From Staff Reports

Uninsured Figures Climb

The number of people in the United States without health insurance edged higher in 2005, fueled in part by a drop in employer-sponsored health insurance, according to figures released in August from the U.S. Census Bureau. In 2005, 46.6 million people were uninsured, up from 45.3 million the year before. The percentage of people covered by employer-sponsored health insurance dropped from 59.8% to 59.5% between 2004 and 2005, while the percentage covered by government insurance stayed the same, according to the Census figures. The new figures, compiled as part of the Current Population Survey, showed that the number of uninsured children also increased. Between 2004 and 2005, the number of uninsured children rose from 7.9 million to 8.3 million. And children living in poverty were the most likely to be uninsured, with the uninsured rate at 19% for children living in poverty, compared with 11.2% of children overall in 2005. The American Medical Association issued a statement calling for action to address the uninsured problem. “The AMA plan for reducing the number of the uninsured advocates expanded coverage and choice through a system of refundable tax credits based on income, individually selected and owned health insurance, and market reforms that will enhance new, affordable insurance options,” Dr. Ardis Hoven, an AMA board member, said in a statement.

Part D Premiums Hold Steady

Premiums under Medicare's Part D drug benefit will remain stable in 2007, according to figures released last month by the Centers for Medicare and Medicaid Services. Officials at CMS estimate that the average monthly premium paid by Medicare Part D beneficiaries will be about $24 in 2007, nearly the same as in 2006. “Competition and choice in health care are working,” Dr. Mark McClellan, CMS administrator, said at a press briefing. In addition to holding consumer costs steady, CMS officials reported that the national benchmark that determines Medicare's subsidy of drug coverage will decline next year. Competitive bids for the stand-alone drug plans and the Medicare Advantage managed-care prescription drug plans came in with lower-than-expected bids, according to CMS. The open enrollment period for 2007 starts Nov. 15.

Mixed Reviews for Merck

The most recent Vioxx court cases have produced mixed results for the drugmaker Merck & Co., Inc. In August, a Los Angeles jury ruled in the company's favor, finding that the Vioxx (rofecoxib) was not responsible for the heart attack of Stewart Grossberg, who had been taking the drug intermittently. Merck argued successfully that Vioxx was not responsible for Mr. Grossberg's heart attack because he has high cholesterol levels, atherosclerosis, and a family history of cardiac problems. But about two weeks later, a federal jury in New Orleans found Merck liable for $51 million in damages in the 2002 heart attack of Gerald Barnett, a 62-year-old retired special agent with the FBI. The company is exploring grounds for appeal, including insufficient evidence and the application of incorrect legal standards, according to Merck. The company was also dealt another blow in August, when a New Jersey judge decided to set aside a 2005 jury verdict that had been in the Merck's favor. The judge ordered a new trial to take place early next year. The judge cited a December 2005 New England Journal of Medicine editorial expressing concerns about Vioxx-related study data as the basis for throwing out the jury verdict (N. Eng. J. Med. 2005;353:2813–4).

In the Dark on EC

Despite the controversy surrounding the provision of Plan B emergency contraception without a prescription (see story on p. 1), only about one-quarter of Americans in a recent survey said they had heard a lot about the debate. And nearly an equal number said they had heard nothing about the politically charged issue. The survey was commissioned by the Pew Research Center for the People & the Press and the Pew Forum on Religion & Public Life. The survey also found that about 48% of those surveyed favored selling emergency contraception without a prescription, whereas about 41% opposed the idea. The national telephone survey was conducted in July among more than 2,000 U.S. adults.

Drug Code Directory Incomplete

The Department of Health and Human Services' Office of Inspector General has found that the Food and Drug Administration's National Drug Code Directory is incomplete and inaccurate, largely as a result of drug companies' failure to submit required data, though the FDA shares some blame. The directory is supposed to be a current compendium of marketed drug products. The FDA relies on internal reports and on submissions from pharmaceutical manufacturers, which must report when a new product is introduced or withdrawn. The OIG report is a snapshot of the directory as of February 2005, when 123,856 products had unique entries. The OIG found that the listing left off just more than 9,000 drug products. For about 16%, the drug maker either had not submitted required forms or the agency had not appropriately processed them. Listings for about 5,100 products had been held up because the companies did not provide needed information. Finally, the OIG found that 34,000 products listed were no longer marketed or their entries contained erroneous information, mostly because drug makers had not told the FDA that the products were discontinued. In a comment, the FDA acknowledged many of the failures, but also said there was a decrease in the percentage of missing products since 1990.

Uninsured Figures Climb

The number of people in the United States without health insurance edged higher in 2005, fueled in part by a drop in employer-sponsored health insurance, according to figures released in August from the U.S. Census Bureau. In 2005, 46.6 million people were uninsured, up from 45.3 million the year before. The percentage of people covered by employer-sponsored health insurance dropped from 59.8% to 59.5% between 2004 and 2005, while the percentage covered by government insurance stayed the same, according to the Census figures. The new figures, compiled as part of the Current Population Survey, showed that the number of uninsured children also increased. Between 2004 and 2005, the number of uninsured children rose from 7.9 million to 8.3 million. And children living in poverty were the most likely to be uninsured, with the uninsured rate at 19% for children living in poverty, compared with 11.2% of children overall in 2005. The American Medical Association issued a statement calling for action to address the uninsured problem. “The AMA plan for reducing the number of the uninsured advocates expanded coverage and choice through a system of refundable tax credits based on income, individually selected and owned health insurance, and market reforms that will enhance new, affordable insurance options,” Dr. Ardis Hoven, an AMA board member, said in a statement.

Part D Premiums Hold Steady

Premiums under Medicare's Part D drug benefit will remain stable in 2007, according to figures released last month by the Centers for Medicare and Medicaid Services. Officials at CMS estimate that the average monthly premium paid by Medicare Part D beneficiaries will be about $24 in 2007, nearly the same as in 2006. “Competition and choice in health care are working,” Dr. Mark McClellan, CMS administrator, said at a press briefing. In addition to holding consumer costs steady, CMS officials reported that the national benchmark that determines Medicare's subsidy of drug coverage will decline next year. Competitive bids for the stand-alone drug plans and the Medicare Advantage managed-care prescription drug plans came in with lower-than-expected bids, according to CMS. The open enrollment period for 2007 starts Nov. 15.

Mixed Reviews for Merck

The most recent Vioxx court cases have produced mixed results for the drugmaker Merck & Co., Inc. In August, a Los Angeles jury ruled in the company's favor, finding that the Vioxx (rofecoxib) was not responsible for the heart attack of Stewart Grossberg, who had been taking the drug intermittently. Merck argued successfully that Vioxx was not responsible for Mr. Grossberg's heart attack because he has high cholesterol levels, atherosclerosis, and a family history of cardiac problems. But about two weeks later, a federal jury in New Orleans found Merck liable for $51 million in damages in the 2002 heart attack of Gerald Barnett, a 62-year-old retired special agent with the FBI. The company is exploring grounds for appeal, including insufficient evidence and the application of incorrect legal standards, according to Merck. The company was also dealt another blow in August, when a New Jersey judge decided to set aside a 2005 jury verdict that had been in the Merck's favor. The judge ordered a new trial to take place early next year. The judge cited a December 2005 New England Journal of Medicine editorial expressing concerns about Vioxx-related study data as the basis for throwing out the jury verdict (N. Eng. J. Med. 2005;353:2813–4).

In the Dark on EC

Despite the controversy surrounding the provision of Plan B emergency contraception without a prescription (see story on p. 1), only about one-quarter of Americans in a recent survey said they had heard a lot about the debate. And nearly an equal number said they had heard nothing about the politically charged issue. The survey was commissioned by the Pew Research Center for the People & the Press and the Pew Forum on Religion & Public Life. The survey also found that about 48% of those surveyed favored selling emergency contraception without a prescription, whereas about 41% opposed the idea. The national telephone survey was conducted in July among more than 2,000 U.S. adults.

Drug Code Directory Incomplete

The Department of Health and Human Services' Office of Inspector General has found that the Food and Drug Administration's National Drug Code Directory is incomplete and inaccurate, largely as a result of drug companies' failure to submit required data, though the FDA shares some blame. The directory is supposed to be a current compendium of marketed drug products. The FDA relies on internal reports and on submissions from pharmaceutical manufacturers, which must report when a new product is introduced or withdrawn. The OIG report is a snapshot of the directory as of February 2005, when 123,856 products had unique entries. The OIG found that the listing left off just more than 9,000 drug products. For about 16%, the drug maker either had not submitted required forms or the agency had not appropriately processed them. Listings for about 5,100 products had been held up because the companies did not provide needed information. Finally, the OIG found that 34,000 products listed were no longer marketed or their entries contained erroneous information, mostly because drug makers had not told the FDA that the products were discontinued. In a comment, the FDA acknowledged many of the failures, but also said there was a decrease in the percentage of missing products since 1990.

Uninsured Figures Climb

The number of people in the United States without health insurance edged higher in 2005, fueled in part by a drop in employer-sponsored health insurance, according to figures released in August from the U.S. Census Bureau. In 2005, 46.6 million people were uninsured, up from 45.3 million the year before. The percentage of people covered by employer-sponsored health insurance dropped from 59.8% to 59.5% between 2004 and 2005, while the percentage covered by government insurance stayed the same, according to the Census figures. The new figures, compiled as part of the Current Population Survey, showed that the number of uninsured children also increased. Between 2004 and 2005, the number of uninsured children rose from 7.9 million to 8.3 million. And children living in poverty were the most likely to be uninsured, with the uninsured rate at 19% for children living in poverty, compared with 11.2% of children overall in 2005. The American Medical Association issued a statement calling for action to address the uninsured problem. “The AMA plan for reducing the number of the uninsured advocates expanded coverage and choice through a system of refundable tax credits based on income, individually selected and owned health insurance, and market reforms that will enhance new, affordable insurance options,” Dr. Ardis Hoven, an AMA board member, said in a statement.

Part D Premiums Hold Steady

Premiums under Medicare's Part D drug benefit will remain stable in 2007, according to figures released last month by the Centers for Medicare and Medicaid Services. Officials at CMS estimate that the average monthly premium paid by Medicare Part D beneficiaries will be about $24 in 2007, nearly the same as in 2006. “Competition and choice in health care are working,” Dr. Mark McClellan, CMS administrator, said at a press briefing. In addition to holding consumer costs steady, CMS officials reported that the national benchmark that determines Medicare's subsidy of drug coverage will decline next year. Competitive bids for the stand-alone drug plans and the Medicare Advantage managed-care prescription drug plans came in with lower-than-expected bids, according to CMS. The open enrollment period for 2007 starts Nov. 15.

Mixed Reviews for Merck

The most recent Vioxx court cases have produced mixed results for the drugmaker Merck & Co., Inc. In August, a Los Angeles jury ruled in the company's favor, finding that the Vioxx (rofecoxib) was not responsible for the heart attack of Stewart Grossberg, who had been taking the drug intermittently. Merck argued successfully that Vioxx was not responsible for Mr. Grossberg's heart attack because he has high cholesterol levels, atherosclerosis, and a family history of cardiac problems. But about two weeks later, a federal jury in New Orleans found Merck liable for $51 million in damages in the 2002 heart attack of Gerald Barnett, a 62-year-old retired special agent with the FBI. The company is exploring grounds for appeal, including insufficient evidence and the application of incorrect legal standards, according to Merck. The company was also dealt another blow in August, when a New Jersey judge decided to set aside a 2005 jury verdict that had been in the Merck's favor. The judge ordered a new trial to take place early next year. The judge cited a December 2005 New England Journal of Medicine editorial expressing concerns about Vioxx-related study data as the basis for throwing out the jury verdict (N. Eng. J. Med. 2005;353:2813–4).

In the Dark on EC

Despite the controversy surrounding the provision of Plan B emergency contraception without a prescription (see story on p. 1), only about one-quarter of Americans in a recent survey said they had heard a lot about the debate. And nearly an equal number said they had heard nothing about the politically charged issue. The survey was commissioned by the Pew Research Center for the People & the Press and the Pew Forum on Religion & Public Life. The survey also found that about 48% of those surveyed favored selling emergency contraception without a prescription, whereas about 41% opposed the idea. The national telephone survey was conducted in July among more than 2,000 U.S. adults.

Drug Code Directory Incomplete

The Department of Health and Human Services' Office of Inspector General has found that the Food and Drug Administration's National Drug Code Directory is incomplete and inaccurate, largely as a result of drug companies' failure to submit required data, though the FDA shares some blame. The directory is supposed to be a current compendium of marketed drug products. The FDA relies on internal reports and on submissions from pharmaceutical manufacturers, which must report when a new product is introduced or withdrawn. The OIG report is a snapshot of the directory as of February 2005, when 123,856 products had unique entries. The OIG found that the listing left off just more than 9,000 drug products. For about 16%, the drug maker either had not submitted required forms or the agency had not appropriately processed them. Listings for about 5,100 products had been held up because the companies did not provide needed information. Finally, the OIG found that 34,000 products listed were no longer marketed or their entries contained erroneous information, mostly because drug makers had not told the FDA that the products were discontinued. In a comment, the FDA acknowledged many of the failures, but also said there was a decrease in the percentage of missing products since 1990.

Uninsured Figures Climb

The number of people in the United States without health insurance edged higher in 2005, fueled in part by a drop in employer-sponsored health insurance, according to figures released in August from the U.S. Census Bureau. In 2005, 46.6 million people were uninsured, up from 45.3 million the year before. The percentage of people covered by employer-sponsored health insurance dropped from 59.8% to 59.5% between 2004 and 2005, while the percentage covered by government insurance stayed the same, according to the census figures. The new figures, compiled as part of the Current Population Survey, showed that the number of uninsured children also increased. Between 2004 and 2005, the number of uninsured children rose from 7.9 million to 8.3 million. And children living in poverty were the most likely to be uninsured, with the uninsured rate in 2005 at 19% for children living in poverty, compared with 11.2% of children overall. The American Medical Association issued a statement calling for action to address the uninsured problem. “The AMA plan for reducing the number of the uninsured advocates expanded coverage and choice through a system of refundable tax credits based on income, individually selected and owned health insurance, and market reforms that will enhance new, affordable insurance options,” Dr. Ardis Hoven, an AMA board member, said in a statement.

Teen Risky Behavior Declines

Over the past 15 years, fewer U.S. high school students have been engaging in sexual behaviors that would put them at risk for HIV, according to data from the Centers for Disease Control and Prevention (CDC). The percentage of high school students who reported ever having had sexual intercourse dropped from 1991 to 2005, along with the percentage of students reporting multiple sexual partners and current sexual activity, the CDC reported in the Morbidity and Mortality Weekly Report. For example, the prevalence of multiple sexual partners among U.S. high school students decreased 24% from 1991 to 2005, dropping from 18.7% to 14.3%. In addition, condom use is on the rise among U.S. teens. The CDC found that among currently sexually active students, condom use increased from 46.2% in 1991 to 62.8% in 2005, or about a 36% increase. Officials at the CDC analyzed data from eight national Youth Risk Behavior Surveys.

WIC Would Add Vegetables, Fruits

More vegetables, fruits, and whole grains would be available to beneficiaries of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program, under a proposal issued last month by the U.S. Department of Agriculture. Based in large part on the findings of Institute of Medicine report published last year, the proposed rules would promote greater consistency with established dietary guidelines for infants and children under age 2 years, and would better support breast-feeding, according to USDA. Current WIC-covered foods help increase beneficiaries' intake of protein, iron, calcium, vitamin A, and vitamin C—nutrients that were found lacking in the WIC population when the program was started in 1974, USDA said. When drafting the proposal, USDA used guidelines from the American Academy of Pediatrics and the 2005 Dietary Guidelines for Americans, as well as the IOM report. The department is taking comments until Nov. 6.

Medicare Proposes 5.1% Pay Cut

Unless Congress intervenes by the end of the year, physicians are scheduled to face a 5.1% cut in Medicare payments starting Jan. 1, 2007. Officials at the Centers for Medicare and Medicaid Services published the proposed physician fee schedule changes in the Aug. 22 issue of the Federal Register; the final regulation is expected in the fall. The proposed cut, which comes on the heels of years of pay freezes and minor increases, will have a significant impact on pediatricians since most major payers and the majority of state Medicaid programs base their payments on the Medicare physician fee schedule, said Dr. Richard H. Tuck, the American Academy of Pediatrics' representative on the American Medical Association's Relative Value Update Committee. The RUC makes annual payment recommendations to CMS. The proposed payment cut comes just a few weeks after CMS officials announced plans to change the way Medicare pays for evaluation and management services, with physicians who provide more cognitive services getting a bigger piece of the Medicare pie. Under that proposal, pediatricians who see Medicare beneficiaries are expected to see a 2% increase in allowed charges under Medicare, compared with 2006. But the proposed overall payment cut is likely to neutralize much of that increase, Dr. Tuck said.

Uninsured Figures Climb

The number of people in the United States without health insurance edged higher in 2005, fueled in part by a drop in employer-sponsored health insurance, according to figures released in August from the U.S. Census Bureau. In 2005, 46.6 million people were uninsured, up from 45.3 million the year before. The percentage of people covered by employer-sponsored health insurance dropped from 59.8% to 59.5% between 2004 and 2005, while the percentage covered by government insurance stayed the same, according to the census figures. The new figures, compiled as part of the Current Population Survey, showed that the number of uninsured children also increased. Between 2004 and 2005, the number of uninsured children rose from 7.9 million to 8.3 million. And children living in poverty were the most likely to be uninsured, with the uninsured rate in 2005 at 19% for children living in poverty, compared with 11.2% of children overall. The American Medical Association issued a statement calling for action to address the uninsured problem. “The AMA plan for reducing the number of the uninsured advocates expanded coverage and choice through a system of refundable tax credits based on income, individually selected and owned health insurance, and market reforms that will enhance new, affordable insurance options,” Dr. Ardis Hoven, an AMA board member, said in a statement.

Teen Risky Behavior Declines

Over the past 15 years, fewer U.S. high school students have been engaging in sexual behaviors that would put them at risk for HIV, according to data from the Centers for Disease Control and Prevention (CDC). The percentage of high school students who reported ever having had sexual intercourse dropped from 1991 to 2005, along with the percentage of students reporting multiple sexual partners and current sexual activity, the CDC reported in the Morbidity and Mortality Weekly Report. For example, the prevalence of multiple sexual partners among U.S. high school students decreased 24% from 1991 to 2005, dropping from 18.7% to 14.3%. In addition, condom use is on the rise among U.S. teens. The CDC found that among currently sexually active students, condom use increased from 46.2% in 1991 to 62.8% in 2005, or about a 36% increase. Officials at the CDC analyzed data from eight national Youth Risk Behavior Surveys.

WIC Would Add Vegetables, Fruits

More vegetables, fruits, and whole grains would be available to beneficiaries of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program, under a proposal issued last month by the U.S. Department of Agriculture. Based in large part on the findings of Institute of Medicine report published last year, the proposed rules would promote greater consistency with established dietary guidelines for infants and children under age 2 years, and would better support breast-feeding, according to USDA. Current WIC-covered foods help increase beneficiaries' intake of protein, iron, calcium, vitamin A, and vitamin C—nutrients that were found lacking in the WIC population when the program was started in 1974, USDA said. When drafting the proposal, USDA used guidelines from the American Academy of Pediatrics and the 2005 Dietary Guidelines for Americans, as well as the IOM report. The department is taking comments until Nov. 6.

Medicare Proposes 5.1% Pay Cut

Unless Congress intervenes by the end of the year, physicians are scheduled to face a 5.1% cut in Medicare payments starting Jan. 1, 2007. Officials at the Centers for Medicare and Medicaid Services published the proposed physician fee schedule changes in the Aug. 22 issue of the Federal Register; the final regulation is expected in the fall. The proposed cut, which comes on the heels of years of pay freezes and minor increases, will have a significant impact on pediatricians since most major payers and the majority of state Medicaid programs base their payments on the Medicare physician fee schedule, said Dr. Richard H. Tuck, the American Academy of Pediatrics' representative on the American Medical Association's Relative Value Update Committee. The RUC makes annual payment recommendations to CMS. The proposed payment cut comes just a few weeks after CMS officials announced plans to change the way Medicare pays for evaluation and management services, with physicians who provide more cognitive services getting a bigger piece of the Medicare pie. Under that proposal, pediatricians who see Medicare beneficiaries are expected to see a 2% increase in allowed charges under Medicare, compared with 2006. But the proposed overall payment cut is likely to neutralize much of that increase, Dr. Tuck said.

Uninsured Figures Climb

The number of people in the United States without health insurance edged higher in 2005, fueled in part by a drop in employer-sponsored health insurance, according to figures released in August from the U.S. Census Bureau. In 2005, 46.6 million people were uninsured, up from 45.3 million the year before. The percentage of people covered by employer-sponsored health insurance dropped from 59.8% to 59.5% between 2004 and 2005, while the percentage covered by government insurance stayed the same, according to the census figures. The new figures, compiled as part of the Current Population Survey, showed that the number of uninsured children also increased. Between 2004 and 2005, the number of uninsured children rose from 7.9 million to 8.3 million. And children living in poverty were the most likely to be uninsured, with the uninsured rate in 2005 at 19% for children living in poverty, compared with 11.2% of children overall. The American Medical Association issued a statement calling for action to address the uninsured problem. “The AMA plan for reducing the number of the uninsured advocates expanded coverage and choice through a system of refundable tax credits based on income, individually selected and owned health insurance, and market reforms that will enhance new, affordable insurance options,” Dr. Ardis Hoven, an AMA board member, said in a statement.

Teen Risky Behavior Declines

Over the past 15 years, fewer U.S. high school students have been engaging in sexual behaviors that would put them at risk for HIV, according to data from the Centers for Disease Control and Prevention (CDC). The percentage of high school students who reported ever having had sexual intercourse dropped from 1991 to 2005, along with the percentage of students reporting multiple sexual partners and current sexual activity, the CDC reported in the Morbidity and Mortality Weekly Report. For example, the prevalence of multiple sexual partners among U.S. high school students decreased 24% from 1991 to 2005, dropping from 18.7% to 14.3%. In addition, condom use is on the rise among U.S. teens. The CDC found that among currently sexually active students, condom use increased from 46.2% in 1991 to 62.8% in 2005, or about a 36% increase. Officials at the CDC analyzed data from eight national Youth Risk Behavior Surveys.

WIC Would Add Vegetables, Fruits

More vegetables, fruits, and whole grains would be available to beneficiaries of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) program, under a proposal issued last month by the U.S. Department of Agriculture. Based in large part on the findings of Institute of Medicine report published last year, the proposed rules would promote greater consistency with established dietary guidelines for infants and children under age 2 years, and would better support breast-feeding, according to USDA. Current WIC-covered foods help increase beneficiaries' intake of protein, iron, calcium, vitamin A, and vitamin C—nutrients that were found lacking in the WIC population when the program was started in 1974, USDA said. When drafting the proposal, USDA used guidelines from the American Academy of Pediatrics and the 2005 Dietary Guidelines for Americans, as well as the IOM report. The department is taking comments until Nov. 6.

Medicare Proposes 5.1% Pay Cut

Unless Congress intervenes by the end of the year, physicians are scheduled to face a 5.1% cut in Medicare payments starting Jan. 1, 2007. Officials at the Centers for Medicare and Medicaid Services published the proposed physician fee schedule changes in the Aug. 22 issue of the Federal Register; the final regulation is expected in the fall. The proposed cut, which comes on the heels of years of pay freezes and minor increases, will have a significant impact on pediatricians since most major payers and the majority of state Medicaid programs base their payments on the Medicare physician fee schedule, said Dr. Richard H. Tuck, the American Academy of Pediatrics' representative on the American Medical Association's Relative Value Update Committee. The RUC makes annual payment recommendations to CMS. The proposed payment cut comes just a few weeks after CMS officials announced plans to change the way Medicare pays for evaluation and management services, with physicians who provide more cognitive services getting a bigger piece of the Medicare pie. Under that proposal, pediatricians who see Medicare beneficiaries are expected to see a 2% increase in allowed charges under Medicare, compared with 2006. But the proposed overall payment cut is likely to neutralize much of that increase, Dr. Tuck said.

Fix the SGR, Delay Imaging Cuts

Rep. Michael Burgess (R-Tex.), an ob.gyn., has introduced legislation (H.R. 5866) that would put an end to physician fee cuts under Medicare by halting application of the sustainable growth rate by Jan. 1, 2007. Each year, the SGR has contributed to a decrease in payments; in 2007, that cut is slated to be 5.1%. Rep. Burgess is proposing to tie physician fees to one factor only: the Medicare Economic Index minus 1%. According to Rep. Burgess, this places “more value on actual cost inputs.” The bill also would establish a system of quality measures to give patients more information about Medicare providers, delay by 1 year proposed cuts in imaging services reimbursement, and require the Institute of Medicine to study whether imaging saves money. The American Medical Association called the Medicare Physician Payment Reform Bill and Quality Improvement Act of 2006 an “important step toward replacing the flawed Medicare physician payment formula.” Rep. Burgess' bill is the third in the House to delay or repeal the cuts in imaging fees; a similar bill was recently introduced by Sen. Gordon Smith (R-Ore.) and Sen. Jay Rockefeller (D-W.Va.).

Senate Bill to Boost Drug Safety

After months of public discourse, Sen. Edward Kennedy (D-Mass.) and Sen. Mike Enzi (R-Wyo.) have introduced a bill that aims to increase assurances that drugs are safe before they reach the marketplace, or at least have a plan in place to more closely monitor when they need to be withdrawn. The Enhancing Drug Safety and Innovation Act would require pharmaceutical manufacturers to be more proactive about safety problems. Companies would have to establish risk evaluation and management strategies that will be agreed upon by the manufacturer and the Food and Drug Administration before the product is approved. The companies would have to submit adverse event reports every 15 days, quarterly, and annually. If a company knowingly does not comply with the agreed-upon strategy, the FDA can impose monetary penalties. The senators also proposed that manufacturers make clinical trial results public. Fuller disclosure “will help patients and their health care providers make better informed decisions about treatment,” Sen. Kennedy said in a statement. Finally, the bill would overhaul the FDA's process for vetting outside advisory panel members, with a goal of minimizing conflicts of interest and then ensuring that they are fully disclosed.

Gulf War Research

New federally funded research will test the hypothesis that veterans with Gulf War Illness have metabolic, structural, or functional changes in their basal ganglia that are not accounted for by posttraumatic stress disorder, depression, or alcoholism. This is among 24 projects that were funded by the federal government starting in fiscal year 2005 to examine the health of veterans of the Gulf War. The Department of Veterans Affairs is required to report to Congress each year on the status of research into the health consequences of military service in the Persian Gulf region from Aug. 2, 1990, to July 31, 1991. From fiscal year 1992 through 2005, the federal government has sponsored 300 research projects on Gulf War veterans' illnesses, according to the report, available at

www.research.va.gov/resources/pubs/pubs_individual.cfm?Category=Gulf War Reports

Genetic Testing

Officials at the Centers for Medicare and Medicaid Services should establish a genetic testing specialty under the Clinical Laboratory Improvement Amendments (CLIA) of 1998, according to a coalition of 14 women's health groups. In a letter to CMS Administrator Mark McClellan, the groups urged him to move forward with a Notice of Intent of proposed rulemaking issued in 2000 on the development of a genetic testing specialty. The science is outpacing the current regulations, the groups wrote. Currently there are about 1,000 tests for genetic diseases available clinically and several hundred more under development. Signatories to the letter include the Association for Reproductive Health Professionals, the Reproductive Health Technologies Project, and the Society for Women's Health Research.

HIV Vaccine Grants

The Bill and Melinda Gates Foundation has awarded $287 million to researchers in an effort to accelerate development of an HIV vaccine. The sum will fund 16 grants to more than 165 investigators from around the world. “Some of the vaccine concepts that will be pursued have been talked about for years, but have never been adequately studied,” Dr. Nicholas Hellmann, acting director of the Gates Foundation's HIV, TB, and Reproductive Health program, said in a statement. “If successful, they could lead to entirely new paradigms for HIV vaccine development.”

Payment for Part B Drugs

The federal government spent about $10 billion last year on drugs covered under Medicare Part B, with one rheumatoid arthritis treatment accounting for about 5% of the spending, according the Centers for Medicare and Medicaid Services. Dr. Herb B. Kuhn, director of the Center for Medicare Management at CMS, presented information from a preliminary estimate of allowed charges under Part B to the House Ways and Means subcommittee on health. Infliximab (Remicade) made up about 5% of the total allowed charges under Medicare Part B in 2005, while intravenous immune globulin accounted for about 1.6%. About half the money paid last year for Part B drugs went to oncologists, 5% to urologists, and 4% to rheumatologists, according to Mr. Kuhn's written testimony.

Fix the SGR, Delay Imaging Cuts

Rep. Michael Burgess (R-Tex.), an ob.gyn., has introduced legislation (H.R. 5866) that would put an end to physician fee cuts under Medicare by halting application of the sustainable growth rate by Jan. 1, 2007. Each year, the SGR has contributed to a decrease in payments; in 2007, that cut is slated to be 5.1%. Rep. Burgess is proposing to tie physician fees to one factor only: the Medicare Economic Index minus 1%. According to Rep. Burgess, this places “more value on actual cost inputs.” The bill also would establish a system of quality measures to give patients more information about Medicare providers, delay by 1 year proposed cuts in imaging services reimbursement, and require the Institute of Medicine to study whether imaging saves money. The American Medical Association called the Medicare Physician Payment Reform Bill and Quality Improvement Act of 2006 an “important step toward replacing the flawed Medicare physician payment formula.” Rep. Burgess' bill is the third in the House to delay or repeal the cuts in imaging fees; a similar bill was recently introduced by Sen. Gordon Smith (R-Ore.) and Sen. Jay Rockefeller (D-W.Va.).

Senate Bill to Boost Drug Safety

After months of public discourse, Sen. Edward Kennedy (D-Mass.) and Sen. Mike Enzi (R-Wyo.) have introduced a bill that aims to increase assurances that drugs are safe before they reach the marketplace, or at least have a plan in place to more closely monitor when they need to be withdrawn. The Enhancing Drug Safety and Innovation Act would require pharmaceutical manufacturers to be more proactive about safety problems. Companies would have to establish risk evaluation and management strategies that will be agreed upon by the manufacturer and the Food and Drug Administration before the product is approved. The companies would have to submit adverse event reports every 15 days, quarterly, and annually. If a company knowingly does not comply with the agreed-upon strategy, the FDA can impose monetary penalties. The senators also proposed that manufacturers make clinical trial results public. Fuller disclosure “will help patients and their health care providers make better informed decisions about treatment,” Sen. Kennedy said in a statement. Finally, the bill would overhaul the FDA's process for vetting outside advisory panel members, with a goal of minimizing conflicts of interest and then ensuring that they are fully disclosed.

Gulf War Research

New federally funded research will test the hypothesis that veterans with Gulf War Illness have metabolic, structural, or functional changes in their basal ganglia that are not accounted for by posttraumatic stress disorder, depression, or alcoholism. This is among 24 projects that were funded by the federal government starting in fiscal year 2005 to examine the health of veterans of the Gulf War. The Department of Veterans Affairs is required to report to Congress each year on the status of research into the health consequences of military service in the Persian Gulf region from Aug. 2, 1990, to July 31, 1991. From fiscal year 1992 through 2005, the federal government has sponsored 300 research projects on Gulf War veterans' illnesses, according to the report, available at

www.research.va.gov/resources/pubs/pubs_individual.cfm?Category=Gulf War Reports

Genetic Testing

Officials at the Centers for Medicare and Medicaid Services should establish a genetic testing specialty under the Clinical Laboratory Improvement Amendments (CLIA) of 1998, according to a coalition of 14 women's health groups. In a letter to CMS Administrator Mark McClellan, the groups urged him to move forward with a Notice of Intent of proposed rulemaking issued in 2000 on the development of a genetic testing specialty. The science is outpacing the current regulations, the groups wrote. Currently there are about 1,000 tests for genetic diseases available clinically and several hundred more under development. Signatories to the letter include the Association for Reproductive Health Professionals, the Reproductive Health Technologies Project, and the Society for Women's Health Research.

HIV Vaccine Grants

The Bill and Melinda Gates Foundation has awarded $287 million to researchers in an effort to accelerate development of an HIV vaccine. The sum will fund 16 grants to more than 165 investigators from around the world. “Some of the vaccine concepts that will be pursued have been talked about for years, but have never been adequately studied,” Dr. Nicholas Hellmann, acting director of the Gates Foundation's HIV, TB, and Reproductive Health program, said in a statement. “If successful, they could lead to entirely new paradigms for HIV vaccine development.”

Payment for Part B Drugs

The federal government spent about $10 billion last year on drugs covered under Medicare Part B, with one rheumatoid arthritis treatment accounting for about 5% of the spending, according the Centers for Medicare and Medicaid Services. Dr. Herb B. Kuhn, director of the Center for Medicare Management at CMS, presented information from a preliminary estimate of allowed charges under Part B to the House Ways and Means subcommittee on health. Infliximab (Remicade) made up about 5% of the total allowed charges under Medicare Part B in 2005, while intravenous immune globulin accounted for about 1.6%. About half the money paid last year for Part B drugs went to oncologists, 5% to urologists, and 4% to rheumatologists, according to Mr. Kuhn's written testimony.

Fix the SGR, Delay Imaging Cuts

Rep. Michael Burgess (R-Tex.), an ob.gyn., has introduced legislation (H.R. 5866) that would put an end to physician fee cuts under Medicare by halting application of the sustainable growth rate by Jan. 1, 2007. Each year, the SGR has contributed to a decrease in payments; in 2007, that cut is slated to be 5.1%. Rep. Burgess is proposing to tie physician fees to one factor only: the Medicare Economic Index minus 1%. According to Rep. Burgess, this places “more value on actual cost inputs.” The bill also would establish a system of quality measures to give patients more information about Medicare providers, delay by 1 year proposed cuts in imaging services reimbursement, and require the Institute of Medicine to study whether imaging saves money. The American Medical Association called the Medicare Physician Payment Reform Bill and Quality Improvement Act of 2006 an “important step toward replacing the flawed Medicare physician payment formula.” Rep. Burgess' bill is the third in the House to delay or repeal the cuts in imaging fees; a similar bill was recently introduced by Sen. Gordon Smith (R-Ore.) and Sen. Jay Rockefeller (D-W.Va.).

Senate Bill to Boost Drug Safety

After months of public discourse, Sen. Edward Kennedy (D-Mass.) and Sen. Mike Enzi (R-Wyo.) have introduced a bill that aims to increase assurances that drugs are safe before they reach the marketplace, or at least have a plan in place to more closely monitor when they need to be withdrawn. The Enhancing Drug Safety and Innovation Act would require pharmaceutical manufacturers to be more proactive about safety problems. Companies would have to establish risk evaluation and management strategies that will be agreed upon by the manufacturer and the Food and Drug Administration before the product is approved. The companies would have to submit adverse event reports every 15 days, quarterly, and annually. If a company knowingly does not comply with the agreed-upon strategy, the FDA can impose monetary penalties. The senators also proposed that manufacturers make clinical trial results public. Fuller disclosure “will help patients and their health care providers make better informed decisions about treatment,” Sen. Kennedy said in a statement. Finally, the bill would overhaul the FDA's process for vetting outside advisory panel members, with a goal of minimizing conflicts of interest and then ensuring that they are fully disclosed.

Gulf War Research

New federally funded research will test the hypothesis that veterans with Gulf War Illness have metabolic, structural, or functional changes in their basal ganglia that are not accounted for by posttraumatic stress disorder, depression, or alcoholism. This is among 24 projects that were funded by the federal government starting in fiscal year 2005 to examine the health of veterans of the Gulf War. The Department of Veterans Affairs is required to report to Congress each year on the status of research into the health consequences of military service in the Persian Gulf region from Aug. 2, 1990, to July 31, 1991. From fiscal year 1992 through 2005, the federal government has sponsored 300 research projects on Gulf War veterans' illnesses, according to the report, available at

www.research.va.gov/resources/pubs/pubs_individual.cfm?Category=Gulf War Reports

Genetic Testing

Officials at the Centers for Medicare and Medicaid Services should establish a genetic testing specialty under the Clinical Laboratory Improvement Amendments (CLIA) of 1998, according to a coalition of 14 women's health groups. In a letter to CMS Administrator Mark McClellan, the groups urged him to move forward with a Notice of Intent of proposed rulemaking issued in 2000 on the development of a genetic testing specialty. The science is outpacing the current regulations, the groups wrote. Currently there are about 1,000 tests for genetic diseases available clinically and several hundred more under development. Signatories to the letter include the Association for Reproductive Health Professionals, the Reproductive Health Technologies Project, and the Society for Women's Health Research.

HIV Vaccine Grants

The Bill and Melinda Gates Foundation has awarded $287 million to researchers in an effort to accelerate development of an HIV vaccine. The sum will fund 16 grants to more than 165 investigators from around the world. “Some of the vaccine concepts that will be pursued have been talked about for years, but have never been adequately studied,” Dr. Nicholas Hellmann, acting director of the Gates Foundation's HIV, TB, and Reproductive Health program, said in a statement. “If successful, they could lead to entirely new paradigms for HIV vaccine development.”

Payment for Part B Drugs

The federal government spent about $10 billion last year on drugs covered under Medicare Part B, with one rheumatoid arthritis treatment accounting for about 5% of the spending, according the Centers for Medicare and Medicaid Services. Dr. Herb B. Kuhn, director of the Center for Medicare Management at CMS, presented information from a preliminary estimate of allowed charges under Part B to the House Ways and Means subcommittee on health. Infliximab (Remicade) made up about 5% of the total allowed charges under Medicare Part B in 2005, while intravenous immune globulin accounted for about 1.6%. About half the money paid last year for Part B drugs went to oncologists, 5% to urologists, and 4% to rheumatologists, according to Mr. Kuhn's written testimony.

Fix the SGR, Delay Imaging Cuts

Rep. Michael Burgess (R-Tex.), an ob.gyn., has introduced legislation (H.R. 5866) that would put an end to physician fee cuts under Medicare by halting application of the sustainable growth rate by Jan. 1, 2007. Each year, the SGR has contributed to a decrease in payments; in 2007, that cut is slated to be 5.1%. Rep. Burgess is proposing to tie physician fees to one factor only: the Medicare Economic Index minus 1%. According to Rep. Burgess, this places “more value on actual cost inputs.” The bill also would establish a system of quality measures to give patients more information about Medicare providers, delay by 1 year proposed cuts in imaging services reimbursement, and require the Institute of Medicine to study whether imaging saves money. The American Medical Association called the Medicare Physician Payment Reform Bill and Quality Improvement Act of 2006 an “important step toward replacing the flawed Medicare physician payment formula.” Rep. Burgess' bill is the third in the House to delay or repeal the cuts in imaging fees; a similar bill was recently introduced by Sen. Gordon Smith (R-Ore.) and Sen. Jay Rockefeller (D-W.Va.).

Senate Bill to Boost Drug Safety

After months of public discourse, Sen. Edward Kennedy (D-Mass.) and Sen. Mike Enzi (R-Wyo.) have introduced a bill that aims to increase assurances that drugs are safe before they reach the marketplace, or at least have a plan in place to more closely monitor when they need to be withdrawn. The Enhancing Drug Safety and Innovation Act would require pharmaceutical manufacturers to be more proactive about safety problems. Companies would have to establish risk evaluation and management strategies that will be agreed upon by the manufacturer and the Food and Drug Administration before the product is approved. The companies would have to submit adverse event reports every 15 days, quarterly, and annually. If a company knowingly does not comply with the agreed-upon strategy, the FDA can impose monetary penalties. The senators also proposed that manufacturers make clinical trial results public. Fuller disclosure “will help patients and their health care providers make better informed decisions about treatment,” Sen. Kennedy said in a statement. Finally, the bill would overhaul the FDA's process for vetting outside advisory panel members, with a goal of minimizing conflicts of interest and then ensuring that they are fully disclosed.

Gulf War Research

New federally funded research will test the hypothesis that veterans with Gulf War Illness have metabolic, structural, or functional changes in their basal ganglia that are not accounted for by posttraumatic stress disorder, depression, or alcoholism. This is among 24 projects that were funded by the federal government starting in fiscal year 2005 to examine the health of veterans of the Gulf War. The Department of Veterans Affairs is required to report to Congress each year on the status of research into the health consequences of military service in the Persian Gulf region from Aug. 2, 1990, to July 31, 1991. From fiscal year 1992 through 2005, the federal government has sponsored 300 research projects on Gulf War veterans' illnesses, according to the report, available at

www.research.va.gov/resources/pubs/pubs_individual.cfm?Category=Gulf War Reports

Genetic Testing

Officials at the Centers for Medicare and Medicaid Services should establish a genetic testing specialty under the Clinical Laboratory Improvement Amendments (CLIA) of 1998, according to a coalition of 14 women's health groups. In a letter to CMS Administrator Mark McClellan, the groups urged him to move forward with a Notice of Intent of proposed rulemaking issued in 2000 on the development of a genetic testing specialty. The science is outpacing the current regulations, the groups wrote. Currently there are about 1,000 tests for genetic diseases available clinically and several hundred more under development. Signatories to the letter include the Association for Reproductive Health Professionals, the Reproductive Health Technologies Project, and the Society for Women's Health Research.

HIV Vaccine Grants

The Bill and Melinda Gates Foundation has awarded $287 million to researchers in an effort to accelerate development of an HIV vaccine. The sum will fund 16 grants to more than 165 investigators from around the world. “Some of the vaccine concepts that will be pursued have been talked about for years, but have never been adequately studied,” Dr. Nicholas Hellmann, acting director of the Gates Foundation's HIV, TB, and Reproductive Health program, said in a statement. “If successful, they could lead to entirely new paradigms for HIV vaccine development.”

Payment for Part B Drugs

The federal government spent about $10 billion last year on drugs covered under Medicare Part B, with one rheumatoid arthritis treatment accounting for about 5% of the spending, according the Centers for Medicare and Medicaid Services. Dr. Herb B. Kuhn, director of the Center for Medicare Management at CMS, presented information from a preliminary estimate of allowed charges under Part B to the House Ways and Means subcommittee on health. Infliximab (Remicade) made up about 5% of the total allowed charges under Medicare Part B in 2005, while intravenous immune globulin accounted for about 1.6%. About half the money paid last year for Part B drugs went to oncologists, 5% to urologists, and 4% to rheumatologists, according to Mr. Kuhn's written testimony.

Fix the SGR, Delay Imaging Cuts

Rep. Michael Burgess (R-Tex.), an ob.gyn., has introduced legislation (H.R. 5866) that would put an end to physician fee cuts under Medicare by halting application of the sustainable growth rate by Jan. 1, 2007. Each year, the SGR has contributed to a decrease in payments; in 2007, that cut is slated to be 5.1%. Rep. Burgess is proposing to tie physician fees to one factor only: the Medicare Economic Index minus 1%. According to Rep. Burgess, this places “more value on actual cost inputs.” The bill also would establish a system of quality measures to give patients more information about Medicare providers, delay by 1 year proposed cuts in imaging services reimbursement, and require the Institute of Medicine to study whether imaging saves money. The American Medical Association called the Medicare Physician Payment Reform Bill and Quality Improvement Act of 2006 an “important step toward replacing the flawed Medicare physician payment formula.” Rep. Burgess' bill is the third in the House to delay or repeal the cuts in imaging fees; a similar bill was recently introduced by Sen. Gordon Smith (R-Ore.) and Sen. Jay Rockefeller (D-W.Va.).

Senate Bill to Boost Drug Safety

After months of public discourse, Sen. Edward Kennedy (D-Mass.) and Sen. Mike Enzi (R-Wyo.) have introduced a bill that aims to increase assurances that drugs are safe before they reach the marketplace, or at least have a plan in place to more closely monitor when they need to be withdrawn. The Enhancing Drug Safety and Innovation Act would require pharmaceutical manufacturers to be more proactive about safety problems. Companies would have to establish risk evaluation and management strategies that will be agreed upon by the manufacturer and the Food and Drug Administration before the product is approved. The companies would have to submit adverse event reports every 15 days, quarterly, and annually. If a company knowingly does not comply with the agreed-upon strategy, the FDA can impose monetary penalties. The senators also proposed that manufacturers make clinical trial results public. Fuller disclosure “will help patients and their health care providers make better informed decisions about treatment,” Sen. Kennedy said in a statement. Finally, the bill would overhaul the FDA's process for vetting outside advisory panel members, with a goal of minimizing conflicts of interest and then ensuring that they are fully disclosed.

Gulf War Research

New federally funded research will test the hypothesis that veterans with Gulf War Illness have metabolic, structural, or functional changes in their basal ganglia that are not accounted for by posttraumatic stress disorder, depression, or alcoholism. This is among 24 projects that were funded by the federal government starting in fiscal year 2005 to examine the health of veterans of the Gulf War. The Department of Veterans Affairs is required to report to Congress each year on the status of research into the health consequences of military service in the Persian Gulf region from Aug. 2, 1990, to July 31, 1991. From fiscal year 1992 through 2005, the federal government has sponsored 300 research projects on Gulf War veterans' illnesses, according to the report, available at

www.research.va.gov/resources/pubs/pubs_individual.cfm?Category=Gulf War Reports

Genetic Testing

Officials at the Centers for Medicare and Medicaid Services should establish a genetic testing specialty under the Clinical Laboratory Improvement Amendments (CLIA) of 1998, according to a coalition of 14 women's health groups. In a letter to CMS Administrator Mark McClellan, the groups urged him to move forward with a Notice of Intent of proposed rulemaking issued in 2000 on the development of a genetic testing specialty. The science is outpacing the current regulations, the groups wrote. Currently there are about 1,000 tests for genetic diseases available clinically and several hundred more under development. Signatories to the letter include the Association for Reproductive Health Professionals, the Reproductive Health Technologies Project, and the Society for Women's Health Research.

HIV Vaccine Grants

The Bill and Melinda Gates Foundation has awarded $287 million to researchers in an effort to accelerate development of an HIV vaccine. The sum will fund 16 grants to more than 165 investigators from around the world. “Some of the vaccine concepts that will be pursued have been talked about for years, but have never been adequately studied,” Dr. Nicholas Hellmann, acting director of the Gates Foundation's HIV, TB, and Reproductive Health program, said in a statement. “If successful, they could lead to entirely new paradigms for HIV vaccine development.”

Payment for Part B Drugs

The federal government spent about $10 billion last year on drugs covered under Medicare Part B, with one rheumatoid arthritis treatment accounting for about 5% of the spending, according the Centers for Medicare and Medicaid Services. Dr. Herb B. Kuhn, director of the Center for Medicare Management at CMS, presented information from a preliminary estimate of allowed charges under Part B to the House Ways and Means subcommittee on health. Infliximab (Remicade) made up about 5% of the total allowed charges under Medicare Part B in 2005, while intravenous immune globulin accounted for about 1.6%. About half the money paid last year for Part B drugs went to oncologists, 5% to urologists, and 4% to rheumatologists, according to Mr. Kuhn's written testimony.

Fix the SGR, Delay Imaging Cuts

Rep. Michael Burgess (R-Tex.), an ob.gyn., has introduced legislation (H.R. 5866) that would put an end to physician fee cuts under Medicare by halting application of the sustainable growth rate by Jan. 1, 2007. Each year, the SGR has contributed to a decrease in payments; in 2007, that cut is slated to be 5.1%. Rep. Burgess is proposing to tie physician fees to one factor only: the Medicare Economic Index minus 1%. According to Rep. Burgess, this places “more value on actual cost inputs.” The bill also would establish a system of quality measures to give patients more information about Medicare providers, delay by 1 year proposed cuts in imaging services reimbursement, and require the Institute of Medicine to study whether imaging saves money. The American Medical Association called the Medicare Physician Payment Reform Bill and Quality Improvement Act of 2006 an “important step toward replacing the flawed Medicare physician payment formula.” Rep. Burgess' bill is the third in the House to delay or repeal the cuts in imaging fees; a similar bill was recently introduced by Sen. Gordon Smith (R-Ore.) and Sen. Jay Rockefeller (D-W.Va.).

Senate Bill to Boost Drug Safety

After months of public discourse, Sen. Edward Kennedy (D-Mass.) and Sen. Mike Enzi (R-Wyo.) have introduced a bill that aims to increase assurances that drugs are safe before they reach the marketplace, or at least have a plan in place to more closely monitor when they need to be withdrawn. The Enhancing Drug Safety and Innovation Act would require pharmaceutical manufacturers to be more proactive about safety problems. Companies would have to establish risk evaluation and management strategies that will be agreed upon by the manufacturer and the Food and Drug Administration before the product is approved. The companies would have to submit adverse event reports every 15 days, quarterly, and annually. If a company knowingly does not comply with the agreed-upon strategy, the FDA can impose monetary penalties. The senators also proposed that manufacturers make clinical trial results public. Fuller disclosure “will help patients and their health care providers make better informed decisions about treatment,” Sen. Kennedy said in a statement. Finally, the bill would overhaul the FDA's process for vetting outside advisory panel members, with a goal of minimizing conflicts of interest and then ensuring that they are fully disclosed.

Gulf War Research

New federally funded research will test the hypothesis that veterans with Gulf War Illness have metabolic, structural, or functional changes in their basal ganglia that are not accounted for by posttraumatic stress disorder, depression, or alcoholism. This is among 24 projects that were funded by the federal government starting in fiscal year 2005 to examine the health of veterans of the Gulf War. The Department of Veterans Affairs is required to report to Congress each year on the status of research into the health consequences of military service in the Persian Gulf region from Aug. 2, 1990, to July 31, 1991. From fiscal year 1992 through 2005, the federal government has sponsored 300 research projects on Gulf War veterans' illnesses, according to the report, available at

www.research.va.gov/resources/pubs/pubs_individual.cfm?Category=Gulf War Reports

Genetic Testing

Officials at the Centers for Medicare and Medicaid Services should establish a genetic testing specialty under the Clinical Laboratory Improvement Amendments (CLIA) of 1998, according to a coalition of 14 women's health groups. In a letter to CMS Administrator Mark McClellan, the groups urged him to move forward with a Notice of Intent of proposed rulemaking issued in 2000 on the development of a genetic testing specialty. The science is outpacing the current regulations, the groups wrote. Currently there are about 1,000 tests for genetic diseases available clinically and several hundred more under development. Signatories to the letter include the Association for Reproductive Health Professionals, the Reproductive Health Technologies Project, and the Society for Women's Health Research.

HIV Vaccine Grants

The Bill and Melinda Gates Foundation has awarded $287 million to researchers in an effort to accelerate development of an HIV vaccine. The sum will fund 16 grants to more than 165 investigators from around the world. “Some of the vaccine concepts that will be pursued have been talked about for years, but have never been adequately studied,” Dr. Nicholas Hellmann, acting director of the Gates Foundation's HIV, TB, and Reproductive Health program, said in a statement. “If successful, they could lead to entirely new paradigms for HIV vaccine development.”

Payment for Part B Drugs

The federal government spent about $10 billion last year on drugs covered under Medicare Part B, with one rheumatoid arthritis treatment accounting for about 5% of the spending, according the Centers for Medicare and Medicaid Services. Dr. Herb B. Kuhn, director of the Center for Medicare Management at CMS, presented information from a preliminary estimate of allowed charges under Part B to the House Ways and Means subcommittee on health. Infliximab (Remicade) made up about 5% of the total allowed charges under Medicare Part B in 2005, while intravenous immune globulin accounted for about 1.6%. About half the money paid last year for Part B drugs went to oncologists, 5% to urologists, and 4% to rheumatologists, according to Mr. Kuhn's written testimony.

Bowel-Cleansing and Nephropathy

Acute phosphate nephropathy has been reported in 22 patients who used oral sodium phosphates for bowel cleansing, according to a warning issued by the Food and Drug Administration.

In 21 of the cases, the patients had used an oral sodium phosphate solution (such as Fleet Phospho-soda or Fleet ACCU-PREP, made by C.B. Fleet Company). One case was documented in a patient who used oral sodium phosphate tablets (Visicol, made by Salix Pharmaceuticals Inc.). No cases of kidney failure have been associated with OsmoPrep tablets (also made by Salix), which were recently approved for bowel cleansing.

Individuals at increased risk of acute phosphate nephropathy include those of advanced age, those with kidney disease or decreased intravascular volume, and those using medications that affect renal perfusion function (diuretics, angiotensin II receptor blockers, ACE inhibitors, and possibly NSAIDs).

Physicians can find more information from the FDA on the diagnosis of this condition and considerations for choosing a bowel cleanser for patients, along with a patient information sheet, by visiting

www.fda.gov/medwatch/safety/2006/safety06.htm#phosphate

Colorectal Ca Screening Rising Slowly

Use of colorectal cancer screening is on the rise, but still lags behind rates for mammography and Pap tests, the Centers for Disease Control and Prevention reported.

Data from the 2002 and 2004 Behavioral Risk Factor Surveillance System showed that 57.3% of adults aged 50 and older reported having had a fecal occult blood test (FOBT) within the previous year and/or a lower endoscopy (sigmoidoscopy or colonoscopy) within the past 10 years in 2004, compared with 54.4% in 2002.

The proportion who had received an FOBT within 1 year dropped from 21.8% in 2002 to 18.7% in 2004, while the proportion receiving a lower endoscopy within 10 years rose from 45.2% to 50.6% in the same time period, the CDC said (MMWR 2006;55:308–11).

By state, the proportions screened by any method in 2004 ranged from 47.9% in Mississippi to 68.2% in Minnesota. A total of 14 states plus the District of Columbia reported that 60% or more of their residents aged 50 and older had been screened in 2004, compared with just 7 states and the District of Columbia in 2002.

The CDC has initiated several programs designed to increase colorectal cancer screening rates, including demonstration programs in five states for low-income individuals aged 50 and older who have no health insurance coverage for colorectal cancer screening. The CDC also has funded 21 state programs to implement specific colorectal cancer prevention strategies through National Comprehensive Cancer Control Program initiatives (

www.cdc.gov/cancer/ncccp/index.htm

IBD-Related Colorectal Ca Not Worse

Colorectal cancer is no more lethal to patients with inflammatory bowel disease than it is among the general population, according to a large, retrospective study.

Investigators at the Mayo Clinic, Rochester, Minn., identified 290 patients diagnosed with inflammatory bowel disease (IBD)-related colorectal cancer (CRC) between 1976 and 1996. Of those, 241 had chronic ulcerative colitis and 49 had Crohn's disease. The IBD group was compared with 290 controls with sporadic CRC matched on age, sex, and tumor stage at presentation (Clin. Gastroenterol. Hepatol. 2006;4:335–42).

IBD-related cancers were spread more evenly throughout the colon, whereas sporadic cancers were more likely to be left-sided. Between 56% and 63% of patients with IBD-associated CRC had TNM (tumor-regional nodes-metastasis) classification stage I or II disease. Chronic ulcerative colitis-related tumors were more likely to be multiple. Tumor grades tended to be higher, and mucinous differentiation was more frequent, among those with IBD, the authors said.

Despite these findings, patients with IBD-associated CRC had no significant difference in their overall 5-year survival rate, compared with patients with sporadic CRC. “A total of 163 patients in the IBD-associated CRC subgroup (56%) died during the [5-year] follow-up period, whereas 164 patients died in the sporadic CRC subgroup (57%),” they added. “Secondary analyses suggested that certain subgroups may have a worse prognosis.”

“Interestingly, in our population, approximately one-half of patients with Crohn's disease-related cancers developed tumors at subsites without any endoscopic or pathologic evidence of prior colonic inflammation,” the investigators said, speculating that, based upon a relatively small number of cases, inflammation may not be a mandatory prerequisite to tumorigenesis among all IBD patients.

Bowel-Cleansing and Nephropathy

Acute phosphate nephropathy has been reported in 22 patients who used oral sodium phosphates for bowel cleansing, according to a warning issued by the Food and Drug Administration.

In 21 of the cases, the patients had used an oral sodium phosphate solution (such as Fleet Phospho-soda or Fleet ACCU-PREP, made by C.B. Fleet Company). One case was documented in a patient who used oral sodium phosphate tablets (Visicol, made by Salix Pharmaceuticals Inc.). No cases of kidney failure have been associated with OsmoPrep tablets (also made by Salix), which were recently approved for bowel cleansing.

Individuals at increased risk of acute phosphate nephropathy include those of advanced age, those with kidney disease or decreased intravascular volume, and those using medications that affect renal perfusion function (diuretics, angiotensin II receptor blockers, ACE inhibitors, and possibly NSAIDs).

Physicians can find more information from the FDA on the diagnosis of this condition and considerations for choosing a bowel cleanser for patients, along with a patient information sheet, by visiting

www.fda.gov/medwatch/safety/2006/safety06.htm#phosphate

Colorectal Ca Screening Rising Slowly

Use of colorectal cancer screening is on the rise, but still lags behind rates for mammography and Pap tests, the Centers for Disease Control and Prevention reported.

Data from the 2002 and 2004 Behavioral Risk Factor Surveillance System showed that 57.3% of adults aged 50 and older reported having had a fecal occult blood test (FOBT) within the previous year and/or a lower endoscopy (sigmoidoscopy or colonoscopy) within the past 10 years in 2004, compared with 54.4% in 2002.

The proportion who had received an FOBT within 1 year dropped from 21.8% in 2002 to 18.7% in 2004, while the proportion receiving a lower endoscopy within 10 years rose from 45.2% to 50.6% in the same time period, the CDC said (MMWR 2006;55:308–11).

By state, the proportions screened by any method in 2004 ranged from 47.9% in Mississippi to 68.2% in Minnesota. A total of 14 states plus the District of Columbia reported that 60% or more of their residents aged 50 and older had been screened in 2004, compared with just 7 states and the District of Columbia in 2002.

The CDC has initiated several programs designed to increase colorectal cancer screening rates, including demonstration programs in five states for low-income individuals aged 50 and older who have no health insurance coverage for colorectal cancer screening. The CDC also has funded 21 state programs to implement specific colorectal cancer prevention strategies through National Comprehensive Cancer Control Program initiatives (

www.cdc.gov/cancer/ncccp/index.htm

IBD-Related Colorectal Ca Not Worse

Colorectal cancer is no more lethal to patients with inflammatory bowel disease than it is among the general population, according to a large, retrospective study.

Investigators at the Mayo Clinic, Rochester, Minn., identified 290 patients diagnosed with inflammatory bowel disease (IBD)-related colorectal cancer (CRC) between 1976 and 1996. Of those, 241 had chronic ulcerative colitis and 49 had Crohn's disease. The IBD group was compared with 290 controls with sporadic CRC matched on age, sex, and tumor stage at presentation (Clin. Gastroenterol. Hepatol. 2006;4:335–42).

IBD-related cancers were spread more evenly throughout the colon, whereas sporadic cancers were more likely to be left-sided. Between 56% and 63% of patients with IBD-associated CRC had TNM (tumor-regional nodes-metastasis) classification stage I or II disease. Chronic ulcerative colitis-related tumors were more likely to be multiple. Tumor grades tended to be higher, and mucinous differentiation was more frequent, among those with IBD, the authors said.

Despite these findings, patients with IBD-associated CRC had no significant difference in their overall 5-year survival rate, compared with patients with sporadic CRC. “A total of 163 patients in the IBD-associated CRC subgroup (56%) died during the [5-year] follow-up period, whereas 164 patients died in the sporadic CRC subgroup (57%),” they added. “Secondary analyses suggested that certain subgroups may have a worse prognosis.”

“Interestingly, in our population, approximately one-half of patients with Crohn's disease-related cancers developed tumors at subsites without any endoscopic or pathologic evidence of prior colonic inflammation,” the investigators said, speculating that, based upon a relatively small number of cases, inflammation may not be a mandatory prerequisite to tumorigenesis among all IBD patients.

Bowel-Cleansing and Nephropathy

Acute phosphate nephropathy has been reported in 22 patients who used oral sodium phosphates for bowel cleansing, according to a warning issued by the Food and Drug Administration.

In 21 of the cases, the patients had used an oral sodium phosphate solution (such as Fleet Phospho-soda or Fleet ACCU-PREP, made by C.B. Fleet Company). One case was documented in a patient who used oral sodium phosphate tablets (Visicol, made by Salix Pharmaceuticals Inc.). No cases of kidney failure have been associated with OsmoPrep tablets (also made by Salix), which were recently approved for bowel cleansing.

Individuals at increased risk of acute phosphate nephropathy include those of advanced age, those with kidney disease or decreased intravascular volume, and those using medications that affect renal perfusion function (diuretics, angiotensin II receptor blockers, ACE inhibitors, and possibly NSAIDs).

Physicians can find more information from the FDA on the diagnosis of this condition and considerations for choosing a bowel cleanser for patients, along with a patient information sheet, by visiting

www.fda.gov/medwatch/safety/2006/safety06.htm#phosphate

Colorectal Ca Screening Rising Slowly

Use of colorectal cancer screening is on the rise, but still lags behind rates for mammography and Pap tests, the Centers for Disease Control and Prevention reported.

Data from the 2002 and 2004 Behavioral Risk Factor Surveillance System showed that 57.3% of adults aged 50 and older reported having had a fecal occult blood test (FOBT) within the previous year and/or a lower endoscopy (sigmoidoscopy or colonoscopy) within the past 10 years in 2004, compared with 54.4% in 2002.

The proportion who had received an FOBT within 1 year dropped from 21.8% in 2002 to 18.7% in 2004, while the proportion receiving a lower endoscopy within 10 years rose from 45.2% to 50.6% in the same time period, the CDC said (MMWR 2006;55:308–11).

By state, the proportions screened by any method in 2004 ranged from 47.9% in Mississippi to 68.2% in Minnesota. A total of 14 states plus the District of Columbia reported that 60% or more of their residents aged 50 and older had been screened in 2004, compared with just 7 states and the District of Columbia in 2002.

The CDC has initiated several programs designed to increase colorectal cancer screening rates, including demonstration programs in five states for low-income individuals aged 50 and older who have no health insurance coverage for colorectal cancer screening. The CDC also has funded 21 state programs to implement specific colorectal cancer prevention strategies through National Comprehensive Cancer Control Program initiatives (

www.cdc.gov/cancer/ncccp/index.htm

IBD-Related Colorectal Ca Not Worse

Colorectal cancer is no more lethal to patients with inflammatory bowel disease than it is among the general population, according to a large, retrospective study.

Investigators at the Mayo Clinic, Rochester, Minn., identified 290 patients diagnosed with inflammatory bowel disease (IBD)-related colorectal cancer (CRC) between 1976 and 1996. Of those, 241 had chronic ulcerative colitis and 49 had Crohn's disease. The IBD group was compared with 290 controls with sporadic CRC matched on age, sex, and tumor stage at presentation (Clin. Gastroenterol. Hepatol. 2006;4:335–42).

IBD-related cancers were spread more evenly throughout the colon, whereas sporadic cancers were more likely to be left-sided. Between 56% and 63% of patients with IBD-associated CRC had TNM (tumor-regional nodes-metastasis) classification stage I or II disease. Chronic ulcerative colitis-related tumors were more likely to be multiple. Tumor grades tended to be higher, and mucinous differentiation was more frequent, among those with IBD, the authors said.

Despite these findings, patients with IBD-associated CRC had no significant difference in their overall 5-year survival rate, compared with patients with sporadic CRC. “A total of 163 patients in the IBD-associated CRC subgroup (56%) died during the [5-year] follow-up period, whereas 164 patients died in the sporadic CRC subgroup (57%),” they added. “Secondary analyses suggested that certain subgroups may have a worse prognosis.”

“Interestingly, in our population, approximately one-half of patients with Crohn's disease-related cancers developed tumors at subsites without any endoscopic or pathologic evidence of prior colonic inflammation,” the investigators said, speculating that, based upon a relatively small number of cases, inflammation may not be a mandatory prerequisite to tumorigenesis among all IBD patients.

Simvastatin Raises Retinal Blood Flow

Simvastatin increases retinal blood flow and decreases intraocular pressure in healthy subjects, making it a potential treatment for diabetic retinopathy and glaucoma, according to Dr. Taiji Nagaoka of Asahikawa (Japan) Medical College and associates. Noting that long-term statin use has been reported to reduce the risk of retinal ischemic diseases, the researchers assessed the effect of simvastatin on the retinal circulation and on intraocular pressure in 12 healthy volunteers. The subjects were nonsmoking Japanese men aged 19–23 years. They were examined 90 minutes after a single 20-mg dose of the drug on one occasion and after taking a placebo on a separate occasion. They also underwent similar assessments after taking daily doses of either simvastatin or placebo for 1 week. Retinal blood flow increased significantly, by 20% in the retinal arteries and by 23% in the retinal veins, after 1 week of simvastatin therapy. Intraocular pressure decreased significantly, from 14.3 mm Hg at baseline to 12.6 mm Hg after a single dose of the drug and to 12.4 mm Hg after 1 week of therapy. Plasma nitrite/nitrate levels also rose by 60% after 1 week on simvastatin. In contrast, all retinal measurements remained unchanged after administration of the placebo. This is the first study to show that simvastatin increases retinal blood flow, “probably via the increase in nitric oxide,” the investigators said (Arch. Ophthalmol. 2006;124:665–70). The increase appears to be exerted mainly on the more downstream vessels in the retinal microvascular network, notably the capillaries, they added. “The increased retinal blood flow associated with treatment with simvastatin may be a potential therapy for diabetic retinopathy,” Dr. Nagaoka and associates said.

Sertraline Staves Off Depression

Maintenance therapy with sertraline prevents a recurrence of major depression in diabetic patients whose mood disorder initially responds well to the drug, reported Patrick J. Lustman, Ph.D., of Washington University, St. Louis. Clinical depression has been reported to occur in one-fourth of people with diabetes, and recurrent episodes are common. The researchers evaluated maintenance therapy in 152 patients with either type 1 or type 2 diabetes and major depressive disorder. The study subjects had a mean of five previous episodes of depression. The current episode had resolved with sertraline therapy, at a mean dose of 118 mg per day (range of 50–200 mg per day). Subjects were then randomly assigned to either continue with the same dosage of sertraline that had induced recovery (79 subjects) or to switch to placebo (73 subjects), and were followed for 12 months or until depression recurred. Depression symptoms and glycemic control were monitored in monthly office visits and via telephone interviews at every midpoint between office visits, to permit rapid detection of recurrences. Sertraline was significantly more effective than placebo at prolonging the depression-free interval. At 1 year, the calculated rate of nonrecurrence was 66% in patients treated with sertraline, compared with 48% for those who received placebo, the investigators wrote (Arch. Gen. Psychiatry 2006;63:521–9). The study was supported in part by Pfizer Inc., which provided the sertraline for study subjects.

Give Diabetics ACE Inhibitors, ARBs

Most, if not all, elderly people with diabetes have at least one indication for ACE inhibitors or angiotensin receptor blockers, but only about 40% are receiving the drugs, according to a national survey. Dr. Allison B. Rosen of the University of Michigan Health Systems, Ann Arbor, analyzed data from 4 years of the National Health and Nutrition Examination Survey to calculate the proportion of older diabetic patients with clinical indications for ACE inhibitors or ARBs. Her study sample included 742 respondents who represented over 8 million Americans aged 55 years or older who have diabetes. A total of 92% of the respondents had at least one indication besides diabetes for the medications, according to several sets of guidelines. These indications included albuminuria, cardiovascular disease, congestive heart failure, and hypertension. Two additional risk factors—hyperlipidemia and smoking—are listed as indications on some guidelines, and patients with these risk factors are believed to benefit from ACE inhibitor or ARB therapy. When these two indications were added to the list, 100% of the respondents had at least one indication for the medications, Dr. Rosen said. Yet despite this “nearly universal” indication for treatment, only 43% of the respondents were taking an ACE inhibitor or an ARB, she said (J. Gen. Intern. Med. 2006;doi:10.1111/j.1525–1497.2006.00351.x). Of particular note, only 53% of those with diabetes and four or more additional indications were taking the drugs, a “disturbingly low” rate for such high-risk patients.

Simvastatin Raises Retinal Blood Flow

Simvastatin increases retinal blood flow and decreases intraocular pressure in healthy subjects, making it a potential treatment for diabetic retinopathy and glaucoma, according to Dr. Taiji Nagaoka of Asahikawa (Japan) Medical College and associates. Noting that long-term statin use has been reported to reduce the risk of retinal ischemic diseases, the researchers assessed the effect of simvastatin on the retinal circulation and on intraocular pressure in 12 healthy volunteers. The subjects were nonsmoking Japanese men aged 19–23 years. They were examined 90 minutes after a single 20-mg dose of the drug on one occasion and after taking a placebo on a separate occasion. They also underwent similar assessments after taking daily doses of either simvastatin or placebo for 1 week. Retinal blood flow increased significantly, by 20% in the retinal arteries and by 23% in the retinal veins, after 1 week of simvastatin therapy. Intraocular pressure decreased significantly, from 14.3 mm Hg at baseline to 12.6 mm Hg after a single dose of the drug and to 12.4 mm Hg after 1 week of therapy. Plasma nitrite/nitrate levels also rose by 60% after 1 week on simvastatin. In contrast, all retinal measurements remained unchanged after administration of the placebo. This is the first study to show that simvastatin increases retinal blood flow, “probably via the increase in nitric oxide,” the investigators said (Arch. Ophthalmol. 2006;124:665–70). The increase appears to be exerted mainly on the more downstream vessels in the retinal microvascular network, notably the capillaries, they added. “The increased retinal blood flow associated with treatment with simvastatin may be a potential therapy for diabetic retinopathy,” Dr. Nagaoka and associates said.

Sertraline Staves Off Depression

Maintenance therapy with sertraline prevents a recurrence of major depression in diabetic patients whose mood disorder initially responds well to the drug, reported Patrick J. Lustman, Ph.D., of Washington University, St. Louis. Clinical depression has been reported to occur in one-fourth of people with diabetes, and recurrent episodes are common. The researchers evaluated maintenance therapy in 152 patients with either type 1 or type 2 diabetes and major depressive disorder. The study subjects had a mean of five previous episodes of depression. The current episode had resolved with sertraline therapy, at a mean dose of 118 mg per day (range of 50–200 mg per day). Subjects were then randomly assigned to either continue with the same dosage of sertraline that had induced recovery (79 subjects) or to switch to placebo (73 subjects), and were followed for 12 months or until depression recurred. Depression symptoms and glycemic control were monitored in monthly office visits and via telephone interviews at every midpoint between office visits, to permit rapid detection of recurrences. Sertraline was significantly more effective than placebo at prolonging the depression-free interval. At 1 year, the calculated rate of nonrecurrence was 66% in patients treated with sertraline, compared with 48% for those who received placebo, the investigators wrote (Arch. Gen. Psychiatry 2006;63:521–9). The study was supported in part by Pfizer Inc., which provided the sertraline for study subjects.

Give Diabetics ACE Inhibitors, ARBs

Most, if not all, elderly people with diabetes have at least one indication for ACE inhibitors or angiotensin receptor blockers, but only about 40% are receiving the drugs, according to a national survey. Dr. Allison B. Rosen of the University of Michigan Health Systems, Ann Arbor, analyzed data from 4 years of the National Health and Nutrition Examination Survey to calculate the proportion of older diabetic patients with clinical indications for ACE inhibitors or ARBs. Her study sample included 742 respondents who represented over 8 million Americans aged 55 years or older who have diabetes. A total of 92% of the respondents had at least one indication besides diabetes for the medications, according to several sets of guidelines. These indications included albuminuria, cardiovascular disease, congestive heart failure, and hypertension. Two additional risk factors—hyperlipidemia and smoking—are listed as indications on some guidelines, and patients with these risk factors are believed to benefit from ACE inhibitor or ARB therapy. When these two indications were added to the list, 100% of the respondents had at least one indication for the medications, Dr. Rosen said. Yet despite this “nearly universal” indication for treatment, only 43% of the respondents were taking an ACE inhibitor or an ARB, she said (J. Gen. Intern. Med. 2006;doi:10.1111/j.1525–1497.2006.00351.x). Of particular note, only 53% of those with diabetes and four or more additional indications were taking the drugs, a “disturbingly low” rate for such high-risk patients.

Simvastatin Raises Retinal Blood Flow

Simvastatin increases retinal blood flow and decreases intraocular pressure in healthy subjects, making it a potential treatment for diabetic retinopathy and glaucoma, according to Dr. Taiji Nagaoka of Asahikawa (Japan) Medical College and associates. Noting that long-term statin use has been reported to reduce the risk of retinal ischemic diseases, the researchers assessed the effect of simvastatin on the retinal circulation and on intraocular pressure in 12 healthy volunteers. The subjects were nonsmoking Japanese men aged 19–23 years. They were examined 90 minutes after a single 20-mg dose of the drug on one occasion and after taking a placebo on a separate occasion. They also underwent similar assessments after taking daily doses of either simvastatin or placebo for 1 week. Retinal blood flow increased significantly, by 20% in the retinal arteries and by 23% in the retinal veins, after 1 week of simvastatin therapy. Intraocular pressure decreased significantly, from 14.3 mm Hg at baseline to 12.6 mm Hg after a single dose of the drug and to 12.4 mm Hg after 1 week of therapy. Plasma nitrite/nitrate levels also rose by 60% after 1 week on simvastatin. In contrast, all retinal measurements remained unchanged after administration of the placebo. This is the first study to show that simvastatin increases retinal blood flow, “probably via the increase in nitric oxide,” the investigators said (Arch. Ophthalmol. 2006;124:665–70). The increase appears to be exerted mainly on the more downstream vessels in the retinal microvascular network, notably the capillaries, they added. “The increased retinal blood flow associated with treatment with simvastatin may be a potential therapy for diabetic retinopathy,” Dr. Nagaoka and associates said.

Sertraline Staves Off Depression

Maintenance therapy with sertraline prevents a recurrence of major depression in diabetic patients whose mood disorder initially responds well to the drug, reported Patrick J. Lustman, Ph.D., of Washington University, St. Louis. Clinical depression has been reported to occur in one-fourth of people with diabetes, and recurrent episodes are common. The researchers evaluated maintenance therapy in 152 patients with either type 1 or type 2 diabetes and major depressive disorder. The study subjects had a mean of five previous episodes of depression. The current episode had resolved with sertraline therapy, at a mean dose of 118 mg per day (range of 50–200 mg per day). Subjects were then randomly assigned to either continue with the same dosage of sertraline that had induced recovery (79 subjects) or to switch to placebo (73 subjects), and were followed for 12 months or until depression recurred. Depression symptoms and glycemic control were monitored in monthly office visits and via telephone interviews at every midpoint between office visits, to permit rapid detection of recurrences. Sertraline was significantly more effective than placebo at prolonging the depression-free interval. At 1 year, the calculated rate of nonrecurrence was 66% in patients treated with sertraline, compared with 48% for those who received placebo, the investigators wrote (Arch. Gen. Psychiatry 2006;63:521–9). The study was supported in part by Pfizer Inc., which provided the sertraline for study subjects.

Give Diabetics ACE Inhibitors, ARBs

Most, if not all, elderly people with diabetes have at least one indication for ACE inhibitors or angiotensin receptor blockers, but only about 40% are receiving the drugs, according to a national survey. Dr. Allison B. Rosen of the University of Michigan Health Systems, Ann Arbor, analyzed data from 4 years of the National Health and Nutrition Examination Survey to calculate the proportion of older diabetic patients with clinical indications for ACE inhibitors or ARBs. Her study sample included 742 respondents who represented over 8 million Americans aged 55 years or older who have diabetes. A total of 92% of the respondents had at least one indication besides diabetes for the medications, according to several sets of guidelines. These indications included albuminuria, cardiovascular disease, congestive heart failure, and hypertension. Two additional risk factors—hyperlipidemia and smoking—are listed as indications on some guidelines, and patients with these risk factors are believed to benefit from ACE inhibitor or ARB therapy. When these two indications were added to the list, 100% of the respondents had at least one indication for the medications, Dr. Rosen said. Yet despite this “nearly universal” indication for treatment, only 43% of the respondents were taking an ACE inhibitor or an ARB, she said (J. Gen. Intern. Med. 2006;doi:10.1111/j.1525–1497.2006.00351.x). Of particular note, only 53% of those with diabetes and four or more additional indications were taking the drugs, a “disturbingly low” rate for such high-risk patients.

Markers May Signal Early Alzheimer's

Biomarkers in cerebrospinal fluid may indicate whether patients with mild cognitive impairment will progress to Alzheimer's disease and could assist in the development of new screening tools or treatments, according to Dr. Oskar Hansson of Lund University, Malmö, Sweden, and his associates.

The investigators followed 137 patients with mild cognitive impairment (MCI) who had consulted the memory disorder clinic at the university hospital during 1998–2001. A control population of 39 healthy volunteers with no memory complaints was recruited from Malmö. Subjects were followed for 4–6 years after a sample of cerebrospinal fluid was obtained from a lumbar puncture.

Of the 137 patients with MCI at baseline, 57 developed Alzheimer's disease (AD) during the study period, and 21 developed other forms of dementia. Those patients with abnormal concentrations of the biomarkers β-amyloid, total tau, and phosphorylated tau at baseline were more likely to have progressed to AD (Lancet Neurol. 2006;5;228–34).

Concentrations of total tau greater than 350 ng/L and β-amyloid of less than 530 ng/L at baseline were defined as pathologic. Patients with pathologic levels of the biomarkers were more than 20 times more likely to progress to AD than patients with MCI without pathologic levels of the biomarkers, the authors reported. These biomarkers have been analyzed in previous research, but the studies followed patients for only 1–2 years.

Early Motor Symptoms May Predict PD

Motor symptoms, including stiffness, tremors, and imbalance, are associated with a significantly increased risk for development of Parkinson's disease (PD).

“Subjective complaints related to motor function might indicate a very early phase of not-yet-diagnosable Parkinson's disease during which dopamine loss is not sufficient to produce overt typical PD symptoms” wrote Dr. Lonneke M.L. de Lau and colleagues (Arch. Neurol. 2006;63: doi:10.1001/archneur.63.3.noc50312).

Dr. de Lau of Erasmus Medical Center, Rotterdam, the Netherlands, prospectively followed 6,038 elderly patients (mean age 69 years) who were free of dementia and parkinsonian signs at baseline. At baseline, 52% of subjects reported at least one of the five typical features of the disease: stiffness (32%), tremor (11%), slow movement (21%), feeling of imbalance (11%), and falling (15%).

After a mean of 6 years' follow-up, 56 subjects had developed PD. Of those, 72% had reported at least one motor symptom during the initial assessment, and 41% had reported at least two symptoms. Stiffness and tremor at baseline were each associated with more than a twofold increase in the risk of the disease, while a feeling of imbalance was associated with more than a threefold increased risk.

Self-reported falling and slow movement were not significantly associated with increased risk.

If a preclinical screening tool could be developed, the investigators said, it might be able to identify a window of opportunity during which neuroprotective medication could someday slow or arrest the progress of the disease, the authors noted.

Driving Safely After Cataract Surgery

Nearly all patients who were driving 5 years after cataract surgery had sufficient visual acuity to do so safely, according to researchers who assessed vision in 189 Swedish persons.

Most had undergone standard, sutureless clear corneal phacoemulsification with a temporal incision and insertion of a foldable intraocular lens; 117 men (mean age 71 years) and 72 women (mean age 69 years) were still actively driving 5 years after the procedure, reported Dr. Eva Mönestam and Dr. Britta Lundqvist of Umeå (Sweden) University.

Almost all the subjects (95%) stated they had no difficulties driving in daylight, and all said they had no problems estimating distances while driving. The percentage who reported visual difficulties while driving in darkness was large (43%) but comparable to that reported in the literature for elderly people with healthy eyes (J. Cataract Refract. Surg. 2006;32:50–5).

Only five patients (3%)—four men and one woman—were found to have a best corrected visual acuity below the legal requirement for driving in Sweden. Most of the subjects with the poorest vision had visual impairment due to macular degeneration. Only one subject had “after-cataract,” in which part of the lens not removed during surgery becomes cloudy.

Women were 1.8 times more likely than men to report having visual difficulties while driving after cataract surgery. It may be that the surgery is less successful in women, or it may be that women either are more conscious of their symptoms or more willing to report their symptoms than are men, the researchers said.

Markers May Signal Early Alzheimer's

Biomarkers in cerebrospinal fluid may indicate whether patients with mild cognitive impairment will progress to Alzheimer's disease and could assist in the development of new screening tools or treatments, according to Dr. Oskar Hansson of Lund University, Malmö, Sweden, and his associates.

The investigators followed 137 patients with mild cognitive impairment (MCI) who had consulted the memory disorder clinic at the university hospital during 1998–2001. A control population of 39 healthy volunteers with no memory complaints was recruited from Malmö. Subjects were followed for 4–6 years after a sample of cerebrospinal fluid was obtained from a lumbar puncture.

Of the 137 patients with MCI at baseline, 57 developed Alzheimer's disease (AD) during the study period, and 21 developed other forms of dementia. Those patients with abnormal concentrations of the biomarkers β-amyloid, total tau, and phosphorylated tau at baseline were more likely to have progressed to AD (Lancet Neurol. 2006;5;228–34).

Concentrations of total tau greater than 350 ng/L and β-amyloid of less than 530 ng/L at baseline were defined as pathologic. Patients with pathologic levels of the biomarkers were more than 20 times more likely to progress to AD than patients with MCI without pathologic levels of the biomarkers, the authors reported. These biomarkers have been analyzed in previous research, but the studies followed patients for only 1–2 years.

Early Motor Symptoms May Predict PD

Motor symptoms, including stiffness, tremors, and imbalance, are associated with a significantly increased risk for development of Parkinson's disease (PD).

“Subjective complaints related to motor function might indicate a very early phase of not-yet-diagnosable Parkinson's disease during which dopamine loss is not sufficient to produce overt typical PD symptoms” wrote Dr. Lonneke M.L. de Lau and colleagues (Arch. Neurol. 2006;63: doi:10.1001/archneur.63.3.noc50312).

Dr. de Lau of Erasmus Medical Center, Rotterdam, the Netherlands, prospectively followed 6,038 elderly patients (mean age 69 years) who were free of dementia and parkinsonian signs at baseline. At baseline, 52% of subjects reported at least one of the five typical features of the disease: stiffness (32%), tremor (11%), slow movement (21%), feeling of imbalance (11%), and falling (15%).

After a mean of 6 years' follow-up, 56 subjects had developed PD. Of those, 72% had reported at least one motor symptom during the initial assessment, and 41% had reported at least two symptoms. Stiffness and tremor at baseline were each associated with more than a twofold increase in the risk of the disease, while a feeling of imbalance was associated with more than a threefold increased risk.

Self-reported falling and slow movement were not significantly associated with increased risk.

If a preclinical screening tool could be developed, the investigators said, it might be able to identify a window of opportunity during which neuroprotective medication could someday slow or arrest the progress of the disease, the authors noted.

Driving Safely After Cataract Surgery

Nearly all patients who were driving 5 years after cataract surgery had sufficient visual acuity to do so safely, according to researchers who assessed vision in 189 Swedish persons.

Most had undergone standard, sutureless clear corneal phacoemulsification with a temporal incision and insertion of a foldable intraocular lens; 117 men (mean age 71 years) and 72 women (mean age 69 years) were still actively driving 5 years after the procedure, reported Dr. Eva Mönestam and Dr. Britta Lundqvist of Umeå (Sweden) University.

Almost all the subjects (95%) stated they had no difficulties driving in daylight, and all said they had no problems estimating distances while driving. The percentage who reported visual difficulties while driving in darkness was large (43%) but comparable to that reported in the literature for elderly people with healthy eyes (J. Cataract Refract. Surg. 2006;32:50–5).

Only five patients (3%)—four men and one woman—were found to have a best corrected visual acuity below the legal requirement for driving in Sweden. Most of the subjects with the poorest vision had visual impairment due to macular degeneration. Only one subject had “after-cataract,” in which part of the lens not removed during surgery becomes cloudy.

Women were 1.8 times more likely than men to report having visual difficulties while driving after cataract surgery. It may be that the surgery is less successful in women, or it may be that women either are more conscious of their symptoms or more willing to report their symptoms than are men, the researchers said.

Markers May Signal Early Alzheimer's

Biomarkers in cerebrospinal fluid may indicate whether patients with mild cognitive impairment will progress to Alzheimer's disease and could assist in the development of new screening tools or treatments, according to Dr. Oskar Hansson of Lund University, Malmö, Sweden, and his associates.

The investigators followed 137 patients with mild cognitive impairment (MCI) who had consulted the memory disorder clinic at the university hospital during 1998–2001. A control population of 39 healthy volunteers with no memory complaints was recruited from Malmö. Subjects were followed for 4–6 years after a sample of cerebrospinal fluid was obtained from a lumbar puncture.

Of the 137 patients with MCI at baseline, 57 developed Alzheimer's disease (AD) during the study period, and 21 developed other forms of dementia. Those patients with abnormal concentrations of the biomarkers β-amyloid, total tau, and phosphorylated tau at baseline were more likely to have progressed to AD (Lancet Neurol. 2006;5;228–34).

Concentrations of total tau greater than 350 ng/L and β-amyloid of less than 530 ng/L at baseline were defined as pathologic. Patients with pathologic levels of the biomarkers were more than 20 times more likely to progress to AD than patients with MCI without pathologic levels of the biomarkers, the authors reported. These biomarkers have been analyzed in previous research, but the studies followed patients for only 1–2 years.

Early Motor Symptoms May Predict PD

Motor symptoms, including stiffness, tremors, and imbalance, are associated with a significantly increased risk for development of Parkinson's disease (PD).

“Subjective complaints related to motor function might indicate a very early phase of not-yet-diagnosable Parkinson's disease during which dopamine loss is not sufficient to produce overt typical PD symptoms” wrote Dr. Lonneke M.L. de Lau and colleagues (Arch. Neurol. 2006;63: doi:10.1001/archneur.63.3.noc50312).

Dr. de Lau of Erasmus Medical Center, Rotterdam, the Netherlands, prospectively followed 6,038 elderly patients (mean age 69 years) who were free of dementia and parkinsonian signs at baseline. At baseline, 52% of subjects reported at least one of the five typical features of the disease: stiffness (32%), tremor (11%), slow movement (21%), feeling of imbalance (11%), and falling (15%).

After a mean of 6 years' follow-up, 56 subjects had developed PD. Of those, 72% had reported at least one motor symptom during the initial assessment, and 41% had reported at least two symptoms. Stiffness and tremor at baseline were each associated with more than a twofold increase in the risk of the disease, while a feeling of imbalance was associated with more than a threefold increased risk.

Self-reported falling and slow movement were not significantly associated with increased risk.

If a preclinical screening tool could be developed, the investigators said, it might be able to identify a window of opportunity during which neuroprotective medication could someday slow or arrest the progress of the disease, the authors noted.

Driving Safely After Cataract Surgery

Nearly all patients who were driving 5 years after cataract surgery had sufficient visual acuity to do so safely, according to researchers who assessed vision in 189 Swedish persons.

Most had undergone standard, sutureless clear corneal phacoemulsification with a temporal incision and insertion of a foldable intraocular lens; 117 men (mean age 71 years) and 72 women (mean age 69 years) were still actively driving 5 years after the procedure, reported Dr. Eva Mönestam and Dr. Britta Lundqvist of Umeå (Sweden) University.

Almost all the subjects (95%) stated they had no difficulties driving in daylight, and all said they had no problems estimating distances while driving. The percentage who reported visual difficulties while driving in darkness was large (43%) but comparable to that reported in the literature for elderly people with healthy eyes (J. Cataract Refract. Surg. 2006;32:50–5).

Only five patients (3%)—four men and one woman—were found to have a best corrected visual acuity below the legal requirement for driving in Sweden. Most of the subjects with the poorest vision had visual impairment due to macular degeneration. Only one subject had “after-cataract,” in which part of the lens not removed during surgery becomes cloudy.

Women were 1.8 times more likely than men to report having visual difficulties while driving after cataract surgery. It may be that the surgery is less successful in women, or it may be that women either are more conscious of their symptoms or more willing to report their symptoms than are men, the researchers said.

Hip OA Injections Have Limited Effect

Intraarticular corticosteroid injections into the hip joints of osteoarthritis patients provide significant temporary pain relief, but do not provide long-term relief, according to a new study.

“I believe that the important message is that you cannot use this for standard therapy,” Dr. Henning Bliddal, a coauthor of the study, said in an interview.

Researchers at the Parker Institute at Frederiksberg (Denmark) Hospital tested pain relief among 101 patients with hip osteoarthritis randomized into three groups. The researchers wrote that to their knowledge, it is the first randomized, placebo-controlled trial of hyaluronic acid injections in the hip joint (Osteoarthritis Cartilage 2006;14:163–70).

Each patient underwent three injections at 14-day intervals. Patients receiving hyaluronic acid were given three injections of the medication. Those receiving corticosteroids were given a single injection of the medication followed by two sham injections. Those receiving a placebo received injections of saline water.

Researchers' primary outcome was “pain on walking,” using the patients' self-assessment on the 100-mm visual analog scale, measured at baseline, 14 days, 28 days, and 90 days.

The mean reduction in “pain on walking” for patients receiving corticosteroid injections was 12 points on the visual analog scale at 14 days, 15 points at 28 days, and 9 points at 90 days. The difference at 90 days was not considered statistically significant.

For those patients receiving the hyaluronic acid injection, the “pain on walking” measurement on the visual analog scale was reduced a mean of 10 points at 14 days, 11 points at 28 days, and 11 points at 90 days.

Assess Knee Replacement Expectations

Clinicians should assess osteoarthritis patients' understanding of total knee replacement before ordering the procedure, because their perceptions about the surgery may cloud the decision process, according to Dr. Francine M. Toye of Nuffield Orthopaedic Centre, Oxford, England, and her associates.

To explore patient beliefs, Dr. Toye and her associates conducted lengthy interviews with 18 patients awaiting total knee replacement (TKR) at a single British orthopedic hospital. The 12 men (aged 54–77 years) and 6 women (aged 60–76 years) had scored lower than average for both knee pain and loss of function on a standard assessment tool, indicating that they fell “below a certain threshold of clinical need” for the procedure.

Although their symptom burden was low, all patients believed that a specific medical diagnosis (osteoarthritis) confirmed by x-ray findings made TKR a virtual necessity. All patients also reported that their physicians compelled the surgery, not by means of coercion but simply because their “expert” opinion prevailed.

All but a few patients believed their osteoarthritis would inevitably progress, and they thought they would become “crippled” or “totally immobile” if they didn't undergo TKR quickly. They reported that health care professionals reinforced this belief in many instances, even though it was clearly erroneous, the researchers said (Soc. Sci. Med. 2005; doi:10.1016/j.socscimed.2005.11.054).

Most patients viewed TKR as the “only cure” for knee osteoarthritis. Most didn't expect a 100% improvement, but still many patients, particularly men, reported that they thought they would be “back to normal” after the procedure.

Adalimumab Aids All Psoriatic Arthritis

Adalimumab is effective in treating both mild to severe skin disease in patients with psoriatic arthritis, Dr. Dafna D. Gladman reported in a poster presentation at the annual meeting of the American Academy of Dermatology.

To assess whether the level of skin disease affected the response of psoriasis to the drug, Dr. Gladman and her associates performed a posthoc analysis of a 24-week, placebo-controlled phase III trial of patients with moderately active to severely active psoriatic arthritis.

Among those in the adalimumab-treated group, 53 patients had mild to moderate skin disease, with a Psoriasis Area and Severity Index (PASI) score of less than 10 at baseline. Sixteen patients had moderate to severe skin disease, with a PASI score of 10 or more.

PASI responses occurred quickly and were maintained. After 24 weeks of drug treatment, the two subgroups had similar response rates. Comparing the mild-moderate and moderate-severe groups, a PASI 50 score (a 50% reduction from baseline) was achieved by 39 (74%) and 13 (81%), respectively; a PASI 90 score was achieved by 23 (43%) and 6 (38%) in the respective groups, reported Dr. Gladman of the University of Toronto. Dr. Gladman is a primary investigator for Abbott Laboratories, which makes adalimumab (Humira).

Hip OA Injections Have Limited Effect

Intraarticular corticosteroid injections into the hip joints of osteoarthritis patients provide significant temporary pain relief, but do not provide long-term relief, according to a new study.

“I believe that the important message is that you cannot use this for standard therapy,” Dr. Henning Bliddal, a coauthor of the study, said in an interview.

Researchers at the Parker Institute at Frederiksberg (Denmark) Hospital tested pain relief among 101 patients with hip osteoarthritis randomized into three groups. The researchers wrote that to their knowledge, it is the first randomized, placebo-controlled trial of hyaluronic acid injections in the hip joint (Osteoarthritis Cartilage 2006;14:163–70).

Each patient underwent three injections at 14-day intervals. Patients receiving hyaluronic acid were given three injections of the medication. Those receiving corticosteroids were given a single injection of the medication followed by two sham injections. Those receiving a placebo received injections of saline water.

Researchers' primary outcome was “pain on walking,” using the patients' self-assessment on the 100-mm visual analog scale, measured at baseline, 14 days, 28 days, and 90 days.

The mean reduction in “pain on walking” for patients receiving corticosteroid injections was 12 points on the visual analog scale at 14 days, 15 points at 28 days, and 9 points at 90 days. The difference at 90 days was not considered statistically significant.

For those patients receiving the hyaluronic acid injection, the “pain on walking” measurement on the visual analog scale was reduced a mean of 10 points at 14 days, 11 points at 28 days, and 11 points at 90 days.

Assess Knee Replacement Expectations

Clinicians should assess osteoarthritis patients' understanding of total knee replacement before ordering the procedure, because their perceptions about the surgery may cloud the decision process, according to Dr. Francine M. Toye of Nuffield Orthopaedic Centre, Oxford, England, and her associates.

To explore patient beliefs, Dr. Toye and her associates conducted lengthy interviews with 18 patients awaiting total knee replacement (TKR) at a single British orthopedic hospital. The 12 men (aged 54–77 years) and 6 women (aged 60–76 years) had scored lower than average for both knee pain and loss of function on a standard assessment tool, indicating that they fell “below a certain threshold of clinical need” for the procedure.

Although their symptom burden was low, all patients believed that a specific medical diagnosis (osteoarthritis) confirmed by x-ray findings made TKR a virtual necessity. All patients also reported that their physicians compelled the surgery, not by means of coercion but simply because their “expert” opinion prevailed.

All but a few patients believed their osteoarthritis would inevitably progress, and they thought they would become “crippled” or “totally immobile” if they didn't undergo TKR quickly. They reported that health care professionals reinforced this belief in many instances, even though it was clearly erroneous, the researchers said (Soc. Sci. Med. 2005; doi:10.1016/j.socscimed.2005.11.054).

Most patients viewed TKR as the “only cure” for knee osteoarthritis. Most didn't expect a 100% improvement, but still many patients, particularly men, reported that they thought they would be “back to normal” after the procedure.

Adalimumab Aids All Psoriatic Arthritis

Adalimumab is effective in treating both mild to severe skin disease in patients with psoriatic arthritis, Dr. Dafna D. Gladman reported in a poster presentation at the annual meeting of the American Academy of Dermatology.

To assess whether the level of skin disease affected the response of psoriasis to the drug, Dr. Gladman and her associates performed a posthoc analysis of a 24-week, placebo-controlled phase III trial of patients with moderately active to severely active psoriatic arthritis.

Among those in the adalimumab-treated group, 53 patients had mild to moderate skin disease, with a Psoriasis Area and Severity Index (PASI) score of less than 10 at baseline. Sixteen patients had moderate to severe skin disease, with a PASI score of 10 or more.

PASI responses occurred quickly and were maintained. After 24 weeks of drug treatment, the two subgroups had similar response rates. Comparing the mild-moderate and moderate-severe groups, a PASI 50 score (a 50% reduction from baseline) was achieved by 39 (74%) and 13 (81%), respectively; a PASI 90 score was achieved by 23 (43%) and 6 (38%) in the respective groups, reported Dr. Gladman of the University of Toronto. Dr. Gladman is a primary investigator for Abbott Laboratories, which makes adalimumab (Humira).

Hip OA Injections Have Limited Effect

Intraarticular corticosteroid injections into the hip joints of osteoarthritis patients provide significant temporary pain relief, but do not provide long-term relief, according to a new study.

“I believe that the important message is that you cannot use this for standard therapy,” Dr. Henning Bliddal, a coauthor of the study, said in an interview.

Researchers at the Parker Institute at Frederiksberg (Denmark) Hospital tested pain relief among 101 patients with hip osteoarthritis randomized into three groups. The researchers wrote that to their knowledge, it is the first randomized, placebo-controlled trial of hyaluronic acid injections in the hip joint (Osteoarthritis Cartilage 2006;14:163–70).

Each patient underwent three injections at 14-day intervals. Patients receiving hyaluronic acid were given three injections of the medication. Those receiving corticosteroids were given a single injection of the medication followed by two sham injections. Those receiving a placebo received injections of saline water.

Researchers' primary outcome was “pain on walking,” using the patients' self-assessment on the 100-mm visual analog scale, measured at baseline, 14 days, 28 days, and 90 days.

The mean reduction in “pain on walking” for patients receiving corticosteroid injections was 12 points on the visual analog scale at 14 days, 15 points at 28 days, and 9 points at 90 days. The difference at 90 days was not considered statistically significant.

For those patients receiving the hyaluronic acid injection, the “pain on walking” measurement on the visual analog scale was reduced a mean of 10 points at 14 days, 11 points at 28 days, and 11 points at 90 days.

Assess Knee Replacement Expectations

Clinicians should assess osteoarthritis patients' understanding of total knee replacement before ordering the procedure, because their perceptions about the surgery may cloud the decision process, according to Dr. Francine M. Toye of Nuffield Orthopaedic Centre, Oxford, England, and her associates.

To explore patient beliefs, Dr. Toye and her associates conducted lengthy interviews with 18 patients awaiting total knee replacement (TKR) at a single British orthopedic hospital. The 12 men (aged 54–77 years) and 6 women (aged 60–76 years) had scored lower than average for both knee pain and loss of function on a standard assessment tool, indicating that they fell “below a certain threshold of clinical need” for the procedure.

Although their symptom burden was low, all patients believed that a specific medical diagnosis (osteoarthritis) confirmed by x-ray findings made TKR a virtual necessity. All patients also reported that their physicians compelled the surgery, not by means of coercion but simply because their “expert” opinion prevailed.

All but a few patients believed their osteoarthritis would inevitably progress, and they thought they would become “crippled” or “totally immobile” if they didn't undergo TKR quickly. They reported that health care professionals reinforced this belief in many instances, even though it was clearly erroneous, the researchers said (Soc. Sci. Med. 2005; doi:10.1016/j.socscimed.2005.11.054).

Most patients viewed TKR as the “only cure” for knee osteoarthritis. Most didn't expect a 100% improvement, but still many patients, particularly men, reported that they thought they would be “back to normal” after the procedure.

Adalimumab Aids All Psoriatic Arthritis

Adalimumab is effective in treating both mild to severe skin disease in patients with psoriatic arthritis, Dr. Dafna D. Gladman reported in a poster presentation at the annual meeting of the American Academy of Dermatology.

To assess whether the level of skin disease affected the response of psoriasis to the drug, Dr. Gladman and her associates performed a posthoc analysis of a 24-week, placebo-controlled phase III trial of patients with moderately active to severely active psoriatic arthritis.

Among those in the adalimumab-treated group, 53 patients had mild to moderate skin disease, with a Psoriasis Area and Severity Index (PASI) score of less than 10 at baseline. Sixteen patients had moderate to severe skin disease, with a PASI score of 10 or more.

PASI responses occurred quickly and were maintained. After 24 weeks of drug treatment, the two subgroups had similar response rates. Comparing the mild-moderate and moderate-severe groups, a PASI 50 score (a 50% reduction from baseline) was achieved by 39 (74%) and 13 (81%), respectively; a PASI 90 score was achieved by 23 (43%) and 6 (38%) in the respective groups, reported Dr. Gladman of the University of Toronto. Dr. Gladman is a primary investigator for Abbott Laboratories, which makes adalimumab (Humira).

Local Anesthesia for Thyroidectomy

Outpatient thyroidectomies performed with local anesthesia on eligible patients can achieve clinical results and patient satisfaction comparable with those done under general anesthesia, according to results of a prospective, randomized clinical trial.

Researchers at Texas A&M University in Temple, Tex., monitored 58 patients at Scott & White Memorial Hospital in Temple who underwent thyroidectomies in 2000–2001. The patients' ages ranged from 19 to 80 years; 53 (91%) were women. Half (29 patients) received local anesthesia while half had general anesthesia (Arch. Surg. 2006;141:167–73).

The researchers found statistically significant differences in the amount of time patients in the two groups spent in postsurgical care: Those who received local anesthesia spent 4 minutes in the postanesthesia care unit, compared with 80 minutes for those treated under general anesthesia. The combined time spent in the postanesthesia care unit and the day surgery unit for those treated under local anesthesia was 165 minutes, compared with 229 minutes for those under general anesthesia.

As a result of the earlier discharge, researchers estimated the per-patient savings at $315 for those treated with local anesthesia.

The researchers found no statistically significant differences in the number of patients undergoing either procedure who were admitted to the hospital after surgery or in the 30 days after initial discharge, the number of complications, or the overall satisfaction with their surgery or anesthesia management.

EBRT for Local Control of Thyroid Ca

High-dose external beam radiotherapy was effective in controlling locally advanced, differentiated thyroid cancer in a retrospective study of 42 patients.

There is little information on the efficacy of external beam radiotherapy (EBRT) as adjuvant therapy in such patients, so the treatment is controversial.

“Retrospective outcome studies remain the most reliable way of assessing therapeutic efficacy but are hampered by significant heterogeneity in diagnostic evaluation, staging, and treatment strategies that have evolved over time. Accordingly, the indications for EBRT for differentiated thyroid cancer remain poorly defined,” said Dr. Kenyon M. Meadows and his associates at the University of Florida, Gainesville (Am. J. Otolaryngol. 2006;27:24–8).

Dr. Meadows and his associates reviewed the records and assessed outcomes in all 42 patients who were treated for advanced or recurrent thyroid cancer with adjuvant high-dose EBRT at their university between 1962 and 2003; median patient age was 58 years.

Ten patients died from thyroid cancer during a mean follow-up of 7 years, while 16 died from unrelated causes. The rate of local or regional recurrence at 5 years was 0% for patients who had no gross residual disease when they underwent EBRT and 30% for those who did have gross residual disease at the time of EBRT.

Five-year cause-specific survival was 90% for patients who had no gross residual tumor when they underwent EBRT and 69% for those who did have gross residual disease at the time of EBRT. Five-year survival free of distant metastases was 82% for those who had no evidence of metastasis when they underwent EBRT.

These findings “confirm the efficacy of EBRT despite the negative patient selection bias inherent in these retrospective analyses,” the investigators said.

The findings also are in line with the results of several other recent studies, which “have consistently shown a favorable impact on local-regional control.” This contrasts with early reports suggesting that “EBRT was either ineffective or even associated with a worse outcome,” the researchers noted.

Cardiac Effects of Hyperthyroidism

Subclinical hyperthyroidism was linked to atrial fibrillation but not to other clinical cardiovascular conditions or deaths in a new study.

The research, conducted by Dr. Anne R. Cappola from the University of Pennsylvania in Philadelphia and her colleagues, examined the link between unrecognized thyroid dysfunction and cardiovascular risk, including atrial fibrillation, coronary heart disease, cerebrovascular disease, and death (JAMA 2006;295:1033–41).

The subjects were a subgroup of 3,233 participants in the population-based, longitudinal Cardiovascular Health Study. They were community-dwelling older adults with a mean age of 73 years. At baseline, 82% were euthyroid, 15% had subclinical hypothyroidism, 1.6% had overt hypothyroidism, and 1.5% had subclinical hyperthyroidism. Individuals with overt hyperthyroidism or thyrotoxicosis were excluded.

The study found no differences in cardiovascular events at baseline between the euthyroid group and any of the three groups with thyroid dysfunction. But over the 12.5-year follow-up period, subjects with subclinical hyperthyroidism had a greater incidence of atrial fibrillation than did euthyroid subjects (67 vs. 31 events per 1,000 person years). After adjustment, this risk was nearly double (hazard ratio, 1.98).

The data support treatment of subclinical hyperthyroidism when it is detected. “If endogenous subclinical hyperthyroidism is detected, older individuals may benefit from treatment to prevent atrial fibrillation.”

The authors disagree with an earlier expert panel report that cited insufficient evidence to treat patients with TSH levels of 0.1–0.45 mU/L and recommended treating only those with TSH levels below 0.1 mU/L (JAMA 2004;291:228–38).

Thyroidectomy Safe for Grave's

Total thyroidectomy can be performed more safely than many clinicians realize, and offers more durable results for people with Grave's disease than do antithyroid drugs or radioiodine, according to Dr. Kaare J. Weber of Mount Sinai School of Medicine, New York, and his associates.

The researchers reviewed the records of all 48 patients who underwent total thyroidectomy for Grave's disease at their hospital between 1993 and 2005. All but 7 of the patients were women, and the mean age was 40 years.

After a mean of 40 months follow-up post thyroidectomy, there were no recurrences of hyperthyroidism. In contrast, relapse rates of 20%–75% are cited in the literature for medical therapy, Dr. Weber and his associates said (Am. J. Surg. 2006;191:400–5).

Of the 20 patients who had mild or severe ophthalmopathy before surgery, 11 showed marked improvement or resolution of eye disorders and the remaining 9 showed either improvement or stabilization. In contrast, radioiodine treatment has been associated with the onset or exacerbation of ophthalmopathy, they said.

Eight patients (17%) were found to have papillary cancer of the thyroid at surgery. “These patients would not have received appropriate treatment for their coexisting cancer if they were treated only with antithyroid drugs and/or radioiodine,” the investigators noted.

No patients suffered permanent laryngeal nerve injury from the procedure. Complications included three cases of transient hypocalcemia and one case of temporary right vocal cord paralysis. Only one patient developed permanent hypoparathyroidism, and that case “followed a previous failed [thyroid] exploration at another institution,” they said.

These results demonstrate that total thyroidectomy now can be performed safely, with little of the morbidity and mortality that occurred when the procedure was first developed years ago. In addition, thyroidectomy addresses potentially cancerous nodules, as medical and radioiodine therapies do not, they said.

Local Anesthesia for Thyroidectomy

Outpatient thyroidectomies performed with local anesthesia on eligible patients can achieve clinical results and patient satisfaction comparable with those done under general anesthesia, according to results of a prospective, randomized clinical trial.

Researchers at Texas A&M University in Temple, Tex., monitored 58 patients at Scott & White Memorial Hospital in Temple who underwent thyroidectomies in 2000–2001. The patients' ages ranged from 19 to 80 years; 53 (91%) were women. Half (29 patients) received local anesthesia while half had general anesthesia (Arch. Surg. 2006;141:167–73).

The researchers found statistically significant differences in the amount of time patients in the two groups spent in postsurgical care: Those who received local anesthesia spent 4 minutes in the postanesthesia care unit, compared with 80 minutes for those treated under general anesthesia. The combined time spent in the postanesthesia care unit and the day surgery unit for those treated under local anesthesia was 165 minutes, compared with 229 minutes for those under general anesthesia.

As a result of the earlier discharge, researchers estimated the per-patient savings at $315 for those treated with local anesthesia.

The researchers found no statistically significant differences in the number of patients undergoing either procedure who were admitted to the hospital after surgery or in the 30 days after initial discharge, the number of complications, or the overall satisfaction with their surgery or anesthesia management.

EBRT for Local Control of Thyroid Ca

High-dose external beam radiotherapy was effective in controlling locally advanced, differentiated thyroid cancer in a retrospective study of 42 patients.

There is little information on the efficacy of external beam radiotherapy (EBRT) as adjuvant therapy in such patients, so the treatment is controversial.

“Retrospective outcome studies remain the most reliable way of assessing therapeutic efficacy but are hampered by significant heterogeneity in diagnostic evaluation, staging, and treatment strategies that have evolved over time. Accordingly, the indications for EBRT for differentiated thyroid cancer remain poorly defined,” said Dr. Kenyon M. Meadows and his associates at the University of Florida, Gainesville (Am. J. Otolaryngol. 2006;27:24–8).

Dr. Meadows and his associates reviewed the records and assessed outcomes in all 42 patients who were treated for advanced or recurrent thyroid cancer with adjuvant high-dose EBRT at their university between 1962 and 2003; median patient age was 58 years.

Ten patients died from thyroid cancer during a mean follow-up of 7 years, while 16 died from unrelated causes. The rate of local or regional recurrence at 5 years was 0% for patients who had no gross residual disease when they underwent EBRT and 30% for those who did have gross residual disease at the time of EBRT.

Five-year cause-specific survival was 90% for patients who had no gross residual tumor when they underwent EBRT and 69% for those who did have gross residual disease at the time of EBRT. Five-year survival free of distant metastases was 82% for those who had no evidence of metastasis when they underwent EBRT.

These findings “confirm the efficacy of EBRT despite the negative patient selection bias inherent in these retrospective analyses,” the investigators said.

The findings also are in line with the results of several other recent studies, which “have consistently shown a favorable impact on local-regional control.” This contrasts with early reports suggesting that “EBRT was either ineffective or even associated with a worse outcome,” the researchers noted.

Cardiac Effects of Hyperthyroidism

Subclinical hyperthyroidism was linked to atrial fibrillation but not to other clinical cardiovascular conditions or deaths in a new study.

The research, conducted by Dr. Anne R. Cappola from the University of Pennsylvania in Philadelphia and her colleagues, examined the link between unrecognized thyroid dysfunction and cardiovascular risk, including atrial fibrillation, coronary heart disease, cerebrovascular disease, and death (JAMA 2006;295:1033–41).

The subjects were a subgroup of 3,233 participants in the population-based, longitudinal Cardiovascular Health Study. They were community-dwelling older adults with a mean age of 73 years. At baseline, 82% were euthyroid, 15% had subclinical hypothyroidism, 1.6% had overt hypothyroidism, and 1.5% had subclinical hyperthyroidism. Individuals with overt hyperthyroidism or thyrotoxicosis were excluded.

The study found no differences in cardiovascular events at baseline between the euthyroid group and any of the three groups with thyroid dysfunction. But over the 12.5-year follow-up period, subjects with subclinical hyperthyroidism had a greater incidence of atrial fibrillation than did euthyroid subjects (67 vs. 31 events per 1,000 person years). After adjustment, this risk was nearly double (hazard ratio, 1.98).

The data support treatment of subclinical hyperthyroidism when it is detected. “If endogenous subclinical hyperthyroidism is detected, older individuals may benefit from treatment to prevent atrial fibrillation.”

The authors disagree with an earlier expert panel report that cited insufficient evidence to treat patients with TSH levels of 0.1–0.45 mU/L and recommended treating only those with TSH levels below 0.1 mU/L (JAMA 2004;291:228–38).

Thyroidectomy Safe for Grave's

Total thyroidectomy can be performed more safely than many clinicians realize, and offers more durable results for people with Grave's disease than do antithyroid drugs or radioiodine, according to Dr. Kaare J. Weber of Mount Sinai School of Medicine, New York, and his associates.

The researchers reviewed the records of all 48 patients who underwent total thyroidectomy for Grave's disease at their hospital between 1993 and 2005. All but 7 of the patients were women, and the mean age was 40 years.

After a mean of 40 months follow-up post thyroidectomy, there were no recurrences of hyperthyroidism. In contrast, relapse rates of 20%–75% are cited in the literature for medical therapy, Dr. Weber and his associates said (Am. J. Surg. 2006;191:400–5).

Of the 20 patients who had mild or severe ophthalmopathy before surgery, 11 showed marked improvement or resolution of eye disorders and the remaining 9 showed either improvement or stabilization. In contrast, radioiodine treatment has been associated with the onset or exacerbation of ophthalmopathy, they said.

Eight patients (17%) were found to have papillary cancer of the thyroid at surgery. “These patients would not have received appropriate treatment for their coexisting cancer if they were treated only with antithyroid drugs and/or radioiodine,” the investigators noted.

No patients suffered permanent laryngeal nerve injury from the procedure. Complications included three cases of transient hypocalcemia and one case of temporary right vocal cord paralysis. Only one patient developed permanent hypoparathyroidism, and that case “followed a previous failed [thyroid] exploration at another institution,” they said.

These results demonstrate that total thyroidectomy now can be performed safely, with little of the morbidity and mortality that occurred when the procedure was first developed years ago. In addition, thyroidectomy addresses potentially cancerous nodules, as medical and radioiodine therapies do not, they said.

Local Anesthesia for Thyroidectomy

Outpatient thyroidectomies performed with local anesthesia on eligible patients can achieve clinical results and patient satisfaction comparable with those done under general anesthesia, according to results of a prospective, randomized clinical trial.

Researchers at Texas A&M University in Temple, Tex., monitored 58 patients at Scott & White Memorial Hospital in Temple who underwent thyroidectomies in 2000–2001. The patients' ages ranged from 19 to 80 years; 53 (91%) were women. Half (29 patients) received local anesthesia while half had general anesthesia (Arch. Surg. 2006;141:167–73).

The researchers found statistically significant differences in the amount of time patients in the two groups spent in postsurgical care: Those who received local anesthesia spent 4 minutes in the postanesthesia care unit, compared with 80 minutes for those treated under general anesthesia. The combined time spent in the postanesthesia care unit and the day surgery unit for those treated under local anesthesia was 165 minutes, compared with 229 minutes for those under general anesthesia.

As a result of the earlier discharge, researchers estimated the per-patient savings at $315 for those treated with local anesthesia.

The researchers found no statistically significant differences in the number of patients undergoing either procedure who were admitted to the hospital after surgery or in the 30 days after initial discharge, the number of complications, or the overall satisfaction with their surgery or anesthesia management.

EBRT for Local Control of Thyroid Ca

High-dose external beam radiotherapy was effective in controlling locally advanced, differentiated thyroid cancer in a retrospective study of 42 patients.

There is little information on the efficacy of external beam radiotherapy (EBRT) as adjuvant therapy in such patients, so the treatment is controversial.

“Retrospective outcome studies remain the most reliable way of assessing therapeutic efficacy but are hampered by significant heterogeneity in diagnostic evaluation, staging, and treatment strategies that have evolved over time. Accordingly, the indications for EBRT for differentiated thyroid cancer remain poorly defined,” said Dr. Kenyon M. Meadows and his associates at the University of Florida, Gainesville (Am. J. Otolaryngol. 2006;27:24–8).

Dr. Meadows and his associates reviewed the records and assessed outcomes in all 42 patients who were treated for advanced or recurrent thyroid cancer with adjuvant high-dose EBRT at their university between 1962 and 2003; median patient age was 58 years.

Ten patients died from thyroid cancer during a mean follow-up of 7 years, while 16 died from unrelated causes. The rate of local or regional recurrence at 5 years was 0% for patients who had no gross residual disease when they underwent EBRT and 30% for those who did have gross residual disease at the time of EBRT.

Five-year cause-specific survival was 90% for patients who had no gross residual tumor when they underwent EBRT and 69% for those who did have gross residual disease at the time of EBRT. Five-year survival free of distant metastases was 82% for those who had no evidence of metastasis when they underwent EBRT.

These findings “confirm the efficacy of EBRT despite the negative patient selection bias inherent in these retrospective analyses,” the investigators said.

The findings also are in line with the results of several other recent studies, which “have consistently shown a favorable impact on local-regional control.” This contrasts with early reports suggesting that “EBRT was either ineffective or even associated with a worse outcome,” the researchers noted.

Cardiac Effects of Hyperthyroidism

Subclinical hyperthyroidism was linked to atrial fibrillation but not to other clinical cardiovascular conditions or deaths in a new study.

The research, conducted by Dr. Anne R. Cappola from the University of Pennsylvania in Philadelphia and her colleagues, examined the link between unrecognized thyroid dysfunction and cardiovascular risk, including atrial fibrillation, coronary heart disease, cerebrovascular disease, and death (JAMA 2006;295:1033–41).

The subjects were a subgroup of 3,233 participants in the population-based, longitudinal Cardiovascular Health Study. They were community-dwelling older adults with a mean age of 73 years. At baseline, 82% were euthyroid, 15% had subclinical hypothyroidism, 1.6% had overt hypothyroidism, and 1.5% had subclinical hyperthyroidism. Individuals with overt hyperthyroidism or thyrotoxicosis were excluded.

The study found no differences in cardiovascular events at baseline between the euthyroid group and any of the three groups with thyroid dysfunction. But over the 12.5-year follow-up period, subjects with subclinical hyperthyroidism had a greater incidence of atrial fibrillation than did euthyroid subjects (67 vs. 31 events per 1,000 person years). After adjustment, this risk was nearly double (hazard ratio, 1.98).

The data support treatment of subclinical hyperthyroidism when it is detected. “If endogenous subclinical hyperthyroidism is detected, older individuals may benefit from treatment to prevent atrial fibrillation.”

The authors disagree with an earlier expert panel report that cited insufficient evidence to treat patients with TSH levels of 0.1–0.45 mU/L and recommended treating only those with TSH levels below 0.1 mU/L (JAMA 2004;291:228–38).

Thyroidectomy Safe for Grave's

Total thyroidectomy can be performed more safely than many clinicians realize, and offers more durable results for people with Grave's disease than do antithyroid drugs or radioiodine, according to Dr. Kaare J. Weber of Mount Sinai School of Medicine, New York, and his associates.

The researchers reviewed the records of all 48 patients who underwent total thyroidectomy for Grave's disease at their hospital between 1993 and 2005. All but 7 of the patients were women, and the mean age was 40 years.

After a mean of 40 months follow-up post thyroidectomy, there were no recurrences of hyperthyroidism. In contrast, relapse rates of 20%–75% are cited in the literature for medical therapy, Dr. Weber and his associates said (Am. J. Surg. 2006;191:400–5).

Of the 20 patients who had mild or severe ophthalmopathy before surgery, 11 showed marked improvement or resolution of eye disorders and the remaining 9 showed either improvement or stabilization. In contrast, radioiodine treatment has been associated with the onset or exacerbation of ophthalmopathy, they said.

Eight patients (17%) were found to have papillary cancer of the thyroid at surgery. “These patients would not have received appropriate treatment for their coexisting cancer if they were treated only with antithyroid drugs and/or radioiodine,” the investigators noted.

No patients suffered permanent laryngeal nerve injury from the procedure. Complications included three cases of transient hypocalcemia and one case of temporary right vocal cord paralysis. Only one patient developed permanent hypoparathyroidism, and that case “followed a previous failed [thyroid] exploration at another institution,” they said.

These results demonstrate that total thyroidectomy now can be performed safely, with little of the morbidity and mortality that occurred when the procedure was first developed years ago. In addition, thyroidectomy addresses potentially cancerous nodules, as medical and radioiodine therapies do not, they said.

CAP Mortality Reduced by Vaccine

Prior pneumococcal vaccination significantly improves outcomes in adults hospitalized with community-acquired pneumonia, results of a recent retrospective study suggest.

Compared with unvaccinated adults, those who had received the pneumococcal vaccine were 50% less likely to die while in the hospital and 33% less likely to develop respiratory failure, after adjustment for confounding factors (Clin. Infect. Dis. 2006;42:1093–101).

“Whether or not [the vaccine] prevents pneumonia is almost irrelevant—it clearly has an effect on reducing death in the individuals who get pneumonia,” Dr. David N. Fisman, lead study author, said in a statement released by the Infectious Diseases Society of America.

Dr. Fisman of Drexel University in Philadelphia and his associates evaluated the benefits of prior pneumococcal vaccination in 62,918 consecutive adult patients hospitalized with community-acquired pneumonia at 109 hospitals.

In addition to the reductions in death or respiratory failure, vaccination also significantly reduced the in-hospital risk of acute respiratory distress syndrome, sepsis syndrome, and cardiac arrest. Overall, 12% of the cohort had received the vaccination, 23% were unvaccinated, and the vaccination status was unknown for the remaining 65% of the patients.

Acute Infection Ups Risk of DVT

The risks of deep vein thrombosis and pulmonary embolism appear significantly increased after acute urinary tract or respiratory infection, according to a large case-series study.

The risk rates of both DVT and PE were highest—almost double that at baseline—in the first 2 weeks after infection, and fell off over subsequent months, returning to baseline after 1 year.

In the first 2 weeks after acute urinary tract infection (UTI), the incidence ratio was 2.10 for DVT and 2.11 for PE. Within 2 weeks after an acute respiratory infection, the overall incidence ratio of DVT was 1.91. A reliable estimate of the risk ratio for PE was not possible for respiratory infection because of the possibility of diagnostic misclassification, reported Liam Smeeth, Ph.D., of the London School of Hygiene and Tropical Medicine and his colleagues (Lancet 2006;37:1075–9).

Using medical records from 1987 to 2004 provided by the U.K. Health Improvement Network's electronic database, the researchers selected 7,278 individuals for analysis from 10,284 who had a first DVT, and 3,755 from 5,574 who had a first PE.

The mean age at diagnosis was 68 years for both DVT and PE, and women made up 58% of the DVT and 57% of the PE populations. The size and accuracy of the Health Improvement Network database—over 20 million person-years of observation from 220 general practices—allowed for detailed analysis and elimination of potential confounders.

The study “confirms that acute infection should be considered in the list of precipitants for venous thromboembolic disease,” the authors wrote.

Test for HIV if Patient Has Delusions

Delusions of parasitosis are a “red flag” for possible HIV infection, Dr. Marcus Conant said at the annual meeting of the California Society of Dermatology and Dermatologic Surgery.

What's the connection? It's crystal methamphetamine, a highly addictive drug that undermines judgment, heightens the sex drive, and is popular in groups where the incidence of HIV infection is rising. The drug often causes delusions, such as the feeling that bugs are crawling on or within the skin, said Dr. Conant, a dermatologist in private practice in San Francisco.

“Every patient I've seen in 2 years with delusions of parasitosis—and I've seen more and more and more of them—is on crystal meth,” Dr. Conant said.

The incidence of HIV infection is rising rapidly among women and minorities, as well as young gay men. Crystal meth users may be having sex with at-risk members of any of these groups. “You need to offer them an HIV test,” he advised.

Other red flags include presence of any major STD, including cutaneous STDs such as genital herpes, genital warts, and even crab lice.

For patients reluctant to have an HIV test, he suggested telling them you want “a look at your immune function to make sure cancer or leukemia isn't causing your problem.” Many patients will then agree to a CD4 count, which, if low, may persuade them to consent to an HIV test.

CAP Mortality Reduced by Vaccine

Prior pneumococcal vaccination significantly improves outcomes in adults hospitalized with community-acquired pneumonia, results of a recent retrospective study suggest.

Compared with unvaccinated adults, those who had received the pneumococcal vaccine were 50% less likely to die while in the hospital and 33% less likely to develop respiratory failure, after adjustment for confounding factors (Clin. Infect. Dis. 2006;42:1093–101).

“Whether or not [the vaccine] prevents pneumonia is almost irrelevant—it clearly has an effect on reducing death in the individuals who get pneumonia,” Dr. David N. Fisman, lead study author, said in a statement released by the Infectious Diseases Society of America.

Dr. Fisman of Drexel University in Philadelphia and his associates evaluated the benefits of prior pneumococcal vaccination in 62,918 consecutive adult patients hospitalized with community-acquired pneumonia at 109 hospitals.

In addition to the reductions in death or respiratory failure, vaccination also significantly reduced the in-hospital risk of acute respiratory distress syndrome, sepsis syndrome, and cardiac arrest. Overall, 12% of the cohort had received the vaccination, 23% were unvaccinated, and the vaccination status was unknown for the remaining 65% of the patients.

Acute Infection Ups Risk of DVT

The risks of deep vein thrombosis and pulmonary embolism appear significantly increased after acute urinary tract or respiratory infection, according to a large case-series study.

The risk rates of both DVT and PE were highest—almost double that at baseline—in the first 2 weeks after infection, and fell off over subsequent months, returning to baseline after 1 year.

In the first 2 weeks after acute urinary tract infection (UTI), the incidence ratio was 2.10 for DVT and 2.11 for PE. Within 2 weeks after an acute respiratory infection, the overall incidence ratio of DVT was 1.91. A reliable estimate of the risk ratio for PE was not possible for respiratory infection because of the possibility of diagnostic misclassification, reported Liam Smeeth, Ph.D., of the London School of Hygiene and Tropical Medicine and his colleagues (Lancet 2006;37:1075–9).

Using medical records from 1987 to 2004 provided by the U.K. Health Improvement Network's electronic database, the researchers selected 7,278 individuals for analysis from 10,284 who had a first DVT, and 3,755 from 5,574 who had a first PE.

The mean age at diagnosis was 68 years for both DVT and PE, and women made up 58% of the DVT and 57% of the PE populations. The size and accuracy of the Health Improvement Network database—over 20 million person-years of observation from 220 general practices—allowed for detailed analysis and elimination of potential confounders.

The study “confirms that acute infection should be considered in the list of precipitants for venous thromboembolic disease,” the authors wrote.

Test for HIV if Patient Has Delusions

Delusions of parasitosis are a “red flag” for possible HIV infection, Dr. Marcus Conant said at the annual meeting of the California Society of Dermatology and Dermatologic Surgery.

What's the connection? It's crystal methamphetamine, a highly addictive drug that undermines judgment, heightens the sex drive, and is popular in groups where the incidence of HIV infection is rising. The drug often causes delusions, such as the feeling that bugs are crawling on or within the skin, said Dr. Conant, a dermatologist in private practice in San Francisco.

“Every patient I've seen in 2 years with delusions of parasitosis—and I've seen more and more and more of them—is on crystal meth,” Dr. Conant said.

The incidence of HIV infection is rising rapidly among women and minorities, as well as young gay men. Crystal meth users may be having sex with at-risk members of any of these groups. “You need to offer them an HIV test,” he advised.

Other red flags include presence of any major STD, including cutaneous STDs such as genital herpes, genital warts, and even crab lice.

For patients reluctant to have an HIV test, he suggested telling them you want “a look at your immune function to make sure cancer or leukemia isn't causing your problem.” Many patients will then agree to a CD4 count, which, if low, may persuade them to consent to an HIV test.

CAP Mortality Reduced by Vaccine

Prior pneumococcal vaccination significantly improves outcomes in adults hospitalized with community-acquired pneumonia, results of a recent retrospective study suggest.

Compared with unvaccinated adults, those who had received the pneumococcal vaccine were 50% less likely to die while in the hospital and 33% less likely to develop respiratory failure, after adjustment for confounding factors (Clin. Infect. Dis. 2006;42:1093–101).

“Whether or not [the vaccine] prevents pneumonia is almost irrelevant—it clearly has an effect on reducing death in the individuals who get pneumonia,” Dr. David N. Fisman, lead study author, said in a statement released by the Infectious Diseases Society of America.

Dr. Fisman of Drexel University in Philadelphia and his associates evaluated the benefits of prior pneumococcal vaccination in 62,918 consecutive adult patients hospitalized with community-acquired pneumonia at 109 hospitals.

In addition to the reductions in death or respiratory failure, vaccination also significantly reduced the in-hospital risk of acute respiratory distress syndrome, sepsis syndrome, and cardiac arrest. Overall, 12% of the cohort had received the vaccination, 23% were unvaccinated, and the vaccination status was unknown for the remaining 65% of the patients.

Acute Infection Ups Risk of DVT

The risks of deep vein thrombosis and pulmonary embolism appear significantly increased after acute urinary tract or respiratory infection, according to a large case-series study.

The risk rates of both DVT and PE were highest—almost double that at baseline—in the first 2 weeks after infection, and fell off over subsequent months, returning to baseline after 1 year.

In the first 2 weeks after acute urinary tract infection (UTI), the incidence ratio was 2.10 for DVT and 2.11 for PE. Within 2 weeks after an acute respiratory infection, the overall incidence ratio of DVT was 1.91. A reliable estimate of the risk ratio for PE was not possible for respiratory infection because of the possibility of diagnostic misclassification, reported Liam Smeeth, Ph.D., of the London School of Hygiene and Tropical Medicine and his colleagues (Lancet 2006;37:1075–9).

Using medical records from 1987 to 2004 provided by the U.K. Health Improvement Network's electronic database, the researchers selected 7,278 individuals for analysis from 10,284 who had a first DVT, and 3,755 from 5,574 who had a first PE.

The mean age at diagnosis was 68 years for both DVT and PE, and women made up 58% of the DVT and 57% of the PE populations. The size and accuracy of the Health Improvement Network database—over 20 million person-years of observation from 220 general practices—allowed for detailed analysis and elimination of potential confounders.

The study “confirms that acute infection should be considered in the list of precipitants for venous thromboembolic disease,” the authors wrote.

Test for HIV if Patient Has Delusions

Delusions of parasitosis are a “red flag” for possible HIV infection, Dr. Marcus Conant said at the annual meeting of the California Society of Dermatology and Dermatologic Surgery.

What's the connection? It's crystal methamphetamine, a highly addictive drug that undermines judgment, heightens the sex drive, and is popular in groups where the incidence of HIV infection is rising. The drug often causes delusions, such as the feeling that bugs are crawling on or within the skin, said Dr. Conant, a dermatologist in private practice in San Francisco.

“Every patient I've seen in 2 years with delusions of parasitosis—and I've seen more and more and more of them—is on crystal meth,” Dr. Conant said.

The incidence of HIV infection is rising rapidly among women and minorities, as well as young gay men. Crystal meth users may be having sex with at-risk members of any of these groups. “You need to offer them an HIV test,” he advised.

Other red flags include presence of any major STD, including cutaneous STDs such as genital herpes, genital warts, and even crab lice.

For patients reluctant to have an HIV test, he suggested telling them you want “a look at your immune function to make sure cancer or leukemia isn't causing your problem.” Many patients will then agree to a CD4 count, which, if low, may persuade them to consent to an HIV test.