11.20.08
Posted in Uncategorized at 1:41 pm by ceo
WASHINGTON (AP) -- The health insurance industry said Wednesday it will support a national health care overhaul that requires them to accept all customers, regardless of pre-existing medical conditions - but in return it wants lawmakers to mandate that everyone buy coverage.
Lawmakers have signaled their intent to craft health care legislation early next year, and the insurance industry's support would make passage easier. That legislation is expected to closely track the proposals of President-elect Barack Obama. However, Obama separated himself from his Democratic challengers by opposing an individual mandate for adults to buy health insurance.
More lawmakers may agree to a mandate if it means the insurance industry will back those efforts. They'll remember it was the industry's opposition 15 years ago that helped scuttle former President Clinton's health plan.
The board of directors for America's Health Insurance Plans agreed to the trade-off Monday night. The board endorsed the proposal after a series of hearings in various states.
"We hope this will be a contribution to help members of Congress fashion their proposal," said Karen Ignagni, president and chief executive officer of the trade group. "We're going to provide all the technical background that we have assembled, all the experience we've assembled at the state level, and we're going to work very hard with members of Congress on both sides of the aisle. We want to make sure that whatever reforms are advanced, no one falls through the cracks."
Obama's health plan calls for a health insurance exchange, a sort of government-run shopping center where customers could go to select from private plans or a plan administered by the federal government. Any insurer that wants to participate in that exchange must accept all customers regardless of pre-existing health conditions, such as diabetes or heart disease.
Insurers will want to participate in the exchange because government subsidies will make it easier for millions of people to buy coverage from them. But the insurers say experience in the states shows the coverage guarantee often makes it harder for people to find coverage. That's because insurers raised premiums to meet the expense of covering all applicants with chronic health conditions.
"They ended up making the problem much worse," Ignagni said of the state efforts. "The data is clear about the need to have everyone part of the system."
Analysts say Massachusetts is an example where the coverage guarantee has worked well, but it's also a state that requires everyone to buy health coverage or suffer a tax penalty.
Some key Democratic lawmakers have already expressed support for an individual mandate. The concept was a centerpiece of Sen. Hillary Rodham Clinton's health care plan. It was also part of the blueprint offered last week by Sen. Max Baucus, chairman of the Senate Finance Committee.
Chris Jennings, senior health care adviser in the White House during the Clinton years, said it remains to be seen whether the industry will support other key components of health care reform. Nevertheless, he called it an important contribution to the coming debate.
"It sends the signal that broad health reform can happen," Jennings said. "There are so many in Washington who are the gloom and doom prophesiers who believe it's impossible."
However, Consumer Watchdog, a consumer advocacy group, called the insurers' position self-serving.
"If consumer's can't afford coverage or refuse to buy it, they'll face tax penalties. Turning the U.S. government into a collection agency for for-profit health insurers is not universal health care, its full employment for HMO executives," said Jerry Flanagan, the group's health care policy director.
© 2008 The Associated Press.
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Posted in Uncategorized at 1:41 pm by ceo
MIAMI (AP) -- D'Zhana Simmons says she felt like a "fake person" for 118 days when she had no heart beating in her chest. "But I know that I really was here," the 14-year-old said, "and I did live without a heart."
As she was being released Wednesday from a Miami hospital, the shy teen seemed in awe of what she's endured. Since July, she's had two heart transplants and survived with artificial heart pumps - but no heart - for four months between the transplants.
Last spring D'Zhana and her parents learned she had an enlarged heart that was too weak to sufficiently pump blood. They traveled from their home in Clinton, S.C. to Holtz Children's Hospital in Miami for a heart transplant.
But her new heart didn't work properly and could have ruptured so surgeons removed it two days later.
And they did something unusual, especially for a young patient: They replaced the heart with a pair of artificial pumping devices that kept blood flowing through her body until she could have a second transplant.
Dr. Peter Wearden, a cardiothoracic surgeon at Children's Hospital of Pittsburgh who works with the kind of pumps used in this case, said what the Miami medical team managed to do "is a big deal."
"For (more than) 100 days, there was no heart in this girl's body? That is pretty amazing," Wearden said.
The pumps, ventricular assist devices, are typically used with a heart still in place to help the chambers circulate blood. With D'Zhana's heart removed, doctors at Holtz Children's Hospital crafted substitute heart chambers using a fabric and connected these to the two pumps.
Although artificial hearts have been approved for adults, none has been federally approved for use in children. In general, there are fewer options for pediatric patients. That's because it's rarer for them to have these life-threatening conditions, so companies don't invest as much into technology that could help them, said Dr. Marco Ricci, director of pediatric cardiac surgery at the University of Miami.
He said this case demonstrates that doctors now have one more option.
"In the past, this situation could have been lethal," Ricci said.
And it nearly was. During the almost four months between her two transplants, D'Zhana wasn't able to breathe on her own half the time. She also had kidney and liver failure and gastrointestinal bleeding.
Taking a short stroll - when she felt up for it - required the help of four people, at least one of whom would steer the photocopier-sized machine that was the external part of the pumping devices.
When D'Zhana was stable enough for another operation, doctors did the second transplant on Oct. 29.
"I truly believe it's a miracle," said her mother, Twolla Anderson.
D'Zhana said now she's grateful for small things: She'll see her five siblings soon, and she can spend time outdoors.
"I'm glad I can walk without the machine," she said, her turquoise princess top covering most of the scars on her chest. After thanking the surgeons for helping her, D'Zhana began weeping.
Doctors say she'll be able to do most things that teens do, like attending school and going out with friends. She will be on lifelong medication to keep her body from rejecting the donated heart, and there's a 50-50 chance she'll need another transplant before she turns 30.
For now, though, D'Zhana is looking forward to celebrating another milestone. On Saturday, she turns 15 and plans to spend the day riding in a boat off Miami's coast.
© 2008 The Associated Press.
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Posted in Uncategorized at 1:41 pm by ceo
DETROIT (AP) -- Dr. Adrian Kantrowitz, a cardiac surgeon who performed the nation's first human heart transplant and who also developed lifesaving medical implants, has died. He was 90. Kantrowitz died Friday in Ann Arbor of complications from heart failure, said his wife, Jean Kantrowitz.
In 1967, Kantrowitz performed the first human heart transplant in the United States, three days after the world's first was performed in South Africa.
But the transplant, on an infant who died several hours later, was only a small part of his life's work to solve the problem of heart failure, his wife said.
Adrian Kantrowitz invented and for decades continued to improve the left ventricular assist device, or LVAD, which would later lend its name to his Detroit-based research company, L-VAD Technology Inc.
The device is designed to be permanently implanted in patients with otherwise-terminal heart failure, helping their hearts circulate blood and allowing them to leave the hospital.
Kantrowitz also invented other lifesaving cardiac devices, including the intra-aortic balloon pump.
He never retired, and "he never lost his mental alertness," said Jean Kantrowitz. He was an avid pilot, motorcyclist and sailor.
Adrian Kantrowitz was born Oct. 4, 1918, in New York City and attended New York University and the Long Island College of Medicine, now part of the State University of New York Downstate Medical Center.
After serving in the Army Medical Corps during World War II, Kantrowitz entered the emerging field of cardiac surgery. He practiced and conducted research in the 1950s and '60s at Brooklyn's Maimonides Medical Center.
In 1970, Kantrowitz moved his federal funding and entire team of residents and other staff to Sinai Hospital in Detroit to better accommodate his research. Sinai Hospital later merged with another hospital and is now known as Sinai-Grace Hospital.
© 2008 The Associated Press.
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11.19.08
Posted in Uncategorized at 1:40 pm by ceo
WASHINGTON (AP) -- Cosmetic surgery patients who think facial fillers are a magical antidote to aging must be better informed of possible risks, government health advisers said Tuesday.
A panel of independent advisers urged the Food and Drug Administration to revise information for consumers and doctors - called the product label - to include the risk of long lasting reactions such as bumps under the skin, blotches and scars.
"This is almost a no-brainer," said panel member Dr. Michael Bigby, a Harvard Medical School dermatologist. "The current label is not adequate." The panel of doctors other experts unanimously agreed on the need for more safety studies.
The gel-like fillers have become immensely popular with baby boomers. Injected into the face, they smooth away wrinkles. Most patients get a couple of touchups a year, at a cost that can easily exceed $1,000 each.
Manufacturers and plastic surgeons say fillers have an excellent safety record. But Tuesday's FDA hearing raised questions about unapproved uses, untrained technicians giving injections, and a lack of long-term safety data. It was a first step as the FDA considers whether to regulate fillers more closely.
Plastic surgeons pledged to help find a new consensus on how to track safety, improve training and provide clearer information to consumers. "We feel it's time for medicine to step up and take the lead," said Dr. Richard D'Amico of New Jersey, representing the American Society of Plastic Surgeons.
Women, and some men, are drawn to fillers by the promise of youthful good looks for less cost and trouble than a face lift. It's also a boost for deflated middle-age egos.
Different from Botox, which is derived from a toxin that acts on facial muscles, wrinkle fillers are like the biological equivalent of a bit of spackle, except they're injected. They include such products as Juvederm, made by Allergan, Inc., and Restylane, from Medicis Aesthetics Holdings.
FDA officials are concerned that fillers are being used for purposes they were never tested nor approved for, not just erasing wrinkles.These include plumping the lips, cheeks and breasts.
"The trouble is that once this material is in the hands of physicians, there's really not much control over how it's used and where it's placed," said Dr. Scott Spear, a Washington plastic surgeon. "That creates the potential for a certain amount of mischief.
"But the good news is that, by and large, these are very safe materials," Spear added. "They have a very healthy risk profile."
The FDA also has questions how darker-skinned patients fare with the beauty treatments. More black, Latino and Asian patients are trying plastic surgery, and some information suggests they may be susceptible to unsightly blotches and other complications.
Plastic surgeons performed some 1.5 million cosmetic surgery procedures with fillers last year alone.
The FDA presented data on 823 patients who suffered serious reactions after treatment with fillers between 2003 and this September. Nearly all were women, and the most common age group was 50- to 60-year-olds.
Although no deaths were reported, the complications were troublesome enough that 638 of the patients required follow-up medical treatment.
"Patients don't want to get rid of wrinkles and end up with large bumps on the face instead," said consumer activist Diana Zuckerman, president of the National Research Center for Women & Families.
Most cases reported to the FDA involved complications that could be foreseen, such as swelling and redness. But there were also "serious and unexpected" reactions, including facial, lip and eye paralysis, disfigurement, vision problems and some severe allergic reactions.
Nineteen patients went to the emergency room with life-threatening allergic reactions. Twelve developed infections that required hospitalization.
Some problems reported to the FDA may be due to unapproved or "off-label" use of fillers. For example, the FDA does not recommend them for plumping the lips, but some doctors see no problem with that.
Another challenge is the sheer variety of fillers. Most are eventually absorbed into the body, but one type contains tiny, round, smooth plastic particles that the body does not absorb. Some are made from natural substances and others are not. That means they may react differently in the body.
"Some of these products don't have a lot of adverse events and some do," said Zuckerman. "How are we going to help patients make decisions without more information?"
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On the Net:
Food and Drug Administration: http://tinyurl.com/5jtuxv
© 2008 The Associated Press.
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Posted in Uncategorized at 1:40 pm by ceo
LONDON (AP) -- Doctors have given a woman a new windpipe with tissue grown from her own stem cells, eliminating the need for anti-rejection drugs. "This technique has great promise," said Dr. Eric Genden, who did a similar transplant in 2005 at Mount Sinai Hospital in New York. That operation used both donor and recipient tissue. Only a handful of windpipe, or trachea, transplants have ever been done.
If successful, the procedure could become a new standard of treatment, said Genden, who was not involved in the research.
The results were published online Wednesday in the medical journal, The Lancet.
The transplant was given to Claudia Castillo, a 30-year-old Colombian mother of two living in Barcelona, suffered from tuberculosis for years. After a severe collapse of her left lung in March, Castillo needed regular hospital visits to clear her airways and was unable to take care of her children.
Doctors initially thought the only solution was to remove the entire left lung. But Dr. Paolo Macchiarini, head of thoracic surgery at Barcelona's Hospital Clinic, proposed a windpipe transplant instead.
Once doctors had a donor windpipe, scientists at Italy's University of Padua stripped off all its cells, leaving only a tube of connective tissue.
Meanwhile, doctors at the University of Bristol took a sample of Castillo's bone marrow from her hip. They used the bone marrow's stem cells to create millions of cartilage and tissue cells to cover and line the windpipe.
Experts at the University of Milan then used a device to put the new cartilage and tissue onto the windpipe. The new windpipe was transplanted into Castillo in June.
"They have created a functional, biological structure that can't be rejected," said Dr. Allan Kirk of the American Society of Transplantation. "It's an important advance, but constructing an entire organ is still a long way off."
So far, Castillo has shown no signs of rejection and is not taking any immune-suppressing drugs, which can cause side effects like high blood pressure, kidney failure and cancer.
"I was scared at the beginning," Castillo said in a press statement. "I am now enjoying life and am very happy that my illness has been cured."
Her doctors say she is now able to take care of her children, and can walk reasonable distances without becoming out of breath. Castillo even reported dancing all night at a club in Barcelona recently.
Genden said that Castillo's progress needed to be closely monitored. "Time will tell if this lasts," he said. Genden added that it can take up to three years to know if the windpipe's cartilage structure is solid and won't fall apart.
People who might benefit include children born with defective airways, people with scars or tumours in their windpipes, and those with collapsed windpipes.
Martin Birchall, who grew Castillo's cells at the University of Bristol, said that the technique might even be adapted to other organs.
"Patients engineering their own tissues is the key way forward," said Dr. Patrick Warnke, a surgeon at the University of Kiel in Germany. Warnke is also growing patients' tissues from stem cells for transplants.
Warnke predicted that doctors might one day be able to produce organs in the laboratory from patients' own stem cells. "That is still years away, but we need pioneering approaches like this to solve the problem," he said.
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On the Net:
http://www.lancet.com
© 2008 The Associated Press.
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