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GOP: Health test recommendations could affect care

Sat, 21 Nov 2009 03:48:54 +0100

WASHINGTON (AP) — Republicans are seizing on this week's recommendations for fewer Pap smears and mammograms to fuel concern about government-rationed medical care — and to try to chip away support by women for President Barack Obama's proposed health care overhaul.

"This is how rationing starts," declared Jon Kyl of Arizona, the party's second-in-command in the Senate, during a news conference. "This is what we're going to expect in the future."

Said Sen. Lisa Murkowski of Alaska: "Those recommendations will be used by the insurance companies as they make a determination as to what they're going to cover."

Democrats said the recommendations had nothing to do with the big health care bill. And besides, they said, the recommendations, especially one that women start mammograms at 50 rather than 40, were deeply flawed.

"It's entirely possible that this panel got it wrong, and I think they did," said Illinois Sen. Dick Durbin, the vote-counting Democratic whip. Fears that the government is going to run health care have not come up during negotiations for Saturday's crucial procedural vote, Durbin added.

But the recommendations have given Republicans something new to talk about in making their case that the 2,074-page bill amounts to government-rationed health care.

The timing of the release of both sets of guidelines this week, though apparently coincidental, couldn't have been worse for majority Democrats. The bill faces its first survival test Saturday, when it must win 60 votes to advance to the next step. In recent days, Democratic leaders have struggled to placate three holdouts from their caucus but appeared Friday night to be winning them over.

One Democrat wasn't taking chances on whether the recommendations had jeopardized access to affordable mammograms. Sen. Barbara Mikulski, D-Md., said she would introduce an amendment that would limit the costs of the breast cancer tests for women 40 and older.

"Otherwise, insurance companies may use this new recommendation as yet another reason to deny women coverage for mammograms," Mikulski said.

That was unlikely, the White House said.

"Under health insurance reform, recommendations like these cannot be used to dictate coverage," said presidential spokesman Reid Cherlin.

The guidelines themselves stress that they're general recommendations for routine screening, not a replacement for the one-on-one health advice that women with various risk factors for breast or cervical cancer get from their doctors in choosing how often to get a Pap or mammogram.

"So, what does this mean if you are a woman in your 40s? You should talk to your doctor and make an informed decision about whether a mammography is right for you based on your family history, general health and personal values," said Dr. Diana Petitti, vice chair of the task force that made the mammogram recommendations.

Still, the new guidelines generated enough confusion and raised enough questions to force proponents of the health care overhaul on the defensive.

Health and Human Services Secretary Kathleen Sebelius has said the mammogram recommendation "does not determine what services are covered by the federal government."

Senate Finance Committee Chairman Max Baucus said the Senate health care bill he authored "doesn't do one single thing to change current law related to the way coverage decisions are made."

"Those decisions will be based only on science and thorough review, just as they are today," said Baucus, D-Mont. "Research comparing the effectiveness of different treatments for different patients cannot be used for rationing care."

"We're not rationing anything," said Rep. Lynn Woolsey, D-Calif. "It's a decision between a woman and her doctors."

The specter of the government making deeply personal medical decisions for millions of Americans — in this case, women — has been propelled in part by the Republican drive to stymie the Democratic bill.

The legislation would require most people to buy health insurance, and the House version would create a government plan that would compete with those offered by private insurers.

This week's recommendations from two different groups called for less-frequent cancer tests for women.

On Monday, a government-appointed but independent panel of doctors and scientists said women generally should begin routine mammograms in their 50s, rather than their 40s.

Then on Friday, the American College of Obstetricians and Gynecologists said that most women in their 20s can have a Pap test every two years — instead of annually — to catch slow-growing cervical cancer.

Neither the task force, which provides advice to government officials who may or may not act on it, nor the ACOG set federal policy. The ACOG's recommendations are aimed at its own members.

The Democratic bill would set up an independent institute to conduct studies. It would not authorize the health secretary to deny coverage solely based on the institute's research.

There are other safeguards. All states except Utah make insurers cover mammograms, and 20 states require coverage that starts at age 40, according to 2007 data compiled by the Washington-based National Women's Law Center.

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Associated Press writers Stephanie Nano in New York and Lauran Neergaard in Washington contributed to this report.

Moderate Dems pivotal in Saturday health care vote

Sat, 21 Nov 2009 03:44:37 +0100

WASHINGTON (AP) — Suitably opaque, Section 2006 takes up only a few dozen lines in a sweeping health care bill that runs to 2,074 pages and mentions neither Sen. Mary Landrieu nor her state of Louisiana.

But the section's purpose is indisputable: to deliver $100 million or more in federal funds to the state. And in the process clear the way for one of three moderate Democratic fence-sitters — Ben Nelson of Nebraska and Blanche Lincoln of Arkansas are the others — to help propel the legislation past its initial hurdle in a crucial Saturday vote.

Nelson, Landrieu and Lincoln emerged several days ago as the last public holdouts among 58 Democrats and two independents whose votes Majority Leader Harry Reid and the White House must have to overcome the Republicans' attempt to strangle the bill before serious debate can begin.

Each has moved carefully with an eye on home-state voters. And inside the Senate, each has taken advantage of the political leverage newly available.

Alone among the three, Nelson issued a statement Friday ending any lingering public suspense about his intentions. "The Senate should start trying to fix a health care system that costs too much and delivers too little for Nebraskans," he said, adding his decision should not be seen as an indication of how he will vote on the legislation itself.

Nelson had been publicly signaling his intentions for more than a week, and his words presumably came as no surprise to Reid or the White House, which issued a statement Friday saying the bill "provides the necessary health reforms that the administration seeks."

This sort of political minuet can be delicate, as shown when the Senate's second-ranking Democrat, Dick Durbin of Illinois, said earlier on Friday that Lincoln had already confided to Reid how she planned to vote.

Republicans, eager to scuttle the bill — and defeat Lincoln in 2010 — instantly accused the two-term senator of telling Democratic party leaders before informing her own constituents in Arkansas.

"No other senator speaks for Senator Lincoln. She is still reviewing the bill," declared the senator's spokeswoman, Leah Vest DiPietro, adding her boss had not yet made up her mind. For his part, Durbin sought to quickly close the loop with a statement saying he had been unclear and misinterpreted.

As for Nelson, several officials, speaking on condition of anonymity, said he had insisted Reid omit from the bill any change in the insurance industry's protection from federal antitrust law. The House version of the legislation would expose the industry to scrutiny by both the Justice Department's antitrust lawyers and the Federal Trade Commission.

Reid, who spoke out strongly in favor of the change in antitrust treatment earlier in the fall, left it out of the bill he drafted over several weeks and unveiled on Wednesday.

Lincoln has been the most close-mouthed about her intention. As a committee chairman, she is the most powerful of the group. As the only one of the three seeking re-election next year, she is also the most politically vulnerable.

In public, she has asked that the bill be available for 72 hours before the vote occurs. In private, her demands have been more substantive, according to officials who did not describe them.

She is virtually certain to be criticized no matter what her vote. After the House cleared its version of the legislation this month, a conservative group began airing commercials criticizing Rep. Vic Snyder, D-Ark., for voting in its favor. At the same time, MoveOn.org, a liberal organization, slammed another one of the state's lawmakers, Rep. Mike Ross, for opposing it.

A hint: At home, Lincoln has suggested her vote will be influenced by former President Bill Clinton, who was Arkansas governor for 12 years before winning the White House.

Clinton recently met privately with Senate Democrats, telling them that passing an imperfect bill was better than nothing. "We don't ever go to Washington with the idea that we're going to create a work of art," Lincoln said afterward. "It's got to be a work in progress."

She and the other moderates face pressure from business groups opposed to the legislation. In a statement Friday the Business Roundtable, which represents big company CEOs, said the Senate bill "will not effect the needed changes to measurably improve the American health care system." Democrats and the White House had seized on a report by the same group last week concluding that some of the provisions under consideration by Congress had the potential to tame runaway medical inflation.

Of the three centrists, Landrieu has been the clearest about her intentions, and her interests ranged beyond health insurance to the oysters for which Louisiana is famous. When the Food and Drug Administration proposed banning sales of raw oysters from the Gulf of Mexico during warm weather months, Landrieu and others objected.

A week ago, the agency thought better of the idea and shelved the plan in favor of further study. "I'm really thankful that they listened," said Landrieu, who had met with FDA Commissioner Margaret Hamburg to discuss the issue.

Over recent weeks, Landrieu has issued a string of statements outlining the areas she wanted addressed for the benefit of her constituents — issues that could be dealt with only after health legislation made it to the Senate floor.

After meeting with Reid almost a month ago, she mentioned the "unique challenges Louisiana is facing in terms of Medicaid."

In a Senate speech and statement, she noted that Louisiana has the highest breast cancer death rate in the country and the lowest female life expectancy of any state. And she said, "Unless something is done, annual health care costs for small firms over the next 10 years are expected to more than double to reach $339 billion in 2018."

Landrieu can point to provisions in the legislation that are designed to attack all three problems.

They include Section 2006.

Reading it is of little assistance. "Special adjustment to FMAP Determination for Certain States recovering from a Major Disaster" is the title, and about two pages of similarly indecipherable legalese follows.

According to the Congressional Budget Office, it will send an additional $100 million to Louisiana to help it cover costs for Medicaid, the federal-state health care program for the poor.

Should Landrieu decide to side with Republicans this weekend, she would also be voting to deny her state those funds.

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Associated Press writer Andrew DeMillo in Little Rock, Ark., contributed to this story.

Giants LB Pierce out indefinitely with neck injury

Sat, 21 Nov 2009 02:39:00 +0100

EAST RUTHERFORD, N.J. (AP) — New York Giants linebacker Antonio Pierce is out indefinitely after an MRI exam on Friday surprisingly revealed a bulging disk in his neck.

The Giants said their defensive captain underwent the test in New York and was examined by team physician Dr. Russell Warren and Dr. Frank Camissa, chief of the spinal surgical services at the Hospital for Special Surgery.

The 31-year-old Pierce originally sustained a burner when the Giants played Arizona on Oct. 25. He had very little discomfort until practice this week, when the club's medical staff scheduled the MRI exam.

"I'm shocked with what I heard from the doctors this afternoon," Pierce said in a statement released by the Giants. "I had no idea that what happened a few weeks ago could keep me off the field. I didn't think it was that serious.

"I'm going to do everything the doctors tell me to do so I can get back out on the field as soon as possible."

The Giants (5-4) will host Atlanta on Sunday. New York, coming off its bye week, has lost four straight games.

Pierce, in his ninth NFL year and fifth with the Giants, has 55 tackles one sack, and one forced fumble in nine games this season. He was looking forward to trying to help New York snap its losing streak on Sunday against the Falcons (5-4).

"This game means a lot to us," Pierce said earlier Friday. "For one, we need a win to get out of this four-game slump and, two, it will help us in the playoff hunt. We are tied for one of the wild card spots and you always want to win the head-to-head battles."

Pierce played in 15 games last season after appearing in all 16 contests each of the previous two seasons. He has led the Giants in tackles for the last three seasons and missed only four regular-season games since leaving the Washington Redskins to join the Giants.

He spent much of the past year in the spotlight after helping former teammate Plaxico Burress when the wide receiver accidentally shot himself in the thigh in a New York nightclub.

Pierce drove Burress to the hospital and then took the gun that Burress used back to his home in New Jersey, later arranging to get it back to the wounded receiver's home. Pierce testified before a grand jury, which declined to indict him for his role in the incident.

Fired therapist: Stressed Marines get shoddy care

Fri, 20 Nov 2009 22:59:11 +0100

CAMP LEJEUNE, N.C. (AP) — Marines treated at Camp Lejeune for post-traumatic stress had to undergo therapy for months in temporary trailers where they could hear bomb blasts, machine-gun fire and war cries through the thin walls, according to servicemen and their former psychiatrist.

The eight trailers were used for nearly two years, until a permanent clinic was completed in September in another location on the base, said a Camp Lejeune medical spokesman, Navy Lt. j.g. Mark Jean-Pierre.

The noise from training exercises "shook me up real bad. I couldn't take it. I almost ran out of there a couple of times," said a Marine patient who spoke on condition of anonymity because he is not authorized to talk to the media. "My mind couldn't focus on the treatment. I couldn't tell the difference between the combat zone and the non-combat zone."

The allegations became public after the dismissal of Dr. Kernan Manion, a civilian psychiatrist who says he was fired for writing memos to his military superiors complaining of shoddy care of Marines returning from Iraq and Afghanistan with PTSD, a condition that can make patients jumpy, fearful of loud noises and prone to flashbacks.

"These guys are saying, 'I'm fried and I can't get out,'" Manion said in an interview. Referring to the Fort Hood shooting rampage in which an Army psychiatrist who counseled PTSD victims allegedly killed 13 people earlier this month, he said: "Is there potential for another blowup? Yes, indeed."

In e-mails shown to The Associated Press, Manion complained, among other things, that the military was not dealing with PTSD properly and that the trailers were infested with bugs and noisy.

"Given that PTSD is the most frequent diagnostic group we see, one would question the sense of locating a clinic in such close proximity to the booming of bombs that shake the trailer, the ratta-tat-tat of machine gun fire and the almost daily occurrence of grunts yelling war cries," Manion wrote.

In an interview with AP, Manion said the military should have rented a building off base.

Manion was fired in September after working for eight months for a company that has a contract with the military to provide mental health care on the North Carolina base. He said that when he asked the contractor why he was being fired, he was told it was ordered by the Navy.

Tom Greene, a regional manager with the contractor, Spectrum Healthcare Resources, said in an e-mail statement to the doctor that Manion "did not meet the government's requirements in accordance with the contract." Greene offered no specifics and did not respond to e-mails seeking further comment.

The inspector general for the Navy's Bureau of Medicine is reviewing the allegations of inadequate care, a military official said Friday on condition of anonymity because he was not authorized to speak about it.

Jean-Pierre said artillery fire can be heard nearly everywhere on the 240-square-mile base, which has 80 live-fire ranges.

In an e-mail, the spokesman said: "We are confident that our medical services are of the highest quality." He would not comment directly on why Manion was fired, but said that civilian doctors have to adapt to the "rapid evaluation and short-term treatment" that the military offers.

Three of Manion's patients told the AP that being so close to the sounds of gunfire made it hard to concentrate and made them jumpy and nervous. The patients, who spoke on condition of anonymity because they are not authorized to speak to media, said they were making progress and were shocked when Manion was fired. All three patients said they trusted Manion after months of treatment and now found it hard to get help from other doctors.

Manion, 59, has 25 years of experience as a psychiatrist with a specialty in traumatic brain injury, or TBI.

He told the AP his Marine patients told him they were ostracized and sometimes punished by superiors for seeking treatment. He said one unit at the base made all of its soldiers suffering from PTSD sit in a room and read infantry manuals.

"How do we help a guy make sense of all that and heal from that when the Marine Corps is saying to get treatment means you're weak?" Manion said.

In an April memo to his superiors, Manion described episodes in which one Marine punched a telephone pole and another slugged a table in Manion's office. Manion said the clinic had no procedures for committing outburst-prone Marines for more intensive psychiatric care, and no safeguards for protecting therapists from violence.

Rep. Walter Jones, a North Carolina Republican whose district includes Lejeune, wrote to Defense Secretary Robert Gates about the situation.

"At this point, I only have one side of the story. However, based on the number of cases reaching my desk involving PTSD and TBI I am absolutely convinced there are serious problems with how mental health care is being delivered in my district," the congressman wrote in a Nov. 16 letter.

A Washington Post expose in 2007 on shabby treatment of soldiers at Washington's Walter Reed Medical Center led to a shake-up in which three top-ranking military officials, including the secretary of the Army, were ousted.

Manion said his patients have been traumatized by seeing friends killed and living for months under constant stress. When they come home, Manion said, they often have trouble sleeping, abuse alcohol and become anti-social.

Manion said that on June 24, a supervisor for the contractor warned him to stop sending e-mails to his superiors. But Manion said the problems continued and he filed a complaint about safety and quality of care to the inspector general of the Navy. Manion also wrote to President Barack Obama.

He said he was fired two days later and escorted from his office by an armed MP in full view of his incredulous patients.

Jones, who met earlier this week with Manion in Washington, said: "From listening to him and reading the letter he wrote to the president, I feel that he is a caring and true professional that wants to help those who have PTSD or other type of mental wounds. If we're going to call on these soldiers and Marines and their families to keep going on these deployments, we better be prepared to help them when they come back."

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Associated Press writer Pauline Jelinek in Washington contributed to this report.

Tamiflu-resistant swine flu cluster reported in NC

Fri, 20 Nov 2009 22:18:34 +0100

ATLANTA (AP) — Four North Carolina patients at a single hospital tested positive for a type of swine flu that is resistant to Tamiflu, health officials said Friday.

The cases reported at Duke University Medical Center over six weeks make up the biggest cluster seen so far in the U.S.

Tamiflu — made by Switzerland's Roche Group — is one of two flu medicines that help against swine flu, and health officials have been closely watching for signs that the virus is mutating, making the drugs ineffective.

More than 50 resistant cases have been reported in the world since April, including 21 in the U.S. Almost all in the U.S. were isolated, said officials with the U.S. Centers for Disease Control and Prevention.

The BBC reported another cluster of five Tamiflu-resistant cases this week in Wales, in the United Kingdom.

The CDC has sent three disease investigators to North Carolina to help in the investigation there, said Dave Daigle, a CDC spokesman. CDC testing confirmed the Tamiflu-resistant cases.

All four cases at the hospital were very ill patients in an isolated cancer unit on the hospital's ninth floor, and it is believed they all caught the flu while at the hospital, said Dr. Daniel Sexton, professor of medicine and director of the Duke Infection Control Outreach Network.

Three of the four patients died and one is recovering, he said. Flu seems to have been a factor in each death, but they were very sick so it was hard to say that it was the primary cause, he added.

North Carolina health officials did not disclose details about the four patients, other than that three of them — including the survivor — were women and their flu illnesses occurred last month and this month.

The first patient had been given Tamiflu before becoming ill with the virus, as a preventive measure. The three others were given Tamiflu after developing flu symptoms, Sexton said.

The case is under investigation, but hospital officials said they have no evidence the cases represent a hospital-wide concern.

The North Carolina cluster is unusual, but "at this time we don't have any information that should raise concerns for the general population," said Dr. Alicia Frye, epidemiologist in the CDC's flu division, in a prepared statement.

The only other reported U.S. instance of Tamiflu-resistant swine flu spreading from one person to another occurred about four months ago at a summer camp in western North Carolina, where two teenage girls — cabin mates — were diagnosed with the same drug-resistant strain. Health officials said at the time that the virus may have spread from one girl to the other, or it's possible that the girls got it from another camper.

Why did both Tamiflu-resistant clusters occur in North Carolina? It could be coincidence, or perhaps North Carolina's disease surveillance is unusually good, said Megan Davies, the state's epidemiologist.

Overall, CDC officials said Friday that swine flu cases appear to be declining throughout most of the U.S., with reports of swine flu illnesses widespread in 43 states last week, down from 46 the week before.

CDC officials also said reports have been increasing in a few states, including Maine and Hawaii. They said it's hard to know whether the epidemic has peaked or not.

Thanksgiving and the holidays may not help matters, said Dr. Anne Schuchat, who heads the CDC's National Center for Immunization and Respiratory Diseases.

"All the kids get together with their grandparents and there's a lot of exchange of warmth and love, but a little exchange of viruses, too," she said.

Swine flu has sickened an estimated 22 million Americans, hospitalized about 98,000 and killed 4,000 since it was first identified last April. It has proved to be similar to seasonal flu but a much bigger threat to children and young adults.

Also on Friday, CDC officials said they are aware of a new report from Norway of a distinct form of swine flu seen in three patients that seems to have an unusual ability to settle deep into the lungs and therefore could potentially be more dangerous.

The Norway report isn't the first time that particular mutation has been seen: About 15 others have been reported around the world, including four in the United States. Some cases proved fatal, but others caused only mild illnesses, CDC officials said.

The swine flu vaccine and antiviral drugs like Tamiflu and Relenza all seem to work well against it, CDC officials also said.

Reid health bill helps chiropractors, drugmakers

Fri, 20 Nov 2009 21:37:59 +0100

WASHINGTON (AP) — Chiropractors get a lift in the Senate health care bill, thanks to a senator from the state practitioners consider the birthplace of their profession — Iowa.

Search the fine print of the bill unveiled this week by Senate Majority Leader Harry Reid, D-Nev., and you'll find scores of provisions making winners out of some interest groups and losers of others, from makers of costly biological drugs to insurance company executives.

It's not surprising considering the $1 trillion, 10-year price tag of the 2,074-page legislation.

Chiropractors, sometimes criticized as unscientific by medical doctors, could join health teams designed to help primary care physicians coordinate the treatment of patients. Though the precise financial impact is unclear, the language would help steer more patients to a profession whose participation in many federal programs is limited, including Medicare, Medicaid and the medical systems for veterans, the military and civil servants.

"It's important because it just further legitimizes the services that are delivered by a chiropractor, and recognizes they are well received by the patient public," said John Falardeau, lobbyist for the American Chiropractic Association.

The language was approved earlier this year by the Senate health committee. Falardeau said that panel's chairman, Sen. Tom Harkin, D-Iowa, was largely responsible for getting it included by Reid, who wrote the final Senate bill behind closed doors. The lobbyist said numerous chiropractors and their patients contacted Harkin and other senators to push for the language.

"I like to call Iowa the Cooperstown of chiropractic," said Falardeau, alluding to the site of Baseball's Hall of Fame. He noted that Iowa is where the discipline began and is home to the Palmer College of Chiropractic, where many practitioners are trained.

Less fortunate were well-paid officials of health insurance companies. Reid included language Sen. Blanche Lincoln, D-Ark., got into the Senate Finance Committee version of the bill. The wording eliminates companies' tax deductions for the portion of insurance executives' pay that exceeds $500,000.

Lincoln faces a difficult re-election campaign next year, and is among a handful of moderate Democratic senators who have not said whether they will support Reid's bill. Health insurance companies have been repeatedly vilified by President Barack Obama and congressional Democrats, and axing an industry tax break could have populist appeal.

Robert Zirkelbach, spokesman for America's Health Insurance Plans, the industry's trade group, said his group has done no lobbying on the provision.

In the latest round of a bitter struggle over the country's $46 billion market for biological drugs, the Senate bill extends the protection some brand-name manufacturers would get from generic competitors.

The drugs, made from living cells, are a growing part of the pharmaceutical market. Benefiting from a well-financed lobbying campaign and influential supporters, the manufacturers won language in the Senate health committee bill — and in the House-passed health overhaul legislation — giving them 12 years of protection from generic competitors.

Reid's bill would add another six months of protection for drugmakers who also test those products for use by children. Generic companies want to be able to compete immediately.

Kathleen Jaeger, president of the Generic Pharmaceutical Association, said Reid's decision represents "a total hijack" by drug manufacturers that she said will keep consumers' costs higher for a longer time. Ken Johnson, a senior vice president for the Pharmaceutical Research and Manufacturers of America, said drugmakers pursued the issue with senators and that the extra six months of protection gives companies an incentive to make products for children.

The bill also has language prohibiting the government from discriminating against health care providers that refuse to provide services for assisted suicides.

Similar provisions were included in earlier versions by Sens. Tom Coburn, R-Okla., and Orrin Hatch, R-Utah. The legal status of the practice is murky in much of the country, with Oregon and Washington the only states with voter-approved assisted suicide laws and a court case pending in Montana.

Reid's bill also allows Medicaid coverage for babies delivered in the roughly 300 birth centers that operate outside hospitals around the country, mostly for low-income women or those in remote areas.

Guidelines for cancer screening differ by group

Fri, 20 Nov 2009 21:24:57 +0100

Several doctors groups and advocacy groups set guidelines for cancer screening, and they update that advice periodically as new information emerges. Sometimes they agree, sometimes they don't. Last year, a number of groups got together and issued consensus guidelines for colon cancer.

The U.S. Preventive Services Task Force, a government-appointed, independent panel of doctors and scientists, also makes recommendations looked to by doctors groups, insurers and policy makers.

The latest advice from the major medical groups for routine screening — primarily for people who don't have a family history of a particular cancer or other risk factors:

Breast cancer:

— American Cancer Society: Mammograms yearly beginning at age 40; breast exam by doctor at least every three years in 20s and 30s, annually after 40; breast self-exam an option.

— American College of Obstetricians and Gynecologists: Mammograms every 1-2 years for women in their 40s; annual mammograms age 50 and older; breast exam by a doctor annually from age 19; breast self-exam can be recommended.

— U.S. Preventive Services Task Force: Mammograms every two years for women ages 50 to 74, after 75 the risks and benefits unknown; recommends against self-exam; value of exams by doctors unknown.

Cervical cancer:

— Cancer Society: Start Pap tests about three years after first intercourse but no later than 21; annually or every 2-3 years for women over 30 who have three normal tests; stop at 70 after at least three negative tests and no abnormal tests in last 10 years; discontinue after a total hysterectomy.

— ACOG: Start Pap tests at age 21 and then every two years; 30 years and older, every three years after three normal tests; reasonable to stop at age 65 or 70; discontinue after hysterectomy.

— Task Force: Start Pap tests within three years of sexual activity or by age 21; at least every three years, stop after 65 if negative tests and no high risk; discontinue after hysterectomy.

Prostate cancer:

— Cancer Society: No routine testing recommended; doctors should discuss benefits and limitations, and offer screening — a physical exam and blood test for a substance called PSA — to men beginning at age 50, with at least a 10-year life expectancy.

— Task Force: No recommendation for or against screening for men under 75; men over 75 should not be screened.

— American Urological Association: Men 40 and older should be offered a baseline PSA test and exam.

Colon cancer:

— Cancer Society and other major groups: Start screening at 50 with one of these tests: colonoscopy every 10 years; a sigmoidoscopy of the lower colon every five years; CT colonography or "virtual colonoscopy" every five years; barium enema every five years, stool blood test annually; stool DNA test, no interval given.

— Task force: Screen from age 50 to 75 with one of three tests: colonoscopy every 10 years; a sigmoidoscopy every five years, combined with a stool blood test every three years; a stool blood test every year.

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On the Net:

Task Force: http://www.ahrq.gov/CLINIC/uspstfix.htm

Cancer Society: http://tinyurl.com/screening-guidelines

Military experiment seeks to predict PTSD

Fri, 20 Nov 2009 19:50:14 +0100

TWENTYNINE PALMS, Calif. (AP) — Two days before shipping off to war, Marine Pfc. Jesse Sheets sat inside a trailer in the Mojave Desert, his gaze fixed on a computer that flashed a rhythmic pulse of contrasting images.

Smiling kids embracing a soldier. A dog sniffing blood oozing from a corpse. Movie star Cameron Diaz posing sideways in a midriff top. Troops cowering for safety during an ambush.

A doctor tracked his stress levels and counted the number of times he blinked. Electrode wires dangled from his left eye and right pinky finger.

Sheets is part of a military experiment to try to predict who's most at risk for post-traumatic stress disorder. Understanding underlying triggers might help reduce the burden of those who return psychologically wounded — if they can get early help.

PTSD is a crippling condition that can emerge after a terrifying event — car accident, sexual assault, terrorist attack or combat. It's thought to affect as many as one in five veterans returning from Afghanistan and Iraq.

Military doctors have been mystified as to why certain warfighters exposed to bombings and bloodshed develop paralyzing stress symptoms while others who witness the same trauma shake it off.

Studies on veterans and civilians point to some clues. Childhood abuse, history of mental illness and severity of trauma seem to raise a person's risk. Having a social net and a coping strategy appear to offer some protection.

However, none of the factors explored so far are reliable predictors.

"Right now, we can't determine with certainty who will and who won't develop PTSD," said Paula Schnurr, deputy executive director of the Department of Veterans Affairs' National Center for Posttraumatic Stress Disorder. "Perhaps with better measures, we can get closer."

Earlier this year, a quarterly publication from the national PTSD center found that studies to date have looked at only "a narrow band of the potential risk and resilience predictors" and that more work beyond surveys was needed.

New PTSD studies are using technology to try to get at the answer. Select Marine and Army units are undergoing a battery of physical and mental tests before deployment including genetic testing, brain imaging and stress exams. They are followed in war zones and upon return.

There's an urgency to detect early signs. Since the 2001 terrorist attacks, more than 1.8 million U.S. troops have fought in Afghanistan or Iraq. The Obama administration is weighing whether to increase forces in Afghanistan where violence has escalated in recent months.

Previously called shell shock, combat fatigue and post-Vietnam syndrome, PTSD was officially recognized as a mental disorder in 1980. Sufferers experience flashbacks, nightmares, sudden outbursts and social withdrawal and are sometimes haunted years after the trauma.

The ongoing wars have given scientists fresh opportunities to follow service members.

One autumn morning, a throng of Marines squeezed into a trailer at the Marine Corps Air Ground Combat Center in Southern California before deploying to Afghanistan. They belonged to the 3rd Battalion, 4th Marine Regiment — nicknamed the "Thundering Third."

"We're doing this not to make you better prepared to go do what you have to do in Afghanistan. We're not doing this to make your health any better," said Dr. William Nash, a retired Navy psychiatrist and study co-investigator. "We're doing this so that we can learn more about how to protect Marines from stress injuries like PSTD."

Nash asked how many have heard of PTSD. A half dozen raised their hands.

Who wants PTSD? "Right, nobody," he answered rhetorically.

The trailer soon buzzed like a factory, with Marines rotating from one test station to another in an assembly line. They donated blood, urine and saliva samples so researchers can search for genetic biomarkers that might play a role.

Groundbreaking research published last year on adult survivors of child abuse suggests that specific variations of a gene increased their chances of developing PTSD. Scientists believe there may be many other gene variants that contribute to PTSD risk.

Marines also underwent a blink test to gauge their startle response and neuropsychological screening. They filled out questionnaires and were interviewed by psychiatrists with a checklist to diagnose PTSD.

The work is funded by the Marine Corps, Veterans Affairs and Navy Medicine. Last year, about 1,000 Marines were recruited before leaving for Iraq.

This latest batch of 673 Marines who were tested during a two-week period in the fall headed to Afghanistan where they're sure to see more intense fighting. They will be followed up in the field by Navy corpsmen with special "stress first-aid" training to read early signals.

Researchers recently did six-month follow-up testing on some Marines who returned from Iraq. It will take time to analyze the results, said the study's lead investigator, Dr. Dewleen Baker of the VA San Diego Healthcare System.

Cmdr. Bryan Schumacher, the 1st Marine Division's top doctor, said the purpose of studying PTSD triggers is not to bar someone from service. If it turns out that something can be done to prevent it, those vulnerable could get special training to reduce their risk, he said.

Similar research is ongoing 1,300 miles away at the University of Texas at Austin where scientists have collected detailed health data from 178 soldiers from nearby Fort Hood who recently came back from Iraq. The base was the scene of a massacre on Nov. 5 when an Army psychiatrist opened fire, killing 13 people and wounding dozens more.

The shooting has not affected the research, which enrolled first-time deployed soldiers. Unlike the Marines, the soldiers filled out monthly questionnaires online while in combat that tracked their experiences such as whether they saw a roadside bomb go off or knew of a wounded buddy.

Before deployment, soldiers submitted a DNA sample, had an MRI scan of their brain and inhaled carbon dioxide as part of a stress reaction test.

Early results suggest soldiers who reacted more strongly to the CO2 test and who were exposed to more stress in the field showed greater PTSD symptoms, said chief researcher Michael Telch, of UT Austin's Laboratory for the Study of Anxiety Disorders.

The decision to volunteer in the Marine experiment was personal for Lance Cpl. Jaecob Kyllo. His grandfather fought in Korea and Vietnam and two uncles served in Operation Desert Storm. They spoke less afterward and would get irritated easily.

Kyllo said his uncles were diagnosed with PTSD and suspects his grandfather had it too.

"I've seen it before and it's not the most pleasant thing," said the 20-year-old from Seattle, who previously served in Iraq.

Melvin Carter, a 27-year-old Marine sergeant who had done three tours in Iraq, noticed buddies who were once laid-back turn angry after coming home. The Oakland, Calif., native copes with stress by laughing and cracking jokes.

Navy corpsman Benjamin Reinhardt was recently trained to look for signs of PTSD in 20 Marines attached to a mortar platoon. He likened his job to a school nurse. Marines confide in him about their innermost struggles. He thinks he can spot when someone is not himself.

"I tend to be reasonably observant with people's personalities. I can see changes," said the 21-year-old from upstate New York.

He added: "I hope none of us become PTSD casualties."

Sheets, a 22-year-old private first class from Newark, Del., has never seen combat before. Before joining the Marines, Sheets dabbled with college and was working a dead-end job hauling trash.

He enlisted after being inspired by a sermon from his pastor. While in infantry school, he met a sergeant who suffered from PTSD. He's not exactly sure what it is, but has heard horror stories.

"A guy comes home from war and he's freaking out. He's beating his wife. He's drinking. He's doing everything he can. He'll go off and he'll hate the Marine Corps," Sheets said. "And it's just like, OK, is that going to be me when I come home?"

Tamiflu-resistant swine flu cluster reported in NC

Fri, 20 Nov 2009 19:32:02 +0100

ATLANTA (AP) — Health officials say four people in North Carolina have tested positive for a type of swine flu that's resistant to the drug Tamiflu.

It's the first cluster of that many cases seen in the U.S.

Health officials said Friday the four cases were reported at Duke University Medical Center in Durham over the past six weeks.

Tamiflu is one of two medicines that help against swine flu. Health officials have been closely watching for signs that the virus is mutating, making the drugs ineffective.

About 52 resistant cases have been reported in the world since April, including 15 in the U.S. so far. Officials with the U.S. Centers for Disease Control and Prevention say almost all the U.S. cases have been isolated.

(This version CORRECTS name of hospital to Duke University Medical Center)

Report: 20-somethings can go 2 years between Paps

Fri, 20 Nov 2009 18:27:57 +0100

WASHINGTON (AP) — First mammograms. Now — in an apparent coincidence — Pap smears.

New guidelines by the American College of Obstetricians and Gynecologists say most women in their 20s can have a Pap smear every two years instead of annually to catch slow-growing cervical cancer.

The change comes amid a separate debate over when regular mammograms to detect breast cancer should begin, in the 40s or the 50s. The timing of the Pap guidelines is coincidence, said ACOG, which began reviewing its recommendations in late 2007 and published the update Friday in the journal Obstetrics & Gynecology.

While the two sets of recommendations are unrelated, they come at a time of intense debate over health-care reform. Mammograms in particular have drawn broad attention in Congress, reflecting a more than decade-long debate in the cancer community about how best to perform mammograms.

Republicans sought to connect the mammogram recommendations to the health-care overhaul, contending that such findings are the way that medical rationing starts.

Under the pending legislation, "nothing would prohibit the federal government from deciding if tests, treatments and procedures are too expensive, and therefore, unnecessary," Sens. Jon Kyl of Arizona, the Republican Whip, and Tom Coburn of Oklahoma, a physician, said in a joint statement.

But the Pap guidelines promise to be far less controversial as doctors for years have been told to perform fewer Paps among many women over 30, to cut back on unneeded care for the least at risk — and there's growing understanding that over-treating younger women is an issue, too.

"The tradition of doing a Pap test every year has not been supported by recent scientific evidence," said Dr. Alan Waxman of the University of New Mexico, who headed ACOG's review.

The guidelines also say:

—Routine Paps should start at age 21. Previously, ACOG had urged a first Pap either within three years of first sexual intercourse or at age 21.

—Women 30 and older should wait three years between Paps once they've had three consecutive clear tests. Other national guidelines have long recommended the three-year interval; ACOG had previously backed a two- to three-year wait.

—Higher-risk women, such as those with HIV, other immune-weakening conditions or previous cervical abnormalities, need more frequent screening.

Paps can spot pre-cancerous changes in the cervix in time to prevent invasive cancer, and widespread use has halved cervical cancer rates in the U.S. in recent decades. About 11,270 new cases will be diagnosed this year, and about 4,070 women will die from it, according to American Cancer Society estimates. Half of women diagnosed with cervical cancer have never had a Pap, and another 10 percent haven't had one in five years.

Cervical cancer is caused by certain strains of the extremely common sexually transmitted virus called HPV, for human papillomavirus. There is a new HPV vaccine that should cut cervical cancer in the future; ACOG's guidelines say for now vaccinated women should follow the same Pap guidelines as the unvaccinated.

But the updated guidelines reflect better understanding of HPV. Infection is high among sexually active teens and young adults. Women's bodies very often fight off an HPV infection on their own without lasting harm, although it can take a year or two. The younger the woman, the more likely that HPV is going to be transient.

Moreover, ACOG cited studies showing no increased risk of cancer developing in women in their 20s if they extended Pap screening from every year to every two years.

As for adolescents, ACOG said cervical cancer in teens is rare — one or two cases per million 15- to 19-year-olds — while HPV-caused cervical abnormalities usually go away on their own. Treating them unnecessarily increases the girls' risk of premature labor years later, and preterm birth is a growing national problem.

Health care issues: Bundling payments

Fri, 20 Nov 2009 15:26:25 +0100

A look at key issues in the health care debate:

THE ISSUE: What can the government do to get doctors and hospitals to deliver cheaper medical services?

THE POLITICS: Medicare's fee-for-service structure means that doctors, hospitals and other providers have a greater financial incentive to provide large quantities of medical services than to provide high-quality medical services. Democrats and the Obama administration want to change that, and use the savings to help pay for their health overhaul legislation and bring down medical costs over the long term. One strategy they've eyed is called "bundling." That's where a range of services — for example a hospital stay and post-discharge care — are grouped together for a single reimbursement, instead of being reimbursed separately. This could give hospitals, doctors and other providers an incentive to provide more efficient care and reduce unnecessary hospital readmissions, since they won't get paid for doing more. But doctors and hospitals have concerns about how any such program would be implemented, since it could mean lower payments to them.

WHAT IT MEANS: The Congressional Budget Office has estimated that the federal government could save nearly $19 billion over 10 years by giving hospitals a single bundled payment covering a hospital stay and any health care service initiated within 30 days of a patient's discharge. President Barack Obama sought savings near that level in his initial list of proposed Medicare cuts meant to pay for a 10-year health care overhaul bill. But after concerns raised by hospitals and others, Congress and the White House appear to be settling for weaker measures like demonstration projects that won't yield cost savings anytime soon.

— Erica Werner

Cost of child vaccines fall, more kids saved

Fri, 20 Nov 2009 15:25:14 +0100

HANOI, Vietnam (AP) — Babies squirmed and wailed as needles plunged into their chubby thighs at a public health clinic on the outskirts of Hanoi on Friday. Like little ones everywhere, the reaction to the sting was never pretty.

Starting next year an extra 6.3 million children worldwide will have the chance to feel that pinch and get vaccinated against some of the world's deadliest illnesses, according to the GAVI Alliance, a global vaccine partnership that helped organize the Hanoi event.

The funding will come from a drop in the price of the one-shot vaccine that safeguards against five infectious diseases to below $3 a dose, nearly 50 cents cheaper than this year, the alliance said.

It has been able to negotiate cheaper vaccine prices through competition created by rising demand for the shots. About half of the vaccines purchased by the alliance were produced in developing countries such as India.

"We know that immunization will start children having healthy lives," former Irish President Mary Robinson, board chair of the alliance, said as she watched the babies being immunized in Hanoi's Tan Hong Commune Heath Center. "We also know that, unfortunately, in the world there are ... children who don't get any vaccines so they die early. It is tragic because we can prevent it."

As a result of not receiving routine vaccinations, about 2 million children die annually.

The pentavalent vaccine protects against diphtheria, tetanus, pertussis, pneumonia, hepatitis B and Hib, which causes meningitis and pneumonia.

The GAVI Alliance, with partners ranging from U.N. agencies to the Bill & Melinda Gates Foundation, has vaccinated about 256 million poor children since 2000.

The Gates Foundation was created in 2000 by the Microsoft chairman and his wife.

AP IMPACT: Gripes about swine flu vaccine abound

Fri, 20 Nov 2009 14:51:40 +0100

ATLANTA (AP) — When the nation's swine flu vaccination program began in early October, health officials predicted it was going to be "messy." They were right.

The program has been plagued with problems and information gaps:

—Health officials have been terrible at predicting when and how much vaccine would be available. Only about 44 million doses have been shipped so far. Initially, officials said more than three times that would be out by now.

—At times vaccine shipments have been inexplicably lopsided. For example, smaller counties in Illinois and California have received the same amount delivered to counties with seven times as many people.

—Health officials have stressed that people most at risk for swine flu complications should go to the head of the line, but they haven't tried to make sure that actually happened.

—And despite pledges that they would be transparent about the vaccine program, some health officials have refused to disclose where all the doses are going, and they have held back on public service announcements telling people who should be coming in for shots. Also, many states were slow to establish Web sites that give vaccination locations.

To be fair, health officials say, the government deserves credit for a herculean effort to develop and distribute a safe and effective vaccine against a deadly virus that was first identified only seven months ago.

"You have a brand-new disease that gets identified in April. By October, you have a vaccine for it. By any standards, it's a miracle," said Dr. Diane Helentjaris, director of the Virginia Department of Health office handling swine flu response.

But complaints have been mounting, with lawmakers this week holding hearings in Washington and elsewhere, pressing for explanations.

"Calls are still coming in to me about, 'Why can't I get the vaccine?'" said Andrea Stillman, a Connecticut state senator speaking at a Wednesday hearing in Hartford.

She noted reports of uneven distribution within her state, and of places where vulnerable patients can't get the vaccine. "Obviously we're very frustrated in southeastern Connecticut," she said.

People are frustrated everywhere, said Sen. Susan Collins, R-Maine. At a hearing in Washington on Tuesday, she complained of "layers of misinformation and miscommunication."

Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics, said health officials should have done more to make sure limited doses get to the people most at danger from the virus. And he said they should have been tougher on nurses and other health-care workers who are putting their patients at risk because they declined to get a shot.

"It is not working right at all," Caplan said.

In their defense, officials at the U.S. Centers for Disease Control and Prevention have said that the main issue is insufficient vaccine from manufacturers — something CDC can't control — and that health authorities are doing the best they can. Officials say all their predictions have been based on what manufacturers told them, and that every step of the way they've warned the public that the flu and the flu vaccine manufacturing process are hard to predict.

"A lot of this is a function of not having as much vaccine as we would like to have," said Dr. Anne Schuchat, who heads the agency's immunization section.

The new swine flu, also called 2009 H1N1, has not turned out to be the deadly global disaster that experts have long feared. But it has sickened an estimated 22 million Americans, hospitalized about 98,000 and killed 4,000. It has proved to be similar to seasonal flu but a much bigger threat to children and young adults.

There was no vaccine to protect against the new virus, so manufacturers had to create a new one. In July, a government health official estimated 120 million vaccine doses would be available by late October. Later, the government backed away from that estimate when manufacturers couldn't crank out vaccine so rapidly.

The CDC has been coordinating the vaccine campaign, but it is not fully in charge. As a matter of tradition and law, states have had more public health authority than the federal government. Each state health department has made decisions about which clinics, doctor's offices and other sites get vaccine from a federally contracted distributor.

"It's a little bit of a messy process and we expect it to be somewhat bumpy in the first few weeks," CDC Director Dr. Tom Frieden said in early October.

The bumps lasted more than a few weeks.

Health officials seem to have a poor idea of how many doses to expect. Two weeks ago, they predicted 8 million doses in the following seven days; it turned out to be 5 million — largely because a tropical storm nearly derailed some deliveries.

Blown delivery promises have had ripple effects at the state and local level. In Alaska, deliveries have lagged significantly, and other states report similar experiences. "We've learned to not put too much faith" in any extended vaccine supply estimates, said South Dakota Health Secretary Doneen Hollingsworth.

Demand has far exceeded supply in many places, and hundreds and even thousands people have waited hours in line. Many have been turned away when the vaccine ran out or the clinic hours ended.

One Delaware pediatrician, Dr. David Epstein, said patients were "banging on the door" for swine flu vaccine, and at some moments he felt like a United Nations relief worker in a refugee camp. "Everybody is desperate for it," said Epstein, who ordered 2,300 doses but had received only 300 as of last week.

Supply problems have forced states to make hard decisions about where to send the doses and which patients should get it.

Tennessee kicked off its campaign by targeting health-care workers, and many rejected the offer. Georgia emphasized getting initial doses to pediatricians and clinics that serve children. Minnesota randomly sent vaccine to clinics across the state as it became available, and then let the providers decide which patients should get it first.

"We haven't tried to micromanage the administration of the vaccine," said Buddy Ferguson, a spokesman for the Minnesota Department of Health.

Authorities made few attempts to police the crowds to make sure priority groups — like pregnant women, young people and those with certain health problems — got vaccine first.

There were inequities, too.

According to Illinois newspaper reports, tiny Kendall County got enough doses to cover nearly 20 percent of its residents, while Will County — with nearly seven times as many people — got just enough for 2 percent.

In California, Santa Cruz County at one point got nearly 30,000 doses, while Santa Clara County — again, with nearly seven times as many people — got less than half as much, local media reported.

In New York, Buffalo schools wanted to start vaccine clinics but hadn't received a single dose. School officials there were irate to learn New York City schools had begun vaccinating hundreds of thousands of students.

"How could the city of Buffalo, which contains the second-largest school district in New York State, not have been designated by your office to receive a proportional share of vaccine supply?" Buffalo schools Associate Superintendent Will Keresztes wrote Nov. 5 to the state health department.

Some inequities were corrected as more vaccine became available. But suspicions that money or politics played a role in some places were fed by news two weeks ago that Wall Street giants Goldman Sachs and Citigroup received swine flu vaccine for some employees.

Also contributing to public mistrust are health officials themselves. CDC officials have stressed repeatedly that they are striving to be transparent. They have held frequent news conferences and given updates on vaccine availability and the disease's toll.

But the CDC has refused to release information about where all the publicly financed vaccine has been going. The agency punted the question to states, but some states have been tightlipped, too.

If swine flu had turned out to be deadlier, the delays and communication problems might have been catastrophic. Now, cases are declining across much of the country.

Indeed, health officials are now beginning to worry that demand for the vaccine may wane, just as vaccine is becoming more plentiful, just as states are perfecting Web sites that help people locate providers, just as new efforts are under way to encourage more health workers to get vaccinated.

Federal health officials say they expect to start running a public service campaign about the shots shortly.

___

Associated Press writers Carla K. Johnson in Chicago; Zinie Chen Sampson in Richmond, Va.; Kristin Hill in Nashville, Tenn.; Susan Haigh in Hartford, Conn.; Carolyn Thompson in Buffalo, N.Y.; Randall Chase in Dover, Del.; Wayne Ortman in Sioux Falls, S.D.; Rachel D'Oro in Anchorage, Alaska; and Steve Karnowski in Minneapolis contributed to this report.

Ky. universities expand smoking, tobacco bans

Fri, 20 Nov 2009 13:10:05 +0100

LEXINGTON, Ky. (AP) — Kentucky's flagship public university gave the official heave-ho to tobacco on Thursday, touting the health benefits of a smoke-free policy covering all of its sprawling campus in the heart of burley tobacco country.

The tobacco ban at the University of Kentucky includes outdoor areas and applies to chew, pipes, cigars and snuff as well as cigarettes. Kentucky leads the nation in the production of burley tobacco, and has some of the nation's highest smoking rates.

"Going tobacco-free may not be the easiest thing to do, it may not be the most politically popular thing to do, but in my mind it's the right thing to do for this campus," UK President Lee Todd said in trumpeting the strict anti-tobacco policy.

Not far behind in the tobacco crackdown is the University of Louisville, which started restricting smoking Thursday to limited areas on its Belknap and Shelby campuses.

The goal is to make the university totally smoke-free in a year from now.

Pikeville College also announced Thursday it plans for its campus to be tobacco-free by next fall.

In Lexington, some UK students welcomed the tobacco prohibition.

"It'll be nice walking to class and not having to walk in a cloud of smoke," nonsmoker Kelly Stilz, a senior, said while eating a quick breakfast on campus.

Sophomore Matt Danter, also a nonsmoker, harbored no strong feelings about the policy, but said "it seems a little contradictory" given Kentucky's heritage as a tobacco producer.

Danter said he has friends on campus who smoke and don't like the policy. He said he expects to see plenty of scofflaws on campus.

"If there's a will, there's a way," he said.

The university is stressing treatment, not punishment, for people caught using tobacco on campus. Citations will not be given to violators, and the school will steer them toward treatment. However, UK employees who are flagrant violators could ultimately be fired, and flagrant student violators could face dismissal from school, said Ellen Hahn, a UK nursing professor who played a leading role in implementing the policy.

"We would not expect that," she said, predicting that people will comply.

But the goal is to help them kick their tobacco habits. To help accomplish that, the university will make nicotine replacement products available at no cost for up to 12 weeks for students, faculty and staff enrolled in UK-sponsored tobacco treatment programs, she said.

Those not ready to give up tobacco but wanting to get through the day without a cigarette or a pinch of snuff can get the replacement products at deep discounts on campus, she said.

"We know it's going to take time," said Anthany Beatty, UK's assistant vice president for campus services. "Nicotine is a powerfully addictive substance, and folks just can't drop the habit."

Kent Ratajeski, a lecturer in UK's Department of Earth and Environmental Sciences, said the tobacco-free policy went too far, encroaching on the freedom of students.

"I think the university is telling them how to live their lives," he said.

UK has prohibited smoking inside and within 20 feet of buildings since 2006.

Tim Bricker, chairman of pediatrics for the Kentucky Children's Hospital, said he understood the tobacco-free policy will be inconvenient for some on campus. But if the ban improves overall health and entices some people to stop smoking, then it's "really worth it," he said.

Kentucky has the nation's highest rate of lung cancer and is third in adult smoking rates, according to the state Department for Public Health.

"Our young people are being targeted by the tobacco companies, and have been for years," said Hahn, who played a key role in implementing the policy. "This policy really is an investment in our young people and in our state."

Even with the ban, UK still has strong ties to tobacco.

Specialists in its College of Agriculture offer production advice to tobacco growers, and UK is home to a research center seeking new commercial uses for tobacco, including pharmaceuticals.

Scott Smith, dean of UK's College of Agriculture, said the university still grows tobacco on its farms as part of research to assist growers and the tobacco industry.

"Tobacco remains an important crop to many Kentucky farms," he said.

Elsewhere, the University of Louisville kicked off its policy Thursday to ban smoking almost everywhere on its campuses. Rather than asking employees and students to quit cold turkey, however, U of L began a phaseout of smoking, with designated smoking areas set up on its Belknap and Shelby campuses. The school will gradually phase out those smoking areas, with the goal of making its campuses totally smoke-free by November 2010.

U of L's Health Sciences campus has been smoke-free since 2004.

"As a university committed to our students, faculty and staff, we are emphasizing the health benefits of not smoking," said U of L Provost Shirley Willihnganz.

San Francisco's health care a model during debate

Fri, 20 Nov 2009 09:45:50 +0100

SAN FRANCISCO (AP) — This city did not wait for Washington's health care overhaul. Most uninsured adults here are already reaping the benefits of a government-run health care program — seeing doctors, filling prescriptions, and getting surgeries they could not otherwise afford.

Healthy San Francisco is the nation's first city-run universal health care plan. While not insurance and not valid outside the city, it does illustrate how some hotly debated elements of plans being considered on Capitol Hill might play out.

In just over two years, the $126 million program has won over its target population, and now covers about 48,000 people — more than two-thirds of San Franciscans who previously had no insurance.

About $20 million a year comes from employers who are required to contribute to their workers' health care. The mandate is a contentious aspect of the Democratic plan, and the most controversial aspect of San Francisco's plan.

The program's challenges — including a suit from the city's restaurant association over the employer mandate — may be an indication of the land mines ahead for legislators crafting a new framework for the nation's health care.

But according to those most directly affected, patients and doctors, the plan works.

"It makes me feel safer to know I have somewhere to go, especially if I get really sick," said Juan Martin, 26, a line cook who showed up at the South of Market Health Care Center feeling nauseous and dizzy.

Martin first tried the program last year, when he needed surgery after boxes collapsed on him at work. It was all covered, he said: the hospital stay, the follow-up visits.

Providing health care to people like Martin is a moral and legal obligation, said Mayor Gavin Newsom, who was behind the plan.

"We're doing this for pragmatic reasons," said Newsom. "I don't know why one would spend more money on the back end, when the patient ends up in the emergency room, rather than stabilizing them on the front end."

Healthy San Francisco assigns patients a home-base clinic, where they get to know their doctors. It provides preventive exams such as mammograms and colonoscopies, and long-term care for chronic conditions such as diabetes.

Surgeries are handled at San Francisco General Hospital, or three private hospitals which, along with Kaiser Permanente, have joined this private-public partnership.

As in Massachusetts, which also offers universal coverage, no one is denied services because of pre-existing conditions or ability to pay.

A recent survey by the nonpartisan Kaiser Family Foundation found 63 percent of users were "very satisfied" with the program, and another 31 percent were "somewhat satisfied."

Communities around the country are paying attention. San Francisco's health department has provided technical assistance to other cities, including New Orleans, Miami, Pittsburgh and Denver, where officials wanted to learn if the program would work for them.

President Barack Obama and House Speaker Nancy Pelosi, who pushed for the passage of the House's landmark health care reform legislation, have pointed to Healthy San Francisco as a model.

"All this fear you hear around those words, 'public option,' said Peter Berman, the clinic's medical director. "What we're seeing here is working."

Anyone can join as long as they show proof of residency, meet income requirements, have been uninsured for at least three months, and do not qualify for state or federal public insurance programs.

For the approximately 70 percent of Healthy San Francisco users who earn less than the federal poverty level, the program is free.

Participants at the highest income level allowed into the program — those making up to $54,180, or five times the federal poverty level — pay $450 every three months, plus copays of $10 for general care and $20 for specialty care. Hospital stays cost $200.

"What San Francisco proved is that if it is affordable, people will overwhelmingly join," said Mitch Katz, the city's public health director.

Businesses can meet the requirement helping fund their workers' health care coverage by getting insurance, paying into Healthy San Francisco, or putting money aside in a health savings account. To many entrepreneurs, the demand looks like a tax on businesses that are already required to pay sick days and a city minimum wage that is $2.54 more per hour than the federal wage.

"I'm paying triple for a waiter than anyone else," said Daniel Scherotter, owner and chef of Palio D'Asti, an Italian restaurant in San Francisco's financial district.

Scherotter has always offered to split the cost of insurance with the employees who want it — but many in his young work force chose to do without. The escalating cost of doing business has forced him to let workers go over the years, and Healthy San Francisco pushed him to cut costs further, he said.

"We used to make our own bread, our own gelato, our own sausage and salami and chocolate truffles — all skilled labor that we've had to outsource," he said.

The Golden Gate Restaurant Association sued the city, saying the requirement placed an undue burden on them. They petitioned the U.S. Supreme Court for a hearing.

While business contributions are significant — $1.85 per hour worked for employers with more than 100 workers — research found this has not translated into layoffs, said William Dow, a health economics researcher with the University of California, Berkeley.

Costs of the program were kept low by relying on providers that already cared for the uninsured, paying doctors a salary instead of fees for service provided, and creating a tracking system that avoids duplication of tests.

Even after a national overhaul, many — the homeless, undocumented immigrants, the severely mentally ill — will likely remain uninsured and needing care. How to care for those who fall through the system may be Healthy San Francisco's greatest contribution to the national debate.

"Will it be done in a systematic, more effective way, or will it be done the old way, which is so wasteful?" Katz asked.

Free clinics tied to health care debate

Fri, 20 Nov 2009 09:42:23 +0100

LITTLE ROCK, Ark. (AP) — A nonprofit group's campaign to hold free medical clinics for the uninsured in three states is turning into a not-so-subtle jab at moderate Democrats to support their party's efforts to reform health care.

More than 800 people have signed up for free care Saturday at a downtown convention center in Little Rock at an event organized by the National Association of Free Clinics — the Virginia-based association's second free event in the past month under a campaign promoted by MSNBC's Keith Olbermann.

More than 1,000 people showed up at the first, in New Orleans on Nov. 14, and a two-day free clinic is planned in Kansas City, Mo. Dec. 9-10.

Olbermann urged his viewers last month to contribute to the association, saying he wanted mass clinics in the states of the "six senators key to defeating a filibuster against health care reform in the Senate." Since then, more than $1.7 million has been contributed to the group for the clinics.

Olbermann has been targeting Democrats from those states who are seen as crucial to passing Democratic-led health care reform legislation spear-headed by Majority Leader Harry Reid. The Senate is expected to begin debating the legislation, which would include a government-run insurance option, Saturday night.

"I want Sens. (Blanche) Lincoln and (Mark) Pryor to see what health care poverty is really like in Little Rock," Olbermann said on his show last month.

The New Orleans clinic was aimed partly at Sen. Mary Landrieu, a Democrat who has not said how she plans to vote on health care reform, while the Kansas clinic was chosen because it symbolized the need for health care in the Midwest, said Rich Stockwell, senior producer for "Countdown with Keith Olbermann."

"We hear the 46 million in this country without insurance over and over, but those people go largely unseen to most of us. By bringing them all to one place, or a very small percentage, on one day is showing, 'hey, you guys in Washington, you need to get something done to help those people," Stockwell said.

Lincoln, who faces a tough re-election battle next year, has not said whether she supports the legislation, but does say she opposes a so-called public option. She has not said if she would support moving legislation forward for debate, but asserts that a larger overhaul of the nation's health care is needed.

"This one-day clinic is a blessing, but it is not a sustainable way to deliver health care for the thousands of uninsured and underinsured Arkansans," Lincoln said in a statement released by her office.

Pryor said this week he was still undecided on Reid's proposal but that he supports moving the legislation to the Senate for debate.

The campaign has found an advocate in Arkansas Lt. Gov. Bill Halter, a Democrat who has said he is raising money for a re-election bid. He has not said if he is considering running against Lincoln.

Halter helped the association secure space at the Statehouse Convention Center for the free clinic and connected the group with an Arkansas team of health care providers, nonprofit associations and government offices to prepare for the free clinic.

Billing the clinic as a nonpolitical event, volunteers have been told that no petitions, buttons or handouts regarding health care reform will be allowed at the clinic.

"What we're focused on is providing health care to as many Arkansans as we can," Halter said.

Nicole Lamoureux, the association's executive director, credited Olbermann and talk show host Dr. Mehmet Oz with helping raise awareness.

"Anytime someone is talking about the 1,200 free clinics in the United States of America who this year will see 8 million patients with 6 million volunteers and little to no state or federal funding at all is a good thing," Lamoureux said. "Mr. Olbermann and Dr. Oz talking about this cause has just elevated the awareness of the average American about what's going on."

___

On the Net:

National Association of Free Clinics: http://www.freeclinics.us/

House moves to protect doctors from Medicare cuts

Fri, 20 Nov 2009 03:51:10 +0100

WASHINGTON (AP) — The Democratic-controlled House voted Thursday to add more than $200 billion to the deficit to prevent steep Medicare payment cuts to doctors, a move Republicans denounced as a political payoff.

The measure, approved on a near party-line vote of 243 to 183, is a top priority for the American Medical Association. The GOP contended that Democrats supported the bill to thank the doctors group for backing President Barack Obama's health care overhaul.

"This is nothing more than a repayment to the American Medical Association for endorsing the larger health care bill that was on the floor several weeks ago," said Rep. Joe Barton, R-Texas.

"This is not a question of payoff to anybody," retorted Majority Leader Steny Hoyer, D-Md. "It's the right thing to do."

Characterizing the measure as "an important step forward," the president lauded the legislators "for taking action to protect the care and physician choice that Medicare beneficiaries and TRICARE (military) patients have earned" in a statement issued by the White House late Thursday.

Doctors are facing a 21 percent reduction in Medicare reimbursement rates in January unless Congress acts first, the result of a flawed funding-formula that lawmakers have had to step in nearly annually to block in recent years.

The bill passed Thursday attempts a permanent fix by restructuring the payments to factor in how much doctors spend on various services, among other changes.

Past votes on the issue have been largely bipartisan, but this year the doctor payment issue has become a proxy for the larger health overhaul debate. Only one Republican voted "yes" Thursday, Rep. Michael Burgess of Texas, an obstetrician. Eleven Democrats voted "no."

Despite intense lobbying by the AMA, the doctor payment legislation failed in the Senate last month in an embarrassing defeat, with moderate Democrats concerned about the deficit joining Republicans to bring it down. That leaves its future uncertain even though the rate cuts loom in less than two months.

AMA president Dr. James Rohack called on the Senate to act, saying the legislation is "an essential element of comprehensive health reform."

Rohack also dismissed GOP arguments that Democrats were paying off the AMA. "This is about patients — not partisan politics — and we are disappointed in those who are trying to make it a partisan issue," he said in a statement. AARP also supports the physician payment measure, fearing seniors could lose their doctors if the cuts take effect.

The Obama administration has sought a permanent solution to avoid the uncertainty of one-year payment patches, and House Democrats obliged by including it in their 10-year health overhaul bill.

But before passing the overhaul bill earlier this month they took out the doctor payment measure, in part to keep the cost of the overall bill low enough to meet Obama's target price tag. Democratic Rep. Pete Stark of California acknowledged as much during Thursday's debate.

"The reason it was separated, I would have to admit, was purely political," Stark said. "We had to abide by the president's request that we not exceed certain costs."

Although House Democrats have vowed not to pass legislation that's not paid for, the doctor payment bill is one of several items they've exempted from that rule, and the Congressional Budget Office says it would increase the deficit by $210 billion over 10 years. Republicans devoted much of Thursday's debate to complaining about that, but Democrats said it was Republicans' fault for setting up the problematic payment formula in the first place.

As a salve to Democratic fiscal hawks upset that the bill adds so much to the deficit, party leaders added a so-called pay-as-you-go provision aimed at making sure future tax cuts or increases in benefit programs are "paid for" with spending cuts or tax increases elsewhere.

Unlike existing pay-go rules, which have been routinely waived, the pay-go measure would be set in law and be enforced with across-the-board spending cuts to several federal benefit programs, including Medicare and farm subsidies.

House Speaker Nancy Pelosi, D-Calif., insists the new pay-go law be in effect as a condition of using deficit dollars to pass the Medicare payment fix and a variety of expiring tax cuts. The Senate hasn't acted on another pay-go bill passed this summer.

___

Associated Press writer Andrew Taylor contributed to this report.

US survey shows southern counties most obese

Fri, 20 Nov 2009 02:31:08 +0100

ATLANTA (AP) — The first county-by-county survey of obesity reflects past studies that show the rate of obesity is highest in the Southeast and Appalachia. High rates of obesity and diabetes were reported in more than 80 percent of counties in the Appalachian region that includes Kentucky, Tennessee and West Virginia, according to the new research from the U.S. Centers for Disease Control and Prevention.

The same problem was seen in about 75 percent of counties in Alabama, Mississippi, Louisiana, Georgia and South Carolina.

The five counties with the highest rates were Greene and Dallas counties in Alabama and Holmes, Humphreys and Jefferson counties in Mississippi. All are small, rural counties in the west central areas of each state, and each reported obesity rates of around 44 or 43 percent. The national adult obesity rate is roughly 26 percent.

The statistics are estimates for the year 2007 — based on surveys, census figures and other information for that and other years — and include a margin of error. The obesity rates in many counties were about the same, so it's difficult to say any county or counties was clearly the single most obese county, CDC officials said.

The CDC also released Thursday county-specific data for diabetes — Type 2 is closely tied to obesity. Counties with the lowest rates of both obesity and diabetes were out west — Boulder County, Colo., Santa Fe County, N.M., and Summit County, Utah, were at the top of each list.

Just under 13 percent of people in those counties were obese, and only about 4 percent reported diabetes, the CDC found.

There are a range of possible explanations for counties in the South and Appalachia have the highest rates of obesity and diabetes, experts said. A culture that embraces fatty, unhealthy foods and shuns exercise may be one. Genetics may be another. Income and education probably have a lot to do with it, too — people living in poor communities may not have the money to eat healthier, more expensive foods or may not have access to gyms or safe jogging trails, they said.

The Alabama counties at the top of the list are low-income, mostly African-American communities that probably ended up high on the list because the estimates assumed higher rates of obesity and diabetes in counties with those demographics, said Dr. Jim McVay, director of the health promotion and chronic disease for the Alabama Department of Public Health.

"I can't say that those are accurate," he said of the CDC estimates.

Some experts said they hope the county estimates will highlight the problem and persuade local officials to focus more attention on combating the problems.

"In the end, it comes down to those that have to direct resources at the local level," said Dr. Miriam Vos, assistant professor of pediatrics at Atlanta's Emory School of Medicine. "It's not something that can change as easily at the federal level."

McVay said local efforts are important, but ultimately obesity comes down to individual behavior and trying to change that. "How do you influence people to make lifestyle changes? That's the question," he said.

The study was published in the CDC's Morbidity and Mortality Weekly Report.

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On the Net:

CDC: http://www.cdc.gov/mmwr

The Botax? Nip/tuck levy to help health care plan

Fri, 20 Nov 2009 01:01:56 +0100

WASHINGTON (AP) — They call it the "Botax."

The White House and Senate Democrats have turned to a proposal to tax breast implants, tummy tucks, wrinkle-smoothing injections and other procedures as they search for ways to pay for costly health care overhaul plans.

Vanity was an easy target as lawmakers scraped for cash for the nearly $1 trillion plan to expand health care to millions of Americans who lack insurance. But it's no joke to the drug makers and people who perform the cosmetic nips and tucks. And they're fighting back.

Skin-smoothing Botox injections could be hard-hit. There were some 4.7 million last year and an average cost per visit of about $400, some including several injections.

"It is a random hit on an easy target that is only punitive and not corrective," said Caroline Van Hove, a spokeswoman for Allergan Inc., the maker of Botox Cosmetic. "The bottom line is that taxing cosmetic procedures is unnecessarily punitive on people who have merely decided to enhance their appearance."

At issue is a proposal in the 10-year, nearly $1 trillion health care draft unveiled by Senate Majority Leader Harry Reid, D-Nev., that would slap a 5 percent excise tax on elective cosmetic surgeries and procedures. The plan, projected to raise $6 billion, wouldn't apply to surgery to fix a deformity or injury, but would include procedures such as face lifts, liposuction, cosmetic implants or teeth-whitening.

The plastic surgeons may have seemed like an appealing bunch to pick on given that they had already been skeptical of the Democrats' overhaul proposal. But they say it will be a blow to countless American women — of every income level.

"The common misconception is that this is going to tax wealthy, suburban Republican women," said Dr. Phil Haeck of Seattle, Wash., the president-elect of the American Society of Plastic Surgeons. In fact, he said, of the 86 percent of cosmetic surgery patients who are female, 60 percent of them have incomes between $30,000 and $90,000.

In addition, he said the tax would be especially hurtful in tough economic times that have prompted many newly jobless women to look for ways to make themselves more marketable to prospective employers. He said, "They're competing with people 10 to 15 years younger than them and they want to look better."

The emergence of the tax in the latest Senate health legislation shows what can happen when an industry or company that's in Congress' cross-hairs isn't vigilant enough.

Dr. Daniel Russo, the Birmingham, Ala., plastic surgeon who heads the American Academy of Facial Plastic and Reconstructive Surgery, said his group first heard of the cosmetic procedure tax idea over the summer. But after being assured by several lawmakers and senior congressional aides that it was not being seriously considered, the group opted not to engage in a major lobbying battle against it, he said.

"On multiple fronts, we were assured that this was not something that any one of the senators or representatives wanted to pursue. This is something that we did not foresee," Russo said in an interview.

"We feel it's unfair to those people who've saved hard-earned moneys to have something to improve their appearance, and now may not even be able to afford it," he said.

His group isn't registered to lobby, although the American Society of Plastic Surgeons reported spending nearly $400,000 this year trying to influence Congress. The society, which has two in-house lobbyists, didn't list a plastic surgery tax among its legislative priorities in disclosures filed on Capitol Hill.

Haeck, president-elect of the society, said industry players whose products would be affected took the lead lobbying against it.

Allergan's shares were down more than 2 percent Thursday after news of the tax broke. The company, which recently projected net product sales for this year of more than $4 billion, expects the injectible wrinkle-smoothing medicine to rake in $1.3 billion in 2009. It has spent $1.4 million lobbying Congress on health care issues this year.

But Medical device and pharmaceutical giant Johnson & Johnson, a maker of breast implants, saw its shares inch up. The company has spent more than $3 million lobbying Congress this year on a wide range of issues, many related to the health overhaul. It was a major player in a successful fight by the medical device industry to get lawmakers to cut in half a proposed $40 billion tax on their products.

Lobbyists and aides familiar with the proposed 5 percent cosmetic surgery tax said Allergan and Johnson & Johnson along with others in the industry helped persuade lawmakers to slash it from a 10 percent levy, which had been projected to cost about $11 billion over a decade.

Accounts vary on who first dreamed up the Botax. It came out of a late-July meeting on health care that included Sen. Max Baucus, D-Mont., the Finance Committee chairman, and Peter Orszag, Obama's budget director, although neither man's staff acknowledges having hatched the scheme.

In the end, Reid revived it simply because "we needed money to make the bill work," his spokesman Jim Manley said.

Now that it's in the Senate legislation, plastic surgeons and the cosmetic product industry are dusting off their arguments against it. Opponents cite as a cautionary tale a similar 6 percent tax in effect in New Jersey. Haeck contends that tax has cost the state $3.39 for every $1 collected.

Whatever money would be raised, he said, would come from doctors and patients at a time they can ill-afford it, given the recession and rising unemployment.

"These women come in, they've lost their jobs, they don't have the money for a facelift," he said.

UC regents vote to reopen troubled LA hospital

Thu, 19 Nov 2009 23:35:01 +0100

LOS ANGELES (AP) — California's public university system on Thursday agreed to fully reopen a troubled South Los Angeles hospital that was partially closed in 2007 after deadly lapses in care.

The Regents of the University of California unanimously approved the plan to provide doctors and residents for Martin Luther King Jr. hospital. Los Angeles County will foot the $353 million bill to expand and fully reopen the facility in 2012.

The reopening will restore emergency and inpatient services to the estimated 600,000 people in the area. The hospital continued offering outpatient services after the partial closure.

Under the plan, a private nonprofit group would hold the hospital's license, have its own independent governing board and operate the facility under a lease agreement with the county.

The hospital, formerly known as King-Harbor and, before that, King-Drew, was built in the wake of the 1965 Watts riots to serve one of the poorest neighborhoods in Los Angeles. The area is plagued by broad inequities in care for its mostly low-income, minority population.

In recent years, state and federal inspectors repeatedly discovered failures in care at the facility. Two years ago, a woman with a perforated bowel was ignored and died after writhing on a waiting room floor for nearly an hour.

The county tried to improve patient care, disciplining workers, reorganizing management, closing the trauma unit and reducing the number of inpatient beds — all without success.

Since the closure, local hospitals have been flooded with the estimated 50,000 patients a year who used to visit King's emergency room, making more acute an existing shortage in emergency care in south Los Angeles.

Before the emergency room closed, the hospital frequently received victims of shootings and stabbings — wounds that can be deadly if immediate treatment isn't available.

The university system already runs former county hospitals at its Irvine, San Diego and Davis campuses. The University of California Los Angeles is responsible for academic oversight of residency programs at two county hospitals, Harbor-UCLA and Olive View-UCLA. At San Francisco General Hospital Medical Center, all the physicians are members of the UCSF faculty.

Gov. Arnold Schwarzenegger praised the decision to reopen the hospital, saying it allows critical medical services that will address "significant need for the people of South Los Angeles."

Outside King's one-time emergency room Thursday, Compton resident Samaria Manzanares, 52, said she was relieved to hear the hospital would expand services.

"Health isn't for rich people only," said Manzanares. In Compton, Watts and the surrounding areas, she said, "most people are poor, and we have to help not only Latinos, but the other immigrants and workers to be strong."

Anatomy drawings owned by Ben Franklin on display

Thu, 19 Nov 2009 22:22:51 +0100

PHILADELPHIA (AP) — Centuries before X-rays, CAT scans and ultrasounds gave doctors a view inside the human body, the best images medical students often had were illustrations drawn by artists of bodies in a morgue.

The country's oldest hospital has unveiled a new exhibit of rare 18th-century anatomical illustrations, once owned by Benjamin Franklin, that provide a glimpse of how early physicians learned their craft.

The 16 pastel-on-paper drawings were cutting edge in their day. They show highly detailed and colored human figures flayed open to show internal organs, bones and muscles of male and female subjects. The female illustrations include a woman carrying a near-term fetus, indicating that both likely died at childbirth.

"For medical students of the time, this may have been the first time they were seeing what the inside of the body looked like," Stacey Peeples, the 258-year-old hospital's archivist, said Thursday. "Books were very expensive, and it could be difficult to get bodies."

Franklin founded Pennsylvania Hospital in 1751. The illustrations were a gift to him in 1762 from his friend Dr. John Fothergill, a prominent London physician and fellow Quaker. They became part of the hospital's medical education curriculum.

Thursday was the first time the illustrations have been on public view, Peeples said. They are normally kept in storage to protect them but will be on display at Pennsylvania Hospital's medical library until December 2010.

Dutch artist Jan Van Rhysdyk, then regarded as one of Europe's most gifted medical illustrators, created the drawings. He wanted to devote his efforts to portraiture but produced anatomical art because it paid the bills, Peeples said.

"He did it begrudgingly, but he was incredibly talented," Peeples said.

The subjects were generally prostitutes, criminals and others of low social stature whose bodies would go unclaimed at the morgue. Other people, then as now, weren't typically eager to donate their bodies to science.

"There were religious and sentimental issues about the body, about what some people saw as desecration of the body," Peeples said. "So this is how medical students learned."

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On the Net:

Pennsylvania Hospital www.uphs.upenn.edu/paharc

HealthPort postpones initial public offering

Thu, 19 Nov 2009 21:47:55 +0100

ALPHARETTA, Ga. (AP) — HealthPort Inc., a health care information technology company, said Thursday it is postponing its planned initial public offering due to market conditions.

The Alpharetta, Ga.-based company did not elaborate further on what triggered the move, nor how long the postponement might last.

HealthPort disclosed details of the IPO plans in an Oct. 21 regulatory filing. On Monday the company said it planned to complete the IPO this week, selling as many as 6.9 million shares for $14 to $16 each.

The latest filing said funds from the offering would be used to redeem senior preferred stock and repay debt. After the IPO is complete, 56 percent of HealthPort shares would be owned by Abry Partners LLC, a private equity firm.

HealthPort handles requests for and delivery of patient information to attorneys, insurance companies and government agencies. It says its services can save time and money for physician practices and hospitals and let them reduce staffing.

The company does business with about 1,900 hospitals and health systems and 8,000 physician clinics.

Last year, the company reported a loss of $49.8 million on revenue of $188.2 million.

Experts say radical measures won't stop swine flu

Thu, 19 Nov 2009 16:25:42 +0100

LONDON (AP) — Health experts say extraordinary measures against swine flu — most notably quarantines imposed by China, where entire planeloads of passengers were isolated if one traveler had symptoms — have failed to contain the disease.

Despite initially declaring success, Beijing now acknowledges its swine flu outbreak is much larger than official numbers show.

China's official count of nearly 70,000 reported illnesses with 53 deaths is dwarfed by estimates of millions of cases with nearly 4,000 deaths in the United States, a nation with about a third of China's population.

Dr. Michael O'Leary, WHO's top representative in China, says there has been a dramatic spike in Chinese swine flu cases recently and those reported by the government are only "minimum numbers."

"We have new cases occurring all the time," he told The Associated Press last week. "There's always more deaths than we could possibly know about."

He said there is little data to prove interventions like mass quarantines and school closures slow down disease transmission. "To draw a causal link ... is not always possible," O'Leary said, adding that WHO expected a disease as contagious as swine flu to spread regardless of what measures countries impose.

China's Health Minister Chen Zhu defended his country's aggressive quarantine policy, telling the AP on Wednesday that the measures helped slow the spread of the virus long enough for China to develop a vaccine, which authorities are now scrambling to administer.

"With initial efforts of containment, actually we not only reduced the impact of the first wave to China, but we also won time for us to prepare the vaccine," Chen said in an interview on the sidelines of a meeting of the Global Forum for Health Research in Havana.

He said China was vaccinating 1.5 million people a day against swine flu as part of a massive effort to try to reach as many as 90 million people — about 7 percent of the country's population — by the end of the year.

"We know this is not enough for a population of 1.3 billion, but at least for the vulnerable people, for the students, people with underlying basic diseases and ... for pregnant women, we have vaccines," Chen said.

On Thursday, Dr. Zhong Nanshan, director of Guangzhou's Institute of Respiratory Diseases, said in a local newspaper he believed government officials were covering up swine flu deaths to appear as though their handling of the epidemic had been successful.

"I totally don't believe the current number of swine flu deaths that have been reported in the country," Zhong said in Guangzhou Daily. He was one of the doctors who openly challenged China's 2003 cover-up of its outbreak of Severe Acute Respiratory Syndrome.

China has acknowledged swine flu is now widespread despite its aggressive attempts at containment.

Earlier this month, Feng Zijian, head of China's Center for Disease Control and Prevention, said the country's reported figures are only "a very small portion" of the total number of cases.

He said China is now focusing on confirming severe cases and no longer tests every person with a fever for swine flu. He said the official figures were based on cases confirmed in outbreaks or at monitoring sites like hospitals.

Other nations that have carried out draconian swine flu policies indicate they have little effect in containing the disease.

Ukraine, which reported more than 250,000 suspected cases last week, closed all schools and universities, and advised people not to travel and to stay away from public places. In Mongolia, all bus travel has been suspended and gatherings of more than 40 people have been banned. Still, both countries are now facing major swine flu outbreaks.

Argentina, Singapore, Malaysia and Egypt have also enacted radical swine flu prevention measures — and all have been gripped by widespread outbreaks.

When WHO declared swine flu to be a pandemic in June, it described the virus as "unstoppable." It advised countries not to close their borders or impose mass quarantines, warning such measures would be useless since people often spread flu viruses before developing any symptoms.

China is no exception, scientists say.

"China did not keep the virus out. They failed," said Dr. Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.

He said he believes the actual number of swine flu cases is "far in excess of what China is reporting," based on the center's own network of official and unofficial sources in the country.

Some experts say the relatively small size of China's reported outbreak is suspicious given that neighboring regions are battling huge epidemics. Last week, WHO said Mongolia, which borders China, was reporting its health system was being crushed by swine flu cases.

In Hong Kong, a city of 7 million on China's southern coastline, authorities have reported 40 swine flu deaths, compared to the 53 reported in China.

"The issue in China has to do with surveillance," said Sandra Mounier-Jack, a flu expert at the London School of Hygiene and Tropical Medicine. Because swine flu symptoms are so vague, many cases are being missed in China, as they are everywhere, she said.

WHO and the U.S. Centers for Disease Control and Prevention gave up counting swine flu cases months ago when the virus became widespread.

Past disease outbreaks also give experts reason to question China's numbers. In 2003, China covered up an epidemic of Severe Acute Respiratory Syndrome, which ultimately killed about 800 people when it spread worldwide.

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Associated Press writers Will Weissert in Havana; Cara Anna, Christopher Bodeen and Gillian Wong in Beijing, and Medical Writer Margie Mason in Hanoi contributed to this report.

Task force doctor stands by mammogram advice

Thu, 19 Nov 2009 13:52:27 +0100

WASHINGTON (AP) — A member of the independent panel whose new mammogram recommendations have led to confusion defended the task force's report, saying Thursday that it was based on the most up-to-date, accurate information available.

Dr. Timothy Wilt, a member of the U.S. Preventive Services Task Force, stuck by its recommendation that most women don't need mammograms in their 40s and should get one every two years starting at 50. The American Cancer Society's long-standing position has been that women should get annual cancer-screening mammograms starting at age 40.

The panel's recommendations "were based on the most rigorous peer review of up-to-date, accurate information about the evidence about the harms and benefits of treatment," Wilt said on ABC's "Good Morning America."

On Wednesday, Health and Human Services Secretary Kathleen Sebelius tried to ease the furor that has erupted since the panel issued its recommendations Monday. She said the task force does "not set federal policy and they don't determine what services are covered by the federal government." She advised women to "keep doing what you've been doing for years — talk to your doctor about your individual history, ask questions, and make the decision that is right for you."

Wilt did not take issue with Sebelius' statement. "Our recommendations support an individualized decision-making process," he said, and each woman still needs to talk with her doctor to make the most informed decision.

The recommendations from the task force have left women confused about whose advice to follow. And opponents of changing health care policy have criticized the new recommendations as an example of what could be expected from government-managed care.

Wilt denied accusations that the recommendations were made to help the government spend less on mammograms.

"Costs are not considered at all," he said.

The panel of doctors and scientists concluded that such early and frequent screenings often lead to false alarms and unneeded biopsies, without substantially improving odds of survival for women under 50.

Senate, House Democratic health bills compared

Thu, 19 Nov 2009 08:15:32 +0100

A comparison of the health care bills before Congress:

___

The Senate Democratic bill (Patient Protection and Affordable Care Act):

WHO'S COVERED: About 94 percent of legal residents under age 65 — compared with 83 percent now. Government subsidies to help buy coverage start in 2014. Illegal immigrants would not receive assistance.

COST: Coverage provisions cost $849 billion over 10 years.

HOW IT'S PAID FOR: Fees on insurance companies, drugmakers, medical device manufacturers. Medicare payroll tax increased to 1.95 percent on income over $200,000 a year for individuals; $250,000 for couples. New 5 percent tax on elective cosmetic surgery. Cuts to Medicare and Medicaid. Excise tax on insurance companies, keyed to premiums paid on health care plans costing more than $8,500 annually for individuals and $23,000 for families. Fees on employers whose workers receive government subsidies to help them pay premiums. Fines on people who fail to purchase coverage.

REQUIREMENTS FOR INDIVIDUALS: Almost everyone must get coverage through an employer, on their own or through a government plan. Exemptions for economic hardship. Those who are obligated to buy coverage and refuse to do so would pay a fine starting at $95 in 2014 and rising to $750

REQUIREMENTS FOR EMPLOYERS: Not required to offer coverage, but medium and large companies would pay a fee if the government ends up subsidizing employees' coverage.

SUBSIDIES: Tax credits for individuals and families likely making up to 400 percent of the federal poverty level, which computes to $88,200 for a family of four. Tax credits for small employers.

BENEFITS PACKAGE: All plans sold to individuals and small businesses would have to cover basic benefits. The government would set four levels of coverage: The least generous would pay an estimated 60 percent of health care costs per year; the most generous would cover an estimated 90 percent.

INSURANCE INDUSTRY RESTRICTIONS: Starting in 2014: no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age and family size. Starting upon enactment of legislation: children up to age 26 can stay on parents insurance; no lifetime limits on coverage.

GOVERNMENT-RUN PLAN: A new federal insurance plan would be offered to compete against private carriers. The government would negotiate — not dictate — payment rates for medical providers. Unlike the House bill, states could opt out of the plan. It's not clear the proposal commands enough votes to survive, and it could be replaced by a standby system pushed by moderates that would not go into effect until it was clear individual states were experiencing a lack of competition among private companies.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Self-employed people, uninsured individuals and small businesses could pick a plan offered through new state-based purchasing pools. Employees would be generally encouraged to keep their work-provided coverage.

DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Drug companies contribute $80 billion over 10 years with the majority of the money used to limit the prescription coverage gap in Medicare.

CHANGES TO MEDICAID: Income eligibility levels likely to be standardized to 133 percent of poverty, which is $29,327 a year for a family of four, for all parents, children and pregnant women. Federal government would pick up the full cost of the expansion during the first three years. States could negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid.

LONG-TERM CARE: New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.

ANTITRUST: Amendment expected to be offered on the Senate floor to strip the health insurance industry of its antitrust exemption.

____

The House bill (Affordable Health Care for America Act):

WHO'S COVERED: About 96 percent of legal residents under age 65 — compared with 83 percent now. Government subsidies to help buy coverage start in 2013. About one-third of the remaining 18 million people under age 65 left uninsured would be illegal immigrants.

COST: The Congressional Budget Office says the bill's cost of expanding insurance coverage over 10 years is $1.055 trillion. The net cost is $894 billion, factoring in penalties on individuals and employers who don't comply with new requirements. That's under President Barack Obama's $900 billion goal. However, those figures leave out a variety of new costs in the bill, including increased prescription drug coverage for seniors under Medicare, so the measure may be around $1.2 trillion.

HOW IT'S PAID FOR: $460 billion over the next decade from new income taxes on single people making more than $500,000 a year and couples making more than $1 million. The original House bill taxed individuals making $280,000 a year and couples making more than $350,000, but the threshold was increased in response to lawmakers' concerns that the taxes would hit too many people and small businesses.

There are also more than $400 billion in cuts to Medicare and Medicaid; a new $20 billion fee on medical device makers; $13 billion from limiting contributions to flexible spending accounts; sizable penalties paid by individuals and employers who don't obtain coverage; and a mix of other corporate taxes and fees.

REQUIREMENTS FOR INDIVIDUALS: Individuals must have insurance, enforced through a tax penalty of 2.5 percent of income. People can apply for hardship waivers if coverage is unaffordable.

REQUIREMENTS FOR EMPLOYERS: Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payrolls under $500,000 annually are exempt — a change from the original $250,000 level to accommodate concerns of moderate Democrats — and the penalty is phased in for companies with payrolls between $500,000 and $750,000.

Small businesses — those with 10 or fewer workers — get tax credits to help them provide coverage.

SUBSIDIES: Individuals and families with annual income up to 400 percent of poverty level, or $88,000 for a family of four, would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Beginning in 2013 through a new Health Insurance Exchange open to individuals and, initially, small employers. It could be expanded to large employers over time. States could opt to operate their own exchanges in place of the national exchange if they follow federal rules.

BENEFITS PACKAGE: A committee would recommend a so-called essential benefits package including preventive services. Out-of pocket costs would be capped. The new benefit package would be the basic benefit package offered in the exchange.

INSURANCE INDUSTRY RESTRICTIONS: Starting in 2013, no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age.

GOVERNMENT-RUN PLAN: A new public plan available through the insurance exchanges would be set up and run by the secretary of Health and Human Services. Democrats originally designed the plan to pay Medicare rates plus 5 percent to doctors. But the final version — preferred by moderate lawmakers — would let the HHS secretary negotiate rates with providers.

CHANGES TO MEDICAID: The federal-state insurance program for the poor would be expanded to cover all individuals under age 65 with incomes up to 150 percent of the federal poverty level, which is $33,075 per year for a family of four. The federal government would pick up the full cost of the expansion in 2013 and 2014; thereafter the federal government would pay 91 percent and states would pay 9 percent.

DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Phases out the gap in Medicare prescription drug coverage by 2019. Requires the HHS secretary to negotiate drug prices on behalf of Medicare beneficiaries.

LONG-TERM CARE: New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.

ANTITRUST: Would strip the health insurance industry of a long-standing exemption from antitrust laws covering market allocation, price-fixing and bid rigging. The bill also would give the Federal Trade Commission authority to look into the health insurance industry at its own initiative.