Leading the News
Overeating may double risk of MCI in seniors.
ABC World News (2/12, story 2, 0:25, Muir) reported, “A new study out tonight shows that the more calories you eat the higher your risk. for memory loss.”
USA Today (2/13, Hellmich) reports, “Older people who consumed more than 2,143 calories a day had more than double the risk of a type of memory loss called mild cognitive impairment (MCI), compared to those who ate fewer than 1,500 calories a day, according to a study…released Sunday by the American Academy of Neurology on its website (aan.com).” The study found that “the more calories older people consumed, the more likely they were to have mild cognitive impairment.” USA Today explains, “MCI is the condition between normal forgetfulness due to aging and early Alzheimer’s disease.”
“For the study, investigators collected data on more than 1,200 people, aged 70 to 89, living in Olmsted County,” MN, HealthDay(2/13, Reinberg) reports. “Among these people, 163 had been diagnosed with the memory deficits known as ‘mild cognitive impairment.’ Each person told the researchers how much they ate.”
WebMD points out, “One-third ate between 600 and 1,526 calories per day, one-third ate between 1,526 and 2,143, and one-third ate between 2,143 and 6,000 calories per day, the study shows.” Notably, “those who took in the highest number of calories per day had double the risk for MCI.”
According to MedPage Today<(2/13, Smith), the National Institutes of Health was one of the study’s supporters.
From the AMA
$200 million in settlement funds distributed to doctors. A federal court judge has cleared the way for releasing payments in a 2009 settlement that ended the historic court challenge the AMA led against UnitedHealth Group. Nearly $200 million in awards will be paid to settle claims from physicians for 15 years of artificially low payments the insurer paid for out-of-network health services. Read more on the AMA website.
AMA National Advocacy Conference kicks off today. Doctors from around the country will be advocating for the future of health care this week in Washington, D.C., during the AMA National Advocacy Conference. The three-day conference begins today—highlighted by insights from David
Gergen, senior political analyst at CNN—and will conclude Wednesday. View the agenda for the conference.
AMA partners with HHS on national campaign to improve heart health. With heart disease the leading cause of death in the United States, the AMA and other key national organizations are partnering with the U.S. Department of Health and Human Services (HHS) on the Million Hearts™campaign to reduce the number of Americans who suffer from heart disease and improve care for those who do. Read more in AMA
Government and Medicine
CMS denies Florida’s request for Medicaid program expansion.
The AP (2/11, Kennedy) reports that “Republican lawmakers’ quest to expand a Medicaid privatization program statewide was dealt a blow this week after federal health officials said” Florida “could not impose $10 monthly premiums on Medicaid beneficiaries.” In addition, the Centers for Medicare and Medicaid Services “denied the state’s proposal to charge $100 co-pays for any non-emergency ER visits, according to a letter sent Thursday.” The piece notes, “Officials at Florida’s Agency for Health Care Administration said they were disappointed with the CMS decisions, but said they would continue to work with the federal agency on other key elements and they are confident statewide expansion can move forward.”
The Fort Myers (FL) News-Press<(2/13) reports, “The federal Medicaid agency, in a letter dated Thursday, notified the state the proposals violated federal requirements that are designed, at least in part, to shield poor people from additional costs.” CMS’ letter stated, “CMS shares the state’s goal of promoting cost-effective use of hospital emergency department services, and we will be happy to work with you to consider alternative approaches to meeting this goal.”
Committee approves Oregon Health Plan overhaul.
The Oregonian reports, “A bill to revamp the Oregon Health Plan was approved by the Joint Ways and Means Committee on Friday after Democrats fought off a push to limit medical malpractice awards.” The bill “would organize local providers to manage Medicaid-funded care, a move supporters say could save billions of dollars over time.”
The AP (2/13, Cooper) reports that Gov. John Kitzhaber’s “proposal comes before the state Legislature this week, seven months after lawmakers overwhelmingly supported the concept and told the Democratic governor to return with more details.” The governor “wants to redesign Oregon’s health care delivery and payment systems with a goal of coordinating patient care and preventing emergency room visits.” The Salem (OR) Statesman Journal (2/13, Wong) also reports this story. New Jersey’s Medicaid spending plan fails to get federal support.
The Newark (NJ) Star-Ledger (2/13, Livio) reports, “Gov. Chris Christie’s plan to spend $300 million less on Medicaid this year has hit a snag with the federal government that jeopardizes about $107 million of the savings he anticipated in the current state budget.” However, “if the governor has another move, his administration declined to share it Thursday with Democratic lawmakers who had planned to hold a public hearing on the matter.”
The piece notes, “The National Governor’s Association wrote a letter in July to US Department of Health and Human Services Secretary Kathleen Sebelius, asking she repay the state debts,” but she replied that “she ‘did not have the statutory authority’ to repay the state’s expenses, adding ‘ I am committed to finding ways to help address Medicaid fiscal pressures.'”
FDA issues draft guidance for drug companies. Modern Healthcare(2/12, Lee, Subscription Publication) reported, “The Food and Drug Administration issued draft guidance addressing the amounts and types of safety data that companies developing drug and biological products should collect in late-stage, pre-market and post-market clinical investigations.” The FDA “said in the draft guidance (PDF) that ‘more selective safety data collection’ could improve the safety database, ease the burden on clinical investigators and participating patients, and lower costs.” The agency also said that “in some late-stage, pre-market and post-market clinical trials, a drug safety profile may already be established and comprehensive data should not be required.”
Physician groups generally object to legislation interfering with CME. American Medical News (2/13, Krupa) reports, “Despite strong opposition from physician organizations, states often react to headline-grabbing issues by trying to impose CME requirements on doctors.” Physician groups strongly “object to legislators and policymakers — for whatever their good intentions — interfering with CME.” American Medical News adds, “The American Medical Association opposes state-mandated CME content and urges medical societies in states that have content-specific CME requirements to work toward having such rules rescinded or amended.”
Medical-Legal Landscape
Study: New York hospitals violate rules about pursuing unpaid bills. In a front-page story, the New York Times (2/13, A1, Bernstein, Subscription Publication) reports that New York has “passed laws curbing hospitals’ pursuit of unpaid bills,” but “a new study of New York hospitals’ practices and state records finds that most medical centers are violating the rules without consequences, even as the state government ignores glaring problems in the hospitals’ own reports.” The study, by the Community Service Society of New York, “found that some hospitals did not provide financial aid applications at all, and that many made impermissible demands for irrelevant documents or failed to supply key information, like eligibility rules for big discounts required by state law in 2007.” New York “state’s Department of Health acknowledges systemic problems, including the need for better reporting and enforcement, a spokesman, Michael Moran, said.”
Charges filed against ApotheCure over deadly drug shipment misbranding. The AP (2/11) reported, “Federal charges have been leveled against a Dallas-based mail-order compounding pharmacy over a shipment of a misbranded drug ingredient federal officials blame for three deaths in the Pacific Northwest.” According to the AP, “a Justice Department statement Friday says ApotheCure Inc. and its owner, Gary D. Osborn, have been charged with two misdemeanor criminal violations of the federal Food, Drug and Cosmetic Act.” The charges center “on a February 2007 shipment of a gout drug containing some vials with dosages more than seven times stronger than what was shown on the label, and some with strengths about two-thirds those shown.”
“Larry Friedman, Osborn’s attorney, said that a former employee of ApotheCure was responsible for mistakenly mixing the wrong doses of the drug that resulted in the deaths,” the Dallas Morning News< (2/11, Trahan) reported. “Osborn ‘had absolutely nothing to do with the incident that led to the deaths of these people,’ Friedman said.” He added, “We thought this was put to bed in 2007. We are surprised the Department of Justice is working on this five years later.”
Health Coverage and Access
Patients seek to use skin cancer drug bexarotene for Alzheimer’s.
The Wall Street Journal (2/11, Wang, Subscription Publication) reported a mouse study published last Thursday in the journal Science showed that the skin cancer drug bexarotene may help treat Alzheimer’s disease. Now patients are requesting to use the drug-off label for Alzheimer’s disease, even though experts have warned that additional studies have to be conducted to determine whether the drug actually works in humans. Gary Landreth, an author of the study, said a safety study with 12 healthy individuals is scheduled to begin next month.
Quality and Safety
Hospitals running out of crucial childhood leukemia drug.
ABC World News (2/10, story 7, 2:00, Muir) reported, “A cancer that can be cured by a drug that tonight is in short supply. Hospitals are rationing the drug,” methotrexate, while others “have already run out of it.” According to Capt. Valerie Jensen, FDA: “We’re extremely worried about this. This is our top priority right now.”
The New York Times (2/11, A15, Harris, Subscription Publication) reported, “Ben Venue Laboratories was one of the nation’s largest suppliers of injectable preservative-free methotrexate, but the company voluntarily suspended operations at its plant in Bedford, Ohio, in November because of’significant manufacturing and quality concerns,’ the company announced.” Since that time, “supplies of methotrexate have gradually dwindled to the point where oncologists now say they are fearful that shortfalls may occur at many hospitals within two weeks.” The Times quotes Dr. Michael P. Link, president of the American Society of Clinical Oncology, as saying, “This is a crisis that I hope the F.D.A.’s hard work can help to avert.”
On its website, ABC News (2/11, Salahi) reported that “drugs for heart patients, some antibiotics, and intravenous drugs have been hard for hospitals to find, but cancer drugs have arguably taken the hardest hit.”
Leaders of some major teaching hospitals criticize government safety rankings.
The Boston Globe /Kaiser Health News (2/13, Rau) reports, “Medicare’s first public effort to identify hospitals with patient safety problems has pinpointed many prestigious teaching hospitals in Boston and around the nation, raising concerns about quality at these places but also bolstering objections that the government’s measurements are skewed.” The data indicate that “Massachusetts General Hospital and Beth Israel Deaconess Medical Center, both affiliated with Harvard Medical School; and Boston Medical Center, affiliated with Boston University, were among those having substantially more complications than the average hospital.” However, “leaders of a number of the nation’s major teaching hospitals are questioning the accuracy and fairness of the data, saying they do not properly account for how severely ill their patients are.”
Health data breaches continue to rise.
The Detroit Free Press<(2/12, Erb) reported that “at least 11 times since 2009, Michigan health care providers lost or otherwise accidentally breached the health data of more than 118,000 patients in all,” and “a report released in December concluded that breaches nationally climbed 32% last year, in part, because doctors are more often relying on smartphones and other electronic devices to update files.” According to the Free Press, “the reasons for the Michigan breaches were human error rather than hacking: a lost laptop, misplaced jump drives.” And “Leon Rodriguez, head of the US Health and Human Service’s Office of Civil Rights, told the Free Press that it’s time to crack down on security lapses: ‘Enforcement promotes compliance,’ he said.”
Public Health
Study: Over four million Americans have artificial knees.
USA Today (2/13, Lloyd) reports, “A soaring demand for new knees from aging Baby Boomers wanting to dance through Zumba workouts or zip down ski slopes is likely to lead to additional, more costly surgeries, according to a new report” presented at the annual conference of the American Academy of Orthopaedic Surgeons. The study is “based on data from the 2009 US Census and the National Health Interview Survey.”
The AP (2/13, Tanner) reports, “Nearly one in 20 Americans older than 50 have artificial knees, or more than four million people, according to the first national estimate showing how common these replacement joints have become in an aging population. … The estimate is important because it shows that a big segment of the population might need future knee-related care, said Dr. Daniel Berry, president of the American Academy of Orthopedic Surgeons.”
HealthDay(2/11, Behen) reported, “The number of new-knee procedures doubled over the last decade, reached more than 620,000 in 2009, and the researchers said younger patients — those 45 to 64 — accounted for a disproportionate amount of that growth. Their relatively young ages meansmany are at risk of revision surgery as well as potential long-term complications of surgery, the authors warned.” In addition, researchers “estimate that nearly 53 percent of men and 52 percent of women diagnosed with symptomatic knee [osteoarthritis] will receive a total knee replacement in their lifetimes.”
Article gives tips on managing injuries. The AP (2/13) reports, “Costly knee replacements have more than tripled in people aged 45-64 in recent years and a study released last week found that nearly one in 20 Americans older than 50 have these artificial joints. But active boomers can avoid that kind of drastic treatment by properly managing aches and pains.” The article advises waiting for “two to three days” on non-emergency injuries, and seeing a doctor “if pain or swelling don’t subside with self-help.” In addition, “injuries that need immediate treatment cause excruciating, unrelenting pain, or force you to immediately stop your activity and prevent normal motion,” while “being able to put weight on an injury means it’s probably not a medical emergency.”
High blood cadmium levels may delay pregnancy.
(2/11, Bristol, Subscription Publication) reported, “As if smokers needed another reason to quit, a new study< sponsored by the National Institutes of Health shows that higher blood levels of cadmium in women delayed pregnancy in couples trying to conceive. Cigarette smoke is the most common source of exposure to cadmium.” The study showed that the chances “of pregnancy was reduced by 22 percent per menstrual cycle with each measured increase in females’ blood level of cadmium.” Researchers “also found a link between higher blood levels of lead in men and delayed pregnancy.”
IOM report issues recommendations on chronic disease control.
American Medical News (2/13, Krupa) reports, “A 304-page Institute of Medicine report released Jan. 31, outlines recommendations to bolster population-based public health efforts, reduce disability rates and mitigate suffering caused by diseases such as arthritis, asthma, diabetes and heart disease. … The report, commissioned by the Centers for Disease Control and Prevention and the Arthritis Foundation, recommends 17 strategies to support public health action.” The IOM also recommended the development of “programs for employers to provide health promotion programs that benefit people with chronic illness and that the Dept. of Health and Human Services establish a work group to coordinate chronic disease surveillance nationwide.”
Study: Experts have “no hard evidence” for how much sleep kids need.
USA Today> (2/13, Healy) reports, “For a century, experts have said children don’t get enough sleep, partly because the blinking lights of technology keep them up. But there’s no hard evidence for such claims, a study says today in Pediatrics. In fact, researchers at the University of South Australia found that from 1897 to 2009, children’s daily sleep decreased about 75 minutes, while the recommendations for how much sleep children should get declined by 70 minutes.” Researchers commented in an email, “Experts have always recommended that children get about 40 minutes more sleep than they do, no matter how much sleep they get.”
High-speed DNA tests may be used to benefit patients with lung, colon cancer.
Bloomberg News< (2/13, Langreth) reports, “More than half of lung and colon cancer patients may benefit from high-speed tests that detect DNA flaws doctors can target with existing medicines,” according to a study published in Nature Medicine. Investigators “used a gene test…to sequence 145 cancer-associated genes in 40 colon tumor samples and 24 lung tumors.” The researchers “found that 53 percent of colon tumors and 71 percent of lung tumors had mutations that may be attacked with cancer medicines on the market or in human trials.”
Americans underwent 1.6M cosmetic surgeries in 2011.
The USA Today (2/11, Painter) “Healthy Perspective” blog reported, “Americans got about 1.6 million cosmetic surgeries in 2011, the second year of increase after a big drop in 2009, according to an annual report from the American Society of Plastic Surgeons.” Nevertheless, “Americans got fewer nose jobs, facelifts and other big-ticket surgeries than in 2005, when they peaked at 2.1 million.” However, “people are going to the same doctors, though, for Botox [onabotulinumtoxinA] injections, facial fillers and other forms of non-surgical primping: There were 12.2 million of those procedures in 2011.”
PAD affects more than 8 million people in US.
The Miami Herald (2/13, Frontado) reports, “the American Heart Association, the American College of Cardiology and the Society for Vascular Medicine have launched” peripheral arterial disease (PAD) “awareness campaigns over the past two years demanding a more proactive diagnosis policy, particularly among high-risk patients.” PAD “affects more than 8 million people in the United States and exponentially elevates the risk of heart attacks or strokes.”
Pharma & Device Update
FDA issues recommendations to ensure safe production of heparin. Reuters reported on Friday, the US Food and Drug Administration issued guidelines to help drug companies manufacturing the active ingredient of heparin avoid contamination during production. Last week, FDA Commissioner Margaret Hamburg told members of Congress, “We’re making sure we have systems in place to prevent that particular problem.”
Practice Management
Suggestions given for maintaining a highly functioning practice.
American Medical News> (2/13, Kelly) offers advice on how physicians can “balance friendliness with employees with the professional need for a highly functioning team.” Key points include “setting boundaries,” treating “others the way we would want to be treated,” hiring carefully, and setting and maintaining clear standards.
“Investing time, attention and personal interest in your staff is crucial to running a profitable and well-run practice,” according to “Terry McGeeney, MD, president and CEO of TransforMED,” who also pointed out that “the staff’s morale is essential” to a successful practice.
Article gives suggestions on sick-day policies.
American Medical News(2/13, Elliott) discusses how to “encourage staffers to call in sick — but only when appropriate.” Various models for managing
paid time off are discussed, such as giving sick days, plus vacation time and flexible days “for nonmedical emergencies.” Some employers give “a bundled time-off bank” which “cuts down on the need for employees to provide a reason and prove how sick they are to take unscheduled time off,” but “the value of the unused time may have to be paid out to a departing employee.” Of note, some hospitals “reserve the right to send home a worker who appears ill and contagious. This is unlikely to run afoul of the Americans with Disabilities Act, but any such policy must be applied uniformly, said Kara Maciel, a labor attorney and partner with Epstein Becker Green in Washington.”
Friday’s Lead Stories
• C-section may raise respiratory distress syndrome risk in small babies.
• FDA issues draft rules for “biosimilar” drugs
• Advocates for the mentally ill file lawsuit against New Hampshire.
• Immigrant children dropped public health insurance after premium increase.
• Analysis: More US nursing homes receiving top government rating.
• Cancer drug bexarotene may reverse Alzheimer’s symptoms in mice.
• FDA panel does not back capsaicin patch for HIV neuropathic pain.
AMA Morning Rounds is a digest of the most important medical news and information selected from thousands of sources by the editors of Bulletin Healthcare. The presence of advertising herein does not endorse, or imply endorsement of, any products or services by the AMA.