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Showing posts with label health. Show all posts
Showing posts with label health. Show all posts

Church and State

Denial of Care Rule Called

'Dangerous Policy'

Group Applauds Biden Admin. for Plan to Rescind Parts of Rule

    Washington D.C. - (AU) - 12/29/2022 - Americans United for Separation of Church and State President and CEO Rachel Laser issued the following statement on Dec. 29 in response to the Biden administration’s proposal to rescind parts of the Trump administration’s Denial of Care Rule, which invited health care workers to deny medical treatment and services to patients because of personal religious or moral beliefs:

    “We applaud the Biden administration for taking positive steps toward protecting both religious freedom and patients’ health by rescinding the Trump-era Denial of Care Rule. No one should be denied medical treatment because of someone else’s religious beliefs.

    “The Denial of Care Rule was a dangerous policy that weaponized religious freedom and put the health and lives of women, LGBTQ people, religious minorities and so many others in jeopardy. Today’s proposed rule recognizes the potential harm to patients and upholds the fundamental principle of church-state separation.”

    The Denial of Care Rule which was issued in May 2019 by the U.S. Department of Health and Human Services under former President Donald Trump. It invited any health care worker to deny medical care to patients because of the health care worker’s personal religious or moral beliefs. Health care facilities risked losing essential federal funding unless they granted employees carte blanche to deny services. That risk could have forced many health care facilities to eliminate services such as reproductive and LGBTQ care. Federal courts had blocked the rule from going into effect.

 Americans United and allies filed two federal lawsuits challenging the Denial of Care Rule, arguing that HHS during the Trump administration exceeded its authority and arbitrarily and capriciously failed to consider the rule’s potential harm to patients and the health care system, in violation of the federal Administrative Procedure Act. We also argued that the rule was unconstitutional because it favored specific religious beliefs in violation of the First Amendment; violated patients’ rights to privacy, liberty and equal dignity as guaranteed by the Fifth Amendment; and chilled patients’ speech and expression in violation of the First Amendment, all to the detriment of patients’ health and well-being.

  • In the County of Santa Clara v. HHS, Americans United joined the Center for Reproductive Rights, Lambda Legal, the law firm Mayer Brown LLP and Santa Clara County, Calif., which runs an extensive public health and hospital system that serves as a safety-net provider for the county’s 1.9 million Bay Area residents. Other plaintiffs in the case include providers across the country that focus on reproductive and LGBTQ care, plus five doctors and three medical associations. In Nov. 2019, the district court granted summary judgment in our favor on our Administrative Procedure Act claims, vacating the rule in its entirety.
  • In Mayor and City Council of Baltimore v. Azar, Americans United joined the Baltimore City Solicitor and the law firm Susman Godfrey LLP to represent the Baltimore City Health Department, which has strived to ensure that vulnerable and historically marginalized people can seek medical care without fear of stigmatization or discrimination. After other federal district courts blocked the Denial of Care Rule, the district court held this case in abeyance pending the government’s appeals.

    More information about those lawsuits is available here.

Economic Issues

 

Report: Nursing Homes Under

Serious Financial Stress


Mike Moen, Producer
Public News Service

    (PNS) - 3/5/2022 - South Dakota continues to grapple with staffing shortages at nursing homes, and a new report found some might not be able to recover financially.

    The findings, issued this week by the American Health Care Association (AHCA), showed between 32% and 40% of nursing-home patients in the U.S. live in facilities considered financially "at risk." Separate reports showed close to half of South Dakota care facilities are dealing with staffing shortages.

    Mark Deak, executive director of the South Dakota Health Care Association (SDHCA), said it is a dangerous mix in trying to provide quality care for the state's older residents.

    "The pandemic has just exhausted our caregivers and nursing homes," Deak observed. "Certainly, it's hit other providers in the health-care sector as well, but not as hard as it's hit nursing homes."

    While staffing shortages existed before the pandemic, the AHCA report noted other factors add to the challenge, including higher operating costs, which have prompting calls for better Medicaid reimbursement rates.

    Deak acknowledged South Dakota recently increased its rate by 10%, but it still lags behind other states.

    Advocates argued when a skilled-nursing home does not have enough money to recruit and retain staff, it creates a domino effect. Deak worried there will not be enough options, because the facilities are struggling to operate.

    "You can't take folks that are being discharged from the hospital or who need your services," Deak pointed out. "It makes it very difficult, and sometimes, it gets to the point where, in fact, you have to close your doors."

    According to the SDHCA, nine nursing homes in South Dakota have closed over the past five years. Deak added it creates big problems especially in smaller communities, where these facilities are key contributors to the local economy.
 

    References: Nursing staffing report American Health Care Assn. 03/02/2022

Story credit: Mike Moen, Public News Service, 3/4/2022

Medical Malpractice

Report: Medical Malpractice is Not

A 'Frivolous' Matter

Accusations of Lawsuit Abuse Fall Flat



By Steve Rensberry
RP News
--------------

    EDWARDSVILLE, Ill. - (RP NEWS) - 7/21/2021 - Nearly 10 percent of patients with symptoms caused by major vascular events, infections or cancers will be misdiagnosed in the United States, with more than half of those suffering death or permanent disability as a result. That's the conclusion of a 2020 study by John Hopkins University School of Medicine Director Professor David E. Newman-Toker, along with others involved with the analysis. (1)

    It's a sobering statistic, as are a long list of others involving medical malpractice cited in the latest report by the national consumer organization, Center for Justice and Democracy (CJ&D). See: Medical Malpractice Briefing Book.

    "Among the 15 diseases analyzed, spinal abscesses was the disease most often missed (62.1%). More than one-on-four aortic aneurysms and dissections have a critical delay in diagnosis (27.9%) and more than one in five (22.5%) lung cancer diagnoses are also meaningfully delayed," the John Hopkins study notes.

    Research by the Emergency Care Research Institute (ECRI) in 2020 points to similar results, concluding that "missed and delayed diagnosis" were a top patient safety concern. Diagnostic errors contributing to death were found in about 10 percent of autopsies, they said, leading to 40,000-80,000 deaths annually. Based on outpatient studies, approximately 1 in 20 adults experience a diagnostic error. (2)

More insights from the CJ&D's briefing book:

  • Despite the Emergency Medical Treatment and Labor Act (EMTALA), which requires emergency departments to treat emergency patients regardless of ability to pay, hundreds of violations of the Act are seen each year. An analysis of 10 years of EMTALA violations (2008-2018), showed more than 4,300 violations involving 1,682 hospitals, roughly 1/3 of the nation's hospitals. (3)
  • Approximately 1 in 12 errors involved women who were pregnant or in labor, while 1 in 7 involved people who were having a mental health crisis, including thoughts of suicide. "Yet experts say the raw numbers belie both the scope and severity of the problem they see. That's because enforcement of the law depends on someone filing a complaint. Although anyone can file a complaint, it's most often a doctor, nurse, or hospital administrator," the report notes.
  •  A study by Professor Ziad Obermeyer of Harvard Medical School, et al, of early death after discharges from emergency departments, using U.S. insurance claims data, shows a significant number of deaths from people on Medicare soon after discharge. "In this national analysis, we found over 10,000 Medicare beneficiaries each year died within seven days after being discharged from emergency departments, despite mean age of 69 and no obvious life limiting illnesses," the report stated. (4)
  •  A 2019 study by University of Michigan School of Public Health candidate Jun Li et al, looked at the amount of data available made available by the U.S. Centers for Medicare and Medicaid Services on 1 million U.S. doctors. Its conclusions: Three quarters of clinicians had no information about their quality of care, 99 percent had no data tied to individual job performance, and lax reporting requirements do not require that every outcome be considered, meaning clinicians may be selective in which cases to submit information on. (5)
  • Diagnostic errors are the most common and costly errors, according to an 2020 analysis by Coverys Inc. of data from 2010-2019, with death and high-severity injury making up approximately 52 percent of events and 74 percent of indemnity paid; emergency department-related events accounts for 66 percent of indemnity paid.

    The bottom line, as stated in Part I of the CJ&D's briefing book, is that medical malpractice litigation, and the cases that are filed on account of it, are not fundamentally "frivolous," despite the allegations.

    As stated in the book: "According to averages calculated from the most recent data release by the National Center for State Courts (2019): 1) Medical malpractice cases represented only 0.15 percent of state civil caseloads in 2019. This rate is consistent with NCSC data from the previous seven years. 2) Medical malpractice cases represented only 3.9 percent of state tort caseloads in 2019. This rate is consistent with NCSC data from the previous seven years."

    A 2014 study, "Medical Harm: Patient Perceptions and Follow-up Action," by Johns Hopkins University School of Medicine Professor of Surgery Martin A. Makary and others, showed lawsuits being filed following patient harms in just 1 out of every 5 cases, or 19.9 percent. "This is similar to the Harvard Medical Practice Study, which reported an estimated ratio of adverse event to malpractice claim of 7.6 to 1. Other studies have estimated that as few as 2% - 3 % of patients pursue litigation. These findings all suggest that the vast majority of patient harms never result in a lawsuit." (6)

    The argument that patient lawsuit increase medical and insurance costs also is weak, given the data.

    According to the group Americans for Insurance Reform, claims per physician were at their lowest level in four decades in 2016, when adjusted for medical care inflation. When adjusted according to the Consumer Price Index, claims are at their lowest since 1982. (7)

    “Even aside from COVID-19, the briefing book includes a number of new studies that undercut the medical industry’s principal argument for so-called ‘tort reform’ laws: cost savings. It is clear that health care and insurance costs fail to decrease when ‘tort reforms’ are enacted, meaning there is no reason for patients to lose their legal rights.” CJ&D Executive Director Joanne Doroshow stated in a March 2021 press release.

Citations

1) Medical Liability Monitor (Feb. 2021) "Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the 'Big Three.'" ECRI Executive Brief, "Top 10 Patient Safety Concerns 2020 (March 2020).

2) ECRI, "Diagnostic Errors: Why Do They Matter, and What Can You Do?" (2019).

3) Brenda Goodman and Andy Miller, "Deprived of Care: When ERs Break the Law," WebMD and Georgia Health News, Nov. 29, 2018.

4) Ziad Obermeyer et al, "Early death after discharge from emergency departments: analysis of national US insurance claim data," BMJ, Feb. 2, 2017.

5) Lena M. Chen, Anup Das and Jun Li, "Assessing the Qualithy of Public Reporting of US Physician Performance," Jame Intern. Med, May 6, 2019; University of Michigan, "System Grading Doctors is Inefficient, Needs Revisions," May 7, 2019; Lisa Rapaport, "U.S. government website for comparing doctors lacks data on most MDs," Reuters, May 6, 2019.

6) Heather G. Lye et al, "Medical Harm: Patient Perceptions and Follow-up Actions," Journal of Patient Safety, November 13, 2014.

7) Americans for Insurance Reform, "Stable Losses/Unstable Rates 2016" (November 2016).

Criminal Scheme

CEO Sentenced for $150M 

Health Care Fraud and 

Money Laundering Scheme

 
 
TEXAS - (USAO-Texas Southern) - 2/7/2021 - The CEO of a Texas-based group of hospice and home health entities was sentenced Feb. 3 to 15 years in prison for falsely telling thousands of patients with long-term incurable diseases they had less than six months to live in order to enroll the patients in hospice programs for which they were otherwise unqualified, thereby increasing revenue to the company.

    Henry McInnis, 50, of Harlingen, Texas was convicted by a federal jury in Brownsville,Texas, in November 2019 of one count each of conspiracy to commit health care fraud, conspiracy to commit money laundering, obstruction of justice, as well as six counts of health care fraud.

McInnis’s co-conspirator, Rodney Mesquias, 50, the owner of the hospice and home health entities, was also convicted following the November 2019 trial. He was sentenced to 240 months in prison in December 2020. Two other co-conspirators have pleaded guilty and are awaiting sentencing.

“McInnis, as CEO of the company, directly oversaw a reprehensible criminal scheme that involved the submission of over $150 million in fraudulent bills, the falsification of patients’ medical records, and the payment of unlawful kickbacks,” said Acting Attorney General Nicholas L. McQuaid of the Justice Department’s Criminal Division. “McInnis preyed upon some of the most vulnerable members of our society, including many who suffered from diminished mental capacity and who were falsely and cruelly told by co-conspirators that they had only months to live. Today’s significant sentence demonstrates the department’s continued commitment to pursuing individuals, at all levels of corporate management, who engage in criminal schemes that prioritize profits over patient care.”

From 2009 to 2018, McInnis, Mesquias and others orchestrated a scheme that involved the submission of over $150 million in false and fraudulent claims for hospice and other health care services. McInnis served as the top corporate officer and administrator and oversaw the day-to-day operations of the Merida Group, a large health care company that operated dozens of locations throughout Texas.

McInnis had no medical training and worked previously as an electrician. However, he acted as the de facto director of nursing for the Merida Group. Witnesses at trial testified McInnis directed employees to admit unqualified patients to hospice and home health, keep unqualified patients on services for long periods of time and fired and reprimanded employees who refused to participate in the scheme.

McInnis also oversaw and enforced a company-wide practice of falsifying medical records to conceal the scheme. Multiple witnesses testified McInnis ordered employees to alter medical records to make it appear patients were terminally ill. In reality, some were employed or even participating in sporting events. The jury also heard that McInnis explained the purpose of the falsified records was to allow the Merida Group to pass insurance company audits.

As CEO, McInnis also adopted a policy that paid illegal kickbacks. They directed bribes to physicians under the guise of medical director fees to certify unqualified patients for hospice and home health. In some cases, they improperly offered payoffs to marketers in exchange for recruitment of patients who could be placed on extremely expensive hospice services.

HHS-OIG, FBI and Texas Health and Human Services Commission conducted the investigation. Assistant Chief Jacob Foster and Trial Attorney Kevin Lowell of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Andrew Swartz of the Southern District of Texas are prosecuting the case.

The Fraud Section leads the Health Care Fraud Strike Force. Since its inception in March 2007, the Health Care Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion. In addition, HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

“McInnis and his co-conspirator’s reprehensible and deceitful actions to defraud Medicare weren’t without harm: vulnerable beneficiaries were unnecessarily enrolled in hospice care, preventing them from accessing needed curative care,” said Special Agent in Charge Miranda L. Bennett, U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Region. “With our law enforcement partners, we will continue to investigate those who put ill-gotten profits above the well-being of patients in our health care system.”

Illinois COVID-19 Update

More Than One Million 

COVID-19 Vaccines 

Administered in Illinois

Regions 8 and 9 on track to move to Phase 4 on Feb. 3


SPRINGFIELD – 2/3/2021 – The Illinois Department of Public Health (IDPH) recently reported 2,304 new confirmed and probable cases of coronavirus disease (COVID-19) in Illinois, including 47 additional deaths. These include:

  • Boone County: 1 female 70s

  • Champaign County: 2 females 80s

  • Clinton County: 1 male 60s, 1 male 90s

  • Cook County: 2 males 50s, 1 female 60s, 5 males 60s, 3 females 70s, 4 males 70s, 1 female 80s, 5 males 80s, 1 female 90s, 1 male 90s

  • Lake County: 1 male 40s, 1 male 50s

  • Madison County: 1 male 60s, 2 males 70s, 2 females 80s, 1 male 80s, 2 females 90s

  • McHenry County: 1 male 70s

  • Monroe County: 1 male 70s

  • Montgomery County: 1 female 70s

  • Saline County: 1 female 70s

  • St. Clair County: 1 male 50s

  • Stephenson County: 1 female 70s

  • Will County: 2 females 70s, 1 female 90s

Currently, IDPH is reporting a total of 1,130,917 cases, including 19,306 deaths, in 102 counties in Illinois. The age of cases ranges from younger than one to older than 100 years. Within the past 24 hours, laboratories have reported 60,899 specimens for a total 16,161,454. As of last night, 2,447 individuals in Illinois were reported to be in the hospital with COVID-19. Of those, 533 patients were in the ICU and 265 patients with COVID-19 were on ventilators.

The preliminary seven-day statewide positivity for cases as a percent of total test from January 26–February 1, 2021 is 3.9%. The preliminary seven-day statewide test positivity from January 26–February 1, 2021 is 4.9%.

A total of 1,455,825 doses of vaccine have been delivered to providers in Illinois, including Chicago. In addition, approximately 496,100 doses total have been allocated to the federal government’s Pharmacy Partnership Program for long-term care facilities. This brings the total Illinois doses to 1,951,925. A total of 1,028,969 vaccines have been administered in Illinois as of last midnight, including 163,592 for long-term care facilities. The 7-day rolling average of vaccines administered daily is 44,139 doses. Yesterday, a total of 32,559 doses were administered.

If all the mitigation metrics continue to improve, regions 8 and 9 will move into Phase 4 of the Restore Illinois Plan on Wednesday, February 3, 2021.

* All data are provisional and will change. In order to rapidly report COVID-19 information to the public, data are being reported in real-time. Information is constantly being entered into an electronic system and the number of cases and deaths can change as additional information is gathered. For health questions about COVID-19, call the hotline at 1-800-889-3931 or email dph.sick@illinois.gov.

COVID-19 Rates

St. Jacob Zip Code Shows

Highest COVID-19 Rate in County

County's Test Positivity Rate at 12.5 Percent


By Steve Rensberry
RP News
__________

EDWARDSVILLE, Ill., - 12/27/2020 - According to the latest COVID-19 Status Report from John Hopkins University, Madison County, Ill., has recorded 20,238 confirmed cases of the deadly coronavirus so far, 373 of which have resulted in death. The county's fatality rate mirrors that of the state's, at 1.84 percent, with about 7,652 cases per 100,000 population.

    A Madison County Health Department
Note: Case totals are cumulative.
update of Dec. 27 shows a slightly higher number of cases based on contact tracing data, with 21,484, and a 7-day average case positivity rate of 12.5 percent. On Dec., 26, the 7-day case positivity rate had dropped to 11.90 percent, according to MCHD numbers.

A breakdown of cases per zip code made available on the department's dashboard shows residents in the St. Jacob zip code area with the highest percentage of COVID cases, at 11.64 percent out of 2,155 people in 62281. The Hamel area zip code, 62046, totaling 713 residents, was second highest with a rate of 11.07 percent. 

 Note: the percentage of COVID cases per zip code as a percentage of population is different than the 7-day positivity rate, which is based on the percentage of positive cases out of the number of people tested for that period of time.

The average preliminary 7-day statewide test positivity rate for the state of Illinois was 8.5 percent on Dec. 25, with approximately 17,336 people who have died from COVID-19 so far, and a total number of recorded cases of about 939,000

MCHD graphic. See: Status Report

   All 11 Illinois COVID Regions entered into Tier 3 Mitigations on Nov. 20.

Madison County, in Region 4, had zero days under the 12 percent threshhold on Dec. 24, ICU Beds at 1 day over the 20 percent threshhold, and med/surgical beds 1 day over the 20 percent threshhold.

"IDPH will continue to track the positivity rates and hospital capacity metrics in regions over 14-day monitoring periods to determine if mitigations can be relaxed, if additional mitigations are required, or if current mitigations should remain in place. For Tier 3 mitigation metrics to be relaxed (i.e., move to Tier 2), a region must experience less than 12% test positivity rate (7-day rolling average) for three consecutive days, AND greater than 20% percent available intensive care unit (ICU) and medical/surgical bed availability (3-day rolling average) for three consecutive days, AND decline in the number of COVID-19 patients in the hospital (7-day rolling average) in 7 out of the last 10 days," the IDPH states.

Additional information can be found on the Illinois Department of Public Health's COVID page, and this page on region metrics. Other information about Madison County and testing options can be found at the MCHD's web page.

By the Numbers


COVID-19 Cases Surge; Countries

Struggle To Avoid Second Deadly Wave


Missouri and Illinois a Contrast in Severity, Approach


By Steve Rensberry 
RP News
___________

EDWARDSVILLE - (RP News) - 10/19/2020 - The COVID-19 pandemic is continuing to threaten the stability of countries around the world, including the United States, with the latest figures showing Europe and many other countries struggling to avoid a potentially devastating second wave amid a new surge in cases.

A graph of COVID-19 cases from statista
    According to statista data journalist Felix Richter, increased testing accounts only for portion of the increase in numbers.

Citing data from the World Health Organization, Richter writes: “According to the World Health Organization, daily new cases hit a new high of 394,501 on October 17, with the seven-day average quickly approaching 350,000. While the high number of new cases is partly due to a steep increase in testing compared to a couple of months ago, the most recent surge in new infections, with Europe at the forefront, cannot be attributed to testing alone.”

The total number of people who have contracted COVID-19 worldwide has now topped 40 million, leading to 1.1 million deaths.

On Oct. 18, Illinois officials reported just over 3,100 new cases of COVID-19 and 22 new deaths in the state. Since the start of the crisis, the state has recorded 347,161 infections, and 9,236 deaths.

Illinois Gov. J.P. Pritzker expressed concern on Monday that the state could be facing a new wave of the virus, citing increasing hospitalizations and positivity rates.

Missouri, meanwhile, has been reporting record numbers and positivity rates. As reported in this AP story, the state logged a record number of COVID-19 cases this past Saturday, with 2,357 infections, and 1,768 cases on Sunday. Total cases statewide are at 156,696, with 2,582 deaths.

Nationwide, the United States has experienced more than 8.4 million infections leading to 224,159 deaths (4 percent). Roughly 5.49 million people (96 percent) have been discharged or have recovered.

Abortion in America


First Online Directory of

Abortion Clinics Marks 25 Years

First Client Was Dr. George Tiller, Murdered in 1995


EDWARDSVILLE, Ill. (RP News) - 10/5/2020 - Abortion Clinics Online recently celebrated its 25th year of continuous service. The future of abortion access, however, remains perennially mired in uncertainty, a spokesperson for the clinic said, now more than ever in the wake of the death of Supreme Court Justice Ruth Bader Ginsburg and the likelihood of a replacement that is far more extreme.

A chart from statista showing a declining rate.
“Abortion Clinics Online will continue to serve as a source of hope and choice without judgment. The hope RBG inspired lives, on,” a Sept. 29 press release announcing the anniversary states.

Through an online directory and hotline, Abortion Clinics Online directs women to reputable abortion clinics, as well as fights back against what are known as fake clinics. The site first went live in September 1995, when the internet was new and only an estimated 14 percent of Americans had an internet connection. Even Planned Parenthood did not have a website at the time.

"Before the Internet, women had barriers to locating an abortion clinic nearby. The internet opened new avenues for women to get good and accurate information about abortion services nearby," founder Ann Rose states.

One of Rose's first clients in 1995 was the now-legendary Dr. George Tiller, who was assassinated in 2009 during a morning church service in Wichita, Kansas by anti-abortion extremist Scott Philip Roeder of Kansas. Roeder was sentenced in 2010 to life imprisonment without any chance of parole for 50 years.

As stated in the news release: “The online presence of abortion clinics has since grown into a powerful force. Clinics have nurtured a new generation of activists through social media and blogs. Most abortion-seekers now begin searching for a clinic online, and several abortion directories have followed, providing alternative models. Abortion advocates have always occupied a dangerous world. Clinics have been bombed or burned. Clinic workers routinely face threats and violence. Rose has been the subject of smear campaigns and threats for her entire career. At a time when choice is under attack, keeping abortion legal is not enough. Women must have ready access to safe, quality abortion clinics.”

One of the biggest challenges today, a spokesperson said, are fake abortion clinics -- well-funded anti-choice centers that offer no medical services and may even threaten or stalk women to convince them not to have abortions.

“Because they are not governed by medical privacy laws, they can use patient's private information to humiliate or terrorize them,” the new release states. “They invest in online ads, often outranking real abortion clinics. Rose and her team have fought to have them removed from these searches so that panicked women never have to listen to scare tactics. To make it less confusing, they were successful in getting Google to label fake clinic paid aids with a disclaimer stating they “Do Not Offer Abortion,” and abortion clinic ads with a statement that they “Provide Abortions."

Medical Malpractice


CJ&D Releases Update

On Medical Malpractice Trends

 

   EDWARDSVILLE - (RP News) - 10/4/2020 - The Center for Justice & Democracy at New York Law School (CJ&D) released an update to its Medical Malpractice: By The Numbers briefing book in March of this year, a publication that may not have received as much attention as usual given the pandemic and related events.

   The fully-sourced 172-page volume includes the latest statistics and research on issues related to medical malpractice, including over 500 footnotes linking to original sources.

   As in prior editions, topics include: medical malpractice litigation, health care costs and “defensive medicine,” physician supply and access to health care, medical malpractice insurance, patient safety, and special problems for vets and military families.

   There are several new sections including sexual assault by doctors, misdiagnoses (the most prevalent and costly type of medical error), childbirth negligence, plastic surgery, how physician stress and burnout leading to errors, and the real cause of insurance spikes for doctors.

   Among the new findings since CJ&D’s December 2019 update:

  • Between 2007-2016, the number (frequency) of medical malpractice cases dropped more than 25%. For ob/gyns, the drop was 44%.

  • 90 percent of doctors with at least five medical malpractice claims are still in practice.

  • There is no “quality of care” information available for 75% of doctors treating Medicare patients.

  • The federal government doesn’t require hospitals to tell the public how often mothers die or suffer from childbirth complications.

  • When Texas enacted severe “tort reform” measures in 2003, access to medical care grew by “close to zero.”

  • When a state caps damages, rates for cardiac stress tests and other imaging tests, Medicare Part B lab and radiology spending, all rise.

     
  •  When it comes to preventing deaths from medical errors, out of 195 countries in the world, the U.S. ranks below the top 50.

   “Organized medicine continues to push laws that would reduce the accountability of unsafe hospitals and incompetent physicians. Yet hundreds of thousands of patients die each year due to preventable medical errors at the same time insurance claims and lawsuits are dropping,” CJ&D Executive Director Joanne Doroshow stated in a press release announcing the book. “We have an enormous patient safety problem in this nation. Even sexual misconduct by physicians is going largely unchecked. The last thing we should do is try to solve these problems by increasing the obstacles harmed patients face in the already difficult process of bringing a case against the person or institution that harmed them.”

   A copy of the full briefing book can be found here:http://centerjd.org/content/briefing-book-medical-malpractice-numbers

National Poll: Zip Code Matters in Overall Health

   (BUSINESS WIRE) – April 4, 2019 – Nearly 90 percent of Americans believe that diet and exercise play the greatest role in influencing their health, and only 44 percent say that where one lives is an important factor, according to a national survey released today by the de Beaumont Foundation. Data from the National Academy of Medicine and other sources indicate that at least 80 percent of a person’s overall health is shaped by social and environmental factors like housing stability and quality, food, and access to parks and public transportation.
   The survey reveals that awareness of health departments is low, and people believe that doctors, schools, police, and firefighters have a greater impact on their communities’ health.
   “The health of our communities largely determines the health of our citizens,” said Brian Castrucci, president and CEO of the de Beaumont Foundation. “Because of that, public health departments are vital to community health and individual health. To improve their visibility and impact, health departments will need adequate funding, partnerships with other sectors, and the ability to demonstrate and communicate their value.”
  •    Also uncovered through the national survey of voters: Americans believe the factors that most influence health are personal choices like diet and exercise (87 percent), the environment (79 percent), and access to healthcare (78 percent). Only 44 percent said that where a person lives plays a major role.
  • Americans believe hospitals, schools, fire departments, and police departments play a more important role in making their community healthier than public health departments. 56 percent said their local public health department plays an important role, compared with 79 percent for hospitals, 75 percent for schools, 72 percent for fire departments, and 68 percent for police departments.
  • Among national voters, 66 percent of women said public health departments are important to community health (scoring them 8-10 on a 10-point scale), compared with only 46 percent of men.
  • In both rural areas and nationally, Democrats were much more likely than Republicans to value the role of public health departments. Among Democrats, 71 percent said public health departments play an important role, compared with 54 percent of Independents and 42 percent of Republicans. Only 17 percent of Republicans gave public health departments a score of 10 (“very important”), compared with 36 percent of Democrats.The perceptions of these organizations were similar among national voters and rural voters, each of whom rated public health departments above parks, libraries, and businesses in their impact on the community’s health.

   The poll findings suggest another reason why people may undervalue the work of local health departments: They’re not familiar with them. Nationally, only 15 percent said they are “very familiar” with their local health department and 34 percent are “somewhat familiar.” More than half, 51 percent, said they are “not too familiar” or “not at all familiar” with the department.
   Public Opinion Strategies conducted a national telephone survey among 1,000 registered voters from Aug. 31 to Sept. 8, 2018 (55 percent landline and 45 percent cell). The margin of error for a 1,000-person sample size is +3.1 percent.



Physician Sentenced For Defrauding Medicare

  Nov. 24, 2015 -- A Detroit-area physician who led and directed a multi-million-dollar Medicare fraud scheme through his medical practice was sentenced today to 72 months in prison.
   Dr. Hicham A. Elhorr, 48, of Dearborn, Michigan, was sentenced by U.S. District Judge Nancy G. Edmunds of the Eastern District of Michigan. In addition to imposing the prison term, Judge Edmunds ordered Elhorr to pay $2,073,108.16 in restitution.
   According to admissions in his plea agreement, from approximately August 2008 through September 2012, Elhorr and his coconspirators fraudulently billed Medicare $4.2 million for purported in-home physician services. Elhorr admitted that he employed unlicensed individuals through his visiting physician practice, House Calls Physicians PLLC, who held themselves out as licensed physicians and purported to provide physician home visits and other services to Medicare beneficiaries in Michigan. The unlicensed individuals prepared medical documentation that Elhorr and other licensed physicians signed as if they had performed the visits when, in fact, no licensed physicians had treated the beneficiaries.
   The case was investigated by the FBI and HHS-OIG and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Eastern District of Michigan. The case was prosecuted by former Assistant Chief Catherine K. Dick and Trial Attorneys Matthew C. Thuesen and F. Turner Buford of the Criminal Division’s Fraud Section.
  The announcement was made by Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge David P. Gelios of the FBI’s Detroit Field Office and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG) made the announcement.
  The Medicare Fraud Strike Force  operates in nine cities across the country and has charged approximately 2,300 defendants who have collectively billed the Medicare program for more than $7 billion since its inception in 2007.


Genetic Information on Diabetes Made Available

   (NIH) - 10/15/2015 -Researchers funded by the National Institutes of Health and the Foundation for the NIH (FNIH) have expanded a recently launched online library, called a knowledge portal, which allows open-access searching of human genetic and clinical information on type 2 diabetes. Individual data will remain confidential. The portal includes information from several major international networks, collected from decades of research.
   A product of the Accelerating Medicines Partnership (AMP) for type 2 diabetes, the portal is aimed at advancing type 2 diabetes research and treatment, and will include data from over 100,000 genetic samples obtained from clinical consortia supported by the NIH and FNIH. AMP is an innovative project of government, industry and nonprofit organizations working together to speed research in type 2 diabetes, Alzheimer’s disease, rheumatoid arthritis and lupus.
   “Through AMP, we have an unprecedented opportunity to advance international research in type 2 diabetes,” said NIH Director Francis S. Collins, M.D., Ph.D. “Our hope is that this portal – and this partnership – will lead to better disease targets and a shorter, less expensive drug development process, enabling companies to get safe and effective medications to patients who need them faster.”
   The portal collects data from human genetic samples, since the animal and cellular models that are typically used in diabetes drug development before human testing do not always replicate human behavior. The portal provides a way to identify the most promising therapeutic targets for diabetes from troves of potentially relevant human data.
   “The knowledge portal will allow us to translate differences in an individual’s genome into an understanding of how those differences affect a person’s risk of developing type 2 diabetes. By harnessing the power of international data sets, we can also better account for differences in race, ethnicity and locality,” said Philip Smith, Ph.D., of the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases. Smith is co-chair of AMP’s Type 2 Diabetes Steering Committee.
   The knowledge portal makes genetic and clinical information searchable in myriad ways, while keeping individual data confidential, to help researchers identify and describe the effects of genes on disease. Searches can include genes, gene variants and genetic regions, and can be cross-referenced with associations between glucose and insulin measurements and other criteria. The data can be sorted to include relevant genetic studies and the kind of data collected, and allows researchers to test biological hypotheses, and conduct many other analyses.
   The portal is publicly searchable and can be used as a tool to learn about genetics and health. However, only approved researchers will be able to access detailed data, while the general public can access aggregate results. Creators of the research engine are eager to expand the network to include more national and international research networks. The international source samples of genetic and clinical data will be housed in their home networks to ensure use of each sample complies with each country’s health information confidentiality rules.
   The portal’s creation was led by David Altshuler, M.D., Ph.D., while at Broad Institute of Massachusetts Institute of Technology and Harvard University in Cambridge. Jose Florez, M.D., Ph.D., also from Broad Institute, and Michael Boehnke, Ph.D., and Goncalo Abecasis, Ph.D., from the University of Michigan, Ann Arbor, were awarded respective grants from NIDDK (U01 DK105554) and FNIH, to continue the portal’s development. The FNIH grant to the University of Michigan supports portal infrastructure and expanded development of analytical tools.
   The portal team will work closely with Broad Institute’s Daniel MacArthur, Ph.D., and Benjamin Neale, Ph.D., who will lead a Center for Genome Interpretation (U54 DK105566) to develop methods to analyze the genomic data collected in the portal.
   “Type 2 diabetes is among our country’s and the world’s greatest and most costly health problems. In the United States alone, the disease affects more than 29 million people, with an additional 79 million more at high risk,” said NIDDK Director Dr. Griffin P. Rodgers. “We need more targeted drug therapies to treat type 2 diabetes. While multiple drugs are available to stabilize the disease, people still progress to complications including heart and kidney diseases.”
   In addition to NIH, support for the AMP Type 2 Diabetes project includes pharmaceutical companies Eli Lilly and Company; Janssen Research and Development, LLC; Merck & Co.; Pfizer Inc.; and Sanofi US Services and the not-for-profit organizations FNIH, JDRF International and the American Diabetes Association. Support from these sources funds awards made by the FNIH directly to awardees institutions. Additional support to Broad Institute for the portal is provided by the Carlos Slim Foundation.
   The NIDDK, part of the NIH, conducts and supports basic and clinical research and research training on some of the most common, severe and disabling conditions affecting Americans. The Institute's research interests include: diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic and hematologic diseases. For more information, visit www.niddk.nih.gov.
   Source: National Institutes of Health

Undiagnosed Disease Network Portal Launched

   (NIH) - 9/20/2015 - The Undiagnosed Diseases Network (UDN), a clinical research initiative of the National Institutes of Health, has opened an online patient application portal called the UDN Gateway. Introduction of this application system sets the stage for the network to advance its core mission: to diagnose patients who suffer from conditions that even skilled physicians have been unable to diagnose despite extensive clinical investigation. These diseases are difficult for doctors to diagnose because they are rarely seen, have not previously been described or are unrecognized forms of more common diseases. 
   The new system streamlines the application process. All applications for the UDN will go through the Gateway, rather through individual clinical sites in the network. The Gateway replaces what had previously been a paper-and-mail application process for the NIH Undiagnosed Diseases Program (UDP), which is now part of the UDN.
   “Although undiagnosed conditions present an array of challenges for clinicians, once identified, they may lead to treatments for individual patients. They also may lead to new, generalizable medical insights,” said James M. Anderson, M.D., Ph.D., director of NIH’s Division of Program Coordination, Planning, and Strategic Initiatives (DPCPSI), which provides financial support and joint leadership for the network via the NIH Common Fund. “The UDN Gateway will provide patients and their families access to the nation’s leading diagnostic teams and sophisticated diagnostic tools.”
   The UDN grew out of both the success of the Undiagnosed Diseases Program at the NIH Clinical Center in Bethesda, Maryland. Since its 2008 launch, the UDP has reviewed more than 3,100 applications from patients around the world. More than 800 patients have been enrolled for a one-week evaluation. While approximately 25 percent of those have received some level of clinical, molecular or biochemical diagnosis, many patients remain undiagnosed.
   By adding six additional clinical sites to the original NIH UDP, the UDN will broaden its diagnostic expertise while expanding the opportunity for patients to participate. These additional clinical sites are:
   -- Baylor College of Medicine, Houston.
   -- Duke Medical Center, Durham, North Carolina, with Columbia University, New York City.
   -- Harvard Teaching Hospitals (Brigham and Women’s Hospital, Boston Children’s Hospital    Massachusetts General Hospital), Boston.
   -- Stanford Medical Center, Stanford, California.
   -- University of California at Los Angeles Medical Center.
   -- Vanderbilt University Medical Center, Nashville, Tennessee.    By the summer of 2017, each new clinical site will accept about 50 patients per year. The network has also brought on board two DNA sequencing facilities. One is at the Baylor College of Medicine, and the other is at the HudsonAlpha Institute for Biotechnology in Huntsville, Alabama, with Illumina in San Diego.
   The broader geographic distribution of sites in the UDN is intended to better serve patients. To support this collaboration on undiagnosed diseases, the UDN Coordinating Center at Harvard Medical School Department of Biomedical Informatics (DBMI) created the UDN Gateway as a centralized online application site.
   “The Gateway is an important part of the infrastructure that we are establishing for the UDN,” said Rachel Ramoni, D.M.D., Ph.D. “Our goal is to match 21st century medicine with 21st century technology by creating a comprehensive and streamlined online application process.” Dr. Ramoni serves as executive director and a principal investigator of the UDN Coordinating Center at DBMI.
   Those who are accepted will be seen by researchers and physicians from a wide array of medical specialties and may have their DNA sequenced to detect variations in genes that may underpin their disorders.
   “The UDN aims to improve the level of diagnosis and care for patients with undiagnosed diseases,” said Anastasia Wise, Ph.D., program director, NHGRI Division of Genomic Medicine and co-coordinator for the NIH Common Fund's Undiagnosed Diseases Network. “Based upon the experience of the NIH UDP, we know that the need and potential are great. The UDN Gateway will expand our ability to connect with patients who may benefit from the UDN. We want to make it as easy as possible for patients and their families to apply to participate in the network.”
For access to the UDN Gateway, go to apply.undiagnosed.hms.harvard.edu.
For more information about the UDN, including related funding announcements, visit http://commonfund.nih.gov/Diseases/index.
  Souce: National Institutes of Health.

Antipsychotic prescriptions a source of concern

   (NIH) - 7/8/2015 - Boys are more likely than girls to receive a prescription for antipsychotic medication regardless of age, researchers have found. Approximately 1.5 percent of boys ages 10-18 received an antipsychotic prescription in 2010, although the percentage falls by nearly half after age 19. Among antipsychotic users with mental disorder diagnoses, attention deficit hyperactivity disorder (ADHD) was the most common among youth ages 1-18, while depression was the most common diagnosis among young adults ages 19-24 receiving antipsychotics. Despite concerns over the rising use of antipsychotic drugs to treat young people, little has been known about trends and usage patterns in the United States before this latest research, which was funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health. Mark Olfson, M.D., M.P.H., of the Department of Psychiatry, College of Physicians and Surgeons and Columbia University and New York State Psychiatric Institute, New York City, and colleagues Marissa King, Ph.D., Yale, New Haven, Connecticut, and Michael Schoenbaum, Ph.D., NIMH, reported their findings on July 1 in JAMA Psychiatry.
   “No prior study has had the data to look at age patterns in antipsychotic use among children the way we do here. What’s especially important is the finding that around 1.5 percent of boys aged 10-18 are on antipsychotics, and then this rate abruptly falls by half, as adolescents become young adults," Schoenbaum said.  “Antipsychotics should be prescribed with care. They can adversely affect both physical and neurological function and some of their adverse effects can persist even after the medication is stopped.”
   The U.S. Food and Drug Administration (FDA) has approved antipsychotics for children with certain disorders, particularly bipolar disorder, psychosis/schizophrenia, and autism. However, the research team found that the medication use patterns do not match the illness patterns. The mismatch means that many antipsychotic prescriptions for young people may be for off-label purposes, that is, for uses not approved by FDA.
  For example, maladaptive aggression is common in ADHD, and clinical trial data suggest that at least one antipsychotic, risperidone, when used with stimulants, can help reduce aggression in ADHD. To date, FDA has not approved the use of any antipsychotic for ADHD, making its use for this diagnosis off-label. In the current study, the combination of peak use of antipsychotics in adolescent boys and the diagnoses associated with prescriptions (often ADHD) suggest that these medications are being used to treat developmentally limited impulsivity and aggression rather than psychosis.
   Olfson and colleagues worked with the IMS LifeLink LRx database, which includes 63 percent of outpatient prescriptions filled in the U.S. The team looked at prescription data for 2006-2010 and found antipsychotic use increased with age in both boys and girls, beginning at 0.11 percent in 2010 for ages 1-6 years, increasing to 0.80 percent for ages 7-12 years and increasing again to 1.19 percent for youth ages 13-18 years before dropping substantially to 0.84 percent for ages 19-24.
   In children ages 1-6, boys were more than twice as likely as girls to receive an antipsychotic prescription (0.16 vs. 0.06 percent in 2010). This pattern held true for boys and girls ages 7-12 (1.20 vs. 0.44 percent in 2010) before narrowing for the 13-18 age group (1.42 vs. 0.95 percent) and finally becoming more comparable for young men and women ages 19 to 24 (0.88 to 0.81 percent in 2010). Among young people treated with antipsychotics in 2010, the youngest children, ages 1-6, were the least likely to receive the prescription from a psychiatrist (57.9 vs. 71.9, 77.9, and 70.4 percent for the other three age groups). This is a source of concern, as practice guidelines caution practitioners on the use of antipsychotic medications for young children in particular.
   Among young people receiving antipsychotic prescriptions, fewer than half had any medical visit that included a mental disorder diagnosis. That may be in part due to stigma about mental illness, or because primary care providers are concerned about reimbursement for treatment related to such diagnoses.
   “In addition to having a new look at antipsychotic use among youth, one positive finding coming from this study is that around 75 percent of these kids have at least some contact with a psychiatrist,” said NIMH Director Thomas Insel, M.D.
   Source: National Institutes of Health

Researchers study brain circuitry shift, PTSD

   (NIH) - 1/24/2015 - People with anxiety disorders, such as post traumatic stress disorder (PTSD), often experience prolonged and exaggerated fearfulness. Now, an animal study suggests that this might involve disruption of a gradual shifting of brain circuitry for retrieving fear memories. Researchers funded by the National Institutes of Health have discovered in rats that an old fear memory is recalled by a separate brain pathway from the one originally used to recall it when it was fresh.
  After rats were conditioned to fear a tone associated with a mild shock, their overt behavior remained unchanged over time, but the pathway engaged in remembering the traumatic event took a detour, perhaps increasing its staying power.
   “While our memories feel constant across time, the neural pathways supporting them actually change with time,” explained Gregory Quirk, Ph.D of the University of Puerto Rico School of Medicine, in San Juan, a grantee of NIH’s National Institute of Mental Health (NIMH). “Uncovering new pathways for old memories could change scientists’ view of post-traumatic stress disorder, in which fearful events occur months or years prior to the onset of symptoms.”
   A research team led by Quirk and Fabricio Do-Monte, D.V.M., Ph.D., report on their findings in the January 19, 2015, issue of Nature.
   Immediately after fear conditioning, a circuit running from the prefrontal cortex, the executive hub, to part of the amygdala, the fear hub, was engaged to retrieve the memory. But several days later, Quirk and colleagues discovered that retrieval had migrated to a different circuit – from the prefrontal cortex to an area in the thalamus, called the paraventricular region (PVT). The PVT, in turn, communicates with a different central part of the amygdala that orchestrates fear learning and expression.
   The Quirk team spotted the moving memory using a genetic/laser technique called optogenetics, which can activate or silence specific pathways to tease apart their workings.
   The researchers say that the PVT may serve to integrate fear with other adaptive responses, such as stress, thereby strengthening the fear memory.
   “In people with anxiety disorders, any disruption of timing-dependent regulation in retrieval circuits might worsen fear responses occurring long after a traumatic event,” Quirk suggested.
   In the same issue of Nature, NIMH grantees Bo Li, Ph.D. and Mario Penzo, Ph.D. of Cold Spring Harbor Laboratory in New York, and colleagues, reveal how the long-term fear memory circuit works in mice to translate detection of stress into adaptive behaviors.
   Li and colleagues independently discovered the same shift in memory retrieval circuitry occurring, over time, after fear conditioning in mice. Using powerful genetic-chemical, as well as optogenetic, methods to experimentally switch pathways on and off, they showed conclusively that neurons originating in the PVT regulate fear processing by acting on a class of neurons that store fear memories in the central amygdala area.
   The Li team traced this activity in the PVT to the action of a messenger chemical, brain-derived neurotrophic factor (BDNF), which has previously been implicated in mood and anxiety disorders. For example, altered BDNF expression has been linked to PTSD.
   BDNF from the PVT, working via a specific receptor, activated the memory-storing amygdala neurons. Simply infusing BDNF into the central amygdala area caused mice to freeze in fear, suggesting that it not only enables the formation of fear memories, but also the expression of fear responses.
   Grants: MH058883, MH086400, GM061838, MH101214
   For more information, visit http://www.nimh.nih.gov.
References


-- Do-Monte HF, Quinones-Laracuente K, Quirk, GJ. A temporal shift in the circuits mediating retrieval of fear memory. Nature, Dec. ??, 2014.
-- Penzo MA, Robert V, Tucciarone J, De Bundel D, Wang M, Van Aeist L, Varvas M, Parada LF, Palmiter R, He M, Huang ZJ, Li B. The paraventricular thalamus controls a central amygdala fear circuit. Nature Dec. ??, 2014.
  Source: National Institutes of Health

Stem Cell Transplants May Halt MS Progression

   (NIH) - 12/31/2014 - Three-year outcomes from an ongoing clinical trial suggest that high-dose immunosuppressive therapy followed by transplantation of a person's own blood-forming stem cells may induce sustained remission in some people with relapsing-remitting multiple sclerosis (RRMS). RRMS is the most common form of MS, a progressive autoimmune disease in which the immune system attacks the brain and spinal cord. The trial is funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and conducted by the NIAID-funded Immune Tolerance Network (ITN).
   Three years after the treatment, called high-dose immunosuppressive therapy and autologous hematopoietic cell transplant or HDIT/HCT, nearly 80 percent of trial participants had survived without experiencing an increase in disability, a relapse of MS symptoms or new brain lesions. Investigators observed few serious early complications or unexpected side effects, although many participants experienced expected side effects of high-dose immunosuppression, including infections and gastrointestinal problems. The three-year findings are published in the Dec. 29, 2014, online issue of JAMA Neurology.
   “These promising results support the need for future studies to further evaluate the benefits and risks of HDIT/HCT and directly compare this treatment strategy to current MS therapies,”  NIAID Director Anthony S. Fauci said. “If the findings from this study are confirmed, HDIT/HCT may become a potential therapeutic option for people with this often-debilitating disease, particularly those who have not been helped by standard treatments.”
   Scientists estimate that MS affects more than 2.3 million people worldwide. Symptoms can vary widely and may include disturbances in speech, vision and movement. Most people with MS are diagnosed with RRMS, which is characterized by periods of relapse or flare up of symptoms followed by periods of recovery or remission. Over years, the disease can worsen and shift to a more progressive form.
  In the study, researchers tested the effectiveness of HDIT/HCT in 25 volunteers with RRMS who had relapsed and experienced worsened neurological disability while taking standard medications. Doctors collected blood-forming stem cells from participants and then gave them high-dose chemotherapy to destroy their immune systems. The doctors returned the stem cells to the participants to rebuild and reset their immune systems.
   “Notably, participants did not receive any MS drugs after transplant, yet most remained in remission after three years,” NIAID Division of Allergy, Immunology and Transplantation Director Daniel Rotrosen said. “In contrast, other studies have shown that the best alternative MS treatments induce much shorter remissions and require long-term use of immunosuppressive drugs that can cause serious side effects.”
  The study researchers plan to follow participants for a total of five years, recording all side effects associated with the treatment. Final results from this and similar studies promise to help inform the design of larger trials to further evaluate HDIT/HCT in people with MS.
   The work was sponsored by NIAID, NIH, and conducted by the ITN (contract number N01 AI015416) and NIAID-funded statistical and clinical coordinating centers (contract numbers HHSN272200800029C and HHSN272200900057C). The ClinicalTrials.gov identifier for the study High-Dose Immunosuppression and Autologous Transplantation for Multiple Sclerosis (HALT-MS) is NCT00288626.
   Source: National Institutes of Health

Approval of 'Enlist Duo' Weed Killer Criticized

   Washington, D.C. – 10/26/2014 - Officials with the Environmental Working Group said on October 15 that they were “deeply disappointed” that the U.S. Environmental Protection Agency had decided to approve a toxic weed killer known as Enlist Duo, despite overwhelming opposition from the scientific and public health community.
   Enlist Duo, manufactured by Dow AgroSciences, a subsidiary of Dow Chemical Company, is a toxic combination of the herbicide 2,4-D and glyphosate, the active ingredient in Monsanto’s Roundup. The EPA’s decision means Dow can sell Enlist Duo in conjunction with its new genetically engineered products, 2,4-D-tolerant corn and soybean seeds. The U.S. Department of Agriculture recently approved Dow’s application to market these seeds.
   Dow has announced plans to start marketing Enlist Duo in Iowa, Illinois, Indiana, Ohio, South Dakota and Wisconsin.
   “The EPA ignored science pointing to the serious health risks – especially to children – associated with 2,4-D,” said Mary Ellen Kustin, EWG’s senior policy analyst. “Giving a chemical company the green light to bring a known harmful weed killer to market for use on millions of acres of crops puts public health and the environment in danger.”
   Last summer, 35 doctors and scientists warned the EPA against expanding the use of 2,4-D, highlighting links between pesticide exposure and health problems such as suppressed immune function and greater risk of Parkinson’s disease. Later, 50 members of Congress asked EPA and USDA to reconsider their approval of the 2,4-D-tolerant seeds and weed killer.
The USDA estimates that use of 2,4-D will triple by 2020, compared to current usage. EWG research shows that more than 480 elementary schools nationwide are within 200 feet of corn and soybean fields that could be sprayed with 2,4-D.
   “Children who are most vulnerable and susceptible to these toxic weed killers will have an increased risk of being exposed to a defoliant linked to cancer and Parkinson’s disease,” added Kustin.
   In addition to toxicity concerns, increasing the use of weed killers could further escalate the evolution of “superweeds” resistant to known herbicides.
   “This continued arms race between chemical companies and superweeds is a threat to sustainable farming and public health,” added Kustin. “EPA’s decision to up the ante of Roundup by approving Enlist Duo is unconscionable.”
   Source: Environmental Working Group

Study Explores the Brain's Capacity to Learn

   (NIH) - 8/29/2014 - Learning is easier when it only requires nerve cells to rearrange existing patterns of activity than when the nerve cells have to generate new patterns, a study of monkeys has found. The scientists explored the brain’s capacity to learn through recordings of electrical activity of brain cell networks. The study was partly funded by the National Institutes of Health.
   “We looked into the brain and may have seen why it’s so hard to think outside the box,” said Aaron Batista, Ph.D., an assistant professor at the University of Pittsburgh and a senior author of the study published in Nature, with Byron Yu, Ph.D., assistant professor at Carnegie Mellon University, Pittsburgh.
   The human brain contains nearly 86 billion neurons, which communicate through intricate networks of connections. Understanding how they work together during learning can be challenging. Batista and his colleagues combined two innovative technologies, brain-computer interfaces and machine learning, to study patterns of activity among neurons in monkey brains as the animals learned to use their thoughts to move a computer cursor.
   “This is a fundamental advance in understanding the neurobiological patterns that underlie the learning process,” said Theresa Cruz, Ph.D., a program official at the National Center for Medical Rehabilitations Research at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). “The findings may eventually lead to new treatments for stroke as well as other neurological disorders.”
   Brain-computer interfaces seek to turn thoughts into action. With small surgically implanted electrodes, researchers can simultaneously monitor the electrical activity of hundreds of neurons. A computer converts the signals into commands to move an external device, such as a robotic arm or a computer cursor. Brain-computer interfaces are being developed to help paralyzed patients as well as to study the function of healthy brains.
   “This evolving technology is a powerful tool for brain research,” said Daofen Chen, Ph.D., a program director at the National Institute of Neurological Disorders and Stroke (NINDS), part of NIH. “It helps scientists study the dynamics of brain circuits that may explain the neural basis of learning.”
   In this study, the research team used brain-computer interfaces in two animals to examine learning in the motor cortex, a part of the brain that controls movement. The firing patterns of the neurons they recorded were used to control a computer cursor. As the animals learned to move the cursor to a designated spot on the monitor, the computer used machine learning to map brain cell activity to cursor movement. Machine learning is a method of programming a computer to learn and constantly adjust its commands based on previous data or experience. In this case, it created a feedback loop between the animal and the computer, which improved the animal’s ability to use its thoughts to move the cursor.
   “Just as Netflix uses machine learning to predict the movies we’d like to watch, we used it to characterize the activity patterns that the brain produced during learning,” Yu said.
   At first, the scientists noticed that the ensemble of neurons recorded in each animal had a small set of natural, or favored, firing patterns that were used to move the cursor, which they called the “intrinsic manifold.” After determining the intrinsic manifold, the team reprogrammed the map between neural activity and cursor movement. For instance, if a firing pattern originally caused the cursor to move to the top of the screen, then the interface would move the cursor to the bottom. The team then observed whether the animals could learn to generate the appropriate neural activity patterns to compensate for the changes.
   “It’s as if we turned a computer mouse upside down in a person’s hand and asked him to click on an icon, except the mouse is entirely within the subject’s brain,” said Patrick Sadtler, a Ph.D. candidate at the University of Pittsburgh, who is the lead author of the study.
   The scientists discovered that the monkeys easily relearned how to move the cursor if they could use patterns within the intrinsic manifold in new ways. In contrast, learning was more difficult when the interface required patterns of neural activity that were outside of the intrinsic manifold.
   “It appears that the brain sets constraints on the speed with which we learn new things. Characterizing those constraints might enable us to predict which skills will be quicker to learn, and which might take longer,” Batista said. He and his colleagues speculated that, for humans, thinking outside the box requires more difficult changes in neural activity.
   This work was supported by grants from the NICHD (HD071686), NINDS (NS065065, NS076405), National Science Foundation (DGE-0549352), and the Burroughs Welcome Fund. 
   For more information on brain research, visit: http://www.ninds.nih.gov
   Source: National Institutes of Health 

WHO calls for drug decriminalization, reforms

   (DPA) - 7/26/2014 - In a report published earlier this month, the World Health Organization (WHO) made a clear call for broad drug policy reforms, including decriminalization of drug use, harm reduction practices such as syringe exchange and opioid substitution therapy, and a ban on compulsory treatment for people who use drugs. This report by the United Nations’ leading health agency focuses on best practices to prevent, diagnose and treat HIV among key populations.
   “It’s good to see the WHO come out so strongly for decriminalizing drugs and rejecting compulsory treatment for people who use drugs,’ said Ethan Nadelmann, Executive Director of the Drug Policy Alliance. “Its recommendations, grounded as they are in science and public health, drive home the need for fundamental reforms in U.S. drug policies, in particular the growing reliance on drug courts to ‘treat’ people arrested for drug possession.”
   In a section titled “Good practice recommendations concerning decriminalization”, the WHO report makes the following recommendations:
Countries should work toward developing policies and laws that decriminalize injection and other use of drugs and, thereby, reduce incarceration.
Countries should work toward developing policies and laws that decriminalize the use of clean needles and syringes (and that permit NSPs [needle and syringe programs]) and that legalize OST [opioid substitution therapy] for people who are opioid-dependent.
Countries should ban compulsory treatment for people who use and/or inject drugs.
   This follows on the heels of a report released in March by a key working group of the United Nations Office on Drugs and Crime (UNODC) discouraging criminal sanctions for drug use. The recommendations of the working group – which included Nora Volkow, head of the U.S. National Institute on Drug Abuse (NIDA) – highlight that “criminal sanctions are not beneficial” in addressing the spectrum of drug use and misuse.
   In 2016, the United Nations General Assembly will hold a special session on drugs (UNGASS) – an initiative proposed in 2012 by the then-president of Mexico, Felipe Calderon – in order to conduct a comprehensive review of the successes and failures of international drug control policy. Whereas the previous UNGASS in 1998 was dominated by rhetorical calls for a “drug-free world” and concluded with unrealistic goals regarding illicit drug production, the forthcoming UNGASS will undoubtedly be shaped by recommendations such as those in the WHO report.
   Last year, Uruguay followed on the heels of Colorado and Washington State and became the first country to legally regulate marijuana for recreational purposes. In June, the West Africa Commission on Drugs, initiated by former United Nations Secretary General Kofi Annan and chaired by former Nigerian President Olusegun Obasango, called for drug decriminalization and for treating drug use as a health issue. This was followed by an announcement by the Jamaican Minister of Justice that the Jamaican Cabinet had approved a proposal to decriminalize the possession of up to two ounces of marijuana and the decriminalization of marijuana use for religious, scientific and medical purposes. And earlier this month, the Heads of Government of the Caribbean Community (CARICOM), agreed to establish a commission to review marijuana policy in the region in order to assess the need for reforms to marijuana laws.
  The WHO recommendations are consistent with the long-standing policy objectives and mission of the Drug Policy Alliance, as well as with a surprisingly broad and rapidly-emerging coalition of stakeholders who are calling for drug decriminalization, including the American Public Health Association, International Red Cross, Organization of American States, NAACP, Human Rights Watch, National Latino Congreso, and the Global Commission on Drug Policy.
   Source: Drug Policy Alliance

Law would ban BPA from food containers

   WASHINGTON, D.C. – 7/17/2014 - Several members of Congress are pushing a bill to better protect consumers – particularly the elderly, pregnant women children, and workers – from a known toxic hormone disruptor bisphenol-A, or BPA.
   Introduced  by long-time champion Sen. Ed Markey (D-Mass.), the Ban Poisonous Additives Act of 2014 would ban BPA from food and beverage containers. It would also grant waivers to manufacturers seeking safer replacements for BPA while requiring them to place specific warning labels on any packaging that still contains the toxic substance. The legislation would also mandate the U.S. Food and Drug Administration to review the safety of all materials deemed safe for use in food and beverage containers .
   Reps. Lois Capps (D-Calif.) and Grace Meng (D-N.Y.) introduced a companion bill in the House.
   “Science shows that BPA is present in the vast majority of Americans and is harmful to human health,” said Jason Rano, EWG’s director of government affairs. “It has been linked to cancer, obesity, diabetes, infertility, hormone disruption and early puberty in children. Congress is taking an important step on behalf of our most vulnerable populations to help reduce exposure to BPA.”
   BPA, a synthetic estrogen, is in the epoxy linings that coat the inside of most canned foods and beverages and ultimately leaches into those products. Some companies have voluntarily taken BPA out of the linings of their containers, and in 2012 the FDA banned BPA in baby bottles and children's sippy cups.
   “It was an important step when the FDA banned BPA in baby bottles and sippy cups, but BPA has no place in food packaging and must be replaced with alternatives that don’t pose a serious health threats to humans,” added Rano. “This legislation would help make that a reality while providing manufacturers with the additional time they need to find safer options.”
   EWG recommends that consumers limit their intake of canned food and beverages and look for products labeled “BPA-free” or packed in glass jars or cardboard cartons, not metal cans.
   Source: Environmental Working Group