Monday, 5 August 2013

Natural health products contain hidden ingredients: May pose serious risk to health

Three natural health products bearing the Natural Health Product Number NPN 80041194 and one unauthorized natural health product were tested by Health Canada and found to contain hidden ingredients (sildenafil analogs) that may pose serious risks to the health of Canadians. The products (called Innerget Instant Erection, Innerget Prolonged Performance, Innerget Everlasting Strength and Megaton 2080) were being sold by Lion King Health Enterprises Group Ltd., at 1328-8368 Capstan Way, Richmond, BC.


These products are promoted as male sexual stimulants and contain hidden prescription medications. Approved drugs that contain these ingredients can only be sold with a prescription and by a pharmacy. The use of these products can put your health at serious risk.

Consult your healthcare practitioner with any questions or concerns regarding use of these products.Report any adverse reaction potentially related to these products to Health Canada.Contact Health Canada’s toll-free line at 1-800-267-9675 with questions or complaints about these products.

Canadians who have purchased or used these products, particularly people with heart problems.


Sildenafil and its analogs are prescription medications that should only be used under the supervision of a health care practitioner. Products containing sildenafil or tadalafil should never be used by individuals taking any kind of nitrate drug (e.g. nitroglycerine) as they can cause potentially life-threatening low blood pressure.


Individuals with heart problems including high blood pressure, a history of heart attack, stroke, abnormal heart beat or chest pain are at higher risk of cardiovascular side-effects if they engage in sexual activity, including if they use sildenafil or tadalafil to help them achieve an erection. Other possible side-effects of using sildenafil or tadalafil include headache, facial flushing, indigestion, dizziness, abnormal vision and hearing loss.


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Synthetic Calcitonin (Salmon) Nasal Spray (NS) - Market Withdrawal of All Products, Effective October 1st, 2013 - For Health Professionals

Subject: Market Withdrawal of All Synthetic Calcitonin (Salmon) Nasal Spray (NS) Products, Effective October 1st, 2013

MIACALCIN® NS, DIN 02240775 (Novartis Pharmaceuticals Canada Inc.)SANDOZ CALCITONIN NS DIN 02261766 (Sandoz Canada Inc.)APO-CALCITONIN NS DIN 02247585 (Apotex Inc.)

The manufacturers of synthetic calcitonin (salmon) nasal spray (NS) products (listed above), in collaboration with Health Canada, would like to advise you of the market withdrawal of these Products, effective October 1st, 2013.


All three products are authorized in Canada for the treatment of postmenopausal osteoporosis in females greater than five years post menopause with low bone mass relative to healthy premenopausal females.

Following the review of safety and efficacy information for synthetic calcitonin (salmon) nasal spray products, Health Canada has concluded, in light of a newly identified risk of malignancies (cancer), that its benefit-risk profile for the treatment of postmenopausal osteoporosis is no longer considered favourable.As a result of these findings, calcitonin (salmon) nasal spray will be withdrawn from the market effective October 1st, 2013.Patients being treated for osteoporosis with synthetic calcitonin (salmon) should be switched to an alternative treatment.

Health Canada has evaluated information on the risk of malignancies from randomised controlled trials in patients with osteoporosis or osteoarthritis receiving calcitonin (salmon) nasal spray or an unlicensed oral calcitonin formulation. Patients treated with calcitonin in these trials had a low but observable increased rate of malignancies compared with patients taking placebo. The increased rates seen with calcitonin compared to placebo varied between 0.7% in studies with the oral formulation to 2.4% in the studies with the nasal formulation.Taking this new safety information and the available efficacy data into account, Health Canada concluded that the risks of calcitonin (salmon) nasal spray outweigh the benefits for the treatment of established post-menopausal osteoporosis.


As of July 3, 2013, the manufacturers cited above have ceased the sale of synthetic calcitonin (salmon) nasal spray (NS) products. Distribution of the products will be phased out and the DINs for the above-cited products will be cancelled on October 1st, 2013.


Healthcare professionals should no longer prescribe the above-mentioned products for the treatment of osteoporosis and are advised to seek alternative therapies for their patients. Pharmacists are advised that dispensing should cease by October 1st, 2013, since the DINs will become inactive on that date. To ensure full inventory depletion, we advise that the above-cited products be removed from your inventory by October 1st, 2013. Pharmacists wishing to return remaining unused product by that date may do so by returning to their wholesaler for a refund. Patients being treated for osteoporosis with any of the above mentioned products are advised to speak to their doctor for a recommendation of suitable alternative treatment.


Managing marketed health product-related adverse reactions depends on health care professionals and consumers reporting them. Reporting rates determined on the basis of spontaneously reported post-marketing adverse reactions are generally presumed to underestimate the risks associated with health product treatments. Any case of serious overdose symptoms or other serious or unexpected adverse reactions in patients receiving calcitonin NS should be reported to the respective product manufacturer or Health Canada at the following addresses:


MIACALCIN® NS:
Novartis Pharmaceuticals Canada Inc.

385 Bouchard blvd,
Dorval, Quebec, H9S 1A9
Phone: 1-800-363-8883 (Medical Information)
Fax:514-636-3175


SANDOZ CALCITONIN NS:
Sandoz Canada Inc.

145, Jules-Leger,
Boucherville, Quebec, J4B 7K8
Phone: 1-800-361-3062 (Drug Information)


APO-CALCITONIN NS:
Apotex Inc.,

150 Signet Drive,
Toronto, Ontario M9L 1T9
Phone: 1-800-667-4708 (Drug Safety)
Fax: 1-416-401-3819
Email: drugsafety@apotex.com


To change your mailing address or fax number, please contact Healthcare Advisor by fax at 1-866-825-7101 or by e-mail athealthcareadvisor@plexus360.com.


You can report any suspected adverse reactions associated with the use of health products to Health Canada by:

Calling toll-free at 1-866-234-2345; orVisiting MedEffect Canada's Web page on Adverse Reaction Reporting for information on how to report online, by mail or by fax

For other health product inquiries related to this communication, please contact Health Canada at:
Marketed Health Products Directorate (MHPD)
E-mail: mhpd_dpsc.public@hc-sc.gc.ca
Tel: 613-954-6522
Fax: 613-952-7738


Should you have any questions or require additional information regarding the use of calcitonin NS, please contact the respective manufacturer :

for MIACALCIN® NS - Novartis Pharmaceuticals Canada Inc., Medical Information Department at 1-800-363-8883,for SANDOZ CALCITONIN NS - Sandoz Canada Inc., Drug Information Department at 1-800-361-3062 andfor APO-CALCITONIN NS - Apotex Drug Information at 1-800-667-4708.
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Friday, 2 August 2013

Longer Looks: Mayo's Demands; Posting Hospital Prices

 


 
When the billionaire owner of the Minnesota Vikings football team decided last year he wanted a new, $1 billion stadium, he did what sports franchise owners often do: threaten to relocate to another state—at least implicitly—and thereby wrung nearly $500 million dollars from taxpayers. ... this year, a different kind of local juggernaut threatened to take its business elsewhere unless Minnesotans helped pay for a multibillion-dollar new development: The Rochester-based Mayo Clinic. ... the state legislature in May approved $585 million in city, county and state funds for infrastructure upgrades to accommodate Mayo's 20-year, $5.6 billion expansion. (Mayo itself is covering $3.5 billion of the cost, while healthcare-related businesses are expected to contribute $2.1 billion.) Worried that Obamacare will hurt its bottom line, Mayo is betting its future on its ability to lure an greater percentage of the wealthiest and sickest patients to its dazzling high-tech hospitals (Ilan Greenberg, 7/24).


The New Yorker: Tweeting Death
In the week before her death, Simon began live-tweeting his mother’s final days to his almost 1.3 million followers from her hospital room. The tweets were poignant and haunting, and have brought Simon—already a mini-celebrity—a new level of renown. Total strangers read what he wrote and responded deeply. ... The tweets, which felt almost aphoristic (a mere hundred and forty characters each), underscored one of the strangest things about being with someone at the end of her life: the surreality of time, the way that time bends and distorts, becomes material. ... It’s our equivalent of the ringing of church bells in the town square, for better or for worse (Meghan O'Rourke, 7/31).


The New York Times: Status And Stress
Although professionals may bemoan their long work hours and high-pressure careers, really, there’s stress, and then there’s Stress with a capital “S.” The former can be considered a manageable if unpleasant part of life; in the right amount, it may even strengthen one’s mettle. The latter kills. What’s the difference? Scientists have settled on an oddly subjective explanation: the more helpless one feels when facing a given stressor, they argue, the more toxic that stressor’s effects (Moises Velasquez-Manoff, 7/27).


The New York Times: Revealing A Health Care Secret: The Price
The Surgery Center of Oklahoma is an ambulatory surgical center in Oklahoma City owned by its roughly 40 surgeons and anesthesiologists. What makes it different from every other such facility in America is this: If you need an anterior cruciate ligament reconstruction, you will know beforehand — because it's on their Web site — that it costs $6,990 if you self-pay in advance. … What's remarkable is that this is remarkable. Why should a business become the subject of news stories simply because it tells people the cost of its services? Because it's health care (Tina Rosenberg, 7/31).


Los Angeles Times: 'Critically Ill' Author Frederick Southwick On What Ails Our Healthcare System
Mary Southwick was 34 when she developed pain on the bottom of one foot. After seeing a neurologist who said she had a nerve injury caused by dancing, she developed thrombophlebitis and was admitted to the hospital. An intern underdosed her heparin (blood thinner), and she suffered a large blood clot in a lung. This was soon followed by a heart attack, then respiratory failure, renal failure and shock. … Frederick Southwick, chief of infectious diseases at the University of Florida in Gainesville, says his wife's trauma motivated him to write the book "Critically Ill: A 5-Point Plan to Cure Healthcare Delivery." Here he offers some guidance to negotiate the healthcare system (Judy Mandell, 7/26).



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Viewpoints: Doctors' Sway Over Medicare Pay; Hospital Rankings Not All They Seem; Legal Immigrants' Health Needs Overlooked

 


Even before the latest Medicare trustees report came out at the end of May, the White House spin masters had already crafted a story to go with it. Medicare's finances have improved, we're being told. The trust fund will last longer. The unfunded liability is lower. One of the reasons is said to be ObamaCare. The core of the new health reform doesn't kick in until next year, but already it's improving things for seniors? Here's the real story (John C. Goodman and Laurence J. Kotlikoff, 7/24).


The Wall Street Journal: Those Hospital Rankings Could Use A Healthy Dose Of Skepticism
The U.S. News & World Report "Best Hospitals" rankings for 2012-13 were released last week, followed by the usual media hoopla and a few chest-thumping press releases from hospitals at the top of the list. Whether the rankings actually mean anything is an entirely different story. The highest-ranked hospitals are always quick to tout their rankings in hopes of attracting new patients who will pay top dollar (Ezekial J. Emanuel and Andrew Steinmetz, 7/24).


Los Angeles Times' Capital Journal: Big-Bucks Battle Shaping Up Over Bid To Raise Malpractice Award Limit
You don't need to be a Nobel economist to understand that dollars today aren't anything close to their worth four decades ago. Gasoline, real estate, medical care—they've all skyrocketed in cost. Everything's gone up, that is, except damage awards for pain and suffering caused by medical malpractice (George Skelton, 7/24). 


The New England Journal of Medicine: Observation Care — High-Value Care Or A Cost-Shifting Loophole?
Current CMS policy on observation care promotes cost shifting without rewarding higher value, since payment is time-based and does not reward the use of evidence-based clinical pathways or hospital units designed to provide efficient care for this group of patients. ... Not all observation care is the same; payment reforms should protect patients from excessive out-of-pocket expenses and reward the efficient care delivered in observation units, which prevents prolonged hospitalizations (Drs. Christopher W. Baugh and Jeremiah D. Schuur, 7/25).


The New England Journal of Medicine: Stuck Between Health And Immigration Reform — Care For Undocumented Immigrants
Although there are valid perspectives on multiple sides of the immigration debate, there are stark public health implications of continuing to permit the existence of a medical underclass comprising more than 10 million people. Neither the recent national health reform law nor the immigration bill currently being considered solves these vexing problems; indeed, these policies may increase the barriers for some undocumented immigrants. For the foreseeable future, undocumented immigrants will remain on the outskirts of our public programs and safety net, a controversial reminder of ongoing inequities in our health care system (Dr. Benjamin D. Sommers, 7/24).


The New England Journal of Medicine: Holes in the Safety Net — Legal Immigrants' Access to Health Insurance
While Congress debates whether publicly supported health care should be available to undocumented immigrants who may be placed on a path to citizenship under immigration reform, the health care needs of already legal immigrants continues to be overlooked. More than 12 million immigrants are lawfully present in the United States. ... Public policies that deny legal immigrants equal access to public insurance programs leave lawful residents and their health care providers unnecessarily vulnerable when injuries and illness strike. By encouraging immigrant-only programs, such policies also perpetuate needless complexity in the health care system (Wendy E. Parmet, 7/24).


The New England Journal of Medicine: Rationing Lung Transplants — Procedural Fairness In Allocation And Appeals
The well-publicized cases of two pediatric candidates for lung transplants have shaken the transplant community with emergency legal injunctions arguing that current lung-allocation policy is "arbitrary and capricious." Although the resulting transplantation seemingly provided an uplifting conclusion to an emotional public debate, this precedent may open the floodgates to litigation from patients seeking to improve their chances of obtaining organs. These cases questioned the potential disadvantaging of children and the procedural fairness in lung allocation. But legal appeals exacerbate inequities and undercut public trust in the organ-transplantation system (Keren Ladin and Dr. Douglas W. Hanto, 7/24).


The New England Journal of Medicine: Accountable Prescribing
As insurance coverage expands, we must ensure that greater access to prescription drugs confers better health, not harm. The need to advance performance measures as health care reform proceeds is well recognized. Ideally, we should assess outcomes valued by patients, but for reasons of feasibility, many measures focus instead on surrogate end points. To improve health, such end points must be based on strong evidence, and how you get there matters (Drs. Nancy E. Morden, Lisa M. Schwartz, Elliott S. Fisher and Steven Woloshin, 7/25). 


The New York Times: Justice For The Mentally Disabled
Gov. Andrew Cuomo closed out a shameful period in New York's history earlier this week when he agreed to give about 4,000 mentally ill people held in highly restrictive institutional settings the option of moving into supported housing, where they can live independently with the help of social service organizations. The agreement, outlined in a consent decree filed in federal court in New York City, ends a long legal battle and could bring a new day for people isolated in inadequate, for-profit residences that make their disabilities that much harder to bear (7/24).


The New York Times: Realities In Global Treatment Of H.I.V.
The World Health Organization recently issued aggressive new guidelines for treating people infected with H.I.V., the virus that causes AIDS. The guidelines are a welcome step forward but fall short of the treatment goals that could and should be set (7/24). 


JAMA: Why Obamacare Needs Millenials
One of the primary goals of the Affordable Care Act (ACA)—now known more commonly as Obamacare—is to make health insurance more accessible, particularly for people with preexisting conditions. … This focus on reaching young and healthy people is almost strangely ironic in that the new health insurance exchanges and Obamacare proponents appear to be engaging in the same "cherry picking" for which they have criticized insurers (Larry Levitt, 7/24).


National Journal: The Unprecedented – And Contemptible – Attempts To Sabotage Obamacare
When Mike Lee pledges to try to shut down the government unless President Obama knuckles under and defunds Obamacare entirely, it is not news—it is par for the course for the take-no-prisoners extremist senator from Utah. When the Senate Republicans' No. 2 and No. 3 leaders, John Cornyn and John Thune, sign on to the blackmail plan, it is news—of the most depressing variety (Norm Ornstein, 7/24).


Chicago Tribune: Looking Back To 2013
On Monday, Gov. Pat Quinn signed into law the state's massive Medicaid expansion. With that flick of his pen, 342,000 low-income Illinois citizens will be newly eligible for Medicaid starting in January. State officials also expect as many as 171,000 others who are now eligible but haven't signed up to do so as an Obamacare marketing campaign rolls out. If so, the number of Medicaid recipients would grow from today's 2.8 million to 3.3 million — more than 1 in 4 Illinoisans. ... We also hope that, a decade or two from now, Illinois citizens don't look back to 2013 and say: What were they thinking? How could the politicians be so willfully blind to the billions that the Medicaid expansion would cost taxpayers? (7/24).


Pittsburgh Post-Gazette: Much Is At Stake For Minorities In Medicaid Debate
As Pennsylvania decides whether to expand its Medicaid program, a new study says the decision will have a major impact on the state's racial and ethnic minorities. A Kaiser Family Foundation analysis found that 15 percent of African Americans in Pennsylvania are without health insurance and nearly two-thirds of them would qualify for coverage under federal poverty level criteria set out by the Affordable Care Act if Medicaid were expanded (Steve Twedt, 7/25).


Sacramento Bee: Use Health Law To Fight Tooth Decay In Kids
Tooth decay is the most common chronic health problem in children, according to the Centers for Disease Control and Prevention. More than a quarter of kids have decay in their baby teeth by the time they enter kindergarten. Nearly 68 percent of teenagers 16 to 19 have decay in their permanent teeth. The Affordable Care Act provides an opportunity to improve children's access to dental care starting in January 2014 – if the California state health exchange, called Covered California, does things right (7/25). 


The Huffington Post: Decline In Cost Of Health Care In America
Undeniably, over the past several years the singular focus of conversation among policy makers has shifted from simply more care and better quality of care to better value in health care, where value is defined as quality over cost. ... Yet if history is any indicator, as our economy strengthens costs of health care will rise once again. So, last month the Bipartisan Policy Center (BPC) made 50 bold recommendations on how to sustain the lower growth of health care costs (Dr. Manoj Jain and Dr. Bill Frist, 7/24).



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Weekend Reading: The Mystery Of Some Innovations That Are Slow To Be Accepted; Myths About The Obesity Crisis

 


Why do some innovations spread so swiftly and others so slowly? Consider the very different trajectories of surgical anesthesia and antiseptics. ... On October 16, 1846, at Massachusetts General Hospital, Morton administered his gas through an inhaler in the mouth of a young man undergoing the excision of a tumor in his jaw. ... By February, anesthesia had been used in almost all the capitals of Europe, and by June in most regions of the world. ... In the eighteen-sixties, the Edinburgh surgeon Joseph Lister ... perfected ways to use carbolic acid for cleansing hands and wounds and destroying any germs that might enter the operating field. The result was strikingly lower rates of sepsis and death. You would have thought that ... his antiseptic method would have spread as rapidly as anesthesia. Far from it. ... In our era of electronic communications, we've come to expect that important innovations will spread quickly. Plenty do ... But there's an equally long list of vital innovations that have failed to catch on. The puzzle is why (Dr. Atul Gawande, 7/29).


The New Republic: Weight Loss Is Not The Answer: What Michelle Obama Doesn’t Get About Obesity
The biggest mystery when it comes to obesity is not how to prevent it. It's how to treat it. Don’t get me wrong. We need to know what expands our girth so that millions more don’t suffer the type 2 diabetes and heart disease that follow. But millions are obese, right now, and the medical establishment doesn’t really know how to help them. I learned that to my dismay when I tried to find a program for a relative who seemed too young for stomach bands and gastric bypasses. The problem is simple and well known. It’s hard but not impossible to lose weight. But it’s nearly impossible to keep it off (Judith Shulevitz, 7/23).


The Atlantic: Answering To Patient Who Yell The Loudest
Few people would argue that scarce medical resources should simply go to patients and families who yell the loudest, but the recent case of a ten year-old Pennsylvania girl with cystic fibrosis shows how such a strategy can work. The parents of Sarah Murnaghan went to court to demand that their daughter be placed on the transplant list for new lungs.  The court agreed, and she has now received a second set of lungs after her immune system rejected the first set. There is a long—and storied—history of activist patients bucking the system to obtain treatments initially denied to them. ... But in an era of rising health care costs and passage of the Affordable Care Act (ACA), which seeks to reign and regulate spending, the privileges of activist patients need to be reexamined (Dr. Barron Lerner, 7/23).


New Scientist: Why Is The Rich U.S. In Such Poor Health?
Americans die younger and experience more injury and illness than people in other rich nations, despite spending almost twice as much per person on health care. That was the startling conclusion of a major report released earlier this year by the U.S. National Research Council and the Institute of Medicine. … As distressing as all this is, much less attention has been given to the obvious question: Why is the United States so unwell? The answer, it turns out, is simple and yet deceptively complex: It's almost everything. ... we can hope that the evidence of a health disadvantage in the United States is now so compelling that the terms of the conversation and even the political calculus will begin to change. Then, perhaps, we can start addressing that disadvantage and stop paying for it with our lives (Laudan Aron, 7/15).


Boston Globe: Hypothermia Making A Comeback In Medicine
The last Dr. Peter Franklin remembers, he was lying on a table in the cardiac catheterization lab in a Miami hospital when his chest started to hurt. Then he died. The medical team raced to restart Franklin's heart, then placed a stent in a blocked artery to allow blood to again flow freely. His doctors also worked to save his brain, using a technique that's as old as ancient Greece — hypothermia. With recent studies lending scientific credibility to the practice, doctors now know that lowering a patient's body temperature — using methods including cooling blankets or an infusion of cold fluid — can improve brain recovery in patients who are comatose after cardiac arrest (Dr. Daniela J. Lamas, 7/22).


The New England Journal of Medicine: The Residency Mismatch
For generations, the supply of practicing physicians in the United States has swung from too small to too large and back again. In 2006, alarmed about a growing physician shortage, the Association of American Medical Colleges (AAMC) recommended that medical school enrollments be increased by 30% over the next decade. ... But there's another barrier to creating enough practicing physicians: there are insufficient residency posts to accommodate all these medical graduates. ... The absence of health-workforce planning, a hallmark of the freewheeling U.S. market economy, may come back to haunt policymakers, particularly when physician shortages become more apparent as the ACA's coverage expansion takes hold



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Viewpoints: Indian Health Service Takes Big Cuts; Labor 'Mutiny' Over Health Law; Gov. Jindal Says Medicaid Expansion Would Have Moved Privately Insured To Medicaid

 
It's an old American story: malign policies hatched in Washington leading to pain and death in Indian country. It was true in the 19th century. It is true now, at a time when Congress, heedless of its solemn treaty obligations to Indian tribes, is allowing the across-the-board budget cuts known as the sequester to threaten the health, safety and education of Indians across the nation. ... One of the most important is the Indian Health Service, which serves about two million people on reservations and is grossly underfinanced even in good times. It routinely runs out of money halfway through the year. Though Medicare, Medicaid and veterans' health were exempted from sequestration cuts, the Indian Health Service was not (7/23).


The New York Times' Economix: The New Economics Of Part-Time Employment, Continued
A revised definition of part-time employment may have some popular appeal, but it will not repair the Affordable Care Act's disincentives for full-time employment or its extra costs for taxpayers (Casey Mulligan, 7/24). 


The Wall Street Journal: Obama's New York Model
President Obama has found a new example for the pending wonders of his health-care reform—New York. In his latest sales pitch last week, he declared that insurance rates in New York's ObamaCare exchange "will be at least 50% lower next year than they are today. Think about that: 50% lower." ... The real news is that New York ruined its individual insurance market two decades ago by imposing the same regulations that ObamaCare is about to impose on every other state (7/23).


The Wall Street Journal's Political Diary: Labor Vs. ObamaCare
The labor union mutiny against the Affordable Care Act expanded Thursday with a letter to President Obama from the head of the Laborers' International Union of North America, which represents more than 500,000 workers in construction and other industries. Echoing a similar appeal by three top union chiefs the previous week, union president Terry O'Sullivan wrote that ObamaCare will have "destructive consequences" for health plans that cover millions of workers and their families (Alexander Kazam, 7/23).


New Orleans Times-Picayune: Gov. Bobby Jindal: Why I Opposed Medicaid Expansion
First, as a general principle, we should not move people from private insurance onto government-run programs. It seems a matter of common sense that we should want to encourage self-sufficiency and target taxpayer spending only for those most in need. But Medicaid expansion would have moved up to 171,000 Louisianians off private insurance and stopped another 77,000 people from obtaining private insurance. To cover 214,000 low-income uninsured people in Louisiana, Obamacare would add more than twice that number -- more than 450,000 people -- to the Medicaid rolls. This makes no sense (Louisiana Gov. Bobby Jindal, 7/23).  


Health Policy Solutions (a Colo. news service): Not So Invincible – Young People Confused About Obamacare
Contrary to what many in the media may believe, young people do care about the implementation of Obamacare, the Affordable Care Act (ACA). But just like many other people in America, many of us may be confused about its provisions and which may apply to us and how. Though I am a senior at Boston University, and have studied health policy, I acknowledge that I do not understand everything I may need to know about the new law (Danielle Robbio, 7/24).


CNN: Will Obamacare Help Primary Care?
You're wiped out, eating too much, your chest feels funny when you climb stairs, sex isn't working well, you can't wait for a drink and your spouse is looking at you warily. But you just bought health insurance online from a health exchange. Now, before you head for an ER, if only you could find a doctor. ... Primary care doctors -- the pediatricians, family doctors and internists who constitute the foundation of our medical system -- are also in trouble (Dr. Tom Delbanco, 7/23).


Tampa Bay Times: Fed Must Save Children From State Apathy
The federal government took the only recourse available by finally asking the courts to end Florida's shameful practice of warehousing disabled children in nursing homes. For two years, Gov. Rick Scott's administration has made clear that it had no intention of changing course on a policy that punishes children with complex medical needs and keeps them from their homes, families and communities. If Florida won't comply with the antidiscrimination laws, then it falls to the federal government and the courts (7/23).


Bloomberg: How Republicans Can Help Us Grow Old Gracefully
If you thought the fight over Obamacare was bruising, brace yourself for the coming battle over long-term-care insurance. Demographic pressure and ill-fitting public programs make the current approach unsustainable, whether we like it or not. ... A better option is for the U.S. to follow the lead of almost every other developed country and create a social insurance plan for long-term care, in which the government collects premiums from the working-age population and uses the money to fund care for those who qualify (7/23).


The Seattle Times: Feds Make A Hash Of State's Mental-Health System
The U.S. Centers for Medicaid and Medicare Services informed the state of Washington that the state's outpatient mental-health system violated federal procurement laws, as articulated in OMB Circular A-87. Hope that didn't lose you. That accountant-speak is bone-dry. ... "Now wait a minute," longtime readers will say, "haven't you spent a lot of time arguing that health insurance doesn't necessarily make us any healthier? (7/22).


The Lund Report: Optimism Abounds In Cover Oregon Land – Is It Real?
Oregonians have been led to expect that they will receive large subsidies to help pay the cost of their personal health insurance now that health insurance is required. We also know they have been told that if they like their current insurance policy, they can keep it. Sounds good on the surface, but if we dig a little deeper we find that both statements don't hold much weight (John Gridley, 7/23).


Georgia Health News: Palliative And Hospice Care Help Make Life Livable
A hundred years ago, the average life expectancy in the United States was just under 50 years. Today it's nearly 80 years – a true testament to the benefits of modern medical advances. The development of highly effective treatments and technologies significantly extended Americans lives. However, these technological treatments can also affect quality of life, and not always for the better (Dr. Victor Alvarez, 7/23).


Minneapolis Star Tribune: Want Better Health Care? Be Pushy
I've been a physician for 35 years. During the most recent 25, I've devoted time to practice improvement and population health initiatives. In part, this involved helping individuals to be healthier. It also involved helping the care delivery system explore how to make care more effective, more efficient and more satisfying to patients (the combination labeled "the triple aim") (Dr. Charles J. Fazio, 7/23).


Bloomberg: What My Dog Taught Me About Health Insurance
Last February, on Valentine’s Day, the Official Blog Spouse and I took custody of an eight-week-old bullmastiff puppy named Fitzgerald. The first thing we did was to drive him home from Indiana and install him in the Stately McSuderman McMansion. The second thing we did was to buy him pet health insurance. "Now wait a minute," longtime readers will say, "haven’t you spent a lot of time arguing that health insurance doesn’t necessarily make us any healthier?" (Megan McArdle, 7/23).


JAMA: The Critical Role of Caregivers in Achieving Patient-Centered Care
Achieving high-quality, cost-effective medical care remains an elusive goal of the US health care system, but there is widespread agreement that patient-centered care will be a key ingredient.1 Yet for frail elders and patients with advanced illness, many of whom have multiple chronic diseases, patient-centered care is impossible without caregiver involvement. Although advocacy groups such as the National Alliance for Caregivers have long endorsed attention to family members and prominent research organizations such as the newly created Patient-Centered Outcomes Research Institute mention families in their research agendas, the critical role of caregivers deserves considerably more attention from clinicians (Dr. Muriel R. Gillick, 7/22).


JAMA: Who Owns Human Genes?
The [Supreme Court's] compromise ruling acknowledged difficult issues in a simmering controversy. Granting commercial rights over naturally occurring biological products seemed unethical because industry should not be able to control access to unaltered materials found in nature. However, failure to afford intellectual property protection could stifle innovation, robbing entrepreneurs of financial incentives for discovery. Myriad lost the exclusive right to isolate the BRCA1 and BRCA2 genes of individuals, but maintained the right to its unique method of synthetically creating BRCA cDNA to produce and market its tests (Lawrence O. Gostin, 7/22). 



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Viewpoints: Health Law Rollout Needs A Better Salesman; The Overhaul Is Shifting The Economy To Part-Timers

We need a serious and sustained presidential conversation with the country about the new health care reform laws—or progressives risk losing ownership of this once-in-generation liberal reform. If you listen to people in focus group discussions right now, they are clueless about the most basic policies in the reforms, even though parts of the law are already in place, the exchanges are to be launched in October, and the law’s requirements and benefits will become fully operative in January. ... And in the most recent national surveys, more people think their health insurance situation will be made worse by the impending changes (Stanley B. Greenberg, 7/30).


USA Today: Lift Health Care Reform's Deductible Cap
The Obama administration recently announced that it would delay until 2015 the Affordable Care Act's "employer mandate," which will require all companies with at least 50 full-time employees to offer health insurance or pay a fine. The delay represents a big help to large firms. Now it's time for the administration to throw a similar lifeline to small businesses -- by lifting the law's cap on annual deductibles (Janet Trautwein, 8/1). 


Fox News: Mr. President, ObamaCare Is Creating A Part Time Economy
The June unemployment rate remained unchanged from the previous month at 7.6 percent, but the June underemployment rate, which includes those who have stopped looking or settled for part-time work, rose sharply from 13.8 percent to 14.3 percent. This is partly due to the transition of employment from full-time to part-time, as the private and public sectors are forced into the perilous compliance standards of the president’s health care law (Rep. Sam Graves, R-Mo., 8/1). 


Chicago Tribune: The Part-Timing Of America
The Affordable Care Act will give companies -- and, surprisingly, their workers -- a big incentive to embrace more part-time employment. That isn't necessarily a problem, except when it comes to paying the health-insurance bills for all those part-timers. Looks like that job will fall to you, taxpayers. Some of the motives at play here will strike you as familiar; others are fresh insights on the part-timing of America (7/31).


New England Journal Of Medicine: The Unanticipated Consequences Of Postponing The Employer Mandate
The Obama administration's decision to postpone implementation of the employer mandate is the latest in a series of delays and alterations of the Affordable Care Act (ACA). But postponing the mandate — which requires larger employers to offer lower-income workers health insurance coverage similar to that available in the new insurance exchanges, on equal and affordable financial terms — may create large ripple effects. The good news is that as compared with instituting the mandate as planned, postponing it should barely increase the number of uninsured Americans after ACA implementation. But it affects other provisions, particularly the individual subsidies for purchasing insurance, and creates distorted incentives that may leave the government paying significantly more than planned (Mark Pauly and Adam Leive, 7/31).


Los Angeles Times: The Latest Misguided GOP Effort To Stop Obamacare
The House is expected to hold yet another symbolic vote this week on a bill to neuter the Patient Protection and Affordable Care Act, once again taking aim at the much-unloved "individual mandate" -- the requirement that virtually all adult Americans obtain coverage, starting in 2014. ... The problem with this approach -- beyond the fact that the bill would be dead on arrival in the Senate -- is that it would leave intact the requirement that insurers offer coverage to all applicants without regard to their medical histories. Insurers would also be barred from charging sicker or riskier customers higher premiums than healthy ones, and would be limited in the surcharges they could impose on older applicants and smokers (Jon Healey, 7/31).


WBUR: Cognoscenti: When Your Doctor Says 'Cancer': The Risks Of Fear Itself
Imagine your doctor saying, "You have cancer." How would you feel? The diagnosis would be more specific: "You have Ductal Carcinoma in Situ" (DCIS) rather than breast cancer, or "You have a Gleason score 4 prostate cancer" rather than prostate cancer. But you would no doubt hear only cancer. How would you react, even if the doctor went on to tell you that what you have is unlikely to ever grow into anything that could kill you, or even harm you, and that in the case of DCIS, it might even go away by itself? (David Ropeik, 8/1).


Sacramento Bee: A Cost Of Dismantling Mental Health Care
Kathy Gaither, the person in charge of daily operations at the California Department of State Hospitals, went on an unexplained administrative leave earlier this month, a week after the state Senate confirmed her appointment. ... Whatever the reason for Gaither's departure, the lack of permanent leadership raises questions of priorities. The California Department of State Hospitals has a $1.6 billion budget and more than 10,000 employees, and is responsible for the care of 6,560 severely mentally ill people in seven state hospitals. The department has been without stable leadership since the previous director retired in December 2010 (Dan Morain, 7/31).



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