Obama invites GOP to healthcare summit

President Obama made a dramatic attempt to jump-start the stalled healthcare debate Sunday, inviting Republicans in Congress to a half-day summit on the subject to be televised live later this month. The president made the offer in an interview with CBS News anchor Katie Couric just hours before the Superbowl. Obama challenged Republicans to come to the discussion armed with their best ideas for how to cover more Americans and fix the health insurance system.

"I want to consult closely with our Republican colleagues," Obama told Couric. "What I want to do is to ask them to put their ideas on the table... I want to come back and have a large meeting, Republicans and Democrats to go through, systematically, all the best ideas that are out there and move it forward."

The invitation to join him later this month follows comments he made on Thursday during a speech at a Democratic fundraiser in which he said he wanted to sit with Republicans and "walk through the [healthcare plans] in a methodical way so that the American people can see and compare what makes the most sense."

It also comes just weeks after the president received high marks for engaging the House Republicans in a televised, 90-minute discussion at their retreat in Baltimore. The president has been hammered by critics who said his year-long push to revamp the healthcare system did not live up to his campaign promise to conduct the debate in the open.

The president's proposed half-day summit, which aides said could take place at the historic Blair House across the street from the White House, represents an effort by Obama to hit the reset button on the top domestic priority of his first year in office. And it is a recognition that he must now have at least some Republican support to get it passed.

In a statement, House Republican leader John Boehner said that he is looking forward to the discussion and is "pleased that the White House finally seems interested in a real, bipartisan conversation on healthcare. Boehner added that "The best way to start on real, bipartisan reform would be to scrap those bills and focus on the kind of step-by-step improvements that will lower healthcare costs and expand access."

But aides said that Obama does not plan to scrap months of legislative effort on the issue. Democratic leaders have continued to work quietly to reconcile House and Senate versions that passed last year, and the president plans to come to the summit armed with a Democratic bill, aides said. "This is not starting over," one White House official said. "Don't make any mistake about that. We are coming with our plan. They can bring their plan." Visit the Washington Post for the article.

Haiti hospital’s fight against TB falls to one man

At a fly-infested clinic hastily erected alongside the rubble of the only tuberculosis sanatorium in this country, Pierre-Louis Monfort is a lonely man in a crowded room. Haiti has the highest tuberculosis rate in the Americas, and health experts say it is about to drastically increase. But amid the ramshackle remains of the hospital where the country’s most infected patients used to live, Monfort runs the clinic alone, facing a vastness of unmet need that is as clear as the desperation on the faces around the room.

“I’m drowning,” said Monfort, 52, flanked by a line of people waiting for pills as he emptied a bedpan full of blood. All of the hospital’s 50 other nurses and 20 doctors died in the earthquake or have refused to return to work out of fear for the building’s safety or preoccupation with their own problems, he said. Monfort joked that the earthquake had earned him a promotion from a staff nurse at the sanatorium to its new executive director.

In normal times, Haiti sees about 30,000 new cases of tuberculosis each year. Among infectious diseases, it is the country’s second most common killer, after AIDS, according to the World Health Organization. The situation has gone from bad to worse because the earthquake set off a dangerous diaspora. Most of the sanatorium’s several hundred surviving patients fled and are now living in the densely packed tent cities where experts say they are probably spreading the disease. Most of these patients have also stopped taking their daily regimen of pills, thereby heightening the chance that there will be an outbreak of a strain resistant to treatment, experts say. A further complication is that definitively diagnosing tuberculosis takes weeks. So doctors are instead left to rely on conspicuous symptoms like night sweats, severe coughing and weight loss.

Dr. Richar D’Meza, the coordinator for tuberculosis for the Haitian Ministry of Health, said his office and the World Health Organization had begun stockpiling tuberculosis medicines. “We are very concerned about a resistant strain, but we are also getting ready,” he said, adding that he is assembling medical teams to begin entering tent camps to survey for the disease. “This will begin soon,” he said. “We will get help to these people soon.”

For Monfort, it is not soon enough. He scavenges the rubble daily for medicines and needles. He sterilizes needles using bleach and then reuses the bleach to clean the floors. Monfort began to explain that his biggest problem was a lack of food. Suddenly a huge crash shook the clinic. A patient screamed. Everyone stood still, eyes darting. A man outside yelled that another section of the hospital had collapsed. People looking for materials to build huts had pulled wood pilings from a section of the hospital roof, which then fell as the scavengers leapt to safety, the man said.

The dire scene at Monfort’s clinic speaks to a larger concern: as hospitals and medical staff are overrun by people with acute conditions, patients who were previously getting treatment for cancer, H.I.V. and other chronic or infectious diseases have been pushed aside and no longer have access to care. Visit the New York Times for the article.

As pot-smoking, pill-popping baby boomers age, new health problems may arise

Roughly 8 percent of Americans ages 50 to 59 had used an illicit drug in the past year, according to a recent survey by the federal Substance Abuse and Mental Health Services Administration. Marijuana was the most commonly used, but close behind was abuse of prescription drugs, such as anti-anxiety medications, painkillers, and sleeping pills. The percentage of pot and pill abusers in this age group grew by more than 50 percent between 2002 and 2008, as more baby boomers hit 50.

Now, researchers who conducted the survey worry that high rates of lifetime drug use among boomers, that massive, society-altering generation born between 1946 and 1964, is likely to create health complications for millions of aging Americans and swamp the country’s drug-treatment programs.

“We are projecting that by the year 2020, we will probably have enough people in the 50-to-59 age group needing [substance abuse] treatment that we will probably need to double the number of treatment facilities,’’ said Peter Delany, the substance abuse agency’s director of the Office of Applied Studies. Delany said that illicit drugs may cause greater impairment as users get older.

That means that marijuana and abused prescription drugs may be lingering longer in people who are now also likely to be regularly ingesting prescribed medications, such as cholesterol-lowering medicine or pills to tackle high blood pressure. That could result in harmful interactions and side effects. It also means that unsuspecting physicians may, for instance, misdiagnose symptoms of memory loss caused by chronic marijuana use as memory impairments caused by the onset of dementia, such as Alzheimer’s disease.

The substance abuse administration, which regularly queries Americans on their drug and alcohol use, surveyed nearly 20,000 adults, ages 50 and over, between 2006 and 2008. It found that 5.2 percent of those in the 50 to 59 age range had used marijuana during that time, and that 2.9 percent had taken prescription drugs that were not prescribed for them, most often painkillers. Overall, 7.9 percent said they had taken some illicit drug.

Precisely how many physicians specifically ask their patients about drug abuse is an open question. The US Preventative Services Task Force, a scientific panel established by the federal government to set standards on disease prevention and primary care, concluded in a 2008 report that there was insufficient evidence to know whether such routine querying of patients would help curb drug problems - even as it noted that abuse of prescription drugs was a growing health problem. The task force has recommended that physicians routinely ask patients about their tobacco and alcohol use, saying evidence shows that such screening can accurately identify patients with problems and that brief counseling in primary care settings is effective in helping patients curb drinking or quit smoking. Now, the federal government is funding studies to determine whether similar routine screening and counseling of patients for drug abuse might also be beneficial.

Among those studying the issue is Dr. Richard Saitz, a primary care physician at Boston Medical Center who specializes in addiction screening and counseling. He said that getting patients to acknowledge drug abuse can be trickier than screening for alcohol or tobacco use because it is illegal. He said he has noticed an increasing level of drug abuse, particularly marijuana, anti-anxiety medications, and sleeping pills, among his boomer-age patients. “People really do have symptoms like insomnia and anxiety, and they may have had these problems earlier in life’’ and been prescribed a medication for it, he said. “And then maybe they get a divorce, or lose their job, or feel less useful in society, and they begin using a prescription drug, that was prescribed in a legitimate way, and it gets out of control.’’

Delany, who directed the recent study on substance abuse among older Americans, said the toll of unchecked problems will extend far beyond health effects to financial burdens for the nation - unless healthcare providers start paying closer attention now. Visit the Boston Globe for the article.

Industrial cleaner linked to increased risk of Parkinson's disease

The degreasing agent trichloroethylene (TCE) has been linked to increased rates of Parkinson's disease among industrial workers in yet another study, this time involving a large, well-studied group of World War II veterans. Workers exposed to tricholorethylene (TCE), a chemical once widely used to clean metal such as auto parts, may be at a significantly higher risk of developing Parkinson's disease, according to a study released today that will be presented at the American Academy of Neurology's 62nd Annual Meeting in Toronto April 10 to April 17, 2010.

"This is the first time a population-based study has confirmed case reports that exposure to TCE may increase a person's risk of developing Parkinson's disease," said study author Samuel Goldman, MD, with the Parkinson's Institute in Sunnyvale, CA, and a member of the American Academy of Neurology. "TCE was once a popular industrial solvent used in dry cleaning and to clean grease off metal parts, but due to other health concerns the chemical is no longer widely used."

The study found workers who were exposed to TCE were five and a half times more likely to have Parkinson's disease than people not exposed to the chemical. Those who were exposed to TCE had job histories including work as dry cleaners, machinists, mechanics or electricians.

A previous study in 2008 had fingered TCE as the most likely culprit behind a cluster of Parkinson's disease cases afflicting workers at a single industrial plant. Also, Goldman said, animal studies have found that TCE is selectively toxic to nigral dopaminergic neurons, the same type of nerve cell that progressively dies off in Parkinson's disease. He said the chemical's activity in rodent brains is very similar to that of MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine), a dopaminergic neurotoxin commonly used to simulate Parkinson's disease in preclinical research.

Goldman said the new study was the first population-based analysis to link TCE to the disease. It focused on 198 twin pairs in the National Academy of Sciences-National Research Council's World War II Twins Cohort, which comprises some 16,000 twin pairs overall. In those pairs chosen for the current study, records showed that one twin had developed Parkinson's disease and the other had not. This design largely eliminates genetics as a confounding factor in the analysis.

Goldman explained that occupational histories for each participant were reviewed by a blinded industrial hygienist and a preventive medicine physician to identify likely exposures to TCE and four other industrial chemicals: xylene, toluene, carbon tetrachloride, and tetrachloroethylene. As a single source of exposure, only TCE was significantly associated with development of Parkinson's disease, Goldman said.

People working as aircraft mechanics, machinists, plumbers, and electricians likely had regular exposure to TCE, Goldman said. The chemical was commonly used as a "spot" cleaner to remove grease and oils from metal surfaces. It was also used for a time as a dry cleaning solvent, although tetrachloroethylene was more common for that purpose. Visit MedPage Today for the article.

California cracks down on discount health plans

At a time when nearly 7 million Californians are uninsured, state regulators are trying to rein in discount health and dental plans that officials say frequently overstate benefits, offer little if any savings and promise access to doctors who aren't part of the system. Some of the discounters fraudulently market themselves as insurance, while preying on the poor, the elderly and others who urgently need care, officials say.

Plan executives bristle at such criticism. They say a few bad apples have tarnished an industry that offers reliable, and relatively inexpensive, services. Consumers, however, have lodged complaints against more than 150 unlicensed discount health and dental plans over the last four years, prompting the California Department of Managed Health Care to seek new licensing regulations. The list of entities includes the Care Entrée discount program, which regulators say falsely promised members unrestricted access to medical providers, and another discount plan offered by the Consumer Resource Assn. It allegedly sold worthless discount cards to a South Gate couple.

To be sure, some discount plans have had success offering a wide range of benefits to large numbers of customers. At least two major health insurers with units in California, for instance, operate programs that have not been the subject of any consumer complaints to state regulators. The two, Vital Savings, a product of Aetna, and OptumHealth Allies - an arm of UnitedHealth Group, do not offer insurance but provide access to discount services to thousands of members.

With high unemployment and swelling ranks of the uninsured, California has provided a fertile environment for discounters which serve an estimated 6 million customers in the state, according to the industry trade group Consumer Health Alliance. By comparison, nearly 21 million Californians get healthcare through health maintenance organizations.

Industry leaders say discounters primarily offer "ancillary" services such as dental, vision or chiropractic care. In many cases, they say, insurance companies or employers themselves offer discounters' programs as an extra benefit to their members or employees. The discounters say they accept members with existing medical conditions, have no limits on use and can slash healthcare costs as much as 80% by negotiating discounts with providers.

State officials ordered Care Entrée to stop operating in California 4 1/2 years ago after determining that its promise of "unrestricted access" to providers was "illusory" and that its advertising was misleading because it suggested that it was insurance. The discounter has since agreed to get licensed.

Industry leaders say the discount health business has long sought regulations to protect consumers. Discount healthcare representatives say that roughly a dozen major companies operate in California through networks of providers. The list includes Glendale-based OptumHealth Allies, which charges its 85,000 individual customers in California as little as $9.95 a month for access to discounted vision and dental services. OptumHealth's website notes that it does not provide insurance but arranges lower fees that members pay directly to providers.

Discount health plans sell their services in all 50 states. Twenty-one of the states, California among them, require licenses. The department has since licensed three discount health plans. Three others are no longer in California after regulators ordered them to get licensed or stop operating in the state, officials said. The department is now weighing proposed regulations that would, among other things, require the plans to verify their discounts, file reports about grievances and indicate that they do not provide insurance. Visit the Los Angeles Times for the article.

Alcohol-related crashes cost state $642 million, new report finds

Alcohol-related car crashes that injure Montana residents boost the overall cost of alcohol abuse to the state's economy to $642 million, according to a new report by a University of Montana economist. Steve Seninger, senior research professor at UM's Bureau of Business and Economic Research, said previous estimates gauged the economic cost of alcohol abuse in Montana at $511 million per year. While that figure included $96 million in alcohol-related fatalities, it did not factor in the cost of alcohol-related crashes with injuries, he said. The economic cost of "injury crashes" adds $131 million to the total, Seninger said.

"Five people are injured or killed each day in Montana because of alcohol-related vehicle crashes," Seninger said. "This is a cost of $621,000 per day paid for by all Montanans." According to Seninger, Montana averages about 135 alcohol-related highway and road fatalities every year, but the average number of people injured is approximately 1,700.

In the report, "Economic Costs of Alcohol-Related Vehicle Crashes in Montana," Seninger said victims of alcohol-related crashes suffer more severe injuries than victims from crashes not involving alcohol. State-collected data show that one-half of the alcohol-related crash injuries involve Montanans under the age of 30 and include high-speed rollovers and collisions with power poles, trees and concrete abutments.

The severity of alcohol crash injuries also result in lengthy hospital stays, Seninger said, with more than half of these hospitalizations lasting 24 days or more. "More than half the people who come into the emergency room for injuries from an alcohol-related crash end up in the hospital for 24 days or more," he said. "I think that speaks to the severity of the injuries."

Seninger said each in jured survivor of an alcohol-related crash in 2005 resulted in costs of $85,000. He attributed 19 percent of that cost to productivity loss, 17 percent to property damage, 24 percent to healthcare and medical services, 19 percent to legal costs and insurance, and 20 percent to loss of quality of life, which includes costs to local law enforcement and emergency services.

Seninger said the new study was prompted by previous epidemiological research by the Bureau of Business and Economic Research on the effect of substance abuse on the state's economy. Alcohol abuse has become endemic in Montana, Seninger said, and the drain that binge drinking has on state resources is enormous. The research only reflects the narrow economic cost, Seninger said, and does not include the emotional costs to families. Copies of the report are available on the BBER Web site, www.bber.umt.edu. Read the article in the Missoulian.

FDA issues guidance to help streamline medical device clinical trials

The U.S. Food and Drug Administration issued guidance on Bayesian statistical methods in the design and analysis of medical device clinical trials that could result in less costly and more efficient patient studies. The Bayesian statistical method applies an algorithm that makes it possible for companies to combine data collected in previous studies with data collected in a current trial. The combined data may provide sufficient justification for smaller or shorter clinical studies.

“This final guidance on the use of Bayesian statistics is consistent with the FDA’s commitment to streamline clinical trials, when possible, in order to get safe and effective products to market faster,” said FDA Commissioner Margaret A. Hamburg, MD. “This is a terrific example of regulatory science in practice at FDA.”

The FDA has substantial experience in the use of Bayesian statistical methods for the design and analysis of scientifically valid clinical studies. The FDA has approved a number of medical devices whose approval applications submitted to the FDA included clinical studies that used these statistical methods.

The final guidance, titled “Guidance for the Use of Bayesian Statistics in Medical Device Clinical Trials,” describes use of Bayesian methods, design and analysis of medical device clinical trials, the benefits and difficulties with the Bayesian approach, and comparisons with standard statistical methods. The guidance also presents ideas for using Bayesian methods in post-market studies. Healthcare payers are also contemplating the role Bayesian methods could play in making coverage decisions. For more information visit the FDA website.