Monthly Archives: April 2013

The View From 30,000 Feet: The Intersection of Medicine, Ethics and Money

(Getty Images)

(Getty Images)

As we’re barreling along toward Jan. 1 and the full implementation of Obamacare, it seems that questions of ethics are embedded in just about every discussion of the practice of medicine and how it will change in the coming years. San Francisco’s Commonwealth Club asked me to explore the issue recently by moderating a discussion featuring three prominent Bay Area physicians that the club had invited to participate.

The formal title of the event was “Improving the Ethics and Practice of Medicine,” but pretty quickly money came right into play.

“We have to come up with the best possible distribution of those resources, so we do the greatest good for the greatest number.”
Dr. Josh Adler, chief medical officer of UCSF, started off by talking about the “age-old principle in care of patients”: Do no harm. And he spoke of patient safety. But then he got right into the cost of health care. We don’t have unlimited resources, ranging from doctors and nurses to hospital beds, he pointed out. “We have to come up with the best possible distribution of those resources, so we do the greatest good for the greatest number.”

He talked about “appropriate stewardship” of limited resources in considering both the health of the individual and the health of broader populations. Continue reading

Supreme Court Seems Skeptical of Patenting Human Genes

SCOTUS_SupremeCourtIn arguments at the Supreme Court Monday, justices appeared skeptical about patenting human genes.

The U.S. Patent and Trademark Office has been granting parents on human genes for nearly 30 years. This is the first case questioning that premise to reach the Supreme Court. At the heart of the case are two genes associated with breast cancer, BRCA1 and BRCA 2. People with certain mutations in these genes have a significantly higher risk for breast, ovarian and other cancers.

Opponents of patenting human genes say genes are products of nature and therefore cannot be patented. Myriad Genetics, which holds the patent on the genes, say that once genes are isolated from the body and processed they are no longer a product of nature.

The Associated Press captured the back and forth:

Justices attempted to break the argument down to an everyday level by discussing things like chocolate chip cookies, baseball bats and jungle plants.

[Gregory A.] Castanias, the Myriad lawyer, argued that the justices could think about the gene question like a baseball bat. “A baseball bat doesn’t exist until it’s isolated from a tree. But that’s still the product of human invention to decide where to begin the bat and where to end the bat,” he said.

That didn’t work for Chief Justice John Roberts. Continue reading

Just in Time for Tax Day: What This Year’s Taxes Have To Do With Next Year’s Obamacare

By John M. Gonzales, CHCF Center for Health Reporting

Tax Form with Stethoscope

The income you declare this year will be used to determine if you’re eligible for a health insurance subsidy starting in January. (Getty Images)

If you’re among millions of uninsured Californians eligible for government-subsidized insurance, the ripples of health reform start with Monday’s tax deadline.

First, the government will use your return this year as its first yardstick for how much of a subsidy or tax break it contributes to your health coverage next year. And second, if you don’t have health insurance a year from now, a penalty will be added to your federal tax bill.

These are among ways the federal tax code will increasingly be at the forefront of health reform’s implementation.  Other provisions are also kicking in as the countdown continues toward full operation of the Affordable Care Act on Jan. 1.

The provision that will provide the biggest boost to taxpayers is the one that offers subsidies for uninsured people who obtain coverage through new insurance exchanges.

“It’s a tremendous deal for the people who are currently uninsured,” said Larry Levitt, senior vice president at the Kaiser Family Foundation. Continue reading

Gene Patent Supreme Court Case Centers Around Two Breast Cancer Genes

It's not the genes themselves, but mutations that can put women at higher risk of breast cancer.(Getty Images)

It’s not the genes themselves, but mutations that can put women at higher risk of breast cancer.(Getty Images)

On Monday, the U.S. Supreme Court will hear oral arguments in a case that asks a central question: Can you patent a human gene?

Are genes naturally occurring and therefore not patentable by law? Or, since DNA must be extracted and processed to be read, is it no longer a natural product and so indeed can be patented, as human genes have been for 30 years?

Over at KQED Science, reporter Lauren Sommer has a great breakdown of the issues in this case — not only the ethical questions but also the business angle, so critical to the Bay Area’s thriving biotechnology industry.

Everyone has these genes — women and men alike — but the question is whether you have a mutation in one or both of these genes that inhibits tumor suppression function.
But let’s take a step back and look at the genes at the heart of the case, BRCA1 and BRCA2. According to the National Cancer Institute, these genes help keep cells’ genetic material in order. They handle what’s called tumor suppression.

Everyone has these genes — women and men alike — but the question is whether you have a mutation in one or both of these genes that inhibits the tumor suppression function. With impaired tumor suppression, you’re at higher risk for cancer. Women with certain types of BRCA mutations are five times more likely to develop breast cancer and at least 10 times more likely to develop ovarian cancer. Both women and men with these mutations are also at increased risk for other cancers, including pancreatic cancer, prostate cancer and melanoma. Continue reading

Will California Smokers Pay More Under the Health Care Overhaul?

By Stephanie O’Neill, KPCC

(Dale M. Moore/Flickr)

(Dale M. Moore/Flickr)

Perhaps the most popular provision of President Obama’s federal health law is that people cannot be turned down or charged a lot more because they are sick. Obamacare also reduces how much more older people can be charged for insurance.

But the president’s health law permits one group to be charged more — a lot more: smokers. States can allow health plans to charge tobacco users up to 50 percent more for their health insurance premiums.

The provision allowing for a “tobacco surcharge” was designed in part to encourage smokers to quit a habit that often leads to major illness.

The Centers for Disease Control puts the nation’s annual price tag for smoking at more than $190 billion in both medical care and lost productivity.

It’s that price tag that prompts some to support higher health care premiums for smokers. Micah Weinberg is a senior fellow with the Bay Area Council, which researches public policy issues that affect businesses and the local economy. While he says caution is needed to avoid premiums so high that they are unaffordable to smokers, “I think that we need to make sure that there is a strong financial disincentive for people to smoke.” Continue reading

State Health Agency Directs Insurers to Stop Discriminating Against Transgender People

The state’s Department of Managed Health Care has issued a letter to “remind” health care plans  that discrimination against transgender people is in violation of anti-discrimination laws passed in 2005. The DMHC regulates HMOs in California.

In a release, the Transgender Law Center called the directive “groundbreaking” and said it will save lives. “For years, transgender Californians have been denied coverage of basic care merely because of who we are,” said Masen Davis, executive director of the center. “Discriminatory insurance exclusions put transgender people and our families at risk for health problems and financial hardship. Now we can finally get the care we need.” Continue reading

Nearly 3 Million Californians Will Be Eligible for Obamacare Tax Credits, Study Says

By Stephanie O’Neill, KPCC

(Vic: Flickr)

(Vic: Flickr)

Federal tax credits designed to make health insurance more affordable, starting next year, will help nearly 3 million Californians buy health insurance, according to a study issued Tuesday.

The report commissioned by Families USA — a supporter of President Obama’s health care reforms — says that more than 85 percent of all Californians who qualify for the federal tax credits live in families with at least one full- or part-time worker who doesn’t receive employer-sponsored health insurance.

It also finds that 52 percent of Californians expected to qualify for the sliding-scale tax credits will come from middle-class families who earn up to $95,000 a year. Continue reading

Unnecessary Early Deliveries Plummet in Multi-State Study, Includes California

American children are less likely to live to age 5 than children in other high-income countries. (Photo: Comstock)

The rate of early elective deliveries dropped from about 28 percent to under 5 percent. (Photo: Comstock)

Hospitals in California were part of a multi-state approach designed to dramatically reduce early elective deliveries of babies. The result? In one calendar year, early deliveries — those without a medical cause for doing so — dropped from about 28 percent to just under 5 percent.

“What everyone is amazed about is we did it in a year,” said Leslie Kowalewski with the California chapter of the March of Dimes, which helped hospitals in setting up the new protocol for the study.

The findings from the study were published this week in Obstetrics and Gynecology. For more than 30 years, the American College of Obstetricians and Gynecologists has recommended that women and their doctors wait until at least 39 weeks of gestation to deliver a baby. Delivering earlier is associated with health complications for the babies, including breathing and developmental problems.

Slippery Slope With Early Deliveries

But a “slippery slope” had developed around early elective deliveries, says Dr. Elliott Main, a high-risk obstetrician and director of obstetrics quality at Sutter Health. “Your due date was 40 weeks, and then we thought 39 was just as good. Then it became 38 and a half, then 38, and that’s the slippery slope.” Continue reading

Quick Read: A Singular Life, an All Too Common End

Among other points, this beautiful essay contrasts how Ronald Reagan publicly revealed his Alzheimer’s diagnosis — and how Margaret Thatcher was so private that the public does not know what her diagnosis was. In any case Paula Span writes, “dementia is part of their stories, and of so many others’.”

The long list of roles Margaret Thatcher played during her 87 years – potent politician, free-market evangelist, labor antagonist, dominant global leader – includes the one she never publicly discussed: person with dementia. The stroke that killed her on Monday was not her first. Mrs.

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Quick Read: Size Indeed Matters, Suggests Male Attractiveness Study

Evolutionary biologists have looked at the question of female “mate-choice” for generations, reports USA Today. In this new study, women rated better-endowed men as more attractive. The study was published in the Proceedings of the National Academy of Science.

“What does a woman want?” asked Freud. A guy who is tall and well-endowed, suggests an Australian study that used male cut-outs to ask the question.

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