The Battle Has Just Begun

Despite the seeming victory in March over health care reform, the battle is far from over. There are many states and members of Congress still fighting hard to disable the act signed into law by President Obama on March 23rd of this year. Supporters of the law need to be working just as hard to keep it alive as they did before it was passed.

The first thing threatening health care reform right now is many states and their Attorneys General in particular (including Virginia’s own Kenneth T. Cuccinelli, II) who have filed lawsuits to challenge the new law. Virginia is one of more than twenty states whose attorneys general have filed lawsuits trying to prevent parts of the health care law from being implemented.

Virginia’s lawsuit was the first to pass any legal test yesterday, when it succeeded in not being thrown out before it even reached a hearing. U.S. District Judge Henry Hudson declared that the law “radically changes the landscape of health insurance coverage in America” and that the case will be heard starting on October 18th.

The health care law is being attacked from another side as well. Many Republicans in Congress, as well as those who are hoping to win seats this November are trying a different tactic. They have pledged to try and win back the House in an effort to de-fund the new law, or at least the sections they find most troubling.

However many parts of the law are already receiving funding and it might be harder to prevent those parts from continuing. That hasn’t stopped nearly 120 candidates for Congress from promising to try and stop funding for as much of the health care reform as they can (they have signed a pledge at DefundIt.org).

Supporters of health care reform must do their best to make sure these measures are not successful. Particularly do as much as they can to support and encourage others' support of candidates who will fully fund health care reform and help the 30 million without care that will be covered by this law.

Do we really have to talk about this?

Yes, we have to. Today’s post focuses on a topic that no one really likes to talk about. It makes men uncomfortable and women anxious and apprehensive. The topic of the day is mammography.

Few women look forward to having the uncomfortable procedure, but for years women, beginning at age forty, have given in and started getting them annually. However, last fall, the US Preventative Services Task Force (USPSTF), changed their recommendations and said women didn’t have to start getting mammograms until age 50, and then only biennially.

Their decision sparked outcries from both sides of the issue. Many cancer groups, including the American Cancer Society, vehemently disagreed with their new standards, while other groups, like the National Breast Cancer Coalition, praised the decision, saying it will allow for focus on finding more effective methods of detection and prevent excessive treatment. The decision and backlash, overall, left many women not knowing what to do in their own lives.

The Coalition for Life Sciences held a briefing on Wednesday discussing this issue, and the speaker, Dr. Ann Partridge, MD, MPH, a clinical breast cancer researcher at The Dana-Farber Cancer Institute in Boston, explained how the decision was made, and what she thought women should do for themselves given this new information.

First, she discussed that the USPSTF had made its decision by reviewing the literature pertaining to mammograms given to women under age 50. The studies showed a slight improvement in mortality rates from breast cancer with annual testing from 39-49 but also greater discomfort, lower accuracy, and much higher false positive rate with the test in this age range. The studies also showed no discernible difference in mortality with biennial testing as compared to annual testing.

Given all the downsides, she said, the task force chose to stop recommending the procedure for women in this age group. However, she emphasized that this is a choice each woman needs to make with her doctor on a personal level. She should decide when to start getting mammograms and how often based on family history, possible risk, past health issues, and her own personal belief in the test.

No woman, Dr. Partridge confirmed, should feel like she cannot get the test if she wants it. It is a personal choice and the task force was merely saying that the risks might outweigh the benefits for women in their 40s, and that these women should make their own decision. So, women, talk to your doctor and make sure you understand these new standards, and make whatever decision is best for you.

One concern however, was that in some of the studies, even when assigned to the group to be tested annual, only 70% of the women got tested, meaning 30% did not. So if those who voluntarily sign up for studies don't get tested when they are told to, what does it mean for the rest of us? Will this more lenient recommendation severely lower the rate at which women get tested? Tell us what you think in the comments.

Meet Hillary Lewis, Health Policy Consultant

Welcome to the debut of our series of profiles of New Voices! First up is Hillary Lewis, JD, health policy consultant to Dr. S. Ward Casscells, vice president for External Relations and Public Policy at the University of Texas Health Science Center, Houston. She was kind enough to answer a few questions for us this afternoon by chat...

NV: Question 1. What do you do?

Hillary: I am currently working as a consultant to the University of Texas Health Science Center in Houston on a grant funded project studying several related health care topics:

1. How do Americans use the health care system?
2. What are Americans' opinions on the health care system (quality, access)?
3. What are Americans' opinions on health care reform? (both pre-passage and as passed)
4. How will health care reform impact various industries, patient advocacy groups, and physician groups?

I also write papers analyzing the poll data we accumulated asking these questions.

NV: Question 2: How does your background in science - and in research particularly - help you?

Hillary: My background in biomedical science as well as my studies in health law have positioned me to ask intelligent, novel questions on these topics. I am also tasked with tracking American opinions on basic and clinical research. I frequently refer to Research!America data to flesh out, support or contradict our findings.

My science background has helped me understand the polling process itself in addition to providing the mental training needed to probe these topics in ways that provide unique insights into areas that are fairly well parsed.

The research process is much like delving into these topics- you have a hypothesis that you're trying to gather more data to support or disprove, depending on your approach to the scientific method!

NV: What is the most exciting component of what you do?

Hillary: Meeting with thought leaders to expand our approach to our areas of interest. No amount of research into the topics and brainstorming with colleagues can top spending half an hour with someone who has spent a significant part of their lives developing the policies in place today.

It is amazing to meet people like Dr. Jay Sanders, the father of telemedicine, or Baroness Nicholson whose NGO, AMAR Foundation, works in Iraq to create community health systems in far-flung regions. These folks have spent enormous amounts of time and energy on the topics we are studying at UT and their insight is invaluable. To top it off, everyone I've had the chance to meet has been gracious and willing to share their knowledge and experience.

NV: Question 4. What advice would you give to someone who wants to get involved in advocacy?

Hillary:

1. Figure out what you know and what gets you fired up. Once you determine this you can shape your activities as an advocate, probably within an established group.
2. Take advantage of what's gone before! There is no reason to re-create the wheel. Research!America has all the tools you need to get started as an advocate for research, if that's what moves you. For other areas of advocacy, there are similar leaders that you can touch base with and who will help you.
3. Don't be shy! Starch your shirt and take your message to your local Congressional or Senate office. They will be happy to hear from you, especially if you follow R!A suggestions for formatting your meeting and imparting you message by telling a story.
4. Follow up and establish those networks. Make yourself known to the staffers and you'll be welcome back!

NV: Alright, last question: if you could change anything about the culture of science in the U.S. today, what would it be?

Hillary: I think we need to be training scientists to get out of the lab and into the community. There is a lot of research to do, true, but in the end you're doing it for the benefit of everyone, and if you just take a few minutes to get out and tell people about it, knowledge about science would spread far more quickly and accurately than if we leave it in the hands of the media.

I doubt we can change the primary investigators who are set in their ways, but if we start with the next generation eventually we'll get there. In this I think we'd have to take a long-term approach rather than expect immediate results.


Thank you to Hillary for giving us a few minutes to learn more about her and her career. Her background - including lab work and law - make her an excellent advocate for research and it's a pleasure to hear from her again on the New Voices for Research blog where she was a regular contributor in January and February 2009.

This is part of our ongoing series Profiling New Voices for Research.

February News Round-Up

As we quickly approach the end of the shortest month of the year, here's some of the interesting stuff the New Voices bloggers are reading.

Reactions on Biomedical Research Funding
As you recall, earlier this month, the President's budget was released and requested $32.1 billion for NIH. This was an increase over the previous year's budget, but a decrease if you consider the financial bump from American Recovery and Reinvestment Act they have received for the past two fiscal years.

This past weekend the annual meeting for the American Association for the Advancement of Sciences was held in San Diego. One of the distinguished guests was Dr. Francis Collins, the director of the National Institutes of Health. During a press conference, Dr. Collins shared his thoughts on funding outlooks for biomedical research. In response to the 2-year stimulus money, Collins emphasized that major scientific progress can't be supported by short-term funding increases. One of the approaches the NIH is considering to compensate for the lower budget is by investing the funds that they do have into more high-risk projects, hoping it will enable larger breakthroughs to occur. Collins said, "If you’re not supporting research that fails sometimes, then you’re probably not doing a good job of encouraging the most groundbreaking ideas."
By: Sarah

New Hopes on the Fight against HIV/AIDS
During the annual meeting for the American Association for the Advancement of Sciences, Brian Williams, a research fellow at the South African Centre for Epidemiological Modeling and Analysis, said that global public health officials could eliminate HIV/AIDS in 40 years, and stop HIV infections in as soon as five years. Epidemiologists are now looking to use anti-retroviral (ARV) medications to curb the spread of HIV/AIDS. Since ARV treatment can result in a reduction of the HIV virus by twenty-five times, epidemiologists are hoping that if more people with HIV are treated earlier, there would be fewer new cases of the disease. If the program is introduced, it would be expensive – between $3 billion to $4 billion per year. However, Williams states that the plan would show savings immediately, reducing hospitalizations and lost years of life from youth passing away from the virus.
By: Kimberly

Reacting to Advancing Technology
Research inevitably leads to new advances. However, it can be a challenge for people to incorporate technologies or knowledge into their lives - be they computers, vaccines, or safety procedures. Over at Slate, Vaughan Bell gives us a history of "new" technology and how society has responded through the years. You might be surprised to find that even writing was once considered to be "too much" of an advancement for society.
By: Heather

Health Research in the President's FY2011 Budget

With the release of his FY 2011 budget proposal, President Obama reaffirmed his commitment to science and research by making them a priority amid efforts to limit spending. Although President Obama recommended a freeze on the part of the budget that includes research, he opted to increase funding for the National Institutes of Health, the Agency for Healthcare Research and Quality and the National Science Foundation.

Under the President’s proposal, the overall NIH budget would increase 3.2% percent to $32.1 billion in FY 2011. This recommended boost to the budget is an excellent beginning to the priority-setting conversation that now moves to Congress. Ultimately, an FY2011 budget less than $35 billion will not allow NIH to sustain the research capacity made possible through the American Recovery and Reinvestment Act. The NIH has been functioning with a $35 billion budget for two years and we cannot afford to lose ground as the nation struggles out of the Great Recession.

In a briefing Monday afternoon, NIH Director, Francis Collins, MD, PhD, emphasized that the administration is focused on science-based budgeting, with the intent to prioritize resources and take advantage of the greatest scientific opportunity. Dr. Collins most recently outlined his priorities for the agency in Science magazine (subscription required). As a result of the science-based budgeting approach, percent increases for individual institutes and centers varied across NIH. President Obama again called for specific increases for cancer and autism research as he did in his 2010 budget proposal.

Maintaining an emphasis on evidence-based medicine, President Obama proposed $611 million for the Agency for Healthcare Research and Quality, a 53.9% increase. Of this, $286 million is allocated for comparative effectiveness research. President Obama is keeping the NSF on a budget doubling track, by recommending $7.4 billion for the agency, an 8.0% increase. The Centers for Disease Control and Prevention did not fare as well, with the President recommending a 2% cut to $6.3 billion.

Since the budget and appropriations process is now in the hands of Congress, it is time for advocates to start contacting their representatives and senators in support of robust increases for research to improve health in FY 2011. New Voices will keep you posted on updates in the budget and appropriations process and alert you when your voice can make the most difference.

Bringing From Ideas to Treatments Home

Photo credit: Sarah Gallagher

This is the last post in the From Ideas to Treatments series.

In the last two posts in the series, I highlighted the importance of getting clinical researchers, health care professionals, and patients to think about the importance of diversity in clinical research. But there's more in the works that I think will also have a huge effect in getting the spotlight on this topic.

You've probably heard about the emergence of personalized medicine. What might that mean for you? Imagine one day being prescribed a treatment based on your specific genetic code. Now that's customer service!

Personalized medicine is touted as the health care system of the future, and as we further develop these techniques, diversity in research is going to mean something entirely different. Population-focused medicine will be a thing of the past, and so diversity will take on a whole new meaning. No longer will it refer to African-Americans, Whites, or Asians as entire populations. The focus will be on me, or you, as individuals. The diversity aspect will be unique to my genetic code, not my race or ethnicity.

But until we get there, we need to continue thinking about how best to utilize our clinical research paradigm, and that means continuing to improve the inclusion of diverse populations in clinical research trials.

How might America do that?

First, it seems that you can't turn on the news without hearing about health care reform. My purpose here isn't to pass judgment on any of the bills offered thus far, but to highlight how the idea of reform could work to improve inclusion in clinical research trials.

If we can get more people covered by health care, then they will have better access to health care professionals. This has the potential to introduce even more people to the idea of participating in clinical research trials.

Further, we've all heard about the movement to electronic records in the medical industry. Some of these programs are extremely advanced. They have a "smart" feature, that for example, will tell doctors when a drug that they have prescribed is not ideal for the patient. Imagine the capability to enter a patient’s diagnosis and have the system tell the doctor what trials that patient is eligible for.

Finally, one of NIH’s goals, currently in progress, is the formation of research consortiums, which recruit research institutions nationwide to collaborate and share resources, making the clinical research process more productive and efficient.

It takes a lot of time, energy and effort to translate an idea into a treatment and then make it accessible to the populations that need it most.

I hope that this series has helped enhance your interest in the research pipeline - and specifically in clinical research trials. I look forward to any thoughts or questions you may have!


This is Part 13 of 13 in our From Ideas to Treatments series.
Part 1 - From Ideas to Treatments
Part 2 - Basic Research: It Starts with an Idea
Part 3 - You're an Animal!
Part 4 - Can I care about animals and do research too?
Part 5 - Regulations for Animal Research
Part 6 - Clinical Research Trials
Part 7 - Patient Safety in Clinical Trials: IRB Approval
Part 8 - Recruitment
Part 9 - Health Disparities in Clinical Research
Part 10 - A Brief History of Inclusion Policies
Part 11 - Breaking News: Women and Men are Different
Part 12 - Including Minorities in Clinical Trial Research
Part 13 - Bringing From Ideas to Treatments Home

You Can Help Make Research a Higher National Priority

Advocates nationwide are expressing their gratitude for the recent revitalization of research by writing letters of thanks to President Obama. If you haven’t, you can join them. As we urge the president to continue to make research a priority in Fiscal Year 2011, we must also reach out to our members of Congress.

Ask your members of Congress to get on the record about where they stand on supporting research online at Your Congress-Your Health and thank those who have already responded.

Patients, scientists and other research advocates across the U.S. must join together to urge Congress to support innovation and invest in research to improve health. Visit http://www.yourcongressyourhealth.org/ today and join the thousands of Americans each week who are helping make research a higher national priority.

The Benefits and Challenges of Electronic Medical Records

October is “Update Your Medical Records Month,” so we want to take this opportunity to remind you to bring your records up to date, if you haven’t already. It also seemed like an appropriate time to write about electronic health records, a current topic of discussion in the health community.

Electronic health records are one measure that many—and the Obama administration in particular—support as a means of improving patient health care. Although there are many significant benefits to electronic systems, including better access to information and the ability to tailor care, there are also some major hurdles to the implementation of such a system including the initial cost. In 2008, however, a study published in the New England Journal of Medicine revealed that only 17% of doctors and 10% of hospitals were using computerized health records (the rest were using a paper based system).

Computerized health records offer a number of benefits to health practices. They can help improve patient care by assisting doctors in finding relevant information more quickly and prescribing the right treatments. “Fully functional” records can provide reminders of care guidelines, helping doctors to avoid problems such as prescribing medications that a patient is allergic to or administering tests for information that has already been acquired through similar tests (which the doctor may otherwise overlook).

In turn, this will cut costs by improving efficiency and eliminating unnecessary procedures. Making depersonalized records available will allow doctors and researchers to look at larger numbers of patients and learn what type of care is most effective for an individual.

Doctors have identified one major challenge to implementing electronic systems: cost. For small practices with only one to three doctors—the type of practice where almost half our country’s doctors practice—the average cost of implementation is $40,000-$50,000. Dissatisfaction with current system options is another barrier: according to the 2008 study 54% of those who had not adopted computerized records said that a major reason was that the existing options did not meet their needs.

The Obama administration has taken strides to reduce the cost by offering $19 billion in incentives to doctors, hospitals, and regional health information networks. Payments can be up to $44,000 per physician for those that demonstrate “meaningful use” of “certified” electronic health records, which means they must demonstrate quality reporting and be able to share information with clinics, hospitals, and government (although the specifics need to be determined). There is also a disincentive to not adopting: if health providers have not switched over by 2015, they may experience a penalty when seeing Medicare or Medicaid patients.

Additionally, providers of electronic records systems are partnering with health providers to make implementation easier.

Patient privacy is the other major concern that needs to be addressed. It will rely on the depersonalization of records, and strong cyber security technology, a necessity for implementation.

Of the physicians, large practices, and hospitals that have already implemented electronic systems, the reviews are overwhelmingly positive: 82 percent said they improved the quality of clinical decisions, 86 percent said they helped in avoiding medication errors and 85 percent said they improved the delivery of preventative care. With help from the government and private industry, the number of health professionals using computerized records is bound to increase in the next few years.

Have you ever used electronic health records? Do you know any doctors who have? How has this affected patient care? Leave a comment and let us know!

And don’t forget to update your own medical records!

Image credit: Ablsa

President Obama's Health Care Reform Speech

Image credit: CBS News

Last night, President Obama addressed a joint session of Congress (and the nation) about health care reform. Pundits from everywhere have put in their two-cents about what the speech means, who it was for, and the merits of specific policy points.

Today on New Voices, we'd like to hear you be the pundits (we'll join in the fun too).

What sections of the speech stood out to you?

How is this like/different from the president's other national addresses?

Do you think the plan has any hope?

The comments section is open for discussion.

Point/Counterpoint: Health Reform

Health reform is the big issue on the congressional agenda this month. With that in mind, we'd like to know:

What five components do you think would be necessary for health reform to be truly successful?

Join us in the discussion section as we debate the issue.

Speak Out for Research Funding Now

"With this much grant money, only experiment we can do is 'flip a coin'!"

Cartoon credit: Vadlo
Thanks to commenter Sarah for the tip!

Increase FY2010 Investment in NIH, CDC, AHRQ and NSF

Urge your members of Congress to support robust funding for NIH, CDC, AHRQ and NSF in FY 2010. With health reform high on the national agenda, now is an ideal time to speak with your representative and senators and let them know that investing in research is critical to the health of Americans and the economy.

Take action now! Meet with, call or write to your delegation in support of a funding increase of at least 10% for NIH in FY 2010 with the goal of reaching an annual appropriation of $40 billion as soon as possible. Other essential investments for research to improve health are increasing CDC's core program budget by $2 billion, establishing a base funding level of $405 million for AHRQ and increasing the NSF budget by 8.5% to $7 billion.

The full House Appropriations Committee will be marking up the Labor, Health, Education, and Transportation and Housing and Urban Development bills on Friday, July 17th at 9:00 AM. The markup will be webcast (though the link may not work until then), so listen to hear how funding may be distributed for FY2010.

Soda as Sin

As we work towards raising the NIH budget and improving the quality and quantity of research in this country, it’s important to think about how it can all be paid for - especially when we take into account the current health care reform proposal set to cost about $700 billion over 10 years. Given the current economic crisis, people are naturally curious about where the government is going to come up with $70 billion a year. One of the most intriguing possible solutions: a soda tax.

As anyone who was ever gone on a diet or attempted to begin a program of regular exercise knows, changing established behavior patterns is difficult even when you know it’s good for you (and sometimes because you know it’s good for you). So the appeal of the soda tax is two fold:

1. It has the potential to provide significant revenue streams to help defray the cost of health care
2. It will discourage people from drinking soda which will have a positive impact on health.

The question then becomes, what does a soda tax have to look like in order to dent the health care costs? And, assuming there is a drop in consumption that corresponds to the price increase, will it help America’s ever expanding waistline?

It’s helpful to compare soda with other items subject to a sin tax: cigarettes and alcohol.

Cigarettes recently underwent a 150% tax increase from $0.40 to $1.01 per pack, but even at the previous tax rate, federal revenues on cigarettes came to approx $15B in 2007. That’s both a lot of money and absolutely shocking number of cigarettes (assuming 20 cigarettes a pack, that’s 750 trillion and an entirely separate health problem).

Alcohol gets a tax rate that differs between beer, wine and spirits, but combined the sin tax brings in around $5B. If we use the beer tax of $0.05 as a guideline for a potential soda tax, we get some large numbers.

Last year Americans consumed 10.2B cases of soda (at 24 cans in a case thats 244,800,000,000 cans). Not diet soda mind you, the incredibly sugary (and better tasting if we’re honest) soda. If we apply the beer tax of $0.05 to this, we get $12.4B in revenue or 19% of President Obama’s proposed health care initiative. This doesn’t affect diet sodas, juices or iced tea. That’s 19% of the massive health care reform taken care of being charging you an extra nickel for your coke.

That's a ten percent increase on a can of soda bought in a 12-pack. In the past a 10% increase in the price of soda saw a decrease in consumption of as much as 8%. Now correlation is not causation, but it’s impossible to look at those numbers and not see that they’re linked.

The economically disadvantaged are most at risk for obesity and part of that is they are the leading consumers of soda. Soda is often the cheapest item in the store.

So, to some degree, the tax targets the economically disadvantaged. But, they stand to benefit the most from the proposed health care reform this kind of economic behavioral incentive is designed to support.

As for those who think this kind of economic incentive doesn’t work, try to remember that 42% of Americans smoked in 1965. 42%. While health awareness campaigns have certainly played a role in the decline, the rising cost of cigarettes (primarily due to taxation) has significantly contributed to the decline of American smokers.

We can’t begin to confront the obesity problem until we begin to confront the sources of that problem. It’s nice to encourage exercise and diet as a means of losing the weight, but the best medicine is the preventive kind. I think if we can cut soda consumption and pay for 19% of a reformed health care system, I say bring it on.

Besides, I’m a juice drinker anyways.


Sources:
All tax data taken from www.taxpolicycenter.org
Price data taken from www.peapod.com