A vaccine or drug that can prevent healthy, yet high-risk people from developing the memory loss, confusion and other devastating cognitive problems that characterize Alzheimer’s disease is the Holy Grail for researchers, drug companies and patient advocates.

Interest in developing such a treatment is growing as it becomes increasingly clear that physiological changes occur in the brain years, even a decade, before patients experience the cognitive decline that we think of Alzheimer’s disease (AD). What was once deemed “early Alzheimer’s” is now recognized as a much later stage of the disease. And the truth is that dozens of drugs have failed to show efficacy in treating AD and the few available offer only modest benefits for alleviating symptoms. Frustration, paired with new research illuminating the molecular underpinnings and progression of Alzheimer’s is fueling a keen interest in devising drugs that can treat the “clinically silent” phase of the disease; years before cognitive symptoms become apparent. An oft-quoted analogy is heart disease, where preventing atherosclerosis is far more successful than treating heart failure.

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Over at Kevin M.D., Kevin Pho has raised the possibility that health care reformers who are calling for more “large integrated health systems like the Mayo Clinic or Kaiser Permanente” may wind up creating monopolies that have the market clout to charge more—raising the total cost of health care.

Kevin notes that “according to the Dartmouth Atlas” these large integrated health systems “lead to better patient care and improved cost control. . .  To that end, [the idea of ]Accountable Care Organizations has become a major part of health reform . . . But,” he warns, “the creation of these large, integrated physician-hospital entities that progressive policy experts espouse comes with repercussions.

“Monopoly power.

“To prepare for the new model of health care delivery, physician practices have been consolidating. In many cases, they’re being bought by hospitals. Last year, I wrote how this is leading to the death of the private practice physician.

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Today, close to one-third of all babies born in the U.S. enter the world through a slit in their mother’s abdomen, usually just above her pubic bone. Since 1975, the share of mother who undergo a Cesarean has more than tripled, rising from roughly 10.5 percent to nearly 32 percent according the Public Citizen Research Group, a health care watchdog based in Washington D.C.

These numbers have been widely reported, most recently by Leap Frog, the employer-driven hospital quality watchdog. But a central question remains unanswered: Why are so many more women choosing C-sections? Do they have enough information to make informed decisions? What role do physicians and perhaps, most importantly, hospitals play in C-section rates?

The Link between C-Sections and Induced Labor

Today, more and more expectant mothers are scheduling their babies’ births. Rather than leaving the timing to the whims of Mother Nature, they arrange to have their physicians induce labor; using drugs or mechanical devices to ripen the cervix two or three weeks before their due-date. Over the past two decades, the odds that a doctor will jump-start labor have doubled, rising to 22.5 percent of all births, reports the National Center for Health Statistics (NCHS).

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Below, a guest post from the Center for Public Integrity, one of the country’s oldest and largest nonprofit news organizations. The Center’s mission is to produce “original investigative journalism about significant public issues to make institutional power more transparent and accountable.”  Recently the Center has begun partnering with other news outlets, including the Wall Street Journal, Newsweek and the Daily Beast, to provide the in-depth investigative reporting that the vast majority of newspapers and magazines in our downsized news industry can no longer afford.

Here I am cross-posting a large chunk from a piece which focuses on how “Digital Mammography Saps Medicare Dollars.”  The subtitle reads: “How GE, Others Used Political Muscle, Advertising to Lure Medicare into the New Procedure.” 

For regular Health Beat readers, the second half of the story will be eye-opening. (Scroll down to “A Promising New Technology”).  Most of you know that our health care system  is suffering from what some call “an epidemic” of testing, but few journalists have written about the role that lobbyists for corporate giants such as GE have played in making hospitals feel that they have no choice but to buy exorbitantly expensive, and not always fully tested, medical equipment.

Click on the link to read the full story.

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Last month I wrote about the Mental Health Parity law that requires insurers to provide equal coverage for both medical and mental health services. When health reform rolls out fully in 2013, many Americans with expanded access to private health insurance will have more equitable coverage for treatment of depression, attention disorders, addiction problems and other serious mental health ills. But parity laws that apply to private insurance will do little to advance the plight of the growing portion of our population that is seriously—and chronically—mentally ill, often homeless and increasingly showing up in the criminal justice system.

According to the Department of Justice, 14.5% of men and 31% of women recently admitted to jail have a serious mental illness. Applied to the 13 million jail admissions reported in 2007 (the most recent figure), the findings suggest that more than 2 million individuals with a serious mental illness may be locked-up annually. In many cases they cycle in and out of the criminal justice system; with a stop on the way to the emergency room or for hospitalization. It’s an expensive and futile exercise.

With all the emphasis on health reform and discussion centering on a vast overhaul of how we deliver, pay for and mandate medical care, the plight of the seriously mentally ill gets short-shrift. But that doesn’t mean there isn’t a real crisis in funding (especially at the state level) and treatment–or that there isn’t a wave of reform coursing through the mental health field. It’s just that without the loud voices of lobbyists from doctor, pharmaceutical and hospital organizations and powerful patient advocates, the mental health field is reform’s poor step-sister—beyond insurance parity, very few provisions in the Patient Protection and Affordability Act address chronic, serious, mental illness.

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We all have heard that “spending more” on health care does not necessarily lead to better care. In fact, in regions of the country where care is more intensive and more expensive, sometimes outcomes are worse. This is the basic thrust of what has become known as the “Dartmouth research,” and most medical researchers agree.

But a paper just published in the Annals of Internal Medicine suggests that specific types of higher hospital spending may lead to better outcomes. After examining the records of some 2.5 million patients admitted to 208 California hospitals from 1999 to 2008 a group of researchers from the University of Southern California and Harvard Medical School report that patients who received more costly and aggressive care were less likely to die while in the hospital.

Let me be clear: this study is not trying to prove that the Dartmouth research is “wrong." The investigators, led by John Romley of the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, begin by acknowledging that “a convincing set of studies demonstrates that U.S. regions that spend more on medical care–using more specialists, diagnostic tests, imaging, and inpatient hospital care–have similar or poorer patient outcomes than areas that spend less. (Here they footnote the Dartmouth Atlas and this article by Dartmouth’s Elliott Fisher, et.al. 

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J. D. Kleinke is a medical economist, author, and health information industry pioneer, and the author of a new book, Catching Babies.

Over at The Health Care Blog, he has published one of the best essays I have ever read revealing “how little obstetricians really know – and how limited the specialty is in its ability to test and expand that knowledge – thanks in part to the visceral fear inspired in patients by statements like ‘a normal pregnancy is a retrospective diagnosis.’”

While protecting the name of his sources, he describes what happens when “Hannah’s” labor does not proceed as quickly as expected:

“Hannah is starting to weary of the process, and she’s hungry; they have put her on a restrictive diet, of course, assuming she will soon go into labor and deliver. When her blood sugar starts dropping, they let her go back on solid food. Her energy picks up, enough to start arguing that maybe she should just go home and wait. ‘Maybe this is a sign that Sam is fine,’ she says, ‘and he just doesn’t want to be born yet.’

“The Kaiser people get wind of our conversation when they walk in to check her IV, and send in the CNM who has just begun her shift.

“She runs through the same argument that had brought Hannah in two days earlier “This time, Hannah argues back.

“’Do you know what could happen, if you wait?’ the CNM finally says with an impatient sigh. ‘Your baby – he could be – stillborn.’”

What can Hannah say?  She is put through the agony of an induced labor:

“The artificially induced contractions are severe, throwing her from the bed. The pain is too intense, and Hannah finally relents and agrees to an epidural, which will numb her from the midsection down and cut her off from the core sensations of the birthing process . . .”

Read the entire post here.

Well, Wisconsin Attorney General, J.B. Hollen didn’t use those words exactly. But on Wednesday, his office released this brash statement; “for Wisconsin, the federal health care law is dead—unless and until it is revived by an appellate court. Effectively, Wisconsin was relieved of any obligations or duties that were created under terms of the federal health care law.”

Hollen was no doubt emboldened by this week’s ruling in Florida by district court judge Roger Vinson that the entire health care reform law is unconstitutional. This decision went beyond Judge Henry Hudson’s ruling in a Virginia court in December that found only the individual mandate to be unconstitutional. “This is a radical decision,” Timothy Jost, a law professor at Washington and Lee University School of Law writes in his analysis of the ruling in Health Affairs. “Judge Vinson has a clear vision of the limited federal government the founders intended that is very much in line with that espoused by the Tea Party Movement…He has thrown down the gauntlet.”

The ruling has emboldened others besides Wisconsin to swear off implementing reform. Florida Governor Rick Scott announced that he would wait for further court rulings before beginning to take any action to carry out the health law. And the Florida insurance commissioner Kevin McCarty wrote to federal officials on Tuesday letting them know that the state will return a $1 million grant intended to help it prepare for reform by setting up a system that would let consumers compare insurance plans. Wisconsin also announced it’s sending back the money. Finally, Minnesota’s Governor Tim Pawlenty issued an executive order barring state officials from participating in the ACA without express approval from his administration.

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Health care information technology [HIT] “is not ready” warns Dr. Scot Silverstein, a clinical IT expert on the faculty at Drexel University’s College of Information Science and Technology. Writing on Roy Poses’ Health Care Renewal at the end of last week, Silverstein argued that Health IT “is dangerous in unqualified hands, which most every medical center and physician office is in 2011 (i.e., an IT backwater).

“The field of health IT [has] somehow [been] transformed from an experimental field into the 'savior of medicine’” Silverstein added, “without the proof of value and safety that would ordinarily be required to move an experimental technology from lab to national rollout. Per the Washington Post, this process appears to have been a highly politicized one, favoring the corporate elites. The Washington Post’s 2009 article on the influential HIT vendor lobby ‘The Machinery behind Healthcare Reform’ is at this link.”

Set Silverstein’s words side by side with what software expert Dan Fornes had to say on The Health Care Blog yesterday, where he reported that vendors selling health care software are “spending like crazy,” and a larger picture begins to emerge.

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The Mental Health Parity and Addiction Equity Act passed by Congress in 2008 was hailed as “a milestone in the quest for civil rights, an effort to end insurance discrimination and to reduce the stigma of mental illness.”

This law, which finally took effect in July 2010, prohibits large group insurance plans from placing coverage or treatment limits on mental health and substance abuse services that are more restrictive than those imposed on medical and surgical services. The Parity Act also prevents these plans from requiring patients to pay a larger share of mental health charges in terms of deductibles and co-payments. When the legislation first passed, federal officials predicted that some 113 million Americans would have better access to behavioral health services—82 million of those through their employer health plans.

Under the Patient Protection and Affordable Health Care Act, mental health parity is now set to be extended to millions more Americans. Most significantly, all insurance plans sold on the state exchanges in 2014—available to individuals and smaller companies with fewer than 50 employees who were exempt from the 2008 Parity Act—will have to offer coverage for mental health services that is on par with medical and surgical services. Some of the 32 million currently uninsured people who will newly qualify for Medicaid benefits will also have mental health parity—but only if they are enrolled in managed care plans.

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