Author: Shirley S. Wang

It’s no joke for doctors that today marks the day that Medicare’s 21% reimbursement pay cuts were to go into effect.

Congress left for its Easter recess without voting to delay the scheduled April 1 start of lower payments to docs. The agency that oversees Medicare has effectively delayed the cuts by deciding not to pay claims for the first 10 business days in April. When Congress returns, it’s still expected to adopt another law to delay the cuts for longer, as it has done annually for years now.

So what does the delay in paying claims mean for doctors? In the short-term, their cash flow shouldn’t be disrupted much, according to the Centers for Medicare and Medicaid. Typically claims are paid no sooner than 14 calendar days anyway, so doctors shouldn’t see a dip in their income unless Congress fails to act with a new delay in the next two weeks, the agency says.

But the long-standing threat of Medicare cuts are weighing on doctors, say medical societies.

“It’s tough,” Andrew LaMar, spokesman for the California Medical Association, told the Health Blog. “Imagine if every month you didn’t know what your paycheck is going to be.”

The American Medical Association and others urged repeatedly for a permanent repeal of Medicare cuts throughout the health-care bill legislative process, but it wasn’t included as part of the final bill.

David Kloth, past president of the American Society of Interventional Pain Physicians, told the Health Blog that private insurers base their rates on those set by Medicare, so a cut in Medicare payments would likely result in reimbursement cuts across the board. And if their revenue drops significantly, docs may reduce the number of Medicare patients they see or have to lay off employees, he says.

“If they’re not careful, they’re going to drive doctors out of Medicare and Medicaid,” says Kloth.

Photo: Associated Press

Suggestions that taxing sugar-sweetened beverages to discourage their consumptions have gotten a lot of attention lately. But two studies published today in Health Affairs suggest that existing soda taxes have a mixed record when it comes to curbing obesity.

One study led by a Rand Corp. researcher examined children’s body mass index and consumption of sugar-sweetened drinks in a national sample of more 7,000 elementary-school students between 1998 and 2004. The majority of the kids lived in states where sodas were taxed more than other foods, with levies on sodas ranging as high as 7%.

The results showed no overall difference in beverage consumption in states that taxed sodas more, but there was some benefit for some groups including kids who started off heavier, those from low-income families, African Americans and those who watched a lot of TV. There was some evidence that a higher tax was linked to lower body mass index in third- to fifth-graders.

“To have a measurable effect on consumption, taxes need to be tied to consumption, and they need to be larger than the existing state variation in sales taxes,” the study authors concluded.

The second study, looking at another national sample of kids, found “little difference” in the body mass indexes of kids who live in states with a soda tax compared with states without one. They also found that fifth through eighth graders drank less sodas at school when vending machine access was limited.

“This finding of little consumer response to soft drink taxes in reducing consumption could be partially explained if consumers do not react to the small, and often hidden, tax rates typically applied to soft drinks,” according to the researchers led by a Yale prof.

Earlier studies have found have found that taxing sugary sodas just a penny an ounce would decrease consumption significantly. A recent study suggest that 10% increase in price leads to an 8% reduction in consumption.

Read more the controversy here and here.

Image: iStockphoto

A federal judge’s ruling earlier this week that some patents on human genes are invalid because they were related to isolated DNA “found in nature” is being watched closely by other holders of such patents of human genes. (Read more from the WSJ about the case.)

The genes in dispute involve BRCA1 and BRCA2, two genes that many geneticists say are particularly important because they are such powerful markers for diagnosing risk of a hereditary form of breast cancer.

But how many discoveries of other single gene mutations that powerful are likely to come in the future?

Probably pretty rare, according to Misha Angrist, a professor at the Duke Institute for Genome Sciences and Policy. “The gold rush is over largely,” he told the Health Blog.

Instead, science is pointing increasingly to the importance of combinations of multiple genes in predicting and potentially combating disease, say geneticists.

Can food be addictive? A new study on the often-debated question suggests that some of the same changes in brain pathways that develop with drug addiction also appear with compulsive eating.

As rats in the study consumed more high-calorie foods and became obese, the parts of the brain associated with pleasure began responding in the same way they do when activated by cocaine or heroin, the study found. Rats who didn’t have access to junk food didn’t exhibit the same brain changes in the dopamine receptors.

Even after the rats given high-calorie foods no longer had access to them, the brain changes persisted. The study was published yesterday in Nature Neuroscience.

“The results of this study could provide insight into a mechanism for obesity,” Paul Kenny, an author on the study and professor at Scripps Research Institute, said in a statement. “It’s possible that drugs developed to treat addiction may also benefit people who are habitual overeaters.”

Read more from Reuters and Businessweek.

Image: iStockphoto

Disclosure of financial ties between doctors and drug companies — a topic we’ve written about often — will finally be universally mandated in the physician payment provisions passed as part of the health-care bill. If you need a reminder about the Physician Sunshine Payment Act or past conflicts, read here, here and here.

We talked to Allan Coukell, director of the Pew Prescription Project, which has been a proponent of the act, about what this new legislation means. The first public report will be released in 2013 regarding payments for the prior year. Here’s an excerpt from our conversation:

What is the significance of the act? Why was it needed?

There has been tremendous concern over the extent of the financial links between doctors and drug companies, and the potential of those ties to influence care that patients need. Until now, there was no way for the patients or the public of knowing how extensive those relationships are. This, for the first time, will make those relationships transparent.

What are the physician reporting requirements?

This act requires medical device and pharmaceutical companies to make annual public reports of gifts and payments to doctors and teaching hospitals of anything over $10. There’s nothing that doctors need to report. Doctors can review the materials before they go public.

If an individual receives more than $100 from a company in a year, then everything [even amounts less than $5] must be reported.

What will the consequences of the act be?

I think it’s possible that the companies will decide that it’s no longer worth it to give out a lot of small gifts and payments because they’ll have to track all those things. I think some physicians, knowing that the relationships with industry will be open to scrutiny, may re-evaluate certain kinds of relationships … Research will continue but with more promotional and market-oriented [relationships], there may be some individuals who will decide to cut back on that kind of work. We will be able to have a much more informed public discussion about these types of relationships.

Is this measure enough to curb conflicts between doctors and industry?

[This measure] is about transparency. I think we will be watching and I’m sure policy makers will be watching to see how things evolve. We will have more information than we ever had before and we’ll have some sense of whether more steps need to be taken.

There has also been concern over payments to other health-care providers, such as nurse practitioners, as well as between companies and disease advocacy groups.

Read here for more from Pew.

There’s more action to report in the hospital industry: Cerberus Capital Management is going to buy Caritas Christi Health Care, the second-largest hospital chain in New England, the WSJ reports. Caritas will become a for-profit entity if the deal is approved.

This deal comes on the heels of Vanguard Health Systems’s deal earlier this month to buy not-for-profit Detroit Medical Center, a chain of seven hospitals. Vanguard is owned by private equity firm Blackstone.

Hospitals have been struggling with increasing costs, low Medicare rates and cuts to Medicaid reimbursement but the industry is expected to benefit from the overhaul of the health-care system.

Health Blog Question of the Day: Will we see more action by investors in the hospital sector?

(Bonus: Read more from the Boston Globe about the history of Caritas, which started as a small Catholic hospital in South Boston 150 years old.)

Image: iStockphoto

More and more doctors are moving away from private practice and are instead becoming employees of hospitals and health systems, reports the NYT.

This trend could mean more coordinated and better care for patients, though without the personal touch that private practice offers. Patients are more likely to see the same doctor in private practice than they are in a health center setting.

For docs, receiving a salary from an employer could mean less worries about changes to the health-care system. They also don’t have to worry about implementing expensive electronic medical records in their practices, according to the NYT. But it also does mean that the practice of medicine is likely changing permanently.

“When I was young, you didn’t blink an eye at being on call all the time, going to the hospital, being up all night,” Gordon Hughes, chairman of the board of trustees for the Indiana State Medical Association, told the NYT. “But the young people coming out of training now don’t want to do much call and don’t want the risk of buying into a practice, but they still want a good lifestyle and a big salary. You can’t have it both ways.”

The school lunch program may be substantially revamped for the first time in 40 years. The Senate Agriculture Committee voted unanimously yesterday for a $4.5 billion increase for child nutrition programs, according to USA Today.

The measure, which now must go to a full Senate vote, would overhaul the $17 billion school lunch program. It would call for the USDA to set new nutrition standards for food served in the cafeteria and vending machines, improve training for cafeteria workers and accelerate recalls of contaminated foods. Some 23,000 children ate food at school that made them sick from 1998 to 2007, according to USA Today. The bill also aims to increase the number of students eligible for free or reduced-price meals.

But, the San Francisco Chronicle points out, in order to pay for it, the committee wants to make cuts to a farm conservation program but leave in place crop subsidies to big corn and other grain growers, which some experts say contribute to diets that are blamed for the rise in obesity.

“Pitting kids against clean water instead of looking for savings in the much, much larger crop insurance and farm subsidy accounts is just wrong,” Craig Cox, an official with Environmental Working Group, an advocacy organization, told the Chronicle. “It’s more than wrong, because it also reduces the increase in child nutrition funding that could otherwise be achieved.”

Image: iStockphoto

Student loans appear to be a health overhaul headache: the reconciliation bill is going back to the House for a vote, thanks to Senate Republicans who found two provisions in the document — including one related to student loans — that violate its rules and can’t be included in the final bill.

Some 16 lines of text will be removed from the 153-page bill. One provision is technical and has no substantive value, and the other is about a measure to protect Pell grant awards from fluctuations in the federal budget, according to the WSJ.

First the Senate will re-vote, which has been scheduled for today at 2 pm. Because the House must pass an identical version of the bill, it also will have to vote again, though its timing for the task hasn’t yet been announced.

But these changes don’t ultimately threaten the bill, say Democrats.

“The parliamentarian struck two minor provisions tonight from the Health Care and Education Reconciliation Act,” Democratic Sen. Tom Harkin’s spokeswoman, Kate Cyrul, told the NYT. “These changes do not impact the reforms to the student loan programs and the important investments in education. We are confident the House will quickly pass the bill with these minor changes.”

Women who donate eggs for use with in-vitro techniques aren’t supposed to be compensated more than $10,000. And the amount paid isn’t supposed to vary based on characteristics of the donor, according to guidelines from the American Society of Reproductive Medicine.

But a new study, published in a report from the Hastings Center, a nonpartisan bioethics institute, looks at egg-donor advertisements placed in 306 college newspapers for a glimpse of what actually be going on.

The results show that nearly a quarter of the ads placed by egg-donation agencies and private couples violate the $10,000 guideline. Compensation also goes up with the SAT scores of the average incoming student at the colleges where the ads were published. For each 100-point increase in scores, compensation offers in the ads increased by $2,350, the study found.

The study’s author, Aaron Levine of Georgia Tech, points out that what the ads offer isn’t necessarily what donors actually receive in compensation. But he still concludes that “many clinics do not comply with this component of the ethical guidelines.”

Sean Tipton, a spokesman for ASRM, told the Health Blog that the group doesn’t have any problem with compensation under $5,000, or under $10,000 if it’s justified. “Our guidelines start with the premise that it’s perfectly acceptable to compensate for the time and trouble associated with egg donation,” he says.

Tipton notes that the cap exists partly so donors aren’t coerced into donating by larger payments. But egg-donor recruiters aren’t part of ASRM so the group as no direct sway over them.

In a separate commentary published with the study, John Robertson, chairman of ASRM’s ethics committee, asks a provocative question about why there should be ASRM guidelines on choosing eggs based on the characteristics of donors. “After all, we allow individuals to choose their mates and sperm donors on the basis of such characteristics. Why not choose egg donors similarly?”

Image of egg: iStockphoto

Think increases in portion size are a modern-day phenomenon? They’ve actually been growing for the last 1,000 years — at least if you look at depictions of the New Testament’s Last Supper.

That’s what duo of brothers — one a psychologist and the other a biblical scholar — decided to do, according to the Los Angeles Times.

Brian and Craig Wansink examined 52 artists’ renderings painted between 1000 and 2000 A.D. of the famous scene. They compared the size of the plates and food in the paintings to the head size of the apostles, which presumably didn’t change.

The found that the size of the entrees ballooned 70% and the bread by nearly a quarter.

“I think people assume that increased serving sizes, or ‘portion distortion,’ is a recent phenomenon,” Brian Wansink told the LA Times. “But this research indicates that it’s a general trend for at least the last millennium.”

Image: iStockphoto

Nutritional labeling on menus will be coming to chain restaurants and vending machines near you! That’s right, menu labeling is going national, thanks to yesterday’s vote passing the health-care bill.

Included in the more than 2,000 pages of the legislation is Section 2572, which mandates that chain restaurants with 20 or more locations will have to display nutritional and calorie information.

Menu labeling is already being put into place in restaurants in New York City, California and several other states. Recently the beverage trade association pledged to put calorie counts on the front of soda containers, soda fountains and vending machines.

The concept hasn’t been warmly received by some food retailers in the past and the National Restaurant Association issued a general statement yesterday about its concerns with the passage of the health-care bill, but some advocacy groups are celebrating.

“Congress is giving Americans easy access to the most critical piece of nutrition information they need when eating out,” said Margo Wootan, nutrition policy director for the Center for Science in the Public Interest, a health-advocacy group, in a statement. “While it’s a huge victory for consumers, it’s just one of dozens of things we will need to do to reduce rates of obesity and diet-related disease in this country.”

Update: The National Restaurant Association just put out a statement praising the menu-labeling provision. “This legislation will replace a growing patchwork of varying state and local regulations with one consistent national standard that helps consumers make choices that are best for themselves and their families,” said Dawn Sweeney, president and CEO of the trade association, in the statement.
Photo: Associated Press

African-Americans are twice as likely as Caucasians to have Alzheimer’s and related memory-robbing diseases, and Hispanics, the fastest-growing segment of the U.S. population, are 1.5 times as likely, according to a new report released this morning by the Alzheimer’s Association.

The higher risk is likely linked to factors like high blood pressure and diabetes, which are risk factors for dementia and more common among those minority groups than among Caucasians.

Yet, African-Americans and Hispanics are less likely to be diagnosed with the disease than their Caucasian counterparts. One barrier to diagnosis of dementia among these populations is access to proper health care, Maria Carrillo, a spokeswoman for the association, told the Health Blog. Language and culture, such as the custom of taking care of individuals within one’s family, could also be contributors, she said.

Alzheimer’s, which affects some 5.3 million people in the U.S., is the seventh leading cause of death. Health care and long-term care costs for these patients total $172 billion annually, according to the report. And, when a patient has Alzheimer’s on top of a medical condition, “the net result is elevated cost,” said Carrillo. For instance, Medicare payments are nearly three times higher for those aged 65 and older with Alzheimer’s than those of the same age without the disease.

Photo: Associated Press

Bad news on the Alzheimer’s drug development front: Pfizer and Medivation announced negative results from a large late-stage trial of Dimebon, thought to be a promising treatment more potent than those currently on the market.

Dimebon, you may remember, got its start a quarter-century ago as a Russian cold medicine that Pfizer plunked down $225 million for licensing rights in 2008. The deal also included potential milestone payments of as much as $500 million.

The drug, considered to be the compound furthest along of those in development to treat Alzheimer’s, had shown impressive effects in a trial 183 Russian patients. But scientists in the field have questioned the small size of the study and the whether the findings could be applied to other populations since it was conducted in Russia.

The companies say it’s too early to say why the results look they way they did. Pfizer and Medivation now will do a deep dive into the data to figure out if there were any mix-ups or “subleties” in the study design that might be responsible, and whether there might be subgroups in the study population who did benefit, Briggs Morrison, who oversees Pfizer’s clinical development of late-stage Alzheimer’s compounds, told the Health Blog.

Many experts and investors are disappointed by the news. Medivation’s stock plunged nearly 68% after the results came out. Read more from DJ Newwires here.

While it’s too early to tell what this means for Dimebon, the results remind us that “there are no sure things in the pipeline,” Robert Egge, VP of public policy and advocacy at the Alzheimer’s Association, told the Health Blog.

Image of neuron: iStockphoto

The American Cancer Society put out updated guidelines for prostate cancer screening today and they look, well, a lot like the current ones.

After reviewing the recent scientific literature, there’s still no evidence that routine screening for men of any age makes sense, according to the committee that issued the guidelines.

They continue to recommend that men of average risk receive information and weigh the “uncertainties, risks, and potential benefits” of screening starting at age 50. Higher-risk individuals — African-Americans or those with one relative diagnosed with prostate cancer before age 65 — should be presented with the information at age 45. Men with a strong family history should start thinking about screening at age 40.

The group also emphasizes the importance of joint decision-making between the patient and his doctor about whether to be screened for prostate cancer. Men don’t always get the information they need to make such decisions about prostate screening, according to the cancer society and findings from other studies.

“Men without access to regular care should not be tested unless high-quality informed decision-making as well as appropriate counseling and follow-up care for those who test positive can be assured,” Otis Brawley, chief medical officer of the American Cancer Society said in a statement. “Without those, community-based screening should not be initiated.”

Prostate cancer screening has long been debated. That’s because screening for slow-growing diseases, like prostate cancer tends to be, may lead to unnecessary treatment.

Geneticist Eric Lander, a biology professor at MIT, says his work as a member of the President’s Council of Advisors on Science and Technology has convinced him that there is too often a disconnect between the fields of science and economics, blocking needed progress.

“We need to forge a deeper understanding and relationship between economics and science,” he told an audience of scientists, educators and journalists at the annual American Association for the Advancement of Science meeting over the weekend.

The lack of coordination between the two has led to problems in science and health care, said Lander. For instance, why can’t we produce vaccines within two or three months of when we need them? Vaccines are low-margin, commodity items, he said. What about advances in sources of clean, low-carbon energy? There’s no natural incentive for buyers or sellers to develop new ones.

And health care is “rife with market failure,” he said. He mentioned the oft-criticized fee-for-service system, which encourages doctors to order more tests and perform more procedures. There is also “no strong sense of urgency” to improve health-care IT, said Lander, pointing out that Kaiser Permanente knew about the dangers of the painkiller Vioxx before the FDA did.

Photo: Associated Press

In apologizing for his high-profile sex scandal, golfer Tiger Woods said today that he has been in intensive therapy for 45 days and will be returning for more sessions starting tomorrow. His reference to his affairs and “repeated irresponsible behavior” prompts us to take a closer look at a condition that many call sex addiction.

Actually, sex addiction currently isn’t considered a specific disorder in the primary reference for psychiatric diagnoses, the Diagnostic and Statistical Manual of Mental Disorders. But a condition called hypersexual disorder — which sounds a lot like sex addiction –- has been proposed for inclusion in the next version of the manual, called DSM-V, which is set to be published in 2013.

The concept of sex addiction “sprung out of the clinical observations of many front-line clinicians that there are people who struggle with what they feel is excessive sexual behavior that is getting them into trouble in some ways,” Kenneth Zucker tells the Health Blog. He’s chairman of the American Psychiatric Association’s DSM-V workgroup on sexual and gender identity disorders and psychologist-in-chief at the Centre for Addiction and Mental Health in Toronto.

There’s a need for clinicians to recognize this group of individuals, according to the committee chaired by Zucker. Many of these individuals exhibit repeated “out of control” sexual behaviors, but the behaviors are otherwise considered to be normal — not deviant, the committee says.

To be diagnosed with the proposed new disorder, individuals must have or engage in uncontrollable repeated and intensive sexual fantasies, urges and behaviors for at least six months. These fantasies or acts have to consume significant periods of the individual’s time and negatively impact their lives.

Woods hasn’t made any mention of sex addition since the scandal began to unfold after Thanksgiving. In his apology today, he said had been unfaithful and that his behavior was the result of thinking rules didn’t apply to him.

According to the proposed criteria for hypersexual disorder, people engage in these behaviors in response to various moods, including anxiety, depression and boredom. Currently, a number of treatments claim to treat sex addiction: individual talk therapy, 12-step group supports similar to Alcoholics Anonymous, drugs and residential treatments such as the Pine Grove Behavioral Health and Addiction Services facility in Mississippi where many believe Woods is being treated.

But, “there hasn’t been a lot of research on the effectiveness and the efficacy of different treatment approaches,” says Zucker.

Photo: Bloomberg News