine…

June 17, 2009

AMA: Delegates Still Mulling Position on Obama Healthcare Reform Plan

A day after President Barack Obama made his case for support of healthcare reform that would include a public plan option to the American Medical Association, it’s still not clear if the AMA is buying his message.

At issue is a resolution from the Kansas State Medical Society that asked the AMA to “express its opposition to ‘public option’ proposals which could result in the elimination of the private health insurance system.”

Obama would like the government to run a Medicare-like insurance option alongside private plans, all of which would be purchased through an insurance clearinghouse called the “exchange.”

But Republicans in Congress are sharply opposed to the idea, calling it a “government takeover,” that would drive private insurance companies out of business.

Last week, the AMA began to signal its opposition to a public plan and immediately found itself enmeshed in controversy as other organized medicine groups criticized the position.

A day after voicing its objections to a public option, the AMA was forced to issue a second statement — this time rebuking The New York Times for its reporting of the AMA stance.

AMA outgoing president Nancy Nielsen, M.D., Ph.D., said the AMA wouldn’t support a public plan option that requires physician involvement and pays Medicare rates.

As the public plan option was debated in a reference committee on Sunday, AMA members streamed to the “pro,” and “con” microphones in equal numbers.

There was a notable age gap, with the youngest members speaking against the resolution that would place the AMA squarely against Obama’s public plan option, while the AMA’s old guard took the contrarian’s role.

Those who opposed the Kansas resolution said it would send a message of resistance at a time when the AMA should be working with the president.

“It does give the appearance of drawing a line in the sand,” said Jacob Ryan, a member the medical student section.

“We can’t let anyone claim we weren’t part of the solution,” he said.

But another AMA member took a different stance.

“This sends the message that we’re opposed to it, and gives [us] a stronger stand to negotiate,” said Peter Lund, M.D., a urologist from Erie, Pa., who is a member of that state’s delegation.

On both sides, the AMA members said they support a system in which there are multiple insurance options — so much so that the reference committee report characterized the debate this way: “Both sides are vehemently agreeing.”

The delegates will vote on the reference committee report later today or tomorrow.

Although it is always difficult to predict which way the AMA’s diverse house will vote, in general the delegates take their lead from the reference committee, which has recommended a substitute resolution stating that the AMA supports ” ‘public option’ alternatives that are consistent with AMA principles of pluralism, freedom of choice, freedom of practice, and universal access for patients.”

But, in matters of healthcare reform the delegates have often balked at following reference committee resolutions, and another likely scenario would be a return to the original Kansas resolution.

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Swine Flu is Still Out There…

June 12, 2009

WHO Declares First Flu Pandemic in 41 Years

The novel H1N1 influenza is now a full-blown pandemic, the World Health Organization said today, the first in 41 years.

“The scientific criteria for an influenza pandemic have been met,” WHO Director-General Margaret Chan, M.D., said in a Geneva press conference.

Those criteria include sustained community transmission in at least two regions of the world, but say nothing about the severity of the outbreak, Dr. Chan said.

Indeed, on the basis of available evidence, she said, the pandemic will be “of moderate severity.”

“The overwhelming majority of patients experience mild symptoms and make a rapid and full recovery, often in the absence of any form of medical care,” Dr. Chan said.

Although there have been 144 deaths, she said, “we do not expect to see a sudden and dramatic jump in the number of fatal infections.”

That said, Dr. Chan noted, influenza is highly variable and can “change the rules without rhyme or reason,” so a sudden increase in severity can’t be ruled out.

Agency officials added that the severity of a pandemic also depends on the population it attacks. In this case, poorer countries and those with a younger population might be harder hit, according to Keiji Fukuda, M.D., an assistant director-general of the agency.

The jump to phase six is no surprise, according to new CDC Director Thomas Frieden, M.D. “It was expected on the basis of the data,” he told a press conference today.

The main implication of the WHO declaration is that the virus is continuing to spread and is “likely here to stay,” he said.

But for the U.S., he said, there are few practical implications. “We have been acting as if it’s a pandemic for some time,” Dr. Frieden said, and no new initiatives are planned.

World-wide, WHO has had official reports of nearly 30,000 cases, Dr. Chan said, but that number is almost certainly an underestimate, since about half of those cases have been reported in countries — like the U.S. and Canada — with highly developed public health and surveillance systems.

The change to phase six of the agency’s pandemic preparedness scale was widely expected, as the disease continued to spread from its origins in North America.

UN officials were at pains earlier in the week, however, to emphasize that most cases of the disease are mild and that increasing the pandemic level would not mean the outbreak is causing more severe disease.

A change to phase six “does not mean that the severity of the situation has increased and that people are getting seriously sick at higher numbers or higher rates than they are right now,” Dr. Fukuda said.

Dr. Chan said it’s very likely that a second wave of the virus will hit northern hemisphere countries in the fall, and urged them to remain vigilant, even if the current outbreak appears to be waning, as it is in Mexico.

In the U.S., the CDC said, most areas of the country are seeing only a few cases of the flu, with the exceptions of New England and the New York/New Jersey region, where flu-like illness remains above baseline values.

For the U.S., Mexico, and Canada — the countries hardest hit so far — the change to phase six means relatively little, a cross-section of experts agreed.

The declaration “merely confirms the obvious — that there is community transmission worldwide,” said Pascal James Imperato, M.D., of the SUNY Downstate Medical Center in New York.

“The raising of the pandemic level is a response to statistics,” said Richard Bradley, M.D., of the University of Texas Medical School in Houston. “For us in the U.S. there is no major significance or effect of the level being raised.”

In essence, he said, “it’s been pandemic all along, nothing is different. Don’t panic. The virus is still mild.”

“Not much, if anything, will change in the U.S.,” agreed William Schaffner, M.D., of Vanderbilt University School of Medicine in Atlanta.

“The U.S. public health structure already is performing enhanced surveillance for influenza throughout the summer,” he said, and hospitals, health departments, and other agencies are revising their pandemic plans.

But, he said, other national governments, especially in the developing world, may respond by enhancing their own planning.

“This is not a surprise,” said Christian Sandrock, M.D., of the University of California Davis School of Medicine, but he said the announcement may lead to better planning for the fall flu season “when we will see these cases in higher numbers.”

Dr. Sandrock said “money and planning from a government level will be improved with this declaration,” although he cautioned it could also cause “misunderstanding and panic.”

Julie Gerberding, M.D., the former director of the CDC, said the main actions suggested by the WHO under phases five and six are identical. But she noted that some countries may have tied their national responses to the different levels, so that going to phase six might lead to “significant local, regional, or national impact.”

But she agreed with other experts that “technically, we have been in phase six for some time.”

Stephen Morse, Ph.D., of Columbia University Medical Center, said the declaration is “essentially just acknowledging the facts that already exist on the ground.”

Like other experts, he cautioned that the term “pandemic” says nothing about the severity of the disease. “As far as I can tell, nothing has really changed dramatically since yesterday,” Dr. Morse said, adding that WHO held off so long to avoid what he called “perceptual” impacts.

That was probably the right decision, according to Philip Alcabes, Ph.D., of CUNY Hunter College in New York City. Dr. Alcabes is the author of Dread: How Fear and Fantasy Have Fueled Epidemics from the Black Death to Avian Flu.

“WHO was right to be cautious about raising the threat barometer to six,” Dr. Alcabes said.

But he said officials were being disingenuous when they said the delay was to avoid panicking the public.

“In general, people don’t panic about disease outbreaks,” Dr. Alcabes said. “The problem, of which WHO is abundantly aware, is that governments do panic.”

In other words, he said, governments often use the threat of disease as a rationale for political acts, such as the “unnecessary” Chinese quarantines or the slaughter of pigs in Egypt.

“In the context of other disease outbreaks, we’ve seen border closings, travel warnings, and nutty investigations of airline passengers,” he said. “All of that is politics, masquerading as public health.”

In the long run, he said, WHO should abandon the pandemic-threat scale altogether.

“That day is probably a ways off, though,” Dr. Alcabes said. “It will take political will on the part of a lot of countries’ governments — including ones that still imagine they can ward off disease by shutting borders (or killing pigs).”

On the other hand, the move to phase six puts “everyone on the same page,” according to Gregory Poland, M.D., of the Mayo Clinic in Rochester, Minn., with the goals of:

* Communicating to individuals, health systems, and governments that there is a pandemic and altering them to be ready for potentially rapid changes and to put plans into action
* Enabling global communication and coordination
* Allowing vaccines, antiviral drugs, masks, medical assistance, and other resources to be moved to poorer countries

Among other things, the move puts pressure on governments and health officials to get ready, Dr. Poland said.

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