Wednesday, June 04, 2008

Quote of the Day:

POLITICS & POLICY

VETERANS' HEALTH: Senate OKs Bill To Address PTSD, Suicide Rates The Senate on Tuesday by voice vote passed a bill (S 2162) that seeks to address increased rates of post-traumatic stress disorder and suicide among veterans, CQ Today reports. The Veterans' Mental Health and Other Care Improvements Act of 2008 would expand research and health care facilities for veterans who have PTSD, substance abuse problems and chronic pain. In addition, the legislation would extend mental health resources to the family members of veterans; provide assistance for low-income veterans and those who live in rural areas; and require the Department of Veterans Affairs to conduct a full review of mental health services offered to veterans. Senate Veterans' Affairs Committee Chair Daniel Akaka (D-Hawaii), who sponsored the bill, said, "For too many veterans, returning home from battle will not bring an end to conflict," adding, "Invisible wounds are complicated and wide ranging, and our solutions must rise to the challenge." Hearing on PTSD E-Mail The committee on Wednesday will hold a hearing to continue an investigation into whether VA "has made a cost-cutting policy of deliberately diagnosing veterans as suffering from ailments less severe than PTSD," according to CQ Today (Rogin, CQ Today, 6/3). In May, VA Secretary James Peake reprimanded Norma Perez, a physician at the Olin E. Teague Veterans Center in Temple, Texas, who discouraged post-traumatic stress disorder diagnoses to reduce the number of veterans who sought financial compensation for the condition. In an e-mail to staff members, Perez wrote, "Given that we are having more and more compensation-seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straight out" and "consider a diagnosis of adjustment disorder." Perez also wrote that staff members "really don't ... have the time to do the extensive testing that should be done to determine PTSD" (American Health Line, 5/20). Perez will testify at the hearing. In her prepared testimony, Perez defended the e-mail. She added that diagnosis of PTSD is not an exact science. Perez wrote, "In retrospect, I realize I did not adequately convey my message appropriately, but my intent was unequivocally to improve the quality of care our veterans received" (CQ Today, 6/3). According to the Post, "Perez indicated she might have been out of line to cite growing disability claims," although "her intent was to remind staffers that stress symptoms could also be caused by adjustment disorder" (Washington Post, 6/4). VA Secretary James Peake criticized the e-mail as "inappropriate," but department officials this week said that the e-mail was taken out of context (AP/New York Times, 6/3). Retired Army Brig. Gen. Michael Kussman, undersecretary for health for the Veterans Health Administration also will testify at the hearing (CQ Today, 6/3). In his prepared testimony, Kussman wrote, "The e-mail, as characterized by others, does not reflect the policies or conduct of our health care system," adding, "We certainly agree that it could have been more artfully drafted" (AP/New York Times, 6/3). "Outside experts maintain that the VA is involved in broadly steering diagnoses away from PTSD to ailments that are less costly to treat," CQ Today reports. Anne Weismann, chief counsel for Citizens for Responsibility and Ethics in Washington, said, "This is a systemic problem," adding, "The VA's position so far has been to deny that there's even a problem." In addition to the committee, the VA Office of Inspector General has begun an investigation into the issue (CQ Today, 6/3).

HEALTH IT: HHS Releases 'Comprehensive' Plan for Nationwide Adoption The Office of the National Coordinator for Health Information Technology at HHS on Tuesday released a cross-agency directive to speed up the adoption of a nationwide health information technology system that would improve health care quality, increase efficiency, reduce medical errors and address concerns of patient privacy and data security, CQ HealthBeat reports. The document lays out "comprehensive" guidelines to help federal agencies over the next five years establish a health IT system that would link the private and public sectors, HHS officials said. HHS' plan was developed as part of an executive order issued by President Bush in 2004, which also established a federal health IT coordinator position. At that time, Bush also announced a goal of granting most U.S. residents access to electronic health records by 2014. The plan focuses on using health IT to aid in direct care to patient as well as for population health, which addresses efforts to improve public health, planning for large-scale emergency health events and biomedical research, according to Shannah Koss, vice president of Avalere Health, the consulting firm in Washington, D.C., that helped HHS develop the directive. Koss added that the plan is the first-ever nationwide health IT plan. The plan's goals include addressing medical privacy, records security, creating uniform standards to ensure the uninhibited flow of health data and methods of assisting health care constituents to work together to create a health IT system. According to CQ HealthBeat, the plan also establishes strategies and milestones for meeting each of its goals. Robert Colodner, the national coordinator for health IT, said the plan "establishes the next generation of health IT milestones." The document also includes a timeline of the efforts made over the last five years at various federal agencies to implement a health IT system, CQ HealthBeat reports (Reichard, CQ HealthBeat, 6/3).

MEDICARE: Democrats Seek Bill Support From Moderate Republicans Proponents of a Democratic Medicare package being written by Senate Finance Committee Chair Max Baucus (D-Mont.) are trying to garner support for the legislation from moderate Republicans, CQ HealthBeat reports (Armstrong, CQ HealthBeat, 6/3). Baucus' bill would halt a scheduled 10.6% cut to Medicare physician payments and institute a 0.5% increase in the payments for next year, among several other provisions. On Thursday, Baucus is scheduled to meet with physician groups to discuss the legislation. Baucus is hoping to bring the package to the floor next week (American Health Line, 6/3). According to CQ HealthBeat, supporters of the package are "trying to pry loose some Republicans" to gain 60 votes needed in the Senate to limit debate on the bill and hold a vote. Committee ranking member Chuck Grassley (R-Iowa) said that a whip count has not been conducted yet to see if Republicans have the 40 votes to prevent cloture. Democrats have "several ways" to try to gain Republican support, including adding "sweeteners" to the legislation such as higher payments for physicians in rural areas and for hospitals that treat the uninsured in certain states, according to CQ HealthBeat. In addition, some Republicans likely "face tough re-election campaigns," and "[v]oting against the bill could irk physician groups and other health care professionals," who are "valuable fundraising sources for Republican candidates," CQ HealthBeat reports (CQ HealthBeat, 6/3). According to CongressDaily, the "split is mainly over how to pay for the package." Democrats are targeting extra payments to Medicare Advantage plans, and Republicans prefer focusing MA plan cuts on indirect medical education payments, CongressDaily reports (Edney, CongressDaily, 6/4). The White House has threatened to veto the legislation (CQ HealthBeat, 6/3). Supporting Republicans So far, Senate Special Committee on Aging ranking member Gordon Smith (R-Ore.), who also is a member of the Finance Committee, has voiced his support for the package. Smith has been working to add provisions to the bill, including increasing low-income beneficiary assistance, copayment parity for mental health services, and more drug coverage for beneficiaries with HIV/AIDS, cancer and other serious conditions, according to a Smith spokesperson. Sen. Olympia Snowe (R-Maine) also supports Baucus' bill, which is "not a surprise" because she has "supported broad Medicare Advantage cuts," CongressDaily reports (CongressDaily, 6/4). E-Prescribing Although Baucus' bill "isn't likely to pass in" its current form, "lobbyists say [electronic] prescribing is one piece that may survive in the final package," the Wall Street Journal "Health Blog" reports. The e-prescribing provision is the "most significant" of the bill's "intriguing ingredients," and it "has considerable support from both parties, as well as a powerful array of interests packing it," according to the "Health Blog" (Wilde Mathews, "Health Blog," Wall Street Journal, 6/3). The provision would increase physician pay by 2% beginning in 2009. By 2011, any payments for any physician not using the technology would be cut by 1%, which would increase to 2% by 2013, according to the AP/Boston Globe. Tony Clapsis, an analyst for Lehman Brothers, in a recent note to investors wrote, "E-prescribing remains the only health IT proposal that can generate short-term savings for the federal government, and as a result is the only one we think can get passed for the foreseeable future." Mark Merritt, president of the Pharmaceutical Care Management Association, said that the penalties outlined in the provision for not adopting e-prescribing will be more important than the rewards (AP/Boston Globe, 6/4).

HEALTH CARE COSTS: Senate Committee Hearing Addresses Issue Lawmakers should not overstate the ability of health care information technology, quality improvement efforts and medical liability reform to reduce health care costs, Paul Ginsburg, president of tthe Center for Studying Health System Change, testified on Tuesday at a Senate Finance Committee hearing, CQ HealthBeat reports. During the hearing, Ginsburg said that such proposals "have merit because they have the potential to improve the quality of care" but added that "it's questionable whether the ... impact on costs will be commensurate with the magnitude of the cost problem." Elizabeth McGlynn, associate director of RAND Health, said that lawmakers should address the issue of health care quality, which she said varies nationwide, separate from the issue of costs. Felicia Fields, group vice president of Human Resource and Corporate Services for Ford Motor, said that lawmakers should seek to address the main causes of increased health care costs and that such an effort would help make health insurance more affordable. "Simply subsidizing excessive health care spending does not offer a long-term solution to our health care problems," and "it may exacerbate them," she said. The hearing marked the second in a series that the committee plans to hold in preparation for a debate on health care reform legislation next year. Committee Chair Max Baucus (D-Mont.) said, "I hope and intend that we can seize the opportunity to achieve what previous Congresses and presidents were unable to do," adding, "We must find a way for all Americans to have access to affordable, high-quality health care" (Carey, CQ HealthBeat, 6/3).

FEMA: Could Use Trailer Units in 2008 Hurricane Season The Federal Management Emergency Agency in 2008 might use trailer units to house disaster victims despite promises never to use them in the future because of high levels of formaldehyde found in those used to house victims of Hurricane Katrina, the AP/Chicago Tribune reports. CDC in February announced that a study of the air quality in the trailer units used to house victims of Hurricane Katrina found toxic levels of formaldehyde, which can cause respiratory and other health problems. According to a five-page draft of a plan for the 2008 hurricane season obtained by the Associated Press, FEMA Director R. David Paulison could authorize the use of trailer units, provided that they met agency standards for formaldehyde levels. Disaster victims could live in the trailer units for only six months. In addition to trailer units, FEMA could use "Katrina Cottages," or small houses, as well as mobile homes and park models. FEMA also would consider other alternatives. FEMA Deputy Director Harvey Johnson on Monday said, "If we had a Katrina again, there's probably no way we could respond to a Katrina without having to deploy all available options, which will include travel trailers." Rep. Bennie Thompson (D-Miss.) -- chair of the House Committee on Homeland Security, which will conduct a hearing on the plan on Wednesday -- said, "It troubles me that three years after Katrina, FEMA has yet to come up with legitimate alternatives to travel trailers" (Sullivan, AP/Chicago Tribune, 6/3).

ELECTION WATCH

PRESIDENTIAL ELECTION: Obama Secures Democratic Nomination Democratic presidential candidate Sen. Barack Obama (Ill.) on Tuesday secured an adequate number of delegates to become the presumptive nominee, the Washington Post reports (Balz/Kornblut, Washington Post, 6/4). Obama also won the Montana Democratic primary with 57% of the vote, compared with 41% for opponent Sen. Hillary Rodham Clinton (N.Y.). Clinton won the South Dakota primary with 55% of the vote, compared with 45% for Obama (CNN.com, 6/4). In a speech to supporters in New York City, Clinton said that she would continue her efforts to expand health insurance to all U.S. residents. She said, "It is a fight I will continue until every single American has health insurance. No exceptions and no excuses" (Kuhnhenn/Fouhy, AP/Houston Chronicle, 6/3). At a rally in St. Paul, Minn., Obama said, "And you can rest assured that when we finally win the battle for universal health care in this country -- and we will win that fight" -- Clinton "will be central to that victory." According to an exit poll, 15% of Montana Democratic primary voters cited health care as their most important issue in the election, compared with 49% who cited the economy and 31% who cited the war in Iraq. Fifty-three percent of Montana Democratic primary voters who cited health care supported Obama, and 44% favored Clinton, the poll found. In South Dakota, an exit poll found that 15% of Democratic primary voters cited health care as their most important issue in the election, compared with 56% who cited the economy and 26% who cited the war in Iraq. Among South Dakota Democratic primary voters who cited health care, 63% supported Clinton, and 37% favored Obama, the poll found. The exit polls, conducted by Edison Media Research and Mitofsky International, included responses from 1,312 Democratic primary voters in Montana and 1,166 voters in South Dakota (CNN.com, 6/4). Economists Discuss Health Care Proposals A panel of economists on Tuesday at a briefing hosted by the Alliance for Health Reform discussed the health care proposals of the major presidential candidates, CQ HealthBeat reports. According to the panel, the proposals could address some problems with the health care system, although their effects on costs remain undetermined. Uwe Reinhardt, an economics professor at Princeton University, said, "Most of us would favor (some of the stipulations of the presidential health care proposals), but, if you give us a truth serum, most of us would say that whether it saves dollars per year is not so clear." He added that the proposals would not address some of the major causes of increased health care costs. Mark McClellan of the Brookings Institution said that reporters should continue to ask candidates about their proposals to finance their health care plans. According to McClellan, although Obama and Clinton have proposed to eliminate tax cuts proposed by President Bush and approved by Congress for households with annual incomes greater than $200,000 to help finance their health care plans, that proposal would not provide significant funds because the cuts will expire in early 2009. McClellan said that presumptive Republican nominee Sen. John McCain (Ariz.) has offered a more realistic estimate of the cost and plan to finance his health care proposal than Obama and Clinton have offered for their plans. "This is the first time I can remember a Republican candidate not proposing anything new as far as subsidies," McClellan said. In addition, Reinhardt called McCain the "true radical in this among these three" because of his proposal to replace a "sacred" tax break for employees who receive health insurance from employers with a refundable tax credit of as much as $2,500 for individuals and $5,000 for families for the purchase of private coverage (Cooley, CQ HealthBeat, 6/4). Opinion Pieces Summaries of several opinion pieces related to health care in the presidential election appear below. Bruce Bodaken, San Francisco Chronicle: Efforts to expand health insurance to all residents of California and Massachusetts "indicate a changing dynamic in which health plans can be a valuable ally of coverage expansion advocates," and "federal policymakers would be making a big mistake if they wrote off the health insurance industry in those deliberations," Blue Shield of California CEO and Chair Bodaken writes in a Chronicle opinion piece. Bodaken writes that health insurers supported the state efforts because "we recognize better than anyone the inconvenient truth that the system as it exists today is failing" and because "state policymakers adopted a cooperative approach that acknowledges our legitimate concerns." He concludes, "If we start the debate in a defensive crouch, we might just end it flat on our backs," but, "if we extend a hand of cooperation, it is likely to be grasped" (Bodaken, San Francisco Chronicle, 6/4). Marie Cocco, Indianapolis Star: "More than halfway through a political season" in which "public concern about America's porous, confusing and costly health insurance system" has "consistently emerged" as a main concern for voters, "this is what we can expect when the next president takes office next year: not so much," syndicated columnist Cocco writes in a Star opinion piece. Neither Obama nor McCain has "pledged to cover all of the 47 million uninsured Americans," and neither has proposed to make health care "more fair and equitable by putting everyone in a pool in which risks are shared" among all residents, Cocco writes. She concludes that, "if Obama wins" the presidential election, Democrats "will have squandered the best opportunity in more than a decade to take a bold leap toward the universal coverage Democrats have promised since the presidency of Harry Truman" (Cocco, Indianapolis Star, 5/31). John Gage, Arizona Daily Star: "With 1.6 million American heroes returning from Iraq and Afghanistan, never has it been more urgent to strengthen the veterans' health care system," but McCain, a veteran who "should be leading the charge," is "doing the opposite," Daily Star columnist Gage writes. McCain has voted against increased funds for health care for veterans from 2004 to 2007, Gage adds. In addition, a proposal by McCain to "abandon the Veterans Health Administration" and provide veterans with a card that allows them to receive treatment from private health care providers would result in a "disaster," Gage writes. According to Gage, the proposal would "direct veterans outside the VHA (and often into HMOs), where they will face worse care and (along with taxpayers) higher costs." He writes, "Any candidate who is serious about supporting our veterans should build on the VHA's innovations and achievements, end underfunding and understaffing, and expand its capacity to meet the new demand" (Gage, Arizona Daily Star, 6/3). Paula Hall, Seattle Post-Intelligencer: "Election day is not the end game" for the health care and other proposals of the presidential candidates because the "real change we want and need will come only when we hold elected leaders accountable to the standards and promises they make on the campaign trail," guest columnist Hall writes in a Post-Intelligencer opinion piece. She writes, "You wouldn't invest in the stock market and then ignore the returns. It's the same concept with politicians. If we do not continue our phone calls, lobby-day visits and our collective actions, we can't expect to see our government rebuild the middle class, secure affordable health care for all and ensure all workers have the freedom to unite for a voice on the job" (Hall, Seattle Post-Intelligencer, 6/2). David Hill, The Hill: "The boardroom of Big Tobacco must be abuzz these days over the prospect of the Oval Office again becoming a smoke-filled room," as Obama "may be their next (or last) best hope to make smoking fashionable again," Hill, director of polling firm Hill Research Consultants, writes in an opinion piece in The Hill. "I'd imagine everyone with children would be horrified" by a president who smokes, Hill writes, adding, "It's bound to be demoralizing" to NIH, CDC and groups that seek to reduce smoking rates. Hill adds that, because "minorities and lower-income voters are some of the toughest sales when it comes to tobacco-control ballot measures, like for higher cigarette taxes," these "last holdouts from the common sense of smoking cessation may resist more than ever" in the event that Obama wins the presidential election and "persists in sneaking smokes." He concludes, "I won't speculate as to whether Obama is still smoking behind closed doors or hopelessly addicted to those substitute nicotine lozenges," but neither "is acceptable in a president" (Hill, The Hill, 6/3).

REGULATORY NEWS

FDA: AHL Highlights Recent Developments Summaries of recent FDA news appear below. Epilepsy drugs: Pharmaceutical companies are "scrambling" to convince FDA not to add warnings for suicidal behavior risks to a large class of epilepsy drugs, the Wall Street Journal reports. FDA on Monday presented data during a closed meeting of epilepsy researchers and industry representatives in New York that showed a "statistically significant difference in suicidal tendencies" for patients who have taken one of 11 epilepsy drugs currently on the market. Industry officials "expressed concern" about the analysis because it was a grouping of 199 previous studies instead of new, independent research. FDA has scheduled an advisory committee meeting on the issue for early July (Mundy/Johnson, Wall Street Journal, 6/4). Food dyes: Officials from the Center for Science in the Public Interest on Tuesday requested that FDA ban the use of eight artificial colorings in food because the additives might cause hyperactivity and behavioral problems in some children, the AP/Baltimore Sun reports. The center asked that while the agency considers the ban that it require products with artificial dyes to have a warning label (Freking, AP/Baltimore Sun, 6/3). Although FDA in a brochure dated November 2004 and posted on its Web site states that there is no evidence linking food coloring to hyperactivity, CSPI officials say that studies over the past 30 years have shown that some children's behaviors are worsened by the dyes (Blum, Bloomberg/Boston Globe, 6/4). FDA spokesperson Julie Zawisza on Tuesday said that color additives undergo safety reviews prior to approval, adding that the agency reviewed one of the studies on which the group was basing its argument and "didn't find a reason to change our conclusions that the ingredients are safe for the general population." The colorings included in the request are: Blue 1, Blue 2, Green 3, Orange B, Red 3, Red 40, Yellow 5 and Yellow 6 (AP/Baltimore Sun, 6/3). Staffing issues: Hiring and retainment issues, funding shortages, additional responsibilities and recruitment by outside companies have combined to create a "leaner, less confident staff" at FDA, the AP/Contra Costa Times reports. Retention issues are due in part to pharmaceutical companies hiring FDA staffers to help them through the drug-approval process. However, the smaller, less-experienced staff at FDA is now "hesitant to put new drugs on the market," according to analysts. Meanwhile, FDA staffers "who disagree with management are reportedly discouraged from speaking up," according to the AP/Times. In addition, 30% of the agency's work force already is eligible to retire. FDA has designed a recruiting program, but a lack of funds has delayed the program's implementation, while a public image of being overburdened is discouraging some people from applying to work at the agency (Perrone, AP/Contra Costa Times, 6/3).

INSIDE THE INDUSTRY

RX INDUSTRY: AHL Highlights Recent Developments Summaries of several recent developments in the pharmaceutical and medical device industries appear below. Eli Lilly: A new television advertisement for the osteoporosis medication Evista, manufactured by Lilly, is "not the typical drug ad filled with smiling families or cuddling couples" and includes women in their 50s and 60s who "look confident in some shots, nervous in others and even mildly flirtatious at times" in an "emotional display" designed to "connect with millions of older women," the Indianapolis Star reports. Lilly launched the ad after FDA last fall approved an application to market Evista for prevention of breast cancer. In the ad, the narrator states, "You're past menopause and are treating osteoporosis. Why not ask your doctor about Evista, the only medicine that treats osteoporosis and reduces your risk of invasive breast cancer?" However, advocacy groups for women's health issues have raised concerns that the ad does not include adequate information about the risks of Evista. A clinical trial that involved 10,000 women with heart and other health problems found that participants who took Evista had a 49% higher risk for death from stroke than those who took a placebo (Russell, Indianapolis Star, 6/1). Medtronic: Medtronic officials on Monday announced that the company expects annual revenue growth of 9% to 11% and annual earnings growth of 11% to 14% through fiscal year 2013, the Bloomberg/Minneapolis Star Tribune reports (Nussbaum, Bloomberg/Minneapolis Star Tribune, 6/2). In a meeting with analysts, William Hawkins, president and CEO of Medtronic, said that the company plans to increase operating margins by three to four percentage points and reduce administrative, general and marketing costs by 2.5 to 3.5 percentage points (Kamp, Wall Street Journal, 6/3). Hawkins also said that revenue growth in international markets -- such as Brazil, China, India, Russia and South Korea -- will exceed growth in the U.S. market (Snowbeck, St. Paul Pioneer Press, 6/2). Pfizer: The Wall Street Journal on Tuesday examined how Pfizer, "stuck in a rut of stagnating revenue and profit as it struggles to find new drugs, is facing another headache: how to keep funding its generous dividend." According to the Journal, Pfizer in 2007 made $8 billion in dividend payments to shareholders, one of the "few reasons many investors still hold" on to stock in the company. Pfizer has a dividend yield of 6.67% -- "well above the drug industry average of 3.37% and 2.18% for the Standard & Poor's 500" -- but some Wall Street analysts have raised concerns that the "payout, the industry's richest, may be in jeopardy in coming years because of the limited amount of money Pfizer is thought to hold and generate in the U.S.," the Journal reports (Johnson/Lublin, Wall Street Journal, 6/3).

PROVIDER NEWS

PHYSICIANS: AHL Examines Recent Trends Two newspapers recently published articles examining issues related to physicians. Summaries appear below. Cosmetics: Some ob-gyns, primary care physicians and dentists are opting to provide cosmetic treatments because they are more profitable than traditional services provided to patients, the Houston Chronicle reports. As insurers and programs such as Medicare cut reimbursement rates, some physicians believe treating sick patients can be a "costly, protracted exercise," the Chronicle reports. According to the Chronicle, many patients who complain about $20 to $30 copayments for physician visits "will happily swipe their credit cards" to pay $300 or more for a shot of Botox, or botulinum toxin type A, to relax facial wrinkles. Administering the injections could potentially earn physicians hundreds of thousands of dollars in annual profits. Many physicians say that patients benefit from receiving cosmetic procedures in the safer environment of a physician office, rather than in spas or other nonmedical settings, according to the Chronicle. Ivonne Smith, an ob-gyn with Obstetrical and Gynecological Associates, said the "superficial side" of the practice can sometimes lead to women getting needed treatment for ailments that would not otherwise have been caught (Cook, Houston Chronicle, 6/2). Temporary physicians: The use of temporary physicians by hospitals and medical groups has more than doubled since 2001, according to a study by the physician staffing agency Staff Care, Columbia/Chicago Tribune reports. Medical centers have "long used" temporary physicians, or locum tenens, to fill in for physicians who are sick or on vacation. In addition, the study found that the number of days worked by physicians on a temporary basis has increased by 20% from 2006 to 2007, according to Columbia/Tribune. Temporary positions are "an appealing option" for physicians because they allow physicians to set a limit on the number of hours they work and "avoid administrative hassles," according to Columbia/Tribune. A physician only needs to tell a staffing agency what state or what type of practice in which they wish to work. The agency then places the physicians, checks their licensing for that particular state, arranges accommodations and even covers the cost of malpractice insurance. However, some experts are concerned that the growing use of temporary physicians is an early indication that a primary care physician shortage is looming (Morgan, Columbia/Chicago Tribune, 6/3).

QUALITY & COST

VETERANS' CARE: AHL Highlights Recent Developments Summaries of recent news related to veterans' health care appear below. Patient data: Information for about 1,000 patients at Walter Reed Army Medical Center and other military hospitals has been exposed as a result of a security breach, the AP/Washington Post reports. Data released include names, Social Security numbers and birth dates. Medical records were not included, according to the AP/Post. The AP/Post reports that Walter Reed officials declined to state how the data were compromised but said that the information was found on a "non-government, non-secure computer network." Hospital officials and the Army are currently investigating. According to the AP/Post, Walter Reed officials learned of the breach on May 21 from an outside data mining company. Patients whose information was released will be contacted and will be offered no-cost credit protective services (Kerr, AP/Washington Post, 6/2). PTSD: In response to a report recently released by the Army Surgeon General that found a 50% increase in the number of post-traumatic stress disorder cases last year, Sen. Daniel Akaka (D-Hawaii) is asking the Department of Veterans Affairs and the Department of Defense to address the issue, the AP/Foster's Daily Democrat reports. Akaka called the report "alarming and cause for immediate action by the government as a whole." He added that VA and DOD could work together to develop a plan to address the issue (AP/Foster's Daily Democrat, 6/1). Stress: The Washington Post on Tuesday examined how firing ranges located near "warrior transition" barracks in Fort Benning, Ga., have increased soldiers' stress levels and caused an assortment of physical and mental problems for soldiers. The sound of gunfire hinders soldiers who already "struggle with nightmares, anxiety and flashbacks from their wartime experiences," according to the Post. The sound "makes the wounded cringe, startle in their formations, and stay awake and on edge," and can even cause panic attacks, the Post reports. Soldiers have complained to medical personnel at Fort Benning's Martin Army Community Hospital and officers in their chain of command. However, Fort Benning officials have said day and night training must continue as more soldiers arrive, according to the Post (Scott Tyson, Washington Post, 6/3).

RESEARCH NOTES

COLON CANCER: Family History Increases Survival Chances Colon cancer patients with a family history of the disease have an increased chance of survival, according to a study published Wednesday in the Journal of the American Medical Association, the New York Times reports. The study, conducted by the Dana-Farber Cancer Institute and funded by the National Cancer Institute and Pfizer Oncology, followed 1,087 patients being treated for Stage 3 colon cancer. Of those participants, 195, or 18%, had either a parent or sibling with the disease (Parker-Pope, New York Times, 6/4). Participants with one close relative who had colon cancer had a 28% lower risk of the cancer returning, being diagnosed with a new tumor or dying from any cause during the five-and-a-half years of the study (Conlon, Reuters/Boston Globe, 6/4). Participants with two or more relatives with the disease had a 51% lower risk of recurrence or death. According to the Times, it is unclear how family history contributes to survival rates. Researchers have ruled out several explanations, including healthier lifestyles and additional screenings (New York Times, 6/4). Study leader Jennifer Chan said, "What we suspect ... is that there may be biological differences in the tumors of people who have a family history." Chan said that the results from the study should not change how doctors treat colon cancer (Thomas, Chicago Sun-Times, 6/4). The study is available online.

PEDIATRIC CARE: Higher Rate of Infection for Hospitalized Children Hospitalized children are three times more likely than adults to suffer from care-related infections and complications, according to a study published in this month's issue of the journal Pediatrics, the St. Louis Post-Dispatch reports. For the study, researchers from The Children's Hospital of Philadelphia reviewed medical records of 430,000 hospitalized children in 2006 for 12 different kinds of adverse events listed by the Agency for Healthcare Research and Quality, including infections from catheters, bedsores and accidental punctures. The study found that children are more likely than adults to have some complications, like postoperative infections, and less likely to have others, like bedsores. The study, which is the first to analyze only pediatric patients, found in 2006 that 6,600 children suffered complications due to their care, 4,300 children died and 3,000 experienced "distressingly high" complications, according to researchers. Researchers also found complications in up to 4% of all children treated at 38 children's hospitals nationwide. According to study co-author Matthew Kronman, complications lengthen hospital stays by three to 24 days, depending on the condition. The additional charges resulting from the complications can be between $35,000 to $337,000, according to the report. Kronman said, "If we were to eliminate all infections due to medical care, that would save over $700 million in charges each year." According to study co-author Samir Shah, the study could lead to changes in nurse-to-patient ratios and hospital safety policies (Bernhard, St. Louis Post-Dispatch, 6/2). Broadcast Coverage American Public Media's "Marketplace Morning Report" on Monday reported on the study. The segment includes comments from Shah and Brookings Institution health care analyst Henry Aaron (Marshall Genzer, "Marketplace Morning Report," American Public Media, 6/2).

TRENDS & TIMELINES

NIH: Unveils Newly Repaired Baltimore Lab NIH on Monday allowed the press to tour its new research facility in Baltimore, Md., explaining that vibrations and other problems that troubled construction of the facility had been overcome, the Baltimore Sun reports. The 500,000-square-foot building, intended as a "high-tech replacement" for an older building, was originally scheduled to open in 2006, but construction efforts experienced setbacks -- "most notably" the vibrations, which were originally reported by the Sun. Construction of the new facility cost $278 million, about 25% more than originally estimated. NIH Director Elias Zerhouni on Monday said, "We overcame a lot of challenges," adding that the vibrations are "not a real problem." Richard Hodes, director of the National Institute on Aging, said he had a "high level of confidence" that the earlier problems will no longer affect the facility. Officials said that vibrations are now within industry standards but that more than 80 researchers must remain in the old building because vibrations would skew their research results. Officials said 450 scientists should complete their relocation into the building by August (Rockoff, Baltimore Sun, 6/3).

BREAST CANCER: Debate Over Response to Small Amount Examined The New York Times on Tuesday examined how, as "biopsies of the lymph nodes grow more sophisticated and sensitive, oncologists and patients face the unsettling question of what to do with a little bit of cancer." The issue "has become a familiar debate, especially for breast cancer," and, without "more data to guide them, doctors worry that some women may be given test results that are actually too good, leading to more medical attention than necessary," the Times reports. According to the Times, "Until the issue is settled, oncologists will have to navigate patients through complicated choices." One choice involves "whether a node that is positive for micrometastases warrants removing" more lymph nodes, a procedure that can result in years of swelling and tightness in the arms, and a second "dilemma is whether a little cancer is worth a lot of anxiety," as "cancer in a lymph node, no matter how minuscule, can be alarming," the Times reports (Beil, New York Times, 6/3).

ALZHEIMER'S: Issues Related to Early Diagnosis Examined The AP/Miami Herald on Monday examined issues faced by the increased number of Alzheimer's patients diagnosed in the early stages of the disease. According to the AP/Herald, research indicates that as many as half of the estimated five million U.S. residents who have Alzheimer's might "be in the disease's early stages," and physicians "say they've begun diagnosing far more people who still have years of independent living ahead of them than they did just a few years ago." Early diagnosis of Alzheimer's "gives people a chance to plan for their future care while they still have the mental capacity to do so" but also "highlights some harsh unknowns," such as when to begin treatment with medication, which can only alleviate symptoms for a period of time, the AP/Herald reports. In addition, few support groups or studies exist for patients with early-stage Alzheimer's. In response, the Alzheimer's Association, which until recently has focused on public awareness campaigns and legislative efforts that did not target patients directly, this week will launch a pilot advertising campaign in Oklahoma City, Minneapolis and Richmond, Va., that seeks to increase early diagnosis of the disease. Early-stage Alzheimer's patients also have begun to lobby Congress to increase funds for research on the disease (Neergaard, AP/Miami Herald, 6/2).

OPINIONMAKERS

SEC: Vote 'Politicization of Shareholder Proxies,' Editorial Says "It's corporate proxy season, and as the usual shareholder activists are out to make a splash," but this year "there's an important twist: the Securities and Exchange Commission is helping them," a Wall Street Journal editorial states (Wall Street Journal, 6/4). SEC, in a reversal of a previous position, has told companies that they cannot exclude a health care proposal from proxy materials provided to shareholders (American Health Line, 5/27). According to the Journal, labor activists this year "asked for proxy space on the 'principle' of universal health care" because "voting on general principles isn't shareholder micromanagement and so would evade SEC strictures." The editorial continues, "How universal health care would enhance shareholder value is at best unclear, however." The Journal adds that "these proposals are not about investment returns" but "about browbeating corporate America into endorsing the union health care agenda." The proposals were designed "to echo through national political debates and get businesses on record as supporting 'universal' (read: government) health insurance," the Journal states, adding, "This should have been reason enough for the SEC to throw the proposals out," but "at every company where they were offered, the SEC approved them." The editorial continues, "We're also told the staff also proceeded on its own, without the approval of SEC commissioners." According to the Journal, "If that's true, this is an abuse of discretion by the staff, or an abdication by the commissioners, or both." According to the editorial, SEC this year "reviewed 14 of these health care proposals," and, "[g]iven their success, we can expect more of them next spring." The Journal concludes, "Since the SEC staff is determined to play dumb about their political purpose, the commissioners will have to exercise some adult supervision to prevent further politicization of shareholder proxies" (Wall Street Journal, 6/4).

IMMIGRATION: Government Needs To Reform System "Thanks to the nation's dysfunctional immigration system and the dysfunctional Congress that keeps it that way, tens of thousands of promising, intelligent, ambitious and highly skilled foreign professionals ... will be denied a chance to contribute their expertise and energy to the American economy," a Washington Post editorial states. The editorial adds, "Few policies match this one in terms of sheer irrationality, and few will do as much damage to this country's long-term prospects and competitiveness." According to the Post, "Although the United States welcomes unlimited numbers of foreign students and subsidizes their education in ... medicine and other disciplines, those students face increasingly steep obstacles to employment here," as do "educated foreign workers whose skills are needed in the American work force." While the number of applications the U.S. Citizenship and Immigration Services received in April was one-third higher than last year -- and "shows no sign of abating" -- the agency "was so swamped it stopped accepting applicants after just five days," leaving qualified applications to be "selected at random by computer lottery," according to the editorial. "All of that might seem fine and fair were it not for the fact that American-born scientists" and physicians "are in short supply," as well as workers in other professions. The editorial continues, "The truth is, America will be a feebler place without a continuing and adequate flow of foreign-born brainpower," adding, "America's loss of foreign-born experts translates directly into gains for China, India and other rapidly developing competitors" (Washington Post, 6/4).

HEALTH CARE REFORM: Baucus, Stark Opinion Pieces Address Efforts Senate Finance Committee Chair Max Baucus (D-Mont.) and House Ways and Means Subcommittee on Health Chair Pete Stark (D-Calif.) on Tuesday both published opinion pieces in The Hill. Summaries appear below. There is further work to do "to heal the nation's economy and to enable the health and financial well-being of all U.S. residents," Baucus writes in an opinion piece in The Hill. According to Baucus, the Finance Committee will spend much of the remainder of 2008 working on "how best to go about making fundamental change to an ailing health care system," among other topics. Baucus and committee ranking member Chuck Grassley (R-Iowa) on June 16 will hold a bipartisan summit at the Library of Congress titled, "Prepare for Launch: Health Reform Summit 2008." According to Baucus, the summit "will be an opportunity for senators, representatives and health policy experts to dig in to prepare for health care reform in 2009." He added that the Finance Committee will discuss state-based health care reform efforts, employer-sponsored health insurance tendencies, increasing health costs, insurance reform, public programs' role in health care and health care delivery reform. In addition, the committee will hold hearings through the spring and summer to discuss the U.S. health care system and reform proposals, "in preparation for Committee action next year." Baucus wrote that the "balance of our health care focus right now is on crafting a Medicare bill that works for America's seniors and that increases physician payments to stave off cuts that threaten to kick in on July 1" (Baucus, The Hill, 6/3). Successful reform of the U.S. health care system "will require negotiation and compromise from everyone," Stark writes in an opinion piece in The Hill. Stark notes that all U.S. health insurance programs have "three basic common elements": a group of defined benefits, payment methods to reimburse providers and method of financing that includes premiums, cost-sharing and taxes paid by beneficiaries, employers and the public. According to Stark, each insurance plan "uses free-market bargaining" and must follow government or institutional regulations and price-setting. Stark writes, "Shifting more cost and responsibility to the consumer as a strategy for reform or cost-containment is useless." Stark notes that a majority of U.S. residents "share a strong hope" that the next president will address health care reform. However, "We should not wait until next year to start building the base for reform," Stark writes. He adds that "profit, non-profit and public programs must work in harmony to bring about needed change." Stark concludes, "Reform must provide the right of all Americans to quality medical care; the right of every provider to reasonable (not necessarily desired) compensation; and the duty of each person to finance this program according to his or her ability to pay" (Stark, The Hill, 6/3).