U.S. Federal Appeals Court for the District of Columbia overturns decision of lower Federal District Court on Medicare/HHS lawsuit!

Chiropractors can now pursue hearings challenging whether D.O.s or M.D.s are “qualified” to provide the distinctly chiropractic service as defined by Medicare law. The decision - released by the Appeals Court on December 13 - held that the lower Federal Court lacked jurisdiction to hold that medical doctors or osteopaths, if untrained/unqualified to provide the chiropractic benefit, could claim to do so. The M.D.s and D.O.s must prove they are qualified to provide the service. If a chiropractor’s patient is denied payment for a claim, he/she can assign to the D.C. the right to appeal the denial to an Administrative Law Judge (Executive Branch). American Chiropractic Association, December 14, 2005. Mr. George McAndrews, lead attorney for the American Chiropractic Association (ACA) lawsuit, states, “This victory completely reverses the decision of the lower federal court. Several years ago a suburban Chicago hospital posted a notice that all employees could obtain chiropractic services under the hospital’s health care plan if the service was provided by a medical doctor. When it was brought to my attention, I wrote the hospital and demanded a list of any medical doctor within a 25-mile radius of the hospital that delivered the chiropractic service. I informed the hospital that if they could not present any names, the hospital was guilty of false representation to its employees and action would be taken. In response, a nurse reported that, thereafter, her chiropractic care by a chiropractor was paid for by the hospital’s program. Chiropractors should not be hesitant or bashful in demanding that any Medicare HMO provide chiropractic services to its members. If they profess to provide them only through medical doctors or osteopaths, or not at all, the ACA offices should be informed immediately for proper evaluation under the appeals court ruling. The journals are filled with reports of the lack of knowledge of medical practitioners of the musculoskeletal system. It’s time to make the Medicare HMOs put up or shut up about how they handle members with subluxations. I am very pleased that the appeals court has now emphasized ‘qualified’ as the test.”

Medicine’s sticker shock

A dozen years ago Bill Clinton’s health reform efforts were destroyed by the insurance industry’s duplicity, it’s worth trying again. The health care system is steadily becoming more gummed up in ways that are impossible to hide. “This is one of those fleeting opportunities where a catastrophe creates an opportunity to rebuild something better than before,” says Dr. Irwin Redlener, president of the Children’s Health Fund and associate dean of the Mailman School of Public Health at Columbia University. In a sign of the growing disenchantment with our health system, 13,000 medical doctors have joined Physicians for a National Health Program, which lobbies for a single-payer government-financed health program. U.S. life expectancy in the United States is worse than Costa Rica’s. Medical expenses add $1,500 to the sticker of each General Motors car, and our system is catastrophically inefficient, according to a study in The New England Journal of Medicine. Health administrative costs are $1,059 per capita in the U.S., and just $307 in Canada. Another principle is that we should put less emphasis on curative medicine and more on public health and prevention including encouraging exercise. You get more bang for the buck when you promise healthier lifestyles – fighting obesity, cigarette smoking and the like, says the smart new book, “Prescription for a Healthy Nation.” The New York Times, October 2, 2005.

Significant obstacles in patient care in the U.S.

Compared with Europe, Australia and New Zealand, the U.S. ranked the worst in medical errors, delayed test results, duplicate lab testing and financial burdens. The U.S. leads an international parade of six major nations in medical errors, according to a survey by the Commonwealth Fund. Thirty-four percent of Americans reported at least one of four types of medical errors in the past two years. These included receiving a wrong drug, incorrect treatment, incorrect test results and delayed test results. The survey was published in the September/October issue of Health Affairs. MedPage Today. Source news article: Forbes, MSNBC, Washington Post, November 7, 2005.

Study: Health insurance benefits decline

The percentage of businesses offering health insurance to workers has declined steadily over the last five years as the cost of providing coverage continues to outpace inflation and wage growth, according to the 2005 Annual Employer Health Benefits Survey released September 14 by the Kaiser Family Foundation and Health Research and Educational Trust. Three in five firms (60 percent) offered coverage to workers in 2005, down from 69 percent in 2000 and 66 percent in 2003. The study found that the drop stems almost entirely from fewer small businesses offering health benefits. The survey found that of firms who do not provide health benefits, cost was the key factor. Mealey’s Managed Care Liability Report, September 23, 2005.

Pricing drugs as if they were cars

Some countries set health care spending policies through national legislation. In California, they do it through television advertising. It was almost impossible during the week of November 3 to turn on a television set without seeing an advertisement paid for by the major drug companies that are pushing their plans. The drug companies say they have spent $80 million, a figure that happens to be almost four times what the governor spent when he won his office in a special election in 2003. Americans subsidize such drugs for people in other countries, with prescription spending 67 percent higher in America than in Germany. American employers are finding it is harder to be competitive with foreign companies that do not directly pay health care costs, and are starting to complain.

The New York Times, November 4, 2005.

Patients may ignore “unnecessary” medical doctor care

A new poll says the odds of patients following a medical doctor’s directions are fifty-fifty. More than half of U.S. adults said medical doctors recommend unnecessary treatments because they are worried about medical liability or want to make more money, according to a Harris Interactive poll. Fifty-two percent of the 2,286 adults that the research firm surveyed said they chose not to comply with a medical doctor’s recommendations regarding a prescription, diagnostic test or surgical procedure because they felt it was too aggressive or unnecessary. More than 70 percent of patients said they often or sometimes “experience problems” because of overly aggressive treatments, with 21 percent of patients saying they got a second opinion and 9 percent saying they found a new medical doctor for their care. AMEDNews, October 17, 2005.

Psychiatric drug use drops for children

Warnings that drugs such as Prozac, Paxil and Effexor can increase suicidal behavior in some children have resulted in a nearly 20 percent drop in U.S. pediatric prescriptions of the widely used antidepressants and have triggered deep concerns about the quality of current data on psychiatric drugs, doctors and regulators said. The unprecedented fall of what were once considered wonder drugs comes as a series of taxpayer-funded analyses have systematically undermined the claims of drug trials funded by drug houses, raising thorny questions about the ways in which psychiatric drugs are being tested, marketed and used. Washingtonpost.com, October 8, 2005.

U.S. ranks thirty-seventh among health care systems

Len Nichols, a health economist for the New America Foundation, said the U.S. leads other countries in health-care spending, but its health-care system is ranked thirty-seventh, next to Costa Rica and Slovenia. “Those are countries that should beat us in soccer,” he said. “They should not beat us in health care.” World Capital Bureau, TW, October 6, 2005.

Will California destroy Aetna Insurance?

Will the California legislature destroy Aetna insurance? Probably. It’s in the works. Senate Bill 840, a proposal to destroy ALL health insurance providers within California, and replace them with a State-run system has already passed the California Senate with a vote of 25 to 15. The measure went to the California House where it came up for a vote in November of this year. The health insurance industry brought this on themselves. Frankly, they deserve to get shut down. They are a pall on America. They, in a macrocosm, represent EVERYTHING wrong with health care in the U.S. The U.S., according to the World Health Organization ranks seventy-second in health care, with countries like Morocco, Costa Rica, Nicaragua, etc., rating higher in quality. But, of course, the U.S. ranks number one in health care costs. California has a population of about 34 million people – almost 12 percent of the total U.S. population. A successful action here to destroy the health insurance industry will reverberate nationwide. “Me too” legislation, across America, will look like a domino layout played to a predicted end. Good. Bolin Report, Aetna…Insurance legislation for California, October 5, 2005.

Study suggests most in U.S. will be fat

A new study that followed 4,000 people for three decades suggests that over the long haul, nine out of 10 men and seven out of 10 women will become overweight. Even those who made it to middle age without getting fat were not safe. Half of the men and women in the study who had made it well into adulthood without a weight problem ultimately became overweight. A third of those women and a quarter of the men became obese. The New York Times, October 4, 2005.

Older people who exercise experience less joint and muscle pain

Older people who exercise regularly experience fewer aches and pains than other people their age who are less active. Researchers found elderly people who engage in brisk aerobic exercise, like running, had 25 percent less joint and muscle pain, even though they were more likely to suffer painful injuries. The results appear in the current issue of Arthritis Research & Therapy. The study followed a group of running club members and a similar group of nonrunners in their mid-60s for 14 years. Each year, the participants completed a survey about their overall health, pain levels, injuries and exercise habits. The results showed the running club members logged an average of 314 minutes of exercise per week compared with an average of 123 minutes of regular aerobic exercise among the comparison group. WebMD, September, 19, 2005.

Government raises Medicare premiums again

Senior citizens and the disabled will have to pay a monthly Medicare premium of $88.50 next year for doctors’ visits and other services, a $10.30 boost in fee. Associated Press writer, September 16, 2005.

FDA steps up action on misleading drug ads

U.S. Food and Drug Administration (FDA) warnings to drug companies over misleading advertisements have more than tripled in the last year, an agency official said on September 19. The agency sent 17 warning letters in the 12 months ending in August, compared with an average of about four to five letters per year in recent years. Companies are not doing enough to present balanced information. Public Citizen Health Research Group’s Peter Luried said the increase in warnings was unimpressive since enforcement actions has dropped significantly since 1998, when the agency issued 157 total letters, in both warning and related letters. Reuters, September 20, 2005.

An FDA reviewer battles the drug his boss approved

“I ask that you recognize that as a medical officer at FDA, I get to count the bodies when things go wrong,” Dr. Misbin wrote. Soon after Dr. Misbin wrote this letter he was removed from the FDA Symbin (diabetes drug) review. The drug took another three-and-one-half years before it was finally approved in March 2005. The company agreed to a strong warning label and marketing restrictions. Another whistle blower within the FDA, a safety official, Dr. David Graham, has spoken out since last year accusing the FDA of failing to pay enough attention to drugs’ side effects. Dr. Graham continues to hold his FDA post. Dr. Misbin, who holds a medical degree and has specialized in diabetes, on the diabetes drug Rezulin, joined the FDA in 1995 and soon focused on the diabetes drug Rezulin. After the drug’s approval in 1997, some patients suffered liver failure and died. Dr. Misbin initially defended the drug and recommended broadening its use. Haunted by reports of fatal liver failures and letters from grieving relatives, he prodded the FDA to ban Rezulin. When the agency didn’t move quickly enough to suit him, he sent Congress internal FDA emails and other documents that later surfaced in the media. In March 2000, Rezulin was withdrawn from the U.S. Market. The Wall Street Journal, October 26, 2005.

FDA probes vaccine’s tie to brain illness

The government is investigating five reports of teenagers who came down with a serious neurological disorder after receiving a new vaccine against meningitis. Doctors don’t yet know whether the cases of Guillain Barre Syndrome are related to the shot, called Menactra, or are coincidence, the FDA emphasized on September 30. The government alerted the public as a precaution. Associated Press, October 3, 2005.

Front line against high blood pressure is under siege

Beta blockers, the commonly used drugs for treating high blood pressure unaccompanied by other cardiovascular disease, are probably “less effective” than other drugs, new research says. The work examines the results of 13 randomized trials. The conclusion is the drugs, which have been first-line treatment for high blood pressure for at least 25 years, produce a higher risk for stroke. The New York Times, November 1, 2005.

Ginseng may reduce number and severity of colds

Ginseng, long recommended as a treatment for colds by proponents of herbal medicine, has gained some support in a controlled scientific experiment. Those who took Ginseng in the study had colds had symptoms that were milder and had one-third fewer days with symptoms than those on a placebo. On every measure, the people taking the ginseng did better than those on the placebo. The New York Times, November 1, 2005.

Potential conflicts cited in process for new drugs

The authors of the guidelines to establish standards for prescribing medicines are often paid by the drug companies whose products they discuss, a new survey has found. The study in the journal Nature and published in the October 20 issue, found that more than one-third of the guideline authors acknowledged some financial interest in the drugs they recommended, including owning stock and being paid by the drug company to speak at seminars. Although 34 percent of guidelines explicitly state that their authors had no conflicts of interest at all, in half of the more than 200 guidelines examined, at least one author had received research financing from a relevant drug company. And 43 percent had at least one author who had been a paid speaker for the drug company. The New York Times, October 25, 2005.

FDA warns of suicidal thinking link

The FDA warned medical doctors on September 29 about reports of suicidal thinking in some children and adolescents who are taking Strattera, a drug used to treat attention deficit hyperactivity disorder. Manufacturer drug company Eli Lilly & Co. announced that a black-box warning will be added to the drug’s label in the U.S. Associated Press, TW, September 30, 2005.

Topical antibiotics not effective in childhood conjunctivitis

Most primary care visits for childhood conjunctivitis result in prescriptions for topical antibiotics. However, a Cochrane review of proven bacterial conjunctivitis in a referral population showed a high rate of resolution with placebo and only slightly better results with topical antibiotics. The research strongly suggests that infectious conjunctivitis that lasts less than one week can be managed without office consultation and without antibiotics. Journal Watch, September 1, 2005.

Adverse drug events (ADE) in long-term care facilities

A new study of two large long-term care facilities in Canada and Connecticut identified nearly 10 ADEs per 100 resident months, an estimated 42 percent of which were judged preventable. Of the serious, life-threatening or fatal ADEs, about 61 percent were deemed preventable. Six events resulted in permanent disability or death. Healthcare Daily Data Byte, September 9, 2005.

How often do doctors explain the costs associated with a recommended procedure?

Source: USA Today/Kaiser Family Foundation, Harvard School of Public Health, Health Care Costs Survey April 25 – June 9, 2005.

Experts warn of promising cancer drugs’ serious side effect

Cancer specialists warned on September 23 against widespread use of one of the most promising and novel cancer drugs, Avastin, after its maker stopped a study of it in ovarian cancer patients because many of them developed a serious bowel problem. Five out of 44 patients given Avastin developed gastrointestinal holes or tears. The danger of a hole in the bowel is that it allows bacteria to leak into the abdominal cavity, where it can cause very serious infections. The Des Moines Register, September 24, 2005.

The New York Times examines confusing medical billing system, looks to solutions