by Bill Barrow,
The Times-Picayune
AP file photo
Charity Hospital has been
closed since Hurricane Katrina in 2005.
A group that has
criticized plans for construction of a new teaching hospital in lower Mid-City
is touting a poll it commissioned that suggests New
Orleans voters prefer by a two-to-one margin gutting Charity Hospital and building within its
shell.
Of the 500
registered voters included in the results -- about 100 from each of the
city's five Council districts -- 60 percent said they favored the Charity
location downtown. Thirty percent opted for the state's existing plans for a
424-bed, $1.2 billion complex north of South Claiborne Avenue, between Tulane Avenue and
Canel
Street.
The poll was conducted
for Smart Growth Louisiana by Ed Renwick of the Loyola Institute of Politics.
Smart Growth is among the planning, neighborhood and community organizations that has criticized the planning process and
site selection for the hospital project, including pushing Gov. Bobby Jindal to reassess the viability of reusing the Charity
shell.
The results carry
a margin of error of plus or minus 4.5 percentage points.
Almost six out of
10 respondents said they had heard "a lot" about the state's
proposal, which still awaits land acquisition and complete financing. Another
third said they had heard "a little." Eight out of 10 said they
were familiar with the Charity alternative, with more than half of that group
saying they had heard "a lot" about the idea and the remainder
"a little."
The poll did not
ask about the proposed U.S. Department of Veterans Affairs hospital planned
in lower Mid-City adjacent to the state footprint.
Smart Growth
officials say they plan to present the results to elected and appointed
officials at various levels of government, all of which are on board with the
Mid-City plan.
http://www.nola.com/politics/index.ssf/2009/08/poll_suggest_orleans_voters_pr.html
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The New Orleans Mental Health Crisis, Exposed
Harry Shearer
Sometimes,
journalism consists of "discovering" things that everybody knows --
at least, everybody in the affected area -- but that have
slipped off the national radar screen. Such is the case with a remarkable
three-part series this week in -- wait for it -- the Washington Times.
Yes, the paper
owned by you-know-who has reported on one of the two long-running crises in
New Orleans that have been ignored by the national media since so-called
Katrina fatigue set in: the mental health crisis among the city's population.
(The other long-running crisis, in affordable rental housing after the flood
damaged or destroyed 80,000 units, remains undiscovered by outsiders.)
The Times stories
focus on all the salient points of the mental health mess: the long-term
depression of many Katrina survivors, the degree to which the crime rate is
swelled by mentally-disturbed people acting out, the heroic efforts of police
crisis units and volunteer organizations to find and help people who can't
seek out help themselves, and the increasing disparity between the need and
the resources available for care and help.
All this is
welcome, if overdue, and admirable.
And yet...Even
from three reporters who've been in New
Orleans for weeks researching these articles there
is a remarkable lapse: a failure to explain why the disaster happened, why
the city was inundated. Instead, in addition to the numerous references to
"Katrina's floodwaters", there is, in the series' second article,
this strangely bland sentence:
"City, state
and federal agencies have pointed fingers at one another for four years,
seeking to lay blame for the failure of the levees that allowed the
floodwaters to wash over the city."
In two words, not
true. The United States Army Corps of Engineers, in its June, 2006 IPET
report, acknowledged what had already been amply documented in the ILIT and
Team Louisiana reports, namely, that Katrina was not a natural disaster in
New Orleans (as it was on the Gulf Coast), but rather a massive, catastrophic
failure of poorly designed and constructed levees and floodwalls -- a project
under the supervision and control of the ACE. Odd that a paper in Washington, home of
the Corps, would choose to ignore, and obscure, these facts.
Do we have to wait
four more years for a non-New Orleans
newspaper to discover them?
What the city,
state and feds have been fighting about, in fact, has been the fate of
downtown's large and iconic Charity
Hospital, flooded but
(according to doctors who worked there) not destroyed. Closed since the
flood, it's been the subject of a tug of war between LSU, which ran the
Charity Hospital system and which desires to build a new hospital in a new
location, and FEMA, which has resisted paying the tab for the replacement.
(And the Bush Administration actively sought the closing of hospitals like
Charity, part of a "two-tier" system that specifically served the
working poor and indigent -- for ideoglogical
reasons) Charity, many knowledgeable people report, could be reopened more
cheaply than the cost of the new hospital LSU wants. While this fight goes
on, the folks once served by Charity (including the mentally ill) go ill- or
un-served.
And the Obama
Administration's response to all this? Are those crickets I hear?
Yes, I know, he's
"only been in office six months." And, of course, the presidency
gets less complicated as you go along, doesn't it?
http://www.huffingtonpost.com/harry-shearer/the-new-orleans-mental-he_b_251714.htm
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LSUHSC's
O'Brien receives singular national dental teaching honor
LSUHSC
Michael E. O'Brien
DDS, JD, Clinical Associate Professor and Director of Predoctoral
Studies in the Department of Oral and Maxillofacial Surgery at LSU Health
Sciences Center New Orleans School of Dentistry, has been selected as the
recipient of the 2009 Daniel M. Laskin Award by the
American Association of Oral and Maxillofacial Surgeons. The award recognizes
the "Outstanding Predoctoral Educator in
OMS" (Oral and Maxillofacial Surgery).
The recipient must
have exemplified the highest ideals of an educator, be respected by his peers
in education, have fostered an excellent relationship between the
undergraduate faculty and students with the oral and maxillofacial surgery
residency program and oral and maxillofacial surgeons in the community, have
been actively involved in efforts to improve undergraduate education as well
as residency and continuing education, both locally and nationally, and be
respected and admired by his current and former students.
"This
national honor recognizes the excellence of the dental education at Louisiana's only dental school," notes Dr. Henry Gremillion, Dean of the School of Dentistry
at LSU Health Sciences Center New Orleans. "We are proud of Dr. O'Brien
and what he contributes to each new generation of Louisiana dentists."
Dr. O'Brien
received his pre-dental requirements from Louisiana State
University. He attended
Loyola University Dental
School and graduated
in1970 with a DDS degree. His honor societies included C. Victor Vignes, OKU and Alpha Sigma Nu. He then completed an
internship and residency in Oral and Maxillofacial Surgery at Charity Hospital in 1973 and was the chief
resident in his final year. Dr. O'Brien is a diplomate
of the Board of Oral and Maxillofacial Surgery and the Board of Dental
Anesthesia. He is a fellow of the American, Southeastern, and Louisiana
Societies of Oral and Maxillofacial Surgery and now serves as President of
this organization. He is also a member of the American, Louisiana, and New Orleans Dental
Societies and the American Dental Society of Anesthesia.
Dr. O'Brien has
been associated with the LSUHSC School of Dentistry in various part time
capacities for the past twenty-five years. He joined the full time faculty in
2001. In addition to teaching students, Dr. O'Brien also teaches a variety of
continuing education oral surgery courses including all types of anesthesia,
medical emergencies in the dental office, and malpractice lectures.
Prior to teaching
full time, he was in full scope private practice as an Oral and Maxillofacial
surgeon. During that time, Dr. O'Brien also graduated from Loyola Law
School in 1998 and has
served as an attorney for the Louisiana State Board of Dentistry. He still
does some work with the board including the inspection of offices to certify
them for the administration of intravenous conscious sedation and also as a
consultant on difficult and complicated dental disciplinary cases.
He is published in
the Triple-O Journal of Oral and Maxillofacial Surgery and is the recipient
of the 2006 Allen Copping Excellence in Teaching Award for Dentistry.
Dr. O'Brien will
receive the Daniel M. Laskin Award during the 91st
American Association of Oral and Maxillofacial Surgeons Annual Meeting Awards
and Opening Ceremonies in Toronto
on October 14,
2009.
http://www.physorg.com/wire-news/10953277/lsuhscs-obrien-receives-singular-national-dental-teaching-honor.html
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Louisiana creates loan program for EHR purchases
By Pamela Lewis Dolan,
AMNews staff.
The plan will rely
on federal grants and build on previous state efforts to expand health IT
adoption in underserved rural areas.
Louisiana Gov.
Bobby Jindal signed into law a bill that would
create a loan program for physicians and hospitals hoping to buy an
electronic health record system.
The Electronic
Health Records Loan Program Act, signed July 9, gives the Louisiana Dept. of
Health and Hospitals the authority to apply for $25 million in federal
stimulus funds in order to administer loans for EHR purchases. The measure
also included $5 million in matching funds from the state, a requirement under
the American Recovery and Reinvestment Act. The state will learn later this
year if it will get the federal grant.
"This is
another step in updating and improving Louisiana's
health delivery system for all Louisianians," Jindal said in a prepared statement.
The measure builds
on legislation passed in 2007 that helped seven rural hospitals acquire EHRs. The law also established the Louisiana Rural Health
Information Exchange. In 2008, additional funding allowed another seven rural
hospitals to become connected.
To qualify for the
loans, the purchased EHR system must be certified by the body eventually
chosen by the U.S. Dept. of Health and Human Services for such approval.
Loans could also apply to fully integrated telemedicine systems.
Acknowledging
upfront costs are a barrier that the incentives wouldn't help alleviate, many
EHR vendors also launched financing options for physician practices as a
result of the stimulus. General Electric Co., for example, is giving
practices the options of deferring payments until incentives start being paid
in 2011.
Jenny Smith,
health information technology project manager for the Louisiana Health Care
Quality Forum, which is the state-designated entity for distributing all
grants coming out under the federal stimulus package, said details are still
being worked out in terms of the loan agreements. Work groups consisting of
several stakeholders in the state are currently working on structuring the
loan program, she said.
"The goal is
to maximize the amount of support we can give to providers in Louisiana who
couldn't otherwise purchase an electronic health record or upgrade their
electronic health record to meet the meaningful-use criteria for the
incentives," Smith said.
Once the state has
reached 100% compliance, Smith said, the fund would likely be used for
support such as upgrading systems or training.
http://www.ama-assn.org/amednews/2009/08/03/bise0806.htm
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As the medical community in the Alexandria metro area continues to grow,
so, too, do the opportunities for patients and the challenges for those in
the business of providing health care.
That is good news for consumers, who want to manage their
own health care and who see competition as an appropriate and effective means
of controlling costs.
Among the more pronounced challenges for those who work in
the industry is the increased availability and use of ambulatory surgery
centers, known as ASCs.
The number of surgery centers nationwide has exploded in
the past 25 years as more people have chosen to have out-patient surgery and
other medical procedures done at a center. In 1980, according to American
Medical News, there were 275 ambulatory surgical centers in the United States.
In 2003, there were 3,700.
At the same time, more doctors are referring patients more
frequently to surgery centers for a variety of reasons, not the least of
which is this: More physicians either own or have other business relationships
with a surgery center.
Such is the case with the Central Louisiana
Ambulatory Surgical
Center on La. Highway 1
North near MacArthur Drive.
The facility, owned by two dozen local physicians, is both busy and
successful with its menu of out-patient services -- so much so that the
owners are expanding the center significantly so they can perform procedures
that require overnight stays.
The expansion, which is well under way, will allow the
center to increase the number and type of procedures it chooses to provide.
"Chooses" is important.
The project, to be completed in 2010, will change the
medical landscape, a fact that is not lost on the region's full-service
hospitals -- Christus St. Frances Cabrini Hospital,
Rapides Regional Medical
Center and, to a lesser
extent Huey P. Long Hospital.
The migration of selected services from hospitals to
surgery centers, taking place nationwide, concerns some hospital
administrators. They do not get to pick and choose the people they treat.
Instead, they are required to treat all patients -- regardless of condition
and ability to pay. That meets a doctor's Hippocratic Oath to "do no
harm," but it leaves lots of uncompensated care, a huge cost for any
hospital.
That dynamic holds significant potential repercussions for
patients and providers everywhere. It is an industrywide
phenomenon that is accelerating health care's evolution -- one that is
clearly visible here in Central Louisiana.
http://www.thetowntalk.com/article/20090806/OPINION/908060315
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Jimmie Jossey
After reading numerous letters to the editor about how the
government would ruin health care, I wonder if the writers live under the
same United States
government that I do -- the one that said it would put a man on the moon in
10 years, the one that saved the world in two World Wars.
This same government stepped in when no one could get
flood insurance without paying astronomical sums and started the national
flood insurance program. Think where South Louisiana
would be without it today!
The insurance companies are putting out bad information
and swaying our congressmen with campaign donations. Are we really so worried
about them having a little competition that might cut in to their profits?
Or are people in this country compassionate enough to
think of everyone, not just themselves?
Consumer Reports, which backs the government plan, says
that without reform, by 2010 a fifth of Americans will have no health
coverage.
Jimmie Jossey
Slidell
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-14/1249536748306950.xml&coll=1
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Tim Page
Mistrust of government is one thing (maybe the only thing)
liberals and conservatives have in common. And none of us likes it when our
elected leaders “spin” the truth to cater to special-interest groups.
Unfortunately, our congressman, U.S. Rep. Cassidy, R-Baton
Rouge, appears to be doing just that on health-care reform.
According to the Center for Responsive Politics, the
health-care industry is Congressman Cassidy’s largest campaign contributor.
So maybe it shouldn’t be surprising that Congressman Cassidy’s recent mailer
repeated the same fear-mongering propaganda put out by that special-interest
group to defeat any meaningful health-care reform that might cut into its
profits.
Congressman Cassidy calls the Democratic-proposed
health-insurance reform a “government takeover” and says that “over 114
million Americans would lose their current health coverage” with Democratic
plans.
What Congressman Cassidy doesn’t say is that this bogus
figure was put out by a company wholly owned by one of the country’s biggest
health insurers.
No independent research organization agrees with that
figure. In fact, the Congressional Budget Office says that the Democratic
health reform actually would increase coverage for 37 million previously
uninsured people and that the number of employer-insured people would also
increase.
Yes, we all mistrust government, but why on Earth should
we trust insurance companies more? At least with government oversight of
health care, there would be public accountability if you ran into problems
with your coverage.
As we all know, our present system is just fine, if you
are lucky enough to be employed at a good job and also if you never get
seriously sick. Otherwise, you have no guarantee of keeping your coverage.
That’s how the insurance companies manage health care.
It’s time for a change.
Tim Page
educator
Baton Rouge
http://www.2theadvocate.com/opinion/52563457.html
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Shreveport Times | 08.06.09
What do you do if your toddler eats a stick of deodorant?
Your teenager is bitten by a snake? Your spouse accidentally takes too much
medication?
The advice has always been to call the poison control
center. Between 70 and 80 percent of poisoning incidents can be treated at
home, and the center's trained experts can walk callers through appropriate
first aid or call an ambulance if needed.
But at the end of the year, Louisiana's
Poison Control
Center, based in Shreveport, may close because of a 50
percent cut in state funding. Director Mark Ryan says that's just not enough
money to provide any quality service from the 24-hour center.
The cut is another example of state officials not seeing
the big picture in budget decisions.
Nationally, reports of poisonings are increasing with a 46
percent increase in calls between 2000 and 2007, according to the American
Association of Poison Control Centers.
In Louisiana,
the 12-person staff — including a rare board-certified toxicologist — now
operates a hot line serving the entire state. Last year it accepted 113,000
calls, 20 percent of which came from hospitals looking for expert advice on
treatment.
When someone calls the national hot line, they are routed
to state poison control centers. If Louisiana's
center closes, Ryan said, no other state will be able to pick up the calls
and they will go unanswered.
"Those calls largely will go to 911," Ryan said.
"And 911 doesn't have the expertise to handle
these cases, so they'll dispatch EMS. EMS is not in position to make the decision on
treatment, so they'll transport to the hospital."
The association also reports that each dollar spent on a
poison center saves about $7 in unnecessary health care expenses. And on
average, patients helped by poison centers experience shorter
hospitalizations at a median stay of 3.5 days versus 6.5 days without poison
center assistance.
When the center closed in the 1980s because of funding
shortfalls, emergency rooms visits jumped by more than 20,000, Ryan said. If
it closes this year, he expects more than 35,000 additional emergency room
visits from panicked patients.
Poison Control is not just about household concerns. The
center also plays an integral role in Office of Emergency Preparedness and
Homeland Security plans. If a toxin were released on a mass scale, the center
has authority to diagnose and release antidotes.
It also helps authorities manage concerns in case of a
hazardous materials spill. Just last month, a leak from Dow Chemicals near New Orleans, caused a
surge in calls.
To continue operating Ryan has asked the state to find
$500,000, some of which would be federal matching funds.
Poison Control Centers have long been the least noticed of
emergency responders but they fill a vital role in responding to life's
accidents and for major chemical emergencies. Staff
members go through a year of specialized training and follow up on calls to
make sure issues are resolved.
That kind of expertise is worth the cost.
http://www.shreveporttimes.com/article/20090806/OPINION03/908060303/1058
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New Orleans Adolescent
Hospital would lose 74 positions under plan
by Ed Anderson and Bill Barrow
BATON ROUGE -- The State Civil Service Commission approved
a plan Wednesday to abolish 74 jobs at the soon-to-be-closed New Orleans Adolescent Hospital,
including laying off 49 workers by the end of
business Aug. 14.
"It includes a multitude of positions, " ranging from registered nurses to clerical
workers, state Civil Service Director Shannon Templet
said.
Sybil Richard, deputy secretary of the Department of
Health and Hospitals, said the layoffs will involve "a real mix of
people . . . a cross-section" of the jobs at the hospital, including
administrators, clerical help, counselors and doctors now at the Uptown
facility.
Department of Health and Hospitals officials said that
they want to close the Uptown mental health facility by Sept. 1, transferring
the in-patient services to the Southeast
Louisiana Hospital
in Mandeville, and opening two outpatient clinics, one in Algiers and one in Mid-City.
Gov. Bobby Jindal vetoed a $14.2
million appropriation for the 35-bed hospital, saying moving in-patient
facility treatment to Mandeville will save $9.1 million without the overall
loss of services.
The plan approved by the commission Thursday shifted 101
filled positions and 21 vacant ones to Mandeville, Templet
said. Before the layoff and job reductions took place, she said, the hospital
was allocated 233 positions.
"The numbers may fluctuate a little bit but probably
very minimally, " Templet
said of those to be laid off.
Richard said six of the employees who were scheduled to
move to Mandeville have decided to retire, freeing up six positions that can
be offered to those to be laid off.
About 60 workers are expected to remain in New Orleans to help
staff the outpatient clinics, Richard said.
New Orleans
lawyer Willie Zanders filed suit July 10 asking an
Orleans Parish Civil District Court judge to halt the closing of the
hospital, contending that it would violate the legal rights of patients and
employees. The lawsuit has been moved to the 19th Judicial District Court in Baton Rouge for a
hearing.
Zanders appeared before the
commission to ask that layoffs be delayed until after the lawsuit is
resolved. "It's a disrespect to the judicial system,
" he said afterward. Zanders said he is
considering adding the Civil Service Commission as a defendant to the lawsuit
suit, alongside Gov. Bobby Jindal, state Health
Secretary Alan Levine and other state officials.
http://www.nola.com/health/index.ssf/2009/08/new_orleans_adolescent_hospita.html
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by Philip Timothy
PINEVILLE, La. (BP)--Louisiana College
has announced plans to open a medical school in 2012. The new program, which
is expected to have an initial class of 60 students and grow to 110 incoming
students per year, has a proposed $30 million annual operational budget.
While a new medical school is a major undertaking for the
college, which itself has an annual budget of $20 million for its four-year
programs, Louisiana College president Joe Aguillard
believes it will meet a significant need in the state, which ranks among the
worst in the nation in percent of population lacking access to primary care
-- due mainly to a critical shortage of primary care doctors.
The project "is a huge endeavor," said Aguillard in a July 23 announcement of the new school.
"The operational budget and massive number of employees will dwarf what
we presently have here at the college now.
"During the feasibility and economic impact studies,
we engaged many health care leaders in our community, throughout the state
and across the nation," Aguillard added.
"We discovered that although this is going to be a tremendous
undertaking, it is one that can clearly be accomplished with the partnership
of area hospitals, foundations, and other health care entities."
Using funds from an anonymous donor, the school
commissioned a feasibility study to determine the feasibility of establishing
a medical school at Louisiana
College. After studying
the report, the college's board of directors voted unanimously July 21 to
move ahead with the project. Louisiana
College started a School of Allied Health
last year, is opening a new, 7,000-square-foot laboratory building for its
nursing program and is planning to open a law school in 2011.
Aguillard expects to have a
business plan formulated by the end of 2009 and raise $5 million by
Christmas. That would allow the college to hire a dean and some faculty
members to start forming a curriculum.
The consultants retained to do the feasibility study found
a significant need for medical training in the state. The three medical
schools in the state -- Tulane, LSU-New Orleans and LSU-Shreveport -- had
more than 10,000 applicants in 2008 and accepted less than 500.
"Thousands of kids are not getting in," said
Jarrett Flood, founder and president of Flood International Consulting Agency
in Baton Rouge.
"They're going overseas for their education. At the same time, there is
a critical shortage of physicians, and Louisiana
is not going to be able to pull them from other states. If you keep them in Louisiana, train them at Louisiana
College, they do their residency in Louisiana, they are
going to most likely stay here."
Louisiana
College already has a
strong pre-med program. During the past four years, 92 percent of the
college's applicants to medical school have been accepted with an entrance
exam score above 30. That places the pre-medical training program at Louisiana College
as one of the best in the southern region of the United States.
The economic impact of the new medical school in central Louisiana is expected
to reach $1.1 billion by 2025. The total employment impact is predicted to be
6,702 jobs.
While the price tag appears to be a steep one for a mostly
rural area and a small college to support, the consultants believe funding
can, and will, come from a variety of sources, most notably in the form of
grants and donations.
"It requires three parts to make it work," said
Paul Umbach, founder and president of Tripp Umbach. "The most important is philanthropic giving
-- individuals and foundations who want to see health care improve in the
area, who care about the quality of life and
economic development in the community. Since it is an economic development
project in its own right, you have state and other sources of economic
development funds. The third is what all the partners can pull together,
including the hospitals and other health care providers and groups."
http://www.bpnews.net/BPnews.asp?ID=31019
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The New York Times | 08.05.09
By JAMES D. WATSON
Cold Spring
Harbor, N.Y.
THE National Cancer Institute, which has overseen American
efforts on researching and combating cancers since 1971, should take on an
ambitious new goal for the next decade: the development of new drugs that
will provide lifelong cures for many, if not all, major cancers. Beating
cancer now is a realistic ambition because, at long last, we largely know its
true genetic and chemical characteristics.
This was not the case when President Richard Nixon and
Congress declared a “war on cancer” more than 35 years ago. As a member of
the new National Cancer Advisory Board, I argued that money for “pure cancer
research” would be a more prudent expenditure of federal funds than creating
new clinical cancer centers. My words, however, fell on deaf ears, and the
institute took on a clinical mission. My reward for openly disagreeing was
being kicked off the advisory board after only two years.
While overall cancer death rates in the United States began to decrease
slowly in the 1990s, cancer continues to take an appalling toll, claiming
nearly 560,000 lives in 2006, some 200,000 more fatalities than in the year
before the War on Cancer began. Any claim that we are still “at war” elicits
painful sarcasm. Hardly anyone I know works on Sunday or even much on
Saturday, as almost no one believes that his or her current work will soon lead
to a big cure.
A comprehensive overview of how cancer works did not begin
to emerge until about 2000, with more extensive details about specific
cancers beginning to pour forth only after the 2003 completion of the Human
Genome Project (a breathtaking achievement that the Italian-born virologist
and Nobel laureate Renato Dulbecco foresaw in 1985
as a necessary prerequisite for a deep understanding of cancer). We shall
soon know all the genetic changes that underlie the major cancers that plague
us. We already know most, if not all, of the major pathways through which
cancer-inducing signals move through cells. Some 20 signal-blocking drugs are
now in clinical testing after first being shown to block cancer in mice. A
few, such as Herceptin and Tarceva,
have Food and Drug Administration approval and are in widespread use.
Unfortunately, virtually none of these new drugs leads to
a lifelong cure. In most instances, they can offer only modest extensions in
survival time. This is partly because there are often many types of cancer-causing
genetic “drivers” within single cancer cells. While getting a DNA diagnosis
for the drivers of every individual cancer would help us to prescribe more
specific regimens of chemotherapy, given the inherent genetic instability of
most cancer cells, the use of drugs acting against single drivers would all
too soon lead to the emergence of genetic variants driven by increasingly
destructive second, if not third, drivers.
Most anticancer drugs, then, will probably never reach
their full potential unless they are given in combination with other drugs
developed against second or even third drivers. Yet current F.D.A.
regulations effectively prohibit testing in combination new drugs that, when
given alone, have proved ineffective.
While targeted combination chemotherapies would be a big
step forward, I fear we still do not yet have in hand the “miracle drugs”
that acting alone or in combination would stop most metastatic cancer cells
in their tracks. To develop them, we may have to turn our main research focus
away from decoding the genetic instructions behind cancer and toward
understanding the chemical reactions within cancer cells.
The idea that cancer cells may be united in having a
common set of molecules not found in most other cells of our bodies was first
proposed by the great German biochemist Otto Warburg. In 1924, he observed
that all cancer cells, irrespective of whether they were growing in the
presence or absence of oxygen, produce large amounts of lactic acid. Yet it
wasn’t until a year ago that the meaning of Warburg’s discovery was revealed:
The metabolism of cancer cells, and indeed of all proliferating cells, is
largely directed toward the synthesis of cellular building blocks from the
breakdown products of glucose. To make this glucose breakdown run even faster
in growing cells than in differentiated cells (that is, cells that have
stopped growing and taken on their specialized functions in the body), the
growth-promoting signal molecules turn up the levels of the “transporter”
proteins that move glucose molecules into cells.
This discovery indicates that we need bold new efforts to
see if drugs that specifically inhibit the key enzymes involved in this
glucose breakdown have anti-cancer activity. In the late 1940s, when I was
working toward my doctorate, the top dogs of biology were its biochemists,
who were trying to discover how the intermediary molecules of metabolism were
made and broken down.
After my colleagues and I discovered the double helix of
DNA, biology’s top dogs then became its molecular biologists, whose primary
role was finding out how the information encoded by DNA sequences was used to
make the nucleic acid and protein components of cells. Clever biochemists
must again come to the fore to help us understand the cancer cell chemically
as well as we do genetically.
While the major pharmaceutical and biotechnology
corporations have the financial means to exploit their most promising drug candidates, that is not true of many of the smaller
biotechnology companies that are doing highly innovative work. Their
financing from venture-capital firms has drastically dwindled in this
recession. The National Cancer Institute should come to their rescue,
providing funds that will let their products move through animal testing to the
exploratory phases of clinical testing in humans.
At the same time, the institute should provide much more
money to major research-oriented cancer centers to let them take on the low
probability-high payoff projects that pharmaceutical giants and, increasingly
now, the big biotech companies almost reflexively turn down.
Restarting the War on Cancer has to start at the top: in
1971, Congress decided that the president, not the head of the National
Institutes of Health, should appoint the director of the National Cancer
Institute. Yet like all too many outposts of the White House, the institute
has become a largely rudderless ship in dire need of a bold captain who will
settle only for total victory. President Obama must choose strong new
leadership for the institute from among our nation’s best cancer researchers;
it also needs a seasoned developer of new pharmaceuticals who can radically
speed up the pace at which anticancer drugs are developed and clinically
tested.
I expect that my views will provoke rebuttals from
prominent scientists who feel that it’s not yet the time to go all out
against cancer, and that until victory is more certain we should not further
tap our limited coffers for more big-cancer money. While they are right that
victory will not come from money alone, neither will it come from biding our
time.
James D. Watson, a winner of the 1962 Nobel Prize in
Physiology or Medicine, is the chancellor emeritus of Cold Spring Harbor
Laboratory.
http://www.nytimes.com/2009/08/06/opinion/06watson.html
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The New York Times | 08.05.09
By RONI CARYN RABIN
Adults who had just slightly elevated blood cholesterol
when they were in their early 40s were at greater risk of developing dementia
decades later, compared with those whose cholesterol was at optimal levels, a
new study has found.
The findings, which analyzed data from almost 10,000
health care plan members followed for four decades, surprised the
investigators.
While earlier studies have shown an association between
high cholesterol in midlife and an elevated risk of Alzheimer’s disease, “we
were surprised to see the association with borderline levels,” said Rachel A.
Whitmer, an epidemiologist with the Kaiser
Permanente Division of Research and the paper’s senior author.
The study followed 9,844 members of the Kaiser Permanente
Northern California Medical Group who had blood work done between 1964 and
1973, when they were 40 to 45 years old. All had remained members of the plan
until at least 1994, when computerized outpatient diagnoses of dementia were
made available.
Some 598 of the original participants were diagnosed with
Alzheimer’s disease or vascular dementia, a less common form of dementia,
between 1994 and 2007, when they were between 61 and 88 years old.
Those whose total blood cholesterol had been high — over
240 milligrams per deciliter — were 57 percent more likely to have developed
Alzheimer’s disease than those with optimal levels. Those who had borderline
cholesterol values — between 200 and 239 milligrams per deciliter — were at
50 percent greater risk of developing vascular dementia.
“What’s good for the heart is good for the brain,” Dr. Whitmer said, adding, “Midlife is not too soon to be
thinking about risk factors for dementia. This is a modifiable risk factor.
This is something you can change.”
The study is being published online this week in the
journal Dementia & Geriatric Cognitive Disorders.
http://www.nytimes.com/2009/08/06/health/dementia05.html?ref=health
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The New York Times | 08.05.09
By DENISE GRADY
Two new studies cast serious doubt on a widely used and
expensive treatment for painful fractures in the spine.
The treatment, vertebroplasty,
injects an acrylic cement into bones in the spinal
column to ease the pain from cracks caused by osteoporosis, the bone-thinning
disorder common in older people. Doctors began performing it in this country
in the 1990s, patients swore by it — some reporting immediate relief from
terrible pain — and it soon caught on, without any rigorous trials to
determine whether it really worked.
The new studies are exactly the kind of research that
health policy experts and President Obama have been calling for, to find out
if the nation is spending its health care dollars wisely, on treatments that
work. A bill passed by Congress this year provides $1.1 billion for such
so-called comparative effectiveness research.
The studies of vertebroplasty,
being published Thursday in The New England Journal of Medicine, found it no
better than a placebo. But it remains to be seen whether the findings will
change medical practice, because they defy the common wisdom and challenge a
popular treatment that many patients and doctors consider the only hope for a
very painful condition.
“I’m going to be the most reviled radiologist on the
planet,” said Dr. David F. Kallmes, the first
author of one of the studies and a professor of radiology at the Mayo Clinic.
Last year, about 73,000 Americans had the treatment, which
costs $2,500 to $3,000, as well as $1,000 to $2,000 for an M.R.I. scan.
Before it came along, the standard treatment was rest, painkillers and
sometimes a back brace, but those measures did not help everyone.
One reason for studying the procedure is that it does have
risks, which would not be justified if there is no real benefit. Though rare,
complications can be serious. Damage to the heart and lungs, and some deaths,
have occurred when the cement leaked into blood vessels. There are also
unresolved questions about whether cementing one vertebra can stress others
and lead to more breaks.
The studies began several years ago at medical centers in
the United States, Britain and Australia. Working independently
of one another, Dr. Kallmes’s research team and one
based in Australia put vertebroplasty to the
toughest kind of test — an experiment in which patients were picked at random
either to receive the real injection or to be part of a control group given a
sham procedure with no cement. That kind of study had not been done before.
Both teams had trouble recruiting patients because so many
people believed in the treatment, wanted it and did not want to take a chance
on ending up in the control group. In the end, the American study enrolled
131 patients and the Australian study enrolled 78.
The researchers prepared cement even during the sham
procedure, so patients would smell it and imagine they were receiving it. The
Americans assessed the patients one month later, and
the Australians at one week and at one, three and six months.
Vertebroplasty failed the test
in both studies. The treated patients and the control group each had pain
relief, but there was no difference between them.
“It does not work,” said Dr. Rachelle Buchbinder,
a rheumatologist and epidemiologist at Monash University
in Melbourne, Australia, and the leader of the
Australian team. Dr. Buchbinder does not perform vertebroplasty and would “absolutely not” recommend it to
patients, she said.
Dr. Kallmes, who helped develop vertebroplasty and has been performing it for 15 years,
said his team was “shocked at the results.”
How could the treatment group and the controls get the
same pain relief? One possibility is the placebo effect: people felt better
because they believed they had received an effective treatment. Studies have
found that pain is especially susceptible to placebos.
It is also possible that those who improved gradually
healed naturally. Finally, the numbing drugs injected into the patients’
backs during the sham procedure may have had some lasting effect on their
pain.
One patient in the study, Jeanette Offenhauser,
88, said she was convinced that the cement had helped her severe back pain,
even after hearing the results.
Dr. Kallmes has begun a small,
pilot study, he said, in which patients are given only the numbing drugs to
see if they alone can help. But he said he was not ready to give up on vertebroplasty. He said more studies were needed to
determine whether there were specific subgroups of patients for whom it might
work. People who want the treatment should still be able to get it, he said —
but only if they enter a clinical trial that collects data on every case.
In an editorial accompanying the articles, Dr. James N.
Weinstein, director of the Dartmouth Institute for Health Policy and Clinical
Practice, said, “Compassionate care and tincture of time, in and of themselves, can have an effect.”
In an interview, Dr. Weinstein, who does not perform vertebroplasty, suggested that rather than abandoning the
procedure, doctors could let patients decide for themselves, by telling them,
“This is a treatment option no better than a placebo, but if you want to
consider a placebo because you might benefit from it, you might want to know
that.”
Dr. Robert R. Recker, president
of the National Osteoporosis Foundation, said the group had not taken a stand
on vertebroplasty. He also leads the osteoporosis
research center at Creighton University, in Omaha, and said he had referred patients
for the treatment, and thought it helped some. Despite the new findings, he
does not think it should be abandoned.
“I think there needs to be more studies,” Dr. Recker said.
Dr. Kallmes said the only way
medical practice would change would be if Medicare and other insurers were to
stop covering vertebroplasty or to cover it only
when it was part of a study. But patients might still be able to get a
similar procedure that also uses cement, kyphoplasty,
which has been growing even faster than vertebroplasty
— also without placebo-controlled studies.
Susan Pisano, a spokeswoman for America’s Health Insurance Plans,
a trade group for private insurers, said that so far there had been
“considerable coverage” of vertebroplasty, but the
new evidence could change that.
Dr. Marcel E. Salive, a director
in the Medicare division that decides what treatments to cover, said Medicare
had no national policy on vertebroplasty and had
been letting the states decide. They have been covering it. Dr. Salive said Medicare had looked into the treatment in
2005 but found a lack of randomized, controlled studies. The new studies
provide “the kind of evidence we look for when making coverage policy,” he
said. But he said it was too soon to tell whether the research would affect
coverage.
http://www.nytimes.com/2009/08/06/health/research/06spine.html?ref=health
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