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Kaiser Daily Health Policy Report Feature Highlights Recent Blog Entries
"Blog Watch" offers readers a roundup of health policy-related blog posts.Appropriately, the last of the Senate Finance Committee"s three major public roundtables on health reform issues was on finance. Keith Hennessy lauds economist Kate Baicker"s testimony (.pdf) and says it helps connect reform ideas to a system of third-party payment. Hennessy says the current system leads people to "spend more of other people"s money than they do of their own, and less wisely." Hennessy explores the example of employer-sponsored insurance, which he says makes health insurance appear less expensive to employees than it is.Meanwhile, the New Republic"s Jonathan Cohn, who has been calling attention to potential ways of financing the significant cost of reform, recommends the testimony of Center on Budget and Policy Priorities President Robert Greenstein. Greenstein testified that there are no "painless" ways of raising money for reform, and said, "This leads to my first recommendation, in the form of a plea to the Committee. Please do not take any offset options off the table at this time. I believe you ultimately will need to put together a package that contains an array of spending and revenue offsets." Offsets could include removing or limiting the tax exclusion for employer-sponsored insurance. Bob Lazsewski strenuously disagrees. He illustrates a post titled "Paying for a Big Part of Health Care Reform With New Taxes Would Be a Terrible Mistake!" with a graph of the trends in health insurance premiums over the last 20 years and says, "paying for most of health care reform by raising taxes would be nothing less than cowardly and fiscally irresponsible." He continues, "the Congress is so desperate to find money and so unwilling to anger any powerful health care special interests we better get ready for some interesting rationalizations to promote tax increases in the place of fundamental reforms."After the hearing, ranking member Sen. Mike Enzi (R-Wyo.) gave a presentation at the Heritage Foundation on his preferences for bipartisan reform legislation and the Foundry"s Marguerite Higgins blogged Enzi"s key points. She says the senator wants to increase affordability, use private plans for coverage and ensure a bill is fully paid for.The White House appears to be initiating additional outreach efforts to mobilize support. Jose Antonio Vargas of the Washington Post"s Daily Dose reports that President Obama"s administration chose to send its first WhiteHouse.gov e-mail on health reform Wednesday. Vargas says, "It"s only fitting that Obama"s first official e-mail from the White House is about health care reform. As early as December, the incoming Obama administration began using new media tools to build grassroots support around the issue."Interesting elsewhere:
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Identification Of Brain Difference In Psychopaths
Professor Declan Murphy and colleagues Dr Michael Craig and Dr Marco Catani from the Institute of Psychiatry at King"s College London have found differences in the brain which may provide a biological explanation for psychopathy. The results of their study are outlined in the paper "Altered connections on the road to psychopathy", published in Molecular Psychiatry.
News of the day
During Pregnancy, Women With Endometriosis Need Special Care To Avoid Risk Of Premature Birth
The largest study to date of endometriosis in pregnant women has found that the condition is a major risk factor for premature birth, the 25th annual conference of the European Society of Human Reproduction and Embryology heard. Dr. Henrik Falconer, of the Department of Woman and Child Health, Karolinska Institute, Stockholm, Sweden, said that his team had found that women with endometriosis also had a higher risk of other pregnancy complications, as well as being more likely to give birth through Caesarean section. The research is published on-line in the journal Human Reproduction*.
Nutrition

Annals Of Internal Medicine Tip Sheet For June 16, 2009, Issue

Calcium Supplementation Has No Weight-loss Benefit for Obese Patients One in three American adults is overweight or obese, with a body mass index (BMI) of 25 or greater. As the obesity rate continues to rise, researchers seek an approach that can prevent weight gain or promote weight loss. Some studies suggest that people who eat more dairy products weigh less. Dairy products are a good of calcium. Researchers studied 340 overweight and obese patients to determine whether calcium supplementation might prevent weight gain or promote weight loss. The investigators weighed each participant and then randomly assigned half of them to take calcium pills (1500 mg/d) and the other half to placebo. After two years, researchers found no difference in body weight, BMI, or body fat mass between the two groups. The researchers conclude that while calcium supplementation has health benefits, it is unlikely to prevent weight gain in overweight or obese patients. Red Yeast Rice Capsules Reduce Cholesterol Levels in Statin-Intolerant Patients High levels of low-density lipoprotein (LDL) cholesterol put people at risk for heart attack and stroke. Statins are considered the standard of care for lowering LDL cholesterol levels. While generally well-tolerated, some patients cannot take statins due to adverse events such as muscle pain and weakness. Some studies have shown that red yeast rice pills can lower LDL cholesterol levels. Researchers studied patients with statin-associated muscle pain to determine if red yeast rice supplementation could improve cholesterol levels without causing muscle pain. Sixty-two patients with abnormal LDL cholesterol levels and a history of statin intolerance were randomly assigned to either 1800 mg a day of red yeast rice supplementation or placebo. Patients in both groups were enrolled in a therapeutic lifestyle change program that included weekly 3.5 hour meetings and education on cardiovascular disease, nutrition, exercise, and relaxation techniques. The researchers checked LDL and total cholesterol levels in both groups at 12 and 24 weeks. They found that both cholesterol levels improved more in the red yeast rice group than in the placebo group. Pain, creatinine phosphokinase, and liver enzyme levels did not differ between the groups. Study Raises Questions About Establishing an Upper Age Limit for Colonoscopy The four types of colorectal cancer screening tests are fecal occult blood testing (FOBT), sigmoidoscopy, double-contrast barium enema, and colonoscopy. Of the four tests, colonoscopy is considered the best, but is also the most invasive and has the greatest risk for complications. Medicare covers colonoscopy for beneficiaries after the age of 50. While use of colonoscopy by elderly Medicare patients has increased, colonoscopy-related adverse events in this population have not been studied. Researchers looked at a random sample of 53,220 Medicare beneficiaries between the ages of 66 and 95 who underwent outpatient colonoscopy. Individuals in this sample were matched with individuals who did not have colonoscopy and then assessed at 30 days to determine the rate of cardiac and gastrointestinal events. Rates of adverse events following colonoscopy were low, but were greater in patients who had polyps removed, or had specific, common comorbid conditions. Adverse events also increased with age, another reason for establishing an upper age limit for colonoscopy. Stents Ineffective, Potentially Dangerous for Patients with Renal Artery Stenosis and Impaired Renal Function Renal stents are commonly used to treat atherosclerotic renal artery stenosis (ARAS). However, few data support the efficacy and safety of this practice. Researchers studied 140 patients with ARAS and impaired renal function to determine if stenting could help. They randomly assigned patients to medical treatment plus stenting or medical treatment only and followed them over a two-year period. Medical treatment consisted of antihypertensive treatment, a statin, and aspirin. The researchers found that stent placement with medical treatment had no clear effect on progression of impaired renal function but led to a small number of significant procedure-related complications, including two deaths. The researchers conclude that stenting is not a safe or effective treatment for patients with ARAS and impaired renal funcion. They suggest that physicians treat these patients using a conservative therapeutic approach that focuses on managing cardiovascular risk factors. Angela Collom American College of Physicians


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